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Despite living in a nation with myriad excesses, Americans as a whole are suffering from one serious deprivation - sleep. As necessary to life as food, water and the air we breathe, sleep is rarely given the attention it deserves until lack of it leads to accidents, illness or just plain exhaustion day in and day out. In recent years, say the experts, an increase in work and family commitments has made the problem especially severe.

According to a study conducted by the National Sleep Foundation earlier this year, more than 47 million adults may be putting themselves at risk for serious problems- from car accidents to illnesses - because of their lack of sleep. About 37 percent of those polled said drowsiness in the daytime interferes with their work and other activities for a minimum of several days a month. One out of six said daytime sleepiness had a negative impact on their daily lives a couple of times a week. And when people reported sleepiness during the day, they also were more likely to express unhappiness about their lives, more likely to be angry and more likely to overeat.

Just how much sleep should you get? Neurologist Clete Kushida, M.D., Ph.D., director of the Stanford Center for Human Sleep Research, says the amount varies widely among individuals: "There's no minimum or maximum amount of sleep." One means of determining your sleep requirement is to gauge how much you need to feel rested when you have no external time pressures -for instance, on a vacation.

According to Kushida, sleep problems may become more intense in middle age: "Teenagers and young adults sleep very efficiently. They rarely get up in the middle of the night to go to the bathroom and they seem to be able to sleep anywhere - even on a concrete slab. As you get older, sleep is less efficient. It takes longer to fall asleep, your sleep is more fragmented, so it's less restful. And the prevalence of sleep disorders is higher," he notes. "Physical problems like low-back pain and sciatica can also interfere with sleep, and in these cases, a good, comfortable mattress can help."

Kushida emphasizes that medical help is important for those with serious sleep disorders, including periodic limb movements or apnea, where breathing briefly stops. "These disorders cause fragmented sleep, even if you are getting enough hours of sleep," he says. "And apnea can be dangerous. It increases the risk of having right- sided heart failure, stroke, heart attack and hypertension."

But while the chronic problems are treatable, for millions of people who have difficulty getting to sleep, Kushida says there is no magic pill - but there are treatments. "There are some good short-term prescription medications like Ambien (zolpidem) now available that wear off in about four hours. They are not recommended for any extended length of time but they help break the cycle of insomnia," Kushida explains. "We don't recommend over-the-counter sleep aids because they typically have a long half-life and can make you drowsy during the day."

Kushida also offers these strategies to help you get a better night's sleep: keep a regular schedule, with a regular bedtime and awakening time; avoid daytime naps; stay away from caffeinated beverages two to three hours before bedtime; exercise regularly, but not within a couple of hours of going to bed; don't drink before bedtime - alcohol fragments sleep and can contribute to apnea; avoid exposure to bright light before bed; don't watch TV or read in bed unless it makes you sleepy; adopt a ritual of soothing behaviors - a warm bath, reading or meditation - to help you relax before going to bed; expose yourself to five minutes of bright sunlight each morning as soon as you get up, or invest in a special full-spectrum UV-filtered light box if you awaken before sunrise. The light helps regulate your brain's internal clock that's tied to sleeping and awakening.

What do you do if you try all these tips and still find you're drowsy and tired in the daytime? Kushida advises talking to your doctor. "Unfortunately, not every family physician has experience treating sleep disorders," he says. If you find you need additional help, contact the American Academy of Sleep Medicine at 708-492-0930 for a referral to a sleep clinic or sleep-medicine expert in your area.

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