Repaying your sleep debt

When I was in medical school, I often worked for days at a time with little or no sleep. And then once I graduated, I found myself in the same situation as I tried to balance working and caring for my three children. Now, it's unusual for me to get very little sleep for a few days in a row, but it does happen every once in a while. So I was happy to read this article, first published in Harvard Women's Health Watch, where Dr. Epstein, regional medical director of the Harvard-affiliated Sleep Health Centers, tells us how to catch up on sleep. 

• Settle short-term debt. If you missed 10 hours of sleep over the course of a week, add three to four extra sleep hours on the weekend and an extra hour or two per night the following week until you have repaid the debt fully.
• Address a long-term debt. If you've shorted yourself on sleep for decades, you won't be required to put in a Rip Van Winkle–like effort to repay the hours of missed slumber. Nonetheless, it could take a few weeks to recoup your losses. Plan a vacation with a light schedule and few obligations — not a whirlwind tour of the museums of Europe or a daughter's wedding. Then, turn off the alarm clock and just sleep every night until you awake naturally. At the beginning, you may be sleeping 12 hours or more a night; by the end, you'll be getting about the amount you regularly need to awake refreshed.
• Avoid backsliding into a new debt cycle. Once you've determined how much sleep you really need, factor it into your daily schedule. Try to go to bed and get up at the same time every day — at the very least, on weekdays. If need be, use weekends to make up for lost sleep.
• Follow these tried and true rules of sleep hygiene. 

• Create a sleep sanctuary. Reserve it for sleep, intimacy, and other restful activities, like pleasure reading and meditation. Keep it on the cool side. Banish the television, computer, Blackberry, and other diversions from that space.
• Nap only if necessary. Night owls and shift workers are at the greatest risk for sleep debt. Napping an hour or two at the peak of sleepiness in the afternoon can help to supplement hours missed at night. But naps can also interfere with your ability to sleep at night and throw your sleep schedule into disarray.
• Avoid caffeine after noon, and go light on alcohol.
• Get regular exercise, but not within three hours of bedtime.
• If you're able to get enough sleep but don't feel refreshed in the morning, discuss the problem with your clinician. Many common medical conditions, from depression to sleep apnea (the condition in which breathing pauses during sleep), could be responsible. If you're finding it increasingly difficult to get enough sleep but don't have an underlying medical problem, consider consulting one of the 1,100 sleep centers accredited by the American Academy of Sleep Medicine (www.sleepeducation.com).

How often do you find your "sleep account" running in deficit mode? Do you find that catching up on the weekends works for you? 

Julie K. Silver, M.D., is an assistant professor in the Department of Physical Medicine and Rehabilitation at Harvard Medical School. She is also the Chief Editor of Books for Harvard Health Publications.

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