2004-01-21 20:04:33sdssdf
[Perspective]: Insomnia Plaged the Health of Economy (1)
"I Can't Sleep" Business Week Online
Insomnia has left Ron Hansen a desperate man. "There is nothing worse than knowing you have a 10 a.m. meeting with an important client, wanting to get a good night's sleep, and just not being able to," he says.
Hansen's quest for rest drove him to participate in a trial for Estorra, an experimental sleep drug from Sepracor Inc. (SEPR ) in Marlborough, Mass., that's expected to hit the market by midyear.
Hansen is part of a giant and growing class: worn-out, dragged-out denizens of a sleep-robbed netherworld. More than 82 million Americans -- nearly 40% of the teen and adult population -- suffer from some form of insomnia, meaning they routinely have trouble falling asleep and staying asleep. Even for those who grapple with transient insomnia a few times a year, the bouts of sleepless nights are an ordeal, like a bad, recurring flu. On the other side of the empty bed are countless people who cheat on sleep so they can squeeze more hours out of the day. Only 32% get the recommended eight hours of shut-eye on weeknights, according to a 2002 poll by the National Sleep Foundation. They won't outgrow the problem, either. Studies show that as we age, the quality of our sleep deteriorates. And our wired, 24/7 society makes it worse, bombarding us with news of mad cow disease and other coming calamities while beckoning us late at night to finish our work online.
While we've been busy burning the midnight oil, scientists have been amassing evidence that sleep deprivation is a hazardous state. Insomnia has been fingered as a major risk factor for depression, alcoholism, and obesity. Other ruinous effects may be on display right in your office. Surveys indicate that nearly half of all office workers sleep poorly at least a few times a week, and more than 65% confess that they have trouble concentrating after a sleepless night, according to the National Sleep Foundation.
Now think about the people responsible for your safety. A huge proportion of pilots -- not to mention policemen and doctors -- admit to making errors in sleep-deprived states, according to Alertness Solutions, a consulting company in Cupertino, Calif. "It's not as if people are off their game by 1%," says Mark K. Rosekind, president of the company. "They're way off." What's more, all this tossing and turning is putting a damper on the economy. Sleep deprivation costs $45 billion a year in lost productivity, health-care bills, and expenses related to traffic accidents -- rivaling the impact of depression, say, or stroke. As Stanley Coren, a sleep researcher and psychology professor at the University of British Columbia, often preaches: "Lack of sleep makes people clumsy, unhappy, stupid, and dead."
To the world's growth-starved pharmaceutical companies, sleep deprivation spells opportunity. While drug company execs are aware that some insomniacs can be helped by exercise, diet, and keeping regular hours, they note that millions aren't cured by such regimens, or can't stick to them. The drug industry has barely dipped into this pool. Market researcher Decision Resources Inc. estimates that no more than 40% of insomniacs are diagnosed, and only half of those are treated with prescription drugs. The total market for prescription sleep aids is a skimpy $2 billion a year, mostly spent on a single blockbuster, Ambien, from Paris-based Sanofi-Synthelabo (SNY ).
In pharmaceutical circles, Ambien is a symbol of what one sleep drug can achieve. When it was launched in 1993, it was hailed as a breakthrough because it promoted sleep with only a minor risk of hangovers and other side effects. As sales took off, at least a half-dozen companies began developing novel sleep aids, which could start hitting the market in 2004. Some exploit entirely new discoveries about how and why we sleep. And all of them claim to improve on Ambien's powers. Dr. Kris H. Jenner, portfolio manager of the T. Rowe Price Health Sciences Fund (PRHSX ), estimates that the market for sleep drugs will more than double, to $5 billion, by 2010. "This market is set to explode," he says.
Drug companies will make sure that the sleep-deprived hear their message. But they have a mammoth task ahead convincing people first that insomnia is a serious condition, and second that it can be treated safely with drugs. Historically, sleep aids have been linked with addiction, depression, and suicide. Even though newer drugs are designed to avoid such troubles, many physicians and insomniacs are frightened that there will be unforeseen complications. Insomnia, in short, is an enticing pharmaceutical frontier -- but one with more than its share of treacherous passes.
Many Mysteries
To forge better remedies for sleep disorders, scientists have had to struggle with some fundamental mysteries. We spend a third of our lives in bed, yet no one has been able to explain the necessity, and bona fide scientific studies are barely a few decades old. We have learned, for example, that the need for sleep varies greatly by species and is related to physical size: Opossums snooze for 18 hours a day, while elephants need just three hours. Even where sleep is inconvenient or dangerous, evolution provides work-arounds. Dolphins, for example, shutter only half of their brains at a time, remaining half-awake when they sleep.
By dragging humans into sleep labs and hooking them up to monitors, scientists have made a handful of discoveries about what the body does when it's asleep. During the deepest phases of slumber, growth hormone is released, facilitating cell repair and energy restoration. And much has been observed about REM (rapid eye movement) sleep, when our eyes dart frantically beneath our eyelids and we dream vividly of talking petunias and killer clams. Many scientists believe REM and non-REM sleep work together to consolidate memories and experiences and burn them permanently into our brain's hard drive. That could explain why some people wake up and suddenly have a solution to a problem that seemed insurmountable the day before. But the connection to sleep is still unclear.
The consequences of sleeplessness are much better understood. Deprivation messes up the body's metabolism, putting insomniacs at risk for a host of diseases. In a 1999 study at the University of Chicago, healthy men who slept just four hours a night for six nights suffered a 30% shortfall in their ability to secrete and respond to insulin -- the hormone that regulates blood sugar. That large a drop can be an early warning of diabetes.
Blithering Idiots
More recent studies at the University of Chicago demonstrate a possible link between sleeplessness and obesity. Preliminary results show that study participants who were allowed just four hours of sleep a night for two nights suffered a 20% drop in leptin, a hormone that controls body weight. At the same time, their stomachs produced 20% more ghrelin, a hormone that makes people feel hungry. Sleep-deprived subjects craved high-fat, very sweet foods, and "their appetites increased beyond the extra calories they needed to stay awake," says Eve Van Cauter, a professor at the University of Chica- go's medical school and the director of many sleep studies.
Taken to extremes, sleep loss can reduce us, at least temporarily, to blithering idiots. In two studies at the University of Pennsylvania, 48 healthy adults were split into several groups that slept four, six, or eight hours a night for two weeks. All the participants performed tasks that tested their motor skills and memory. By day 14, the four-hour group made an average of 14 times as many errors as they did when they took the tests fully rested. The eight-hour sleepers performed the tasks consistently well -- and actually got better at them each day. And the six-hour sleepers, corresponding to the corporate everyman, may as well have been thoroughly sleep-starved. They scored 11 times as many errors as they normally would make -- about as bad as a test group that stayed awake for two straight days.
But what about the superhumans we all seem to know -- the co-worker who intentionally gets five hours of sleep a night yet outperforms everyone else? Sleep experts say basic biology eventually catches up with these deliberate sleep cheaters. "We have no evidence that CEOs, astronauts, or doctors are exempt from the dangers," says David F. Dinges, chief of the division of sleep and chronobiology at Penn's school of medicine.
Whether people are cheating on sleep or succumbing to insomnia, the perils are the same. Studies show that someone who has been awake for 24 hours has the same mental acuity as a person with a blood-alcohol level of 0.1, which is above the legal limit for driving in most states. That means an executive who is up all night worrying about the quarterly earnings report -- or worse, a hospital resident who takes over in a late-night emergency -- is about as sharp as a light drinker who suddenly downs four margaritas. No wonder drowsy drivers cause 70,000 injury crashes per year, of which 1,550 are fatal.
Insomnia has left Ron Hansen a desperate man. "There is nothing worse than knowing you have a 10 a.m. meeting with an important client, wanting to get a good night's sleep, and just not being able to," he says.
Hansen's quest for rest drove him to participate in a trial for Estorra, an experimental sleep drug from Sepracor Inc. (SEPR ) in Marlborough, Mass., that's expected to hit the market by midyear.
Hansen is part of a giant and growing class: worn-out, dragged-out denizens of a sleep-robbed netherworld. More than 82 million Americans -- nearly 40% of the teen and adult population -- suffer from some form of insomnia, meaning they routinely have trouble falling asleep and staying asleep. Even for those who grapple with transient insomnia a few times a year, the bouts of sleepless nights are an ordeal, like a bad, recurring flu. On the other side of the empty bed are countless people who cheat on sleep so they can squeeze more hours out of the day. Only 32% get the recommended eight hours of shut-eye on weeknights, according to a 2002 poll by the National Sleep Foundation. They won't outgrow the problem, either. Studies show that as we age, the quality of our sleep deteriorates. And our wired, 24/7 society makes it worse, bombarding us with news of mad cow disease and other coming calamities while beckoning us late at night to finish our work online.
While we've been busy burning the midnight oil, scientists have been amassing evidence that sleep deprivation is a hazardous state. Insomnia has been fingered as a major risk factor for depression, alcoholism, and obesity. Other ruinous effects may be on display right in your office. Surveys indicate that nearly half of all office workers sleep poorly at least a few times a week, and more than 65% confess that they have trouble concentrating after a sleepless night, according to the National Sleep Foundation.
Now think about the people responsible for your safety. A huge proportion of pilots -- not to mention policemen and doctors -- admit to making errors in sleep-deprived states, according to Alertness Solutions, a consulting company in Cupertino, Calif. "It's not as if people are off their game by 1%," says Mark K. Rosekind, president of the company. "They're way off." What's more, all this tossing and turning is putting a damper on the economy. Sleep deprivation costs $45 billion a year in lost productivity, health-care bills, and expenses related to traffic accidents -- rivaling the impact of depression, say, or stroke. As Stanley Coren, a sleep researcher and psychology professor at the University of British Columbia, often preaches: "Lack of sleep makes people clumsy, unhappy, stupid, and dead."
To the world's growth-starved pharmaceutical companies, sleep deprivation spells opportunity. While drug company execs are aware that some insomniacs can be helped by exercise, diet, and keeping regular hours, they note that millions aren't cured by such regimens, or can't stick to them. The drug industry has barely dipped into this pool. Market researcher Decision Resources Inc. estimates that no more than 40% of insomniacs are diagnosed, and only half of those are treated with prescription drugs. The total market for prescription sleep aids is a skimpy $2 billion a year, mostly spent on a single blockbuster, Ambien, from Paris-based Sanofi-Synthelabo (SNY ).
In pharmaceutical circles, Ambien is a symbol of what one sleep drug can achieve. When it was launched in 1993, it was hailed as a breakthrough because it promoted sleep with only a minor risk of hangovers and other side effects. As sales took off, at least a half-dozen companies began developing novel sleep aids, which could start hitting the market in 2004. Some exploit entirely new discoveries about how and why we sleep. And all of them claim to improve on Ambien's powers. Dr. Kris H. Jenner, portfolio manager of the T. Rowe Price Health Sciences Fund (PRHSX ), estimates that the market for sleep drugs will more than double, to $5 billion, by 2010. "This market is set to explode," he says.
Drug companies will make sure that the sleep-deprived hear their message. But they have a mammoth task ahead convincing people first that insomnia is a serious condition, and second that it can be treated safely with drugs. Historically, sleep aids have been linked with addiction, depression, and suicide. Even though newer drugs are designed to avoid such troubles, many physicians and insomniacs are frightened that there will be unforeseen complications. Insomnia, in short, is an enticing pharmaceutical frontier -- but one with more than its share of treacherous passes.
Many Mysteries
To forge better remedies for sleep disorders, scientists have had to struggle with some fundamental mysteries. We spend a third of our lives in bed, yet no one has been able to explain the necessity, and bona fide scientific studies are barely a few decades old. We have learned, for example, that the need for sleep varies greatly by species and is related to physical size: Opossums snooze for 18 hours a day, while elephants need just three hours. Even where sleep is inconvenient or dangerous, evolution provides work-arounds. Dolphins, for example, shutter only half of their brains at a time, remaining half-awake when they sleep.
By dragging humans into sleep labs and hooking them up to monitors, scientists have made a handful of discoveries about what the body does when it's asleep. During the deepest phases of slumber, growth hormone is released, facilitating cell repair and energy restoration. And much has been observed about REM (rapid eye movement) sleep, when our eyes dart frantically beneath our eyelids and we dream vividly of talking petunias and killer clams. Many scientists believe REM and non-REM sleep work together to consolidate memories and experiences and burn them permanently into our brain's hard drive. That could explain why some people wake up and suddenly have a solution to a problem that seemed insurmountable the day before. But the connection to sleep is still unclear.
The consequences of sleeplessness are much better understood. Deprivation messes up the body's metabolism, putting insomniacs at risk for a host of diseases. In a 1999 study at the University of Chicago, healthy men who slept just four hours a night for six nights suffered a 30% shortfall in their ability to secrete and respond to insulin -- the hormone that regulates blood sugar. That large a drop can be an early warning of diabetes.
Blithering Idiots
More recent studies at the University of Chicago demonstrate a possible link between sleeplessness and obesity. Preliminary results show that study participants who were allowed just four hours of sleep a night for two nights suffered a 20% drop in leptin, a hormone that controls body weight. At the same time, their stomachs produced 20% more ghrelin, a hormone that makes people feel hungry. Sleep-deprived subjects craved high-fat, very sweet foods, and "their appetites increased beyond the extra calories they needed to stay awake," says Eve Van Cauter, a professor at the University of Chica- go's medical school and the director of many sleep studies.
Taken to extremes, sleep loss can reduce us, at least temporarily, to blithering idiots. In two studies at the University of Pennsylvania, 48 healthy adults were split into several groups that slept four, six, or eight hours a night for two weeks. All the participants performed tasks that tested their motor skills and memory. By day 14, the four-hour group made an average of 14 times as many errors as they did when they took the tests fully rested. The eight-hour sleepers performed the tasks consistently well -- and actually got better at them each day. And the six-hour sleepers, corresponding to the corporate everyman, may as well have been thoroughly sleep-starved. They scored 11 times as many errors as they normally would make -- about as bad as a test group that stayed awake for two straight days.
But what about the superhumans we all seem to know -- the co-worker who intentionally gets five hours of sleep a night yet outperforms everyone else? Sleep experts say basic biology eventually catches up with these deliberate sleep cheaters. "We have no evidence that CEOs, astronauts, or doctors are exempt from the dangers," says David F. Dinges, chief of the division of sleep and chronobiology at Penn's school of medicine.
Whether people are cheating on sleep or succumbing to insomnia, the perils are the same. Studies show that someone who has been awake for 24 hours has the same mental acuity as a person with a blood-alcohol level of 0.1, which is above the legal limit for driving in most states. That means an executive who is up all night worrying about the quarterly earnings report -- or worse, a hospital resident who takes over in a late-night emergency -- is about as sharp as a light drinker who suddenly downs four margaritas. No wonder drowsy drivers cause 70,000 injury crashes per year, of which 1,550 are fatal.
admit to making errors in sleep-deprived states, according to Alertness Solutions, a consulting company in Cupertino, Calif.
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