 Richard L. Bruno
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Dr. Richard Bruno is Chairperson of the International Post-Polio Task Force and Director of The Post-Polio Institute and International Centre for Post-Polio Education and Research at Englewood (NJ) Hospital and Medical Center. His new book, The Polio Paradox: Uncovering the Hidden History of Polio to Understand and Treat "Post-Polio Syndrome" and Chronic Fatigue, will be published by Warner Books in June 2002. Please e-mail questions directly to him at ppsforum@newmobility.com.
Note: This column is for information purposes only and is not intended as a substitute for professional medical advice.
Q: I get more fatigued as the week goes on and my ability to concentrate gets worse and worse. When the weekend comes I just have to nap. I sleep for three hours on Saturday and feel better. I nap for two hours on Sunday but afterward my brain feels sluggish and I often have a headache. I then have trouble falling asleep Sunday night and feel even sleepier on Monday in spite of the naps. What am I doing wrong?
A: You have discovered the pleasures and problems of napping. Rest periods and naps can be very helpful, even lifesaving. The National Aeronautics and Space Administration studied daytime rest periods in those for whom fatigue, trouble concentrating and falling asleep can be deadly: pilots. Fatigued flight crews who took brief hourly breaks had improved alertness. These breaks were similar to the two 15-minute breaks that work so well in reducing fatigue in Post-Polio Institute patients.
NASA also studied the effect of what they dubbed "power naps." Pilots took a planned 40-minute rest period during which they slept for about 30 minutes. After the nap pilots had increased alertness and performance and relief from what was described as "significant sleepiness." The same benefit was found in a study of healthy elderly folk: A 30-minute nap at 1 p.m. significantly reduced afternoon sleepiness and fatigue.
But with napping, as with so many other aspects of life, there can be too much of a good thing. Long naps can actually be detrimental, causing the problems that you have described: grogginess, headaches and a "sluggish" brain after awakening. These symptoms have been given the wonderful name "sleep inertia" (as in physical inertia: "a body at rest tends to stay at rest"). NASA scientists found that deep sleep begins about 30 minutes into a nap. When deep sleep begins, your brain shuts down and is more likely to feel "inert" when you wake up. That's why researchers recommend 30 minutes as the ideal nap length: If you prevent yourself from going into deep sleep, there's no groggy brain and no sleep inertia.
But sleep inertia isn't napping's only detrimental effect. If you get too much sleep during the day, you can have trouble falling asleep or staying asleep at night. Lack of nighttime sleep makes you more fatigued during the day, can make you want to nap longer and gives you even more trouble sleeping at night. So, before you start napping, you have to make sure you're sleeping well at night and don't have the breathing problems or muscle twitching that disturb sleep in half of polio survivors (see PPS Forum, May 2002). You also need to give your body the amount of nighttime sleep it needs. Don't expect to feel rested if your body needs nine hours of sleep and you give it only six.
If your sleep is good enough and long enough and you still have daytime fatigue, napping is an option. Before you lie down to nap, set an alarm for 40 minutes so you'll sleep for only 30 minutes. Although research has shown that a 30-minute nap is good for pilots and older folk who didn't have polio, 30 minutes may be too short a nap for polio survivors who have brain fatigue. If you need a longer nap, increase your sleep time by 15 minutes a day. But don't nap longer than 90 minutes, which is when dream sleep starts. Also, never nap after 5 p.m. (that includes dozing in front of the television after dinner) because you'll make falling asleep at bedtime and staying asleep more difficult.
Remember that naps are only one part of your fatigue management program. You also need to pace activities, take a 15-minute rest break in the morning, in the afternoon and after lunch. One of these breaks could be substituted with a nap. Remember that the Americans with Disabilities Act permits rest breaks--and even naps--as reasonable accommodations in the workplace. Some days you may not need a nap and can just rest. Or you may plan naps for every Saturday and Sunday. However, long weekend naps aren't substitutes for too little sleep during the week.
Whether you rest or nap during the day, it is important that you keep a consistent daily schedule, including on weekends, with specific times to go to sleep, to wake up, and to take your rest breaks or nap. This schedule will train your brain when it should be sleeping and when it should be awake so that you can manage your fatigue in the cockpit ... or wherever you work.
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