“Sleep is overrated.”
So proclaims Stephen Klasko, who throughout his life has taken pride in sleeping only four or five hours a night. Those extra few hours away from his pillow, he believes, have allowed him to write books, run marathons, and achieve his lofty professional goals. An obstetrician and gynecologist, he’s the president and CEO of Jefferson Health, one of the region’s largest health systems. Under his tenure, it has expanded rapidly to a $5 billion enterprise with 14 hospitals.
As a doctor, he is aware that inadequate sleep has been associated with a mounting list of cardiovascular, metabolic, mood, immune system and cognitive problems, or, as one researcher put it, “pretty much anything bad.” He recently turned 65 and knows his habits might catch up with him. But he feels fine.
“I’m not worried,” he said.
Should he be?
Millions of Americans, including President Donald Trump, are considered “short sleepers,” which means they get six hours or less of shut-eye a night. Experts recommend that adults sleep at least seven hours.
“To me, the only thing more important than sleep is air and water,” said Ying-Hui Fu, a molecular biologist and geneticist who studies sleep at the University of California-San Francisco. “You cannot live very long without sleep.”
So far, most scientific studies have lumped all short sleepers together, but they are not homogeneous, and researchers are increasingly interested in whether all short sleepers share the same risks.
Fu studies a rare and exceedingly lucky group who seem genetically inclined to get — and probably need — less sleep. Many more people choose to scrimp on rest and say they feel OK, but probably aren’t. Others know they feel bad.
Then there are insomniacs, whose difficulty sleeping is often paired with anxiety and stress. And people with sleep apnea, who sometimes sleep plenty of hours, may be in a different category altogether because of poor sleep quality.
Kristen Knutson, a biomedical anthropologist at the Center for Circadian and Sleep Medicine at Northwestern University’s Feinberg School of Medicine, said about 30 percent of adult Americans now qualify as short sleepers, compared with about 20 percent in the 1970s. She thinks longer commuting times are likely a factor as well as extra time spent on computers and smartphones, distractions that didn’t exist 50 years ago.
“We’re in a grand societal experiment where it’s common to sleep less now,” Williams said.
THE NEW FOCUS ON SLEEP
People are getting the message that sleeping too little is bad. James Findley, a psychologist who is clinical director of the behavioral sleep medicine program at Penn Medicine, said short sleepers often seek treatment now because they’re worried about their health, especially the potential for dementia.
Insomniacs may already be having trouble relaxing because they are worried that they’ll be a wreck the next day. Studies about the ill effects of sleep deprivation just give them something else to obsess about. Such devices as Fitbits, which can monitor sleep habits, have spawned a form of sleep perfectionism, which researchers have dubbed orthosomnia, that also can increase anxiety.
Several sleep researchers said they’re most worried about really short sleepers, those who get less than four hours, regardless of how this habit makes them feel. Experts also suspect that feeling tired or fuzzy-headed after sleeping four to six hours is a signal that something is wrong. The most perplexing group is people who sleep four to six hours and say they feel good.
Fu has been studying natural short sleepers for about 10 years. She’s found mutations on five genes that seem to change our need for sleep. When mice were genetically altered to express three of these mutations, they also slept less and didn’t appear to suffer otherwise. The group of about 50 natural short sleepers that Fu has found tends to be energetic, thin and optimistic.
While this group seems most likely to evade problems from sleep deprivation, Williams cautions against assuming that.
“Just because something occurs naturally,” she said, “doesn’t mean it’s good.”
CAFFEINATED ALL DAY
True natural short sleepers are rare. “It’s a low, single-digit number,” Orfeu Buxton, director of the Sleep, Health and Society Collaboratory at Penn State University, said of their percentage in the population. Meanwhile, 12 percent of Americans say they sleep less than six hours without consequences, Williams said. But studies have found that many are not doing as well as they think they are.
Some brag about how little sleep they need but fall asleep in meetings, sleep in on weekends, or guzzle coffee or Diet Coke all day, while some genuinely don’t seem tired. Williams suspects that many of them avoid sleep by keeping themselves constantly stimulated. When forced to sit still in, say an MRI machine or a dark, quiet room, the ones who say they feel fine get just as sleepy as the ones who knew they were tired all along.
Experts say you can test whether you’re pushing your own body too far. Cut back on the caffeine. Put the devices away well before bedtime. Make sure your room is dark. Alcohol can disrupt sleep, so don’t drink too close to bedtime. Use your bed only for sleep and sex. Gradually move your bedtime earlier.
“My advice to anybody would be to try to strive to get sufficient sleep, even if it means catching up,” Williams said.
There are some who side with Klasko and think that some short sleepers may, in fact, be fine.
“Just listen to your body,” Fu said. “Your body will let you know.”