Matthew J. Edlund M.D.

The Power of Rest

Why Can't I Wake Up?

Waking up is hard to do.

Posted Oct 14, 2010

Alien invaders! Laser rifles! Screeching robots that slip away and hide! Automatic bacon cookers!

People will invent almost anything to wake them up in the morning. But why are they so sleepy in the first place?

Anne Marie Chaker wrote a funny, useful article on how to wake up for the Wall Street Journal yesterday in which I'm quoted about the effects of alarming alarms. But why do we have this epidemic of sleepyheads?

Here are some confessions of a sleep doc on major and minor clinical groups that often can't wake up:

1. Young people. Aging changes everything, including body clocks and how our bodies rebuild. When puberty severs a third of your synaptic connections, you need a lot of rebuilding. To learn, earn, create deep memories and be reasonably friendly in the morning, the average high school or college student needs about nine-and-a-half hours of sleep. Their bodies are also biologically set up to go to bed later than at any other age, often with preferred sleep times of 1 to 2 A.M. or later.
School starts at 8 A.M.

The end result? Massive sleep deprivation with resulting obesity, lack of learning including athletic skills, often lousy-looking skin, amazingly inattentive morning classes, and, yes, an almost complete inability to wake up come morning.

Do some school districts recognize this mess and try to set their classes later? Yes, with good results, like the St. George's School in Rhode Island. Most pay no mind.

The kids themselves? Would they imagine taking more time for sleep and rebuilding their bodies and brains? No, they pull their cellphones into bed, waking up throughout the night to answer exciting texts. Their preferred wake-up alarm: the cell phone.

No wonder alarm manufacturers sense an "exciting opportunity" with high school and college students. Many alarms create noise levels that cause hearing loss and are regulated by the Occupational Safety and Health Administration – and the kids still can't wake up.

2. Deep sleep and sleepwalkers. Ever heard someone having night terrors? Chances are good you won't forget. Bloodcurdling screams and Freddie Krueger faces are bad enough, but they still won't wake up! No wonder sleepwalkers with sleep terrors get very quiet telling their boyfriend or girlfriend what they really do at night – particularly as they're asleep, and don't remember what happened.

Deep sleep is indeed deep, the closest we normally get to natural coma. It's really hard to wake people up in deep sleep, which becomes an emergency when your spouse picks up the car keys and starts backing the car out of the garage without activating the garage door.

Deep sleep is when growth hormone is produced. It's necessary for a lot of memory formation. Teenagers do it a lot more than older adults. No wonder they're so hard to wake up.

3. Narcolepsy. Someone tells a very funny joke and your friend drops to the floor, suddenly asleep. That's no joke. Narcoleptics may be 1 in 1,500 of the population, and many of them don't have classic catalepsy where they suddenly hallucinate and fall to the ground, but their lack of the stimulating neurotransmitter hypocretin-orexin can make them very, very hard to wake up.

4. Shift workers. Humans are built to sleep at night and gambol during the daytime. Don't tell that to shift workers, 25% of the working population. Blowing out biological clocks is bad enough on the weekends – late Friday and Saturday nights are followed by body-clock-displaced Sunday sleeps with a whopping five-time increase in cardiovascular events come Monday morning. Yet shift workers hit the wall well beyond the body clock basement of 4 A.M., with greater rates of heart disease, stroke, GI disease and obesity. Chronically sleep deprived, they may find getting up for the next swing shift nearly impossible.

5. Bipolar disorders. Back in the old days, Tom Wehr at the National Institute of Mental Health used to predictably knock people with manic depressive illness from mania to depression, just by manipulating their sleep cycle. People with manic depressive illness, especially the rapid cycling kind, can veer from 18 hours sleep one night to four the next. When deep in the cycle, they can be really difficult to wake.

6. Young people with ADHD. For reasons I do not know, many kids with ADHD also are naturally long sleepers, who tell me they will easily sleep 12 to 14 hours of every 24 unless someone wakes them up. Though not showing any evidence of narcolepsy, they sometimes prove profoundly sleepy on daytime sleepiness tests.

7. Everybody else. There are lots of other people who can't get up. They include naturally long sleepers, who can't imagine why the rest of humanity operates on seven to eight hours a night; folks with sleep apnea, who when they finally do get to sleep find it difficult to stop; and hordes of anybody who has just a regular, ordinary sleep disorder like restless legs or insomnia.

The truth is, lots of the population has trouble waking up. The problems are the normal ones: work hours; kids; elderly parents; an unrelenting economic recession. Americans have knocked off 90 minutes of sleep in the last 40 years, and we're working hard to knock off more.

What people have to learn is not just how to sneak more sleep time, but how to rest on the job – and in very short order. That's where active rest techniques come in. Lots of physical activity also helps, letting the body more efficiently remake itself.

But the truth is rest is like food. You can't live without it. And sometimes, you just have to give it sufficient time and space.