Sleep Management in the Social Whirl

By Dr. Margaret Rappaport

Committing to a regular pattern of sleep and wakefulness is not easy because of the modern, busy lifestyle. Our individual “biological clocks” do their best to keep us rhythmical throughout each twenty-four hour period, but frequently are unsuccessful. We get signals such as yawning, poor concentration, low energy and numerous stress reactions. Still, we stay caught up in the social whirl that requires “burning the candle at both ends”. Understanding why we should be purposeful about sleeping and waking might support our resolve and help us cope with several sleep disruptions that are part of modern living.

Consider the fact that our internal, biological clocks have a twenty-five hour face, while our social clocks have a twenty-four hour structure. Our personal clocks run slower that the light – dark cycle caused by the rotation of the earth around the sun. Thus, our bio-clocks require a daily setting back of about one hour to keep us in time with day and night. With our first exposure to light in the morning, a multitude of physiological and psychological functions reset our rhythms so we are able to live and work in accordance with our social schedules. This happens relatively effortlessly and quite routinely unless we deliberately interfere with it by varying our sleeping schedule (sleeping late on weekends), or traveling to another time zone (jet lag), or shifting our work to the night.

So, the fact is that sleep disruption problems will not develop as long as we have a predictable sleep-wake schedule timed fairly closely to first morning light and we get sufficient sleep of between seven and eight hours every night. Unfortunately, for most of us this is a simple suggestion to hear but a difficult goal to accomplish.

Most people vary the time they go to bed and change the time they get up to match the demands of modern society rather than to meet their physical and psychological needs. Alarm clocks, radios, automatic coffee makers, wake-up calls are among a myriad of devices we use to assist us in not keeping a disciplined sleep-wake schedule. Besides the bother (and noise) of the modern tools, and although they keep us on a social schedule, they are useless in helping us with feelings of being out of sorts, lethargy and fatigue, and vulnerability to stress which results from fighting our internal clocks. Instead, we should simply not change the time we get up by more that one hour across a span of time. It is best not to exceed the limits of our ability to readjust our sleep-wake pattern because sleep disruption is the result. Negative feelings and behaviors that are caused by sleep disruption create a vicious cycle that often leads to sleep disorders.

Having and understanding of sleep-wake rhythms helps us cope. For example, recognizing that sleeping late on weekends is analogous to jet lag may help us avoid doing it. If a person on Cape Cod arises five days a week at 6:00 AM and sleeps until 8:00 AM on Saturday and Sunday, falling asleep on Sunday night will be significantly delayed by at least two or three hours, as though he lived for two days on Denver time. The 6:00 AM rising time on Monday is difficult because of the excessive internal rhythm readjustment required as well as the need to carry on against a backdrop of insufficient sleep.

Jet lag is another modern social phenomenon. People traveling between and among time zones can’t escape sleep disruptions and the consequences for health and happiness. When traveling from coast to coast in the United States there are several things to do. For shorter trips of less that seven days, sleep and wake on your home schedule or as nearly as possible, using the one-hour benefit to best advantage. Or compromise with your sleep needs and sleep on central time when visiting the east coast and on mountain time when on the west coast. For longer stays, you can “hurry” the adjustment to the new time zone by varying the time you go to sleep or arise by two hours for three days before your begin your trip. Changing your sleep schedule prior to travel gives you the benefit of familiar surroundings while you synchronize to the new time zone. The best way to mitigate jet lag symptoms is to anticipate and manage them before you travel.

Crossing time zones that are greater than three or four hours results in more severe and persistent jet lag. Travelers must maximize their exposure to new light – dark cycle by immediately assuming the social schedule of the destination. They need to rise as early as possible each day to experience more daylight. Keeping to a strict sleep-wake pattern helps eliminate jet lag in a shorter time. Incidentally, sleep aids don’t work very well. They often add to the sleep disruption problem, rather than help it.

Sleep disruptions are a chronic problem for shift workers. This is especially true for workers who are permanently on the night shift. It is due to both the underlying physiology (circadian rhythms), as well as the psychological and social adjustments required in dealing with disturbed interpersonal events.

Three circadian rhythms: temperature, cortisol levels and subjective alertness appear to be more resistant to change. These factors are fixed to the hours of darkness. Their regulation is triggered by the absence of light, just as the phases of the sleep-wake cycle when humans are sleepiest occurs during the night.

Unavoidably night shift workers must be productive during these hours. Equally unavoidable is the overwhelming lack of energy and sleepiness experienced by even experienced night shift workers. Night shift workers typically get less sleep that they require. Surveys report a 6-hour sleep period is the norm. This results in chronic tiredness as well as poorer quality sleep. A related problem is what to do on nights off. Almost all night shift workers revert to a night sleeping schedule on nights off. This happens because of social pressure to some extent, but is also due to the biological clock that always wants to get back to the norm. The result is difficulty falling asleep and frequent waking. In short, on nights off the worker has a best serious jet lag, or more likely, chronic sleep disorder.

The long-term impact on the health of night shift workers is considerable. For example, they experience more stomach and bowel problems and heart disease than permanent day shift workers. They also report more social and family problems than day workers.

Coping with shift work is especially challenging. There are no easy answers to the variety of issues that are prevalent in this demanding modern lifestyle. What can be said with a fair degree of confidence is that night shift workers should wait until early afternoon to begin sleep. They may be able to sleep longer and better, especially when their social environment respects and supports their sleep schedule.

Finally, for all of us who are managing to sleep despite the obstacles in modern life, the benefit is apparent and great, indeed. Sleep well.