Not Getting Enough Time in Bed
Paul Smith (not his real name) is a 63-year-old accountant. He works hard, he plays hard. He is happily married, with lovely children and grandchildren. He has been a patient off and on for many years. I have seen him over the years for sleepiness, for snoring, and for attention deficit. He tends to go to bed between 1 and 3 am, and get up at 7 am. He sleeps well. Thus, he gets 4-6 hours of sleep. He has not been getting enough time in bed.
He is like many of our patients (at least until they retire). They are hard-working professionals. Others work a lot of overtime. Still others work two jobs. Some work a different shift than their spouse, and want to spend time with each other before going to bed. The result is not enough time in bed.
When we are awake, our brains are very active and cannot get rid of metabolic byproducts and toxins. In sleep, our brains get rid of these toxic chemicals. If you do not get enough time in bed, your brain does not get rid of toxins as well. You get sleepy. Attention wanders. You might forget things. Snoring worsens. All this happens gradually, and some people do not even notice it.
We tested him for sleep apnea when he was younger. He did not have it. He wanted treatment for attention deficit. His daughter did well on stimulant medicines. We advised him that he had to get enough time in bed if he wanted stimulant medicines. He did not see the need to increase time in bed and passed on the stimulants. We advised him that he had to get 7-8 hours in bed if he wanted to not be sleepy during the day. He thought he could plow through the sleepiness and sleep was a waste of time. We tested him again for sleep apnea when he was older. His weight is normal. He does not have sleep apnea.
A few days ago, he dozed off driving on the highway. He hit another car. Both cars were damaged badly. Luckily, there were no significant injuries. This haunts him. He could have killed someone (or himself). He is now increasing time in bed. He never wants to doze off again while driving.
Of course, that is not easy. It means changing schedules and giving up on some activities. In the beginning, even the brain may rebel. It is not used to sleeping 7-8 hours and may wake up in the middle of the night with some difficulty falling back to sleep. It will take time to fall into new habits and routines.
However, if you get sufficient time in bed, you will feel more refreshed. You will be more efficient and you will get more done in less time. You are less likely to doze off while driving and kill yourself or someone else. Patients with primary disorders of daytime sleepiness will remain sleepy even when they are getting enough time in bed. We can then evaluate them, and treat them if there is a primary sleep disorder.