Sleep to Perform

By Mika Ono

Sleep? Why bother? Dozens of The Scripps Research Institute (TSRI) employees gathered last week to hear Milt Erman, adjunct associate professor at TSRI, president of Pacific Sleep Medicine Services, and physician of Scripps Clinic Medical Group, answer this question.

In the "Lunch and Learn" seminar on January 30, Erman argued that, despite prevailing American culture, sleep is a necessary part of our 24-hour cycle. Sleep is necessary for emotional regulation, physiological functioning, and peak performance.

"Sleep affects waking functioning and waking functioning affects sleep," noted Erman.

Our level of alertness cycles with the clock, with lows between 3 and 5 AM and highs in the mid-morning and early evening. Alertness also dips in the early to mid afternoon. Erman noted that the number of fatigue-related automobile crashes mirrors this curve over a 24-hour period. Notable accidents in recent history—Three Mile Island, Chernobyl, the Exxon Valdez, the Challenger—occurred during the early hours of the morning, the period of the lowest alertness in our circadian rhythm.

"It's a fantasy that our circadian clock doesn't matter," he said. "We are prisoners of our biological destiny. When we try to change that, we run into problems."

Erman noted that sleep changes as we age. The young have the most Delta sleep—the deepest sleep—and the elderly spend the most time lying awake in bed. Sleep disorders become more likely as we age, as we become more susceptible with longer periods of lighter sleep.

Erman addressed recent speculation that a new medication (modafinil/Provigil) could reduce people's need for sleep. While the medication seems to stimulate the brain's wakefulness center and reduce the negative impact of sleep deprivation, Erman believes trying to minimize sleep is the wrong approach.

"If sleep were not important, it would have been selected against years ago," Erman said. "Over time, nature would have done away with it. But sleep has persisted."

In light of data that show that individuals who suffer from insomnia are more prone to absenteeism, depression, anxiety, and psychiatric disorders, Erman encourages measures to promote good sleep. These include:

• Waking up at the same time each day;
• Discontinuing caffeine four to six hours before bedtime;
• Avoiding nicotine;
• Avoiding alcohol to facilitate sleep;
• Avoiding heavy meals close to bedtime;
• Exercising, but not within three to five hours of bedtime;
• Minimizing noise and light exposure during the sleep period;
• Using the bedroom for sleep rather than normal daytime activities;
• Reducing arousing stimuli (Erman recommends moving the alarm clock away from the side of the bed);
• Promoting light exposure in the morning and early afternoon.

"If you take sleep seriously, even though society tells you differently, you will improve your functioning and quality of life," Erman concluded.

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Milt Erman is Adjunct Associate Professor at TSRI, President of Pacific Sleep Medicine Services, and physician of Scripps Clinic Medical Group.