Who Gets a Good Night’s Sleep Anymore?

Why rest is essential for navigating the pandemic and all of its adjustments.

Posted Sep 14, 2020

The effect of insomnia on mental and physical well-being has been well characterized. Insufficient duration of sleep, difficulty in falling and staying asleep, frequent awakenings and the effects of shifting the sleep/wake cycle because of work schedules, jet lag, and even early sunrise, have been linked to forgetfulness, poor performance, persistent daytime tiredness, weight gain, and cognitive impairment.

A study of the long-term effects of sleep disturbances on cognitive decline conducted by Professor Lauderdale and her colleagues found that people who suffered from cognitive impairment were likely to experience disrupted sleep, i.e., being awake frequently for short periods of time during the night.  Interestingly, the duration of their sleep was no different from those who were cognitively normal.

Now it seems that sleep disturbance itself may be a risk factor for cognitive impairment. In their review, Wennberg and others describe studies showing that abnormal duration of sleep, fragmented sleep, and sleep disorders seem to be a risk factor for dementia.

And yet, despite these rather worrisome findings, many of us, night after night, fail to have what we would describe to ourselves as “a good night’s sleep.”  Sometimes the cause can be a random event like a noisy thunderstorm or car alarm in the middle of the night; other causes may be persistent, but related to situations that will improve with time.  Physicians in hospital residence training endure frequent awakenings at night when they are on call, and consider themselves fortunate if they sleep more than one or two hours the night they are on duty.  Parents of newborns know they will endure weeks or more of frequent awakenings, to be followed by less frequent ones later on when their older children wake up because they are sick or had a bad dream.  A puppy-training book warned prospective puppy owners to take a few days off from work when attempting to have the new dog sleep in a crate.  A crying puppy does not make for a restful night.  Students living away from home at a boarding school or university are likely to experience fragmented sleep because of environmental noise.  Currently, universities have been placing students in single rooms because of Covid-19.  However, according to this study, normally about 90% of students have at least one roommate, and 41% report waking up during the night due to the noise of others.

But many experience sleeping conditions that disrupt sleep persistently.  Workers who must rotate shifts suffer from chronic insomnia and wake frequently because their wake-sleep cycles are continually disrupted.  Jobs requiring 24-hour availability may cause disrupted sleep due to the necessity of dealing with problems that arise during the night.  Frequent travel to time zones that require days for adjustment, makes it difficult to sleep through the night without periods of being wide awake when the clock says one should be asleep.

The list of what awakens us frequently in the night also includes physical discomfort such as back pain, frequent urination, side effects of some prescription medications, obstructive sleep apnea, and of course the good old standbys of anxiety, worry, stress, and Covid-19. These problems, and others that may be associated with emotional or physical problems, should be under the care of a health provider.

Have some of us become so accustomed to not sleeping through the night that we are indeed somewhat astonished and delighted when we do?  If this were a problem that had a visible effect other than half-closed eyes outlined by shadows, and difficulty in remembering where we left our keys or why we walked into the bedroom, maybe we would take our inability to sleep through the night more seriously.  But fragmented sleep may not rise to the level of a sleep disorder sending us to a sleep clinic because we stop noticing.  Sometimes we barely wake up, stumbling to the bathroom or checking on a child before crawling back to bed.  We may not even know how many times we wake up unless our sleep partner happens to be awakened by our stumbling around in the bedroom, and reminds us of it the next morning.

This problem should not go unnoticed or accepted because “this is how it is.” The inability to maintain continuous sleep can be associated with serious problems if it persists, including memory problems, increased sensitivity to pain, weight gain, cardiac and metabolic disorders, including Type 2 diabetes and the possibility of dementia.  

The National Sleep Foundation cautions against daytime napping because it might decrease sleepiness at night and increase frequent wakefulness.  This advice is probably not relevant for parents of newborns who try to sleep when their baby is sleeping, and others who anticipate being awakened often at night because of work, noisy roommates, or living next to a fire station.  But, as the article pointed out, darkening shades, earplugs, eyeshades, and a white noise machine may help with environmental noise (like a snoring bed partner or dog).  Some causes will go away; infants and puppies do sleep through the night eventually and residencies come to an end.  But solutions may be harder to achieve, especially when they are work-related, or involve family situations like an elderly parent who wanders around the house at night.  Even though sleep problems are probably as common as weight problems, the options for restoring continuous sleep are much more limited.  And often our health providers fail to ask us about our sleep unless we bring it up.  If we gained or lost a significant amount of weight this would be discussed.  But even if we are unable to maintain continuous sleep, we may not mention it, and our healthcare provider won’t ask. 

Perhaps the time to do so is now.