Sleep is a battlefield

fls researchers unlock the mysteries of the human dream state and the need for rest, they find buried evolutionary cues, keys to u/akefulness and the

borderline betu/een memory and madness

screen door hangs open. Voices inside, shouting. You haven't slept for 40 hours, but you're wired, adrenalized, Glock drawn, following the voices to the kitchen—

—where a black male, early 20s, has a black female by the arm. He's got a gun. She's holding a baby. You announce yourself. "Police!"

He aims at you. The baby's head is inches from the barrel of his gun. Do you shoot? No, you hesitate for the split second it takes him to say "Motherfucker!"

and kill you. Pop pop. Bullets hit your chest and you think,

Ow, that stings!

Too bad. You were too slow. The air cannon over the simula­tor got you with nylon bullets that leave red blotches on your chest. Those welts would be bloody holes if this were real life instead of a simulation in a lab at Washington State University Spokane, where you just died in the name of sleep science.

"Deadly-force scenarios can tell us a lot," says Bryan Vila, director of the university's Simulated Hazardous Operational Tasks Laboratory. A tattooed ex-marine and former police chief, Vila is studying the reaction time and judgment of cops. "What's the impact of the adrenaline burst that hits you when a situation turns deadly? Can it offset a night without sleep? Two nights?" Like many of us, police officers are often sleep-deprived, working overtime and double shifts. Vila, who wrote

the book Tired Cops, expects his work to save lives on both sides of the badge. Next door to his lab, where cops trade their service revolvers for simulation-ready laser Glocks, is WSU Spokane's Sleep and Performance Research Center. Here law enforcement types and other experimental subjects sleep under infrared cam­eras in beds hooked to brainwave monitors. The data aren't in yet, but sleep is starting to give up its secrets.

Sleep science didn't start until the 1890s. In those days nobody knew if your brain shut off like a light at night or opened at the ears to let dream demons in. Researchers didn't identify rapid eye move­ment (REM) sleep until 1953. (They considered reporting it earlier, but they were worried about wasting paper on something so weird.) Since then the field has boomed, with the most striking discoveries coming in the past few decades:

Seventy million Americans have trouble sleeping. Some are proud

of it, but they may be deluded or insane. The more we learn about

sleep, the more essential it turns out to be.

Fatigue costs the U.S. economy an estimated $136 billion a year.

Chronic sleep deprivation screws up hormones and may help cause

obesity—a finding that could get McDonald's off the hook.

According to one theory, dreams can break through into waking

Life—that's schizophrenia.

Lack of sleep exaggerates the effect of alcohol. With enough sleep­

lessness, three drinks can hit you as hard as six.

Ducks sleep with half a brain. One hemisphere sleeps while the

other—including a wide-open eye on the opposite side—keeps a

lookout for predators.

Elephants sleep about four hours a day, opossums 18. Bees are like

us: six to eight hours. The researcher who did the bee study said he

knew they were asleep because their antennae got droopy.

Some people sleepwalk. Others sleep-eat, sleep-drive or sleep-e-mail.

Still the prime question looms: What is sleep? To Shakespeare it was "nature's soft nurse." To Poe, "slices of death." We know that we eat to get fuel and breathe to oxygenate our blood, but at the end of the day—and the night—sleep is still a mystery. It's possible the brain needs to shift gears while its cells repair themselves. Maybe sleep is for memory filing, with some of the day's memories getting saved while others are sent to the trash. Or maybe evolution built us to lie low at night, safe from noctur­nal predators. For now everything anybody knows for sure can be

boiled down to an in-joke: Sleep is like sex, money and Johnnie Walker Blue. Most of us don't get enough.

You don't have to be a cop, a firefighter or an air traffic controller for sleep to be a matter of life and death. All you have to do is drive to work.

"Falling asleep at the wheel is epidemic," says Dr. William Dement, who founded the world's first sleep lab, the Stanford University Sleep Research Center. Dement drives defensively, particularly at night, be­cause he knows America's roads are full of half-asleep drivers who cause 100,000 crashes and more than 1,500 deaths a year. People who wouldn't dream of driving drunk think nothing of driving drowsy: In one poll 28 percent of licensed drivers admitted to nodding off at the wheel. That translates into more than 50 million drivers. Add a few drinks and Saturday night turns into a demolition derby.

Perhaps you think you can tough it out—focus harder, roll down the window. Dement says you're wrong. "The problem is sleep defi­cits impair your judgment," he says. "You may think you're fine, but you're weaving down the road."

Most drivers have experienced microsleeps, nodding off at the wheel for a second or two. You wake when your tires hit the shoulder

or a curb. "That's a common occurrence," says Vila. "Usually nothing bad happens because most roads are straight. The trouble is when microsleeps happen at a curve. Then you're flying off the road when you open your eyes."

The airborne car is one outcome of sleep dep. There's also the melting nuclear core, the exploding spaceship and the big-box store zombie. Sleep-deprived workers helped cause the Three Mile Island meltdown in 1979, the Challenger space shuttle explosion in 1986, the Chernobyl nuclear disaster in 1986 and the Exxon Valdez oil spill in 1989. Reality shows stress contestants by keeping them awake. A lack of sleep makes for better TV—high emotions and low inhibitions.

Or take the lousy work of a discount chain employee who describes his attitude as "sleepy as hell but used to it." Like countless others, he works in a world where sleep deprivation is the new normal. He behaves like a tired old circus tiger dozing on his chair, eyelids droop­ing, only waking when a whip is cracked. Then he nods off again, missing his cues while the other tigers roar and jump through hoops. When the spotlight hits him at the end of the show, he prances to his cage as if he hasn't missed a beat.

How can people live this way? They think, (continuedon page 112)

SLEEP

(continued from page 54) dully, that they're sharp. "We humans are good at comparing today to yesterday but not so good at remembering how we felt last week or last year," says Dr. Thomas Balkin, chairman of the National Sleep Founda­tion. "So we forget how it feels to be fully alert." In other words, millions of Ameri­cans are at risk of turning into the hourly wage slave: pessimistic, depressed without knowing why, reaching for drugs, liquor or sleeping pills because they're sleepy as hell but used to it.

At the cozy Research Outer at WSU Spo­kane, sleep volunteers are paid to eat, read, play board games, watch DVDs and spend full nights in bed, hooked to instruments that record their vital signs and brain waves. In this calm setting most people settle into the same pattern, sleeping from eight to nine hours a night. That's what the body wants. It fits historical levels: Before elec­tric lights remade the day, almost everyone slept nine to 10 hours a night. But who even gets eight hours of sleep today? Who gets seven? For many of us, the new normal is about six hours—sometimes five—which may be why ours is an age of new and dif­ferent sleep screwups.

American doctors write more than 50 mil­lion sleeping pill prescriptions every year. About 12 million Americans have obstruc­tive sleep apnea, in which sleepers actually stop breathing for 10 to 30 seconds. They wake because they're suffocating. Those with severe apnea semi-suffocate at least five times an hour, jarring themselves awake 30 to 40 times a night, waking up frazzled. There are drugs for insomnia and apnea, but they can gum up your brain, leading to more trouble and stronger drugs. Lack of sleep haunted insomniac Michael Jack­son, who allegedly paid his private doctor to put him to sleep with propofol, a powerful anesthetic used to knock patients out dur­ing surgery. What Jackson experienced was oblivion, not sleep. lie went into an induced coma, which lacked whatever mysterious benefits real sleep provides. He dwindled to 112 pounds and died at 50.

Sleep can morph into still weirder shapes. Sleepwalking is as old as sleep, its cause still unclear. Sleep-eating wasn't recognized until 1991. Recent years have seen countless more cases of refrigerator raids by otherwise nor­mal people who rise from bed in the middle of the night, sleepwalk to the fridge and eat like zombies. Some prepare full meals using blenders, toasters and microwaves. Others pig out on raw bacon, fistfuls of salt, ketchup in milk, dog food or nonfoods like Vaseline, shaving cream and buttered cigarettes. One possible cause of the uptick in sleep-eating is the use of the sleeping pill Ambien, which seems to trigger it in some people. But sleep-eating is nothing compared with some other sleep disorders. A 19-year-old "cat boy" didn't just dream he was a jungle cat—• he sleep-prowled the house, growled, leapt on sofas and lifted a marble table with his teeth. His parents took him to a sleep lab,

where scientists observed him sleeping. Sure enough, Cat Boy rose in the predawn hours, still sound asleep. He hissed, clamped his jaws on his mattress and dragged it around the lab.

Another sleep disorder provides one of the best reasons yet for premarital sex. A young husband reported that his newlywed had a disturbing and mysterious predilec­tion: She would sit up in bed, still asleep, and slug him in the face.

Then there's sleep sex. A young wife was raped by her husband, who climbed onto her in the middle of the night and pumped away like a robot. She knew he was asleep because he never stopped snoring.

Some women are sexually shy by day but masturbate like porn stars in their sleep (see sexsoinnia.org). And some straight men slide bi in their sleep, which is why you should think twice before crashing on a buddy's couch. "In some cases, a heterosexual per­son will attempt a homosexual act while sleeping," writes Dr. Carlos Schenck of the Minnesota Regional Sleep Disorders Center. "This is most frequently cited among friends who are sleeping at each other's houses."

In the last circle of sleep hell, insomnia leads to madness and death. A rare disease called fatal insomnia begins with lack of sleep, then night sweats. Next come months of jumpy sleep and then, as the brain turns to a Swiss-cheesy sponge, total sleepless­ness. It's been called the worst disease in the world because sufferers know exactly what's happening until the bitter end. They're fully awake. The last stages result in exhaustion, hallucinations and loss of bladder control. In This Will Kill You, IIP Newquist and Rich Maloof describe death by fatal insomnia. "Your body will twitch uncontrollably, and you will howl in pain as your Ixxly tries to find relief from its inability to sleep," they write. "Eventually you will become unable to speak, unable to walk and will fall into a coma. Death will happen very suddenly, but not suddenly enough."

Warriors have always regarded sleeping as a weakness. Odysseus stabbed the Cyclops in the eye wliile the giant slept. He and his men slipped out of the Trojan horse while the city of Troy slept. Three thousand years later American GIs were given amphetamines dur­ing World Wai" II—drugs that "cured" the need for sleep, keeping them up for combat. America's enemies ate speed as well. Many of Japan's kamikaze pilots were flying on methamphetainines when they clashed their planes into U.S. ships, and Nazis ate primitive crank. By the end of the war Hitler's doctor was giving der Fiihrer injections of meth every day, topped off with cocaine eyedrops.

Speed freaks from Hitler to Elvis have explored the dark frontier where wired wake-fulness borders on madness. It killed them but not necessarily because they were on the wrong track, pharmaceutically speaking. Maybe they were just ahead of their time.

The quest to beat sleep ramps up every year. According to a Pentagon report, an army that needs only two hours of sleep a night would be unbeatable. To fight such a force, an enemy would need 40 percent more troops. That's why military planners

fell in love with modafinil, a drug that helped the French Foreign Legion stay awake and alert for up to 40 hours during the first Gulf War in 1991. But niodalinil's no nieth. It's milder, more like coffee, with side effects (nausea, vertigo) you don't want if you're Hying a plane. Today's U.S. pilots still pop old-fashioned forms of speed like Dexedrine, which have their own downsides. When two F-lfi pilots fired at Canadian sol­diers in Afghanistan, their lawyers claimed government-issued Dexedrine may have clouded their judgment.

More recently, the Pentagon's Defense Advanced Research Projects Agency funded tests on ampakines, a newer class of chemi­cals. In one test, "sleep-deprived monkeys that had been administered ampakines... restored performance to levels compara­ble to or better than those for well-rested monkeys without ampakine treatment." However, ampakines are not yet considered a viable option for humans.

And the madness continues. One Harvard study examined the performance of closely monitored medical interns and found that on extended work shifts (24 hours or more), they made 36 percent more medical errors than when they were fresh. Fatigue had crip­pled their brains. Those bumbling interns were like the soldiers in a study conducted by the British military: After one night of limited or no sleep, the soldiers performed their duties easily. After two they got jumpy. F.ventua]ly they looked out into the dark and had visions of "little men, little animals, beds, lawn chairs and carnival props." One sentry saw sheep and thought they were polar bears.

"But then there's adrenaline," says a sol­dier who fought in Afghanistan. "Nobody nods oil'in a firelight." True—nobody falls asleep returning Taliban fire, defusing an IED or landing a plane on an aircraft car­rier. But the adrenaline that briefly erases fatigue dwsn't last long and may not help as much the next time. A stark example of adrenaline's limits came during World Wai' II when Allied troops parachuted into battle over Normandy on D-day. Some had barely slept in past days, but they were terrified and ultra-awake. Floating down past enemy trenches, adrenaline pumping as the Ger­mans shot at them and killed some of their buddies, the paratroopers landed behind German lines and promptly fell asleep. They were still in mortal danger, but the immedi­ate peril was past and the sleep imperative took over. More alert paratroopers ran for cover, but others were so deeply asleep they couldn't be roused even when under fire.

Today's military leaders know sleep is vital to soldiers' performance. For decades the U.S. Army's combat manuals recom­mended four hours of sleep per 24. Soldiers in battle often stayed awake for 48 hours or more, a prescription for disaster. But according to the latest manual, "soldiers require seven to eight hours of good qual­ity sleep every 24-hour period.... Sleep should be viewed as being as critical as any logistical item ofresupply, such as water, food, fuel and ammunition." Meanwhile, war-science researchers keep hunting for ways to limit or erase the need for sleep. In tests, British scientists have reset soldiers'

body docks with high-tech glasses that iire bright white light—the same spectrum as a sunrise—around their retinas. American pilots who wore the specs during bombing runs over Kosovo worked without sleep for up to 36 hours. Researchers think drugs will help win future wars. "They'll be part of the armamentarium," says one expert, pictur­ing a generation of soldiers who never yawn, dream or waver from duty.

For now the sleepy warrior's number one ally is plain old caffeine.

Many Army Rangers and Navy SEALs (as well as pro football and baseball play­ers) eat coffee crystals for a quick boost. The coffee may be instant, but the boost isn't, since coffee hits the stomach first. There's a better caffeine-delivery system: Stay Alert gum, developed by Wrigley and tested at the Walter Reed Army Institute of Research. It reaches the body faster by being absorbed through the tissues in your mouth rather than your gut. (It also beats Red Bull or any other energy drink, unless you're try­ing to energize your stomach acids.) Stay Alert gum, sold at military bases and online, delivers 1(X) milligrams of caffeine per piece, roughly the same as in a cup of coffee. Two pieces every two hours can get you through sentry duty—or an exam cram or a 1,000-mile drive—awake and alert.

During non-RKM sleep, which accounts for about 75 percent of sleep, the brain shifts down like an idling car. But during REM cydes, which add up to about two hours a night, the brain lights up. Behind closed lids our eyes move as if we were awake. Fortu­nately for our bed partners, one part of the brain, the locus coeruleus, paralyzes most muscles during REM. That's why we don't act out our dreams. (Sleeping cats with that bit destroyed chase dream mice that aren't there.) In effect, the dreaming brain spends two hours revving its engines while the body is out of gear. Why?

British scientist Jim Home compares REM sleep to a computer in screen-saver mode. It seems cell repair gets done during non-REM, memory filing during REM. This notion has gained support from sleep exper­iments. We're more alert when wakened from REM—ready to react to danger. (The best way to wake someone? Repeat his name. We're wired to snap to attention when we hear our names.) However, though subjects get stressed and fatigued when deprived of non-REM sleep, they seem to do fine when deprived of REM, in the strictest sense of survival. Maybe we don't need it.

Recent studies suggest that REM and dreaming are crucial at one stage of life: when you're a fetus. REM sleep has been observed as occurring in human fetuses, though it's hard to imagine what they're dreaming. It's possible that such dreams provide stimulation (images, sensations, even emotions) before birth, while the brain makes its first connections. Such pre­wiring would give infants a head start at birth. The idea that dreams are practice for life—the original virtual reality—makes evolutionary sense and matches a remark­able fact from the animal world. In animals REM sleep correlates to how immature or

"unfinished" the offspring are at birth. Por­poises have to swim and dodge sharks from the moment of birth, so they're born rather mature and do almost no REM sleeping. Platypuses, born tiny, blind and defense­less, get about eight hours of REM a day. Humans fall between the two, toward the dreamier end of the scale.

If the pre-wiring theoiy is right, dreaming may be a relic of fetal development. Use­less in adults, like men's nipples, it survives because evolution weeds out only stuff'thai affects reproduction. REM doesn't do that. In fact, for unknown reasons it's the sexiest kind of sleep.

For most men, the first and last intense sexual experiences in life occur during sleep. A boy's first wet dream comes long lx-fore he has real sex. An elderly mail for whom masturbation is a form of nostalgia has a last heroic hump in his dreams. According to Plato, who fretted about his own dirty dreams, the dreaming man "acts as if he were totally lacking in moral principle." Sex researchers have shown that men get erec­tions and women experience ditoral swelling during REM, even when their dreams aren't sexual. In studies, technicians fit a set of rub­ber rings around the penises of male subjects.

Each ring is attached to a wire leading to a stylus that graphs tumescence. It turns out the sleeping penis doesn't lie—in fact, such tests can distinguish medical impotence from the psychic kind. Medically disabled penises stay limp even during sex dreams, but for the majority of patients who can't perform when awake because they're conflicted about sex or can't stand their wives, erections rise and fall with REM sleep.

It happens to all of us: You're hanging upside down from a rope strung across the Grand Canyon. The rope breaks; you'll die unless you grab the giant bat flying by, and you think, This is a dream. It's called a lucid dream, and lucid dreaming is no fantasy. "We proved it in our lab," says Dement. He and his Stanford colleagues instructed experimental subjects to try to take action during their dreams. So, say they were dreaming about driving down a road with telephone poles on both sides. They were told to look at the poles to the left and right a certain number of times. Sure enough, the subjects' eyes went lefl-righl-lefl-right (luring REM. Newer studies suggest we can shape the content of our dreams. It takes prac­tice, but if dreams are "movies the brain

shows itself," as one expert claims, future dreamers may have the chance to direct. One woman who had recurring nightmares of being eaten by sharks trained herself to turn the sharks into dolphins that carried her to the surface. "I woke up so happy!" she reported.

Men may employ different strokes. By 2030 you might be able to train your­self to have particular sex dreams. If that means virtual sex with the Playmate of your dreams, would you do it? If so, should she get 99 cents, the price of an il'une? And what if your wife found out? This could open new realms of intellectual-property and divorce law.

To Dr. Gregory Belenky of WSU Spo­kane, sleep is life's fundamental mystery. Even cutting-edge researchers like Belenky can't say why or how staying awake makes us drowsy, irritable and lousy at otherwise easy tasks and eventually maddens or kills us.

The answers must be coded in our genes. Molecular genetics is likely to crack the code in the next 20 years, a process that's already under way. While most of us need at least seven hours of sleep a night to function at top efficiency, there are outliers—maybe one person in 20—who need only three or four. Some of these "short sleepers" share a gene that was identified just last year.

For now, though, the rest of us probably need more time in the sack. In a yet-to-be-published study Dement brought members of Stanford's basketball team into his lab. They went through the usual sleep-lab program, lying in bed for as long as they liked. It was almost always more than they were used to getting. "We eliminated their sleep debt," Dement says. Then the Cardi­nal hoopsters went back to Maples Pavilion. "They ran their standard timed sprint, and we kept seeing personal bests. Even their three-point shooting improved."

Last year some NBA teams ditched morn­ing shoot-arounds so their players could sleep in. The Celtics joined them after coach Doc Rivers met with Harvard's Dr. Charles C/eisler, known in the league as the Sleep Doctor. "If you go three, four, five days in a row with less than six hours of sleep, your reaction time is comparable to that of some­one legally drunk," Rivers told The New York Times. "You're trying to play a game where just a tenth of a second throws your whole game off."

For most of us, the game is real life. It hap­pens every day, from the battlefield to the police beat. You get more sleep, you remem­ber how it feels to be fully alert. You step back into Vila's deadly-force simulator.

A messy kitchen. A white male, 30ish, no shirt.

You announce yourself: "Police!"

lie shows you his hands, empty. "What's the problem?" He starts to put his hands behind him as though he expects you to cuff him. But one hand's palm-forward, as if he's reaching for—

—the pistol in his belt, yelling as you shoot him, yelling, "I'll kill "

In your dreams, tough guy.

"THE TROUBLE 15 UJHEH fTUCROSLHPS HflPPEK PIT ft CURVE. THEH VOU'RE FLVIKG OFF THE ROfiD."

One woman who had

recurring nightmares of

being eaten by sharks trained

herself to turn the sharks

into dolphins that carried her

to the surface.