•  Getting a Great Night's Sleep

The Promise of Sleep
By William C. Dement, MD, PhD, and Christopher Vaughan
Dell Publishing
560 pp paperback $14.95

The Promise of Sleep is not, as the title might suggest, a slim volume of wistful reflections to slip into a backpack. Nor is William C. Dement, a Stanford University professor and "the world's leading authority on sleep," a shy scientist, dazzled by the light outside his laboratory. The book is a 450-page tome (not counting appendices), and Dement is a crusader, bringing the gospel of sleep to a wakeful nation. When it comes to sleep, he's the man.

Most of the time, Dement swept me along in his current of rhetoric. Imagine, a few more hours of sleep and you, too, could reach the promised land of renewed vitality and creativity. Sleep off your "sleep debt," America! Eliminate the automobile crashes and industrial accidents caused by drowsiness! Rise, rise, to your full potential! When he explained circadian rhythm and jet lag, I believed. I trusted his exposition of his role as a pioneer in sleep research. Only rarely did I long for a less bombastic tone. I was reminded of a patient who confided that she had left one of our community's most respected internists because he spoke so loudly.

"He's all bark and no bite," I assured her.

"Oh, I know," she smiled. "It's just that sometimes I get tired of the bark."

Voice aside, Dement has a lot to say. He points out (over and over) that doctors don't know much about sleep problems, and many patients don't think sleep issues are worth mentioning. "Chronic intermittent" insomnia is often clearly related to office stress or a fretful baby: Isn't a certain amount of interrupted sleep inevitable under the circumstances? What Dement reminds us is that no matter how "normal" sleep deprivation may be in modern life, our bodies are still compromised. We may think we have learned to function on less shut-eye than we need, but we are likely to fall asleep at the wheel all the same. "What's dangerously deceptive is how awake you can feel even when you're carrying a heavy sleep load," he says.

This was a new concept to me, the idea that our daily arousal times, in the morning and the evening, can override sleepiness temporarily, but that the danger of falling asleep is still there. The chapters explaining healthy sleep and how to adopt a sleep-smart lifestyle are full of good advice. So good, my whole family was anxious for me to finish reading, because I felt compelled to share my new knowledge.

As a physician, I was more familiar with the "sleep disorders," like obstructive sleep apnea, which, Dement correctly points out, are woefully underdiagnosed. The poster child for this condition is the heavy middle-aged man who snores loudly (the uncle asleep in front of the football game before dessert on Thanksgiving). The walls of the throat pull together when a person snores. As the air moves through the narrowed passageway it makes noise. In obstructive sleep apnea, the airway actually closes briefly, so that the person can't breathe (apnea means "no breath"). The pattern of "snore, snore, snore -- quiet -- splutter" memorialized in cartoons is obstructive sleep apnea. People with the disorder are drowsy in the daytime and frequently develop cardiac complications: high blood pressure, palpitations, and congestive heart failure.

While we have recognized obstructive sleep apnea for a while, we are just beginning to develop the habit of screening patients with heart trouble for sleep disorders as well. There is mounting evidence that treating the sleep disorder may cure or at least ameliorate the heart condition. Dement is impatient to get the word out about obstructive sleep apnea and other sleep disorders. He acknowledges that not everyone has a sleep lab around the corner, but he skirts the issue that insurance companies are not eager to pay for a night of monitored sleep.

At this point, sleep scientists can describe the bad consequences of sleep deprivation, but they can't tell us what sleep does. This is not an intellectually satisfying position. Critics of sleep research downplay the importance of sleep as a health factor in itself. They forget that sleep research is following a typical scientific path. A hundred years ago, scientists figured out that people became ill if they didn't have enough of certain vital elements, "vitamins," in their diet. They were even able to determine how much of each vitamin we needed to stay healthy. Yet we are still learning how vitamins function in the body.

The chapters speculating about the function of sleep and dreams are intriguing. Did you ever wonder how a mammal like a dolphin can sleep in the water without drowning? "The dolphin solves this problem by letting only one-half of the brain go to sleep at a time. First the left side sleeps for two hours or so, and then the right side, and so on until the day's sleep requirement is fulfilled."

According to colleagues who should know, Dement is the nation's dean of sleep experts. When he vents his frustration regarding the nation's sleep habits, he sounds like a typical primary care doctor after a long day. My teenagers would tell him to chill out. Not me. I know he only nags because he cares.

-- Toni Martin, M.D., is a board-certified internist and geriatrician who has practiced in Oakland, California for 19 years. She is also a member of the clinical faculty at UCSF Medical School, and has written for Hippocrates magazine, among other publications.

Last updated March 30, 2009
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