EDITORIAL: To Sleep, Perchance to Dream

Dustin Ballard, MD

In the great green room there was a telephone, and a red balloon, and a picture of—the cow jumping over the moon.” So begins the final chapter of a ritual played out in bedrooms across the land. “Goodnight room, goodnight moon, goodnight cow jumping over the moon.”

The soothing repetition of Goodnight Moon and similar verses is employed by millions of parents each night as they send their kids off to dreamland. For many parents, including myself, this is but the penultimate step in an extended bedtime routine for our children. Dinner, bath, pajamas, warm milk, books on the couch, clean teeth, a wave to the stars, a march upstairs, a tuck into bed (making sure to get the pillows propped just so), Goodnight Moon, songs, and finally a kiss goodnight. Phew.

I know I’m not alone in performing a regimen of this sort—in fact I know many moms and dads who practically obsess about the timing, ritual and quality of their children’s sleep. Why is their children’s sleep so important? Because, as everyone knows, sleep matters. Children whose rest routines are irregular are irritable, transformed from adorable puddle jumpers into barely bearable brats.

This parental common sense is also backed by strong science. Rats that don’t sleep don’t just become brats, they become dead (within four to five weeks). And the data isn’t just about rats. Studies demonstrate that sleep-deprived people have delayed reactions, difficulty concentrating, and impaired cognition and judgment. This, of course, explains the rationale for sleep-deprivation interrogations. Given all this, why is it that a nation so meticulous about its children’s sleep is so careless when it comes to properly resting its adults?

Do you recall the 2011 report on sleep from the Centers for Disease Control and Prevention? Based on a telephone survey of over 70,000 adults, over one-third of Americans get less than seven hours of sleep a night—less than the minimum amount recommended by the CDC, the National Sleep Foundation and The Sleep Train.

An even more concerning finding in the CDC study is that 38% of respondents reported nodding off unintentionally in the last 30 days, and 5% of these people admitted that the nodding occurred while driving. This finding suggests that data from the National Highway Traffic Safety Administration indicating that driver fatigue is responsible for an estimated 100,000 motor vehicle accidents and 1,500 deaths each year may actually be an underestimation.

As a shift worker, I have personal experience with sleep-deprived drivers. Driving home after a night shift in the ED can be scary—sometimes it seems like my consciousness is on the verge of automatic shutdown. For shift workers and parents of young children, some level of sleep deprivation is virtually inevitable; but for many others, sleep deficits should be prevented in the name of health, safety and sanity.

There’s no shortage of advice about sleeping to be found via Google, but to save you the time of sorting through it all, let me give a less than exhausted—I mean exhaustive—review. What follows (with the help of the good people at Quoteland), is a quip-based guide to getting good with sleep.

The sleeping fox catches no poultry.
—Benjamin Franklin

I am a big Ben Franklin fan, and while he may be technically right on this one, his advice is not applicable to most human beings. Franklin, famously, required very little sleep. And while there are certainly inborn differences between individuals in sleep requirements, there are not too many Franklinesque 30-minute-catnap types out there. Far more common is the burn-it-at-both-ends type who ignores his or her sleep need—piling onto a deficit that can only be repaid at the bedtime bank. To not settle up is to play chicken with health and longevity. If you don’t already know, figure out how much sleep you need to be at your best, and make sure you get it.

The two best physicians of them all—Dr. Laughter and Dr. Sleep.
—Gregory Dean Jr.

Well, I might have to throw Dr. Feelgood into the mix too. But seriously, we are just beginning to understand the physiological functions of sleep—which include encoding memories via nerve-signal repetition; increased cellular production of proteins that are likely involved in repairing damage from stress, ultraviolet light and dietary toxins; and spikes in growth-hormone release in young people. Sleep is good medicine.

You can’t stay married in a situation where you are afraid to go to sleep in case your wife might cut your throat.
—Mike Tyson

Practical advice indeed from Mr. Tyson. How about some other suggestions for ensuring a restful night? The CDC has a list of sleep-hygiene tips that include sticking to a regular sleep schedule (just like your kids!), sleeping in a dark and relaxing environment, removing all computer and other gadgets from the bedroom (but keep the white noise machine), and avoiding alcohol, caffeine and large meals within a few hours of bedtime.

For those who do everything right but still run into a wall of insomnia, it may be time to seek a medical opinion. In this issue of Marin Medicine, our Sleep Team explores a range of more involved treatments for sleep. Drs. Singh and Durr review the surgical and medical therapies for combating one of sleep’s greatest enemies: apnea. Dr. Peters addresses insomnia, and Drs. Junaid and Razavi explore the relationship of sleep to obesity and memory.

In sum, this aims to be the first issue of Marin Medicine with the explicit goal of putting you to sleep.

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Dr. Ballard, an emergency physician at Kaiser Permanente San Rafael and EMS Medical Director for Marin County, serves on the MMS Editorial Board.

Email: dustin.ballard@kp.org