Parents lose an enormous amount of sleep during the first year of a newborn’s life — up to 350 hours each, by Dement’s calculation. The challenge has given birth to an industry of how-to books. One of the best known is Solve Your Child’s Sleep Problems by Dr. Richard Ferber of the Children’s Hospital in Boston, which has sold about one million copies. But Ferber’s tough- love methods — basically, leaving a baby to cry alone for longer periods to instil proper sleep habits — have come under attack. Anthropologist James McKenna, who teaches at the University of Notre Dame in Indiana and runs a mother-baby behavioral sleep laboratory there, insists babies fare better in their parents’ bed — a no-no in Ferber’s book. “Parents are told if they want their child to be independent and sleep through the night, they should give him a separate room,” says McKenna. “But biological evolution expects babies to be physically in contact with adults and be breast-fed through the night.”
McKenna’s proselytizing has spawned a community of parents who sleep with their children. But that does not work for everyone. Some parents want privacy; others cannot get any rest with an infant flailing about. So when the Ogrodniczuk’s neighbours, Mary Lynn Young, 34, and David McGrath, 33, had trouble getting their daughter, Jane, now 2 1/2, to sleep, they turned to Ferber. “Ferber’s methods made a difference until Jane got sick,” Young says. “Then we’d take her into our bed and when she got better we’d have to re-Ferberize her.”
Ferber’s theory works like this: on night 1, you put your child in his crib and leave the room. If he cries, you wait five minutes before going to him, and even then you don’t pick him up, just pat him on the back. If he cries again, repeat the process until he falls asleep. The next night, you follow the same routine, but wait 10 minutes before re- entering the room. The third night, you wait 15 minutes, and so on, until your child figures out how to go to sleep on his own. “It was emotionally difficult to do Ferber,” says Young. “But you get to the point where you are going to snap.”
Last year, Ferber recanted a little, saying there are “plenty of examples of co-sleeping [with parents] where it works out just fine.” But many sleep doctors say his methods are still the best way to get a troubled child to sleep. “If people are desperate and they need a program,” says Dement, “Ferber is the only game in town.”
ON TEENAGE TIME
In The Promise of Sleep, Dement defines late childhood as the “golden age of sleep.” Remember nodding off in your parent’s car after dinner at grandma’s? Healthy children can usually sleep soundly for a good 10 hours — until the hormones that mark puberty kick in. That’s when they begin to stay up late and sleep in. Teenagers’ circadian rhythms — their biological clocks — change as they become sexually mature, says adolescent-sleep specialist Mary Carskadon, professor of psychiatry and human behaviour at Brown University in Providence, R.I. Those changes delay the secretion of sleep-inducing melatonin until later in the evening. That would be OK if teens didn’t require almost as much sleep as younger children, but they do — about nine hours a night. The change in circadian rhythm, coupled with academic and social pressures to stay up late and the school-day requirement to rise early, leaves many teens radically sleep-deprived, Carskadon says.
She and clinical psychologist Amy Wolfson of College of the Holy Cross in Worcester, Mass., have been lobbying to have U.S. high schools start later. Some begin classes as early as 7:10 a.m., a time when, Carskadon says, most teenagers are in the middle of their sleep cycle. In Canada, high schools generally open their doors between 8:30 and 9 — to classes full of yawning teenagers. Victor Gerchikov, 16, and his Grade 10 friends from Vancouver’s Sir Winston Churchill High School are all high achievers in the international baccalaureate program. Busy with soccer practice, art class, 2 1/2 hours of homework and yakking on the phone, Gerchikov rarely goes to bed before 1 a.m. on school nights. His alarm rings at 7 a.m. Although he says he feels no ill effects from running on only six hours of sleep, he often needs to nap when he gets home. Schoolmates Arthur Law and William Hui, both 15, go to bed around midnight and are up by 7. They often fall asleep in class, lulled, they say, by the soporific effect of social studies or French.
That Gerchikov, Law and Hui are doing so well at school is a testament to their academic prowess. Researchers have concluded poor sleep can affect learning, particularly for sleep-deprived high-school and university students. In a study of 3,120 Rhode Island high-school students, Carskadon and Wolfson found those who received low grades got, on average, 25 minutes less sleep and went to bed 40 minutes later than those awarded As and Bs. That does not mean that all students who get less sleep will do poorly, Carskadon says, but those who miss valuable REM sleep — the rapid-eye-movement period when dreams occur – – may have a harder time learning.
Psychologist Carlyle Smith of Trent University in Peterborough, Ont., has determined that REM sleep increases after a new task is learned. But if REM sleep is disrupted, memory retention and motor skills suffer, sometimes in mysterious ways. “Kids at Trent often take all their courses between Tuesday and Thursday,” says Smith. “If they drink Thursday night and stay up late, they’ll lose part of what they’ve learned on Tuesday and Thursday. But they will keep most of what they learned on Wednesday. We don’t know why this happens.” A recent study by Dr. Robert Stickgold of the Harvard Medical School in Boston builds on Smith’s findings. It shows that when new skills are learned, the information will not be properly retained in the absence of at least six to eight hours of sleep.
Sleep can also affect a young person’s mood and behaviour in school, says Carskadon. “Teenagers who get little sleep have more truancy and are often late because they are too tired to go to school,” she says. Sleep loss may also be linked to depression in young adults. “The data,” says Carskadon, “suggests these tired kids react less positively to positive things and more negatively to negative things.” Lack of sleep can also lead teenagers into danger: a National Sleep Foundation study shows drowsy young adults between 15 and 24 are responsible for 50,000 automobile accidents a year in the United States.
So what are parents to do? “It’s important to develop a routine,” Wolfson says. For one thing, be aware that a computer or TV stimulates the visual response and contributes to sleep delay. “Young people,” says Wolfson, “should stop using the computer and watching television late in the evening.”
MIDLIFE SLEEP CRISIS
A lot of accomplished people claim not to need a lot of sleep. Household arts maven Martha Stewart purports to get only four hours a night. So does Tonight Show host Jay Leno. Napoleon, Winston Churchill, John F. Kennedy, Salvador Dali and Leonard da Vinci didn’t get much shut-eye either. So television journalist Pamela Wallin, who also averages only four hours a night, is in august company. “I’ve been an insomniac for as long as I can remember,” says Wallin, a Saskatchewan native who lives in Toronto. “I’ve tried herbal remedies and chamomile tea. I avoid prescription drugs because I can’t afford to lose my sharpness the next day.” Ultimately, Wallin regards her chronic insomnia as something she just has to live with. “If I needed more sleep,” she reasons, “I probably wouldn’t have gotten done what I have done in my life.”
Sixty-two per cent of Americans experience a sleep problem a few nights a week, according to a National Sleep Foundation study released last month. Two-thirds say sleepiness interferes with their concentration. “We should really get nine or 10 hours of sleep,” says psychologist Coren. “But we’re only getting seven. Sleep is not something we value.” Family stresses, the frenetic pace of life and poor bedtime habits all contribute to an epidemic of sleeplessness. Among modern complications: the wired world. “I know people who have a fax machine at the foot of their bed with a little bleeper so they can get up in the middle of the night to read their faxes,” says Coren. “The pressure to lead a 24-hour life is getting worse.”
At least many poor sleepers know they need help. About 2,000 people a year use the sleep clinic at UBC run by psychiatrist Jon Fleming. Thirty-five per cent of them complain of insomnia, a disorder that often runs in families. Others attend the clinic because of sleep apnea (troubled breathing) and narcolepsy (an overwhelming desire to sleep), among other sleep disorders. “The causes of insomnia are legion,” says Fleming. “It can be caused by psychiatric conditions or drug and alcohol abuse. But the leading cause is stress.” When Vancouver children’s bookstore owner Phyllis Simon can’t sleep, she gets out of bed for a while and writes a list of all the things she has to do. “I try to transfer my anxieties to the list. Then I’ll make myself a cup of warm milk.”
But waking up in the middle of the night and then going back to sleep – – as Simon sometimes does — can be harder on cognition than not sleeping at all, says University of Montreal psychiatrist Roger Godbout. “Your performance the next day will be worse than if you stay up all night,” he explains. While insomnia may lead to fuzzy thinking, those who short-circuit sleep by working long hours could also be compromising their physical health. Research at the University of Chicago shows adults who get fewer than seven hours of sleep are more prone to diabetes, high blood pressure and endocrine dysfunction.
Women also report more sleep problems than men — a consequence, often, of their biology. Just before menstruation, says Toronto Western Hospital sleep researcher Helen Driver, “there is a withdrawal of hormones that triggers poor sleep.” Entering menopause doesn’t make it better. Thirty-six per cent of menopausal women polled by the National Sleep Foundation said hot flashes interfered with their night’s rest. Sleep investigators are becoming more aware of the effects of the female hormones, estrogen and progesterone, says Driver. “Progesterone,” she says, “interacts with a receptor in the brain that seems to have sleep-inducing qualities.”
OLD AND AWAKE
Seven years ago, retired Vancouver family practitioner Jimmy White, 82, noticed his sleep began to change: he woke a lot during the night and needed a restorative post-lunch nap for at least half an hour. “I find I have to sleep longer,” White says. When he worked in his medical practice he got by on six hours of sleep; now, he needs at least eight hours spread through the day. Psychiatrist Julie Carrier of Sacre-Coeur hospital in Montreal has determined adult sleep patterns can begin to deteriorate as early as 30, but the changes are not dramatically apparent until old age. “We know elderly subjects don’t sleep well,” she says. “They wake a lot and they don’t go into the deeper stages of sleep.” In fact, many elderly people miss entirely stages 3 and 4 — the deepest phases — and have decreased REM time. In addition, older people have an increased sensitivity to noise and can develop disruptive disorders such as sleep apnea and periodic limb movements.
Insomnia in the elderly can also be associated with living alone, having limited activity and using certain drugs. Dr. Charles Morin of Laval University in Quebec City has determined that such behavioural changes as doing away with daytime naps can do a better job than prescription drugs of improving the sleep habits of the elderly. His findings, reported last year in the Journal of the American Medical Association, inspired two psychologists at Stanford University — Ottawa native Derek Loewy and Rachel Manber — to start a group-therapy clinic for insomniacs. “For people who sleep well, going to bed is a pleasurable thing,” says Loewy. “For insomniacs it’s not. They become anxious, their hearts beat faster and their breathing may change. Insomnia becomes a conditioned response.” Behavioural therapy, he adds, tries to undo those responses through relaxation techniques and a revised sleep schedule. According to UBC’s Fleming, however, it is perfectly natural for the elderly to have sleep problems. No matter how healthy our sleep routine is, he says, “after the age of 30 it’s basically all downhill.”
Last month, Mikayla Ogrodniczuk began to sleep a little longer — just two months short of her third birthday. Her heavy-lidded parents decided to stop the afternoon nap to see what would happen. Since then, Mikayla has been waking only once a night. “It’s so much better,” says mother Jennifer. “I’m still tired, but I hope I will eventually catch up.” That may be harder than she thinks. Sleep, like life, rarely seems to be predictable.
Rest in peace
Having trouble getting a good night’s sleep? Here’s what sleep researchers suggest:
– Have your evening meal at least three hours before bed.
-Try to go to bed and wake up at the same times each day. Even if you get to bed later some nights, make an effort to get up at your regular hour to make it easier to get to sleep the next night.
– Remove the TV and computer from the bedroom. The light they emit provides a visual cue to the brain that can impede sleepiness. Even reading can be a bad idea for people with sleep problems, since it requires light and can set the mind whirling. Save the bed for sex and sleep.
– Try to eliminate caffeine from your diet. Smoking and alcohol are also problematic. Drinking alcohol may interrupt sleep.
– Wear socks. Cold feet can make it difficult to sleep.
– Take a bath before bed. Body temperatures drop after a warm bath, a signal to the body that it is time to sleep.
– Exercise regularly–but not just before bedtime. Being physically active during the day can induce drowsiness at night.
– If you can’t sleep, get up and do something. Go back to bed only when you feel tired, then get up at your regular hour.
Half of all Canadians snore at some point in their lives, says respirologist Raymond Gottschalk of Hamilton, and half of those have persistent problems. Snoring results from a blockage that impedes breathing — the offender’s tongue and palate have slipped towards the back of the throat. Weight gain, which increases fatty tissues in the palate, contributes to the problem. “Snoring,” says Gottschalk, “causes lots of little wakenings and fragments your sleep.”
Solutions that may vary in effectiveness for different people include surgery to remove excess tissue at the back of the throat; dental appliances to pull the jaw forward and keep the airway open; and a Continuous Positive Airway Pressure machine to constantly push air down the throat. While surgery is often successful, in some cases scar tissue remaining at the back of the throat can promote snoring. For Vancouver dentist Richard Kofsky, 52, the CPAP machine provides the relief he sought for years. “It was an annoyance,” he says of his snoring. “You violate your partner’s sleep, and when you wake up you feel like you’ve done 15 rounds with Muhammad Ali.” He sleeps so quietly now, says Sam McClintock, the woman in his life, “I check to see whether he’s still alive.”
Researchers believe some insomnia — or the anxiety that leads to it — can be inherited. They are now beginning to understand that other sleep disorders such as narcolepsy (a periodic, overwhelming need to sleep) and familial advanced sleep-phase syndrome (causing people to go to sleep early in the evening and wake up in the middle of the night) can be genetically induced. “Children born to people affected by familial advanced sleep-phase have a 50-per-cent chance of being affected,” says neurologist-geneticist Louis Ptacek of the University of Utah. Ptacek and his colleague Christopher Jones studied a 69-year-old woman who couldn’t help going to sleep around 5:30 each evening and waking around 2 a.m. Her daughter and young granddaughter, they learned, had the same problem. Scientists have also discovered a life-long tendency to get up late is also inherited. Early to bed and early to rise may not simply be a matter of choice.