After driving for about six hours, a trucker decides to pull over and sleep for a little while. As soon as he falls asleep, he is awoken by some knocks on the door of his cab. "Can you tell me the time, please?" asks a jogger. "Yeah, it's 4:30," answers the trucker. He falls asleep again, but he is awoken again by knocks on his cab. It's another jogger who asks the time. "It's 4:40!" yells the trucker. Deciding he didn't want to be disturbed any more so he could get some sleep, he writes on a piece of paper: I DON'T KNOW THE TIME and sticks the paper in his windshield. Well, he gets to sleep again but before you know it, he is again awakened by knocks on his cab. It's another jogger, who says, "It's 5:25". J

For some of us getting to sleep is much like this trucker who seems to be having trouble. For others of us, not sleeping has become a way of life. Today I want to talk about some concepts related to sleep and highlight some information to streamline your sleep life, no, not your sex life, for the best benefits to your health.

Sleep is perhaps the most important predictor of how long you will live. In a study by the American Cancer Society, a person's habitual sleep time was best correlated with mortality. The highest mortality was found in people who slept four hours or less and in those that slept more than nine hours or more. The lowest mortality was found in those who regularly slept eight hours a night.

The average American has about 25 hours of sleep debt. Sleep debt is the number of hours we owe to the sleep bank if we don't get a usual 8 hours a night. We generally owe the bank hour for hour when we sleep less than 8 hours a night.

The way they figured the average sleep debt is that they put some people in a totally dark place for 7 days straight, 24 hours a day. At first the subjects, I call them victims J , slept more than 8 hours for each 24 hours, but eventually they got back to a natural schedule of 8 hours of sleep a night by the seventh day. On the average, each subject repaid 25 hours of sleep before they returned to the usual 8 hours a night. Consider what your sleep debt might be and understand that 50 hours of sleep debt is about the upper limit of what a person can withstand before you are unable to properly function and put yourself are in danger, driving or otherwise.

A fun way of measuring your own sleep debt can be done by yourself. Lay down with your eyes closed and turn the lights low or draw the curtains. Put one hand over the edge of the bed and hold a metal spoon with a plate on the floor below you. Check the clock before you settle into bed. When you fall asleep, you will be awakened by the metal spoon falling on the plate. This tells you your sleep latency or how long it takes for you to fall asleep. Sleep latency is correlated with your level of sleep debt. If it takes 15-20 minutes to fall asleep, you are optimally rested. If you fall asleep within 5 minutes, you are seriously sleep deprived or sleep disordered. 10-15 minutes of sleep latency means you can afford to work off some sleep debt; 5-10 minutes of sleep latency means you are certainly troubled with sleep debt. Because one's sleep latency depends on the time of day that you measure it, the lowest score on any given day, if you tested yourself several times, is most likely your true sleep latency.

The reason sleep latency varies throughout the day is that there is something called clock-dependent alerting. First let me explain sleep homeostasis, sleep what? J . You could just call it your sleep drive. For every two hours that you are awake, your body will want to sleep one hour to compensate for being awake. The longer you are awake, the stronger is your sleep drive. This sleep drive is continuously active. In contrast, there is a drive to be awake that is related to our biological clocks within us; i.e., we have a clock that regulates our body chemistry and drives us to stay awake, which is called clock-dependent alerting or our wakefulness drive. This drive is active during the morning, takes a slump in the afternoon, then is turned on again around 4-5 PM and slowly dies down when nightfall comes. The after lunch slump that we attribute to eating a sumptuous meal is largely due to this slump in our clock-dependent alerting that is not active during that time of day. You could say then that our level of sleepiness at any given time of day is a combination of: 1) our sleep debt, 2) our clock-dependent alerting, and 3) the stimulation from the environment around us.

You can monitor your daily sleep need by watching your daytime sleepiness in relation to how much you've been sleeping. The more you seem sleepy, the more you need to sleep at night. If you're having trouble staying awake for my stimulating talk, you need to get more sleep at night J .

Daytime fatigue is the most common single sleep symptom that people complain of. In a recent National Sleep Foundation survey, 75% of people said they were obtaining enough sleep, but also regularly experienced daytime sleepiness and fatigue. More than half the time, if you have daytime fatigue, you'll have some kind of sleep disorder. In most cases, you could assume to have obstructive sleep apnea until proven otherwise. Obstructive sleep apnea is a condition in which your physical features get in the way of you being able to breathe properly when you sleep. This could be caused by large tonsils, simple obesity, or just a small airway.

If you snore and are tired during the day, especially consider that you have obstructive sleep apnea. Your chances of having sleep apnea are more likely if you are overweight and you wake up with a sore throat and/or a headache. You must get a sleep study to definitively determine if you have sleep apnea, especially if you already have high blood pressure or any heart problem because sleep apnea can aggravate these conditions.

One way you can yourself check if you have sleep apnea is to record your sleep sounds while you sleep. A simpler way is to ask your bed partner if you snore. There is help for sleep apnea in the form of what is called CPAP, continuous positive airway pressure. You may have to sleep with a mask delivering air under pressure.

Thus far, we've talked about the importance of sleep to your health. We've explained sleep debt, sleep latency, sleep homeostasis, clock-dependent alerting, and obstructive sleep apnea. In closing, I just want to leave you with some tips on for sleeping right that you can incorporate in your lifestyle:

Avoid caffeine in the evenings for obvious reasons.
Avoid eating 3 hours before you go to bed.
Have a regular bedtime and have a regular bedtime ritual to condition yourself to sleep easier.
Take care of your surroundings to insure restful sleep: noise, temperature, comfortable bed and pillow, proper night clothes
Consider taking a power nap when you are tire but need to be alert. A 45 minute nap can lead to 6 hours of alertness after the nap. A one-hour nap can give you 10 hours of alertness afterwards.
For traveling, change your watch to your destination's time zone 1-2 days before your trip. Assuming you are traveling east, like most of us might do, in preparation for your trip, get direct sunlight as soon as you can each day by drawing your curtains. You can also take some Melatonin, 3 mg, late in the evening to advance your biological clock. Also if you travel east, schedule meetings late in the day so you can adjust easier. If traveling east, take no nap during your plane flight so that you sleep early at your destination.
I hope my talk has given you some mental stimulation just when your clock-dependent alerting is in a slump. In any case, you know I'll understand. Just snooze and you won't lose.

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