Lawrence Epstein - The Harvard Medical School Guide to a Good Nights Sleep

THE

HARVARD MEDICAL

SCHOOL GUIDE TO

A Good Nights

Sleep

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LAWRENCE J. EPSTEIN, M.D.,
WITH STEVEN MARDON

Copyright 2007 by the President and Fellows of Harvard College. All rights reserved. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher.

ISBN: 978-0-07-149042-9
MHID: 0-07-149042-6

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To my parents, Stanley and Rosebel, who made

it all possible, and to Dorothy, Collin, and

Evan, whose love and support made it doable

Why would I write a book on sleep? After all, everyone sleeps, it looks easy, and nothing much seems to happen while youre doing it. Thats what I used to think before I started studying sleep. I first came across the intricacies and mysteries of sleep as an undergraduate studying psychobiology at UCLA in the 1970s. I was amazed at how much was actually happening during what most people think of as downtime or wasted hours. Still more fascinating was the emerging idea that time spent asleep was essential to proper functioning. As we gained more knowledge, it became clearer that proper sleep plays a large role in maintaining health, promoting learning, performing at top proficiency, and sustaining emotional well-being.

In some ways, this shouldnt be a mystery. Anything we devote a third of our lives to must be important. Just about every animal we have looked at shows periods of sleep. The sleep of all mammals is very similar to our own, differing only in the amount of time spent asleep. Even birds show a rapid eye movement (REM)/non-REM cycle similar to ours.

Sleep is a complex undertaking, requiring numerous pathways through multiple parts of the brain. Several of these areas seem to function just to direct other regions. Every multistep process in the body is vulnerable to potential problems at any point in that process. It is these problems that cause disease, and the same is true with sleep. Given its complexity, the true mystery is that most of the time everything works correctly.

This brings me back to how Ive come to write this book. After my first exposure to studying sleep, I filed my interest away and went on with my education, finishing college and medical school. But I didnt learn about sleep and sleep disorders in medical school. That didnt happen until I was doing my residency in internal medicine and found out about a sleep disorder called sleep apnea. To understand this disorder, I had to learn about sleep again, which rekindled my interest.

At that time, the only way to study sleep disorders was to do so as part of another field. I chose pulmonary and critical care medicine at Cedars-Sinai Medical Center in Los Angeles, where Dr. Philip R. Westbrook had just arrived from the Mayo Clinic to set up a sleep disorders center. Under his tutelage, I learned about the different sleep systems, the various disorders, and the available treatments. I also learned what a big impact poor sleep and sleep deprivation have on people. This was probably the most valuable lessonsleep is important in maintaining good health and enjoying life.