November 18, 2007

EVERY HEALTH IMPROVEMENT IS JUST A MATTER OF HYGIENE:

The Sleep-Industrial Complex (JON MOOALLEM, 11/17/07, NY Times Magazine)

For years, doctors have been discouraged by Americans’ disregard for and mismanagement of their sleep. (“I might as well have been running a chain of beauty parlors for the last four decades” is how one described his advocacy.) But bragging about how little you sleep, a hallmark of the ’80s power broker, is starting in certain circles to come off as masochistic buffoonery. The sleep docs we once ignored appear on morning shows to offer tips. Health professionals and marketers are hopeful that a new seriousness about sleep will continue moving out of a luxury-minded vanguard and into the mainstream. Sleep may finally be claiming its place beside diet and exercise as both a critical health issue and a niche for profitable consumer products.

A sleep boom, or as Forbes put it last year, “a sleep racket,” is under way. Business 2.0 estimates American “sleeponomics” to be worth $20 billion a year, which includes everything from the more than 1,000 accredited sleep clinics (some of them at spas) conducting overnight tests for disorders like apnea, to countless over-the-counter and herbal sleep aids, to how-to books and sleep-encouraging gadgets and talismans. Zia Sleep Sanctuary, a first of its kind luxury sleep store that I visited in Eden Prairie, Minn., carries “light-therapy” visors, the Zen Alarm Clock, the Mombasa Majesty mosquito net and a $600 pair of noise-canceling earplugs as well as 16 varieties of mattresses and 30 different pillows.

Prescription sleeping pills have been the most obvious beneficiary. Forty-nine million prescriptions were written last year, up 53 percent from five years ago, according to IMS Health, a health-care information company. It is now a $3.7 billion business, more than doubling since 2003. At $3 or $4 per pill, their success indicates not only that we have an increasingly urgent craving for sleep but also that many of us have apparently forgotten how to do it altogether — quite a feat for any mammal.

To hear the mattress industry tell it, we’re skipping them over. A few companies have tried to cash in with ultra-high-end novelties. A video promoting Hastens’s $60,000 Vividus bed shows the horsehair it’s stuffed with being sensuously detangled and fluffed by shapely Nordic women. But more down-to-earth mattresses have not conjured any of that allure. Despite long and influential success in the industry, for instance, Select Comfort’s stock was struggling around the time of my visit. And so America’s mattress men, traditionally a band of fast-talking, price-busting commodities brokers, are now trying to figure out how to transform their anonymous white rectangles into holistic health and wellness machines.

More than once, I heard mattress executives invoke the spectral characters of sleeping-pill commercials — the Day-Glo green moth; Abe Lincoln and the talking beaver — as chastening mascots of everything they’re missing out on. Some point to the quick-fix mentality sleeping pills represent as a sign of how thoroughly confused about sleep society has become. “The good news is, there’s more and more awareness about the power of a good night’s sleep,” says David Perry, bedding editor of the trade magazine Furniture Today. The bad news: “What we’re doing in America is, we’re drugging people to make it through the night on, in many cases, a lousy bed.”

Our misunderstandings about sleep have been centuries in the making. As has already happened in the food and nutrition businesses, some sectors of our new sleep-industrial complex will surely find it profitable to clear up our confusion, while others will simply exploit it. But as mattress companies and sleeping-pill makers both barrel into the marketplace to sell us a good night’s sleep, it’s tough to know where in the jumble of science and storytelling the truth about sleep lies.

All good nights of sleep are alike. Each miserable night of sleep is miserable in its own way. You either close your eyes and, many hours later, open them, or you endure an idiosyncratic epic of waiting, trying, failing, irritation, self-sabotage and despair, then stand up at sunrise racked with war stories you don’t have the energy to tell.

Sleep research is a young field and still doesn’t have a definitive picture of what “normal” sleep is, making discussions of abnormal sleep imprecise. The National Institutes of Health can define insomnia only very broadly, as “complaints of disturbed sleep in the presence of adequate opportunity and circumstance for sleep.” Insomnia can be transient — a few off nights — or horrifically chronic. Complaints may be about difficulty falling asleep or about waking up during the night. But it’s hard to know exactly what those complaints should be judged against. Nor has research determined which objective measures — total time slept, percentage of time spent in the various stages of sleep, etc. — correlate to a person’s subjective feeling of having slept well or poorly. Some people whose sleep looks normal in the lab complain bitterly; some whose sleep looks terrible never do.

Even something as empirical-seeming as how long we sleep becomes problematic. In studies, insomniacs almost invariably overestimate how long it took them to fall asleep and underestimate how long they slept; in one, more than a third of the participants consistently thought they’d slept at least an hour less than their brain-wave activity indicated. Yet in a way, this hardly matters. Wallace Mendelson, past president of the Sleep Research Society, explained to me, “When a patient comes to a doctor, he doesn’t say, ‘I’m here to see you because my EEG shows an insufficient number of minutes of sleep.’ He comes to you saying: ‘I don’t feel like I’m getting enough. I’m tired.’ ” Thus, while insomnia is frequently linked to another, distinct physiological disease or disorder, its diagnosis and treatment often remain, much like pain, locked in the realm of our own inscrutable reports.

Fewer than half of Americans say they get a good night’s sleep every night or almost every night, according to a 2005 poll by the National Sleep Foundation. The N.S.F. is a nonprofit largely financed by the pharmaceutical industry and one of many groups — including the American Academy of Sleep Medicine and the Better Sleep Council, a nonprofit supported by the mattress industry — that have pushed the value of sleep, and the perils of sleep deprivation and disorders, into public view. (You can mark the change in seasons with their press releases. End of summer: “From Zzzs to A’s: Healthy Sleep Is Key for Back-to-School Success.” Daylight Savings Time: “Fall Back Into Bed and Catch Up on Your Sleep.”)

Some of America’s dissatisfaction likely boils down to poor “sleep hygiene” — basic bad habits like not keeping a regular bedtime; overconsumption of alcohol or coffee; or winding ourselves up with work or television before bed. There is a sometimes-stunning failure to see sleep’s cause-and-effect relationship to what we do while awake. One therapist told me he cured a man’s insomnia by suggesting he stop eating spicy Indian curry late at night. Bils says, “Most sleep problems are self-inflicted by sleepers not knowing how to sleep.” Moreover, doctors have long warned that Americans are suffering from self-caused sleep deprivation without even realizing it. The most damaging and persistent delusion we’ve acquired about sleep is that the vital human function is optional. As one psychologist puts it, “You don’t have people walking around figuring out how to get by on less air.”


Electricity has been the main culprit.


MORE:
Zzzz-meisters came. They sawed. They tested pillows' snore-busting abilities
Pillow designs force sleeper to roll over -- and it's not always comfy ... or quiet (Phil Vettel, 11/18/07, Chicago Tribune)

"Spousal Arousal Syndrome" isn't nearly as much fun as it sounds. It's one doctor's catchy phrase to describe what happens when one person's snoring disturbs a partner's sleep. Forget about morning crankiness, reduced work productivity and the like; bad sleep can lead to marital problems and severe financial consequences, such as divorce or remodeling (to add a second bedroom). I can sympathize. I have it on good authority that I am a fairly loud snorer. Snoring doesn't seem to affect my sleep much; the only after-effect I notice is a persistent pain in the rib area. That's where my wife jabs me. And so an opportunity to test a few "anti-snoring" pillows was irresistible. Mandatory, you could say. I rounded up a couple of colleagues with admitted "Spousal Arousal" issues, issued them three anti-snoring pillows and had them test each pillow for at least five consecutive nights. It wasn't the most scientific study in the world, but our snorers -- and their spouses -- were eager to try anything that might help.

Posted by Orrin Judd at November 18, 2007 7:57 AM
Comments

As someone who treats sleep disorders, it is important to mention that not everyone who is having difficulties sleeping is having them because they had too much coffee, or got wound up before they went to sleep that night.

Sleep Apnea, (with heavy snoring as a symptom), is a life threatening disease that is terribly under diagnosed. People wake up tired, feeling as if they have not had enough sleep, and had a workout instead. Their hearts have to work so hard that it can actually leave them subject to heart attacks and strokes. It's imperative that people with this condition make sure that they have it checked out, and sleep clinics do play a role in saving peoples lives, not just get enough "beauty rest"...

It is also good to point out that sleep, most importantly "restorative" rem sleep is where our body has a chance to rejuvenate and heal itself.. drugs do not help with this type of sleep.

The public need to be made aware of this health problem and get it treated!


Dr. Jonathan Greenburg
http://www.apnea-treatment.com
Is Sleep Apnea Killing You?

Posted by: Dr Jonathan Greenburg at November 18, 2007 5:28 PM

Most of that is hygiene too. It's largely a function of the obesity epidemic.

Posted by: oj at November 18, 2007 7:26 PM
« SIENKIEWICZ AND SOLZHENITSYN? OUR NEW FAVORITE FILMMAKER: | Main | GREAT BOOK, BAD IDEA: »