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nsomnia and other sleep disorders constitute a massive medical problem that sleep centers can't even begin to address, says Duke Sleep Disorders Clinic psychologist Jack Edinger. For example, according to a 1993 report of the National Commission on Sleep Disorders Research, some 40 million Americans suffer a chronic sleep disorder. Another 20 to 30 million suffer occasional sleeplessness, said the report, aptly titled Wake Up America. About 20 million people suffer from apnea and another 250,000 from narcolepsy. Perhaps most startling, though, is the study's finding that 95 percent of patients with sleep disorders remain undiagnosed. Even those few who do make it to the clinic, says Edinger, take a long road to get there. "I did one study of insomniacs treated in our lab, and the average duration of their insomnia before they saw us was nine years!"

The costs of sleep disorders are enough to keep anybody up nights, the commission found. The report attributes $15.9 billion in direct costs to sleep disorders, with another $150 billion in fatigue-related lost workplace productivity, accidents, and deaths. And sleepiness is deadly. The nation's highways have been strewn with trucks overturned and cars smashed in accidents where fatigue was a factor. The commission estimates that fatigue contributed to one-third of fatal truck accidents. And the Department of Transportation estimates that 200,000 auto accidents a year may stem from driver fatigue. Railroad engineers and airplane and ship pilots are also nodding off, with disastrous consequences.

The most basic problem in "waking up America" is that sleep is the Rodney Dangerfield of bodily needs--garnering far less respect than breathing, eating, and drinking. We see sleep as somehow optional, despite the fact that experience shows it's just as necessary as breathing. Deprive yourself of a single night's sleep and the next day you'll lack concentration and coordination, and become downright irritable. Keep yourself awake only a few nights and you'll hallucinate and develop psychotic delusions such as paranoia. Forced to stay awake long enough, you'll die. University of Chicago scientists proved it. To probe the ultimate limits of sleep-deprivation, they kept rats awake as long as possible. In two sleepless weeks, the rats began to suffer ulcerated skin and weight loss, even given an unlimited access to food. After four weeks without sleep, the animals lost control of body temperature and other metabolic functions, and died.

Despite such dramatic evidence of sleep's importance, even medical schools don't respect it, says Edinger. "Almost one-third of all medical schools have no structured sleep curriculum. And less than 5 percent of all medical schools offer four or more hours of formal teaching on sleep. Most of that occurs as a fourth-year elective." Thus, says Edinger, the typical physician (also likely a former sleep abuser), faced with a sleep-deprived patient, will do little more than prescribe a sleeping pill.

Research studies revealed long ago the profoundly important restorative role of sleep. For one thing, scientists discovered that sleep is not simply the passive absence of waking. It's different from the unconsciousness of drugs or the near-death state of hibernation. Sleep is an active behavior just like eating and breathing. We don't "fall" asleep; our brain decides to go to sleep when fatigue and our body's twenty-four-hour clock switches on sleep-inducing circuitry in the primitive brainstem. The catnapping Thomas Edison (great inventor, lousy biologist) denigrated sleep as "a deplorable regression to the primitive state of the caveman." But Edison didn't really appreciate the remarkable industry of his own sleeping brain.

In putting itself into sleep, the brain is a busy shopkeeper that closes his doors at night, only to launch into action cleaning out the "mind-garbage," restocking and reorganizing for the next day's barrage of sensory information. Scientists theorize that over the eight or so hours of sleep most humans need, the brain replenishes brain chemicals called neurotransmitters; wires new neural circuits to establish the day's memories; renews old memory circuits; and even rehearses behaviors without the bother of muscle action. Meanwhile, the body, largely disconnected from the brain, conserves its energy for the next day.

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