by Michael Schroeder

The bump of a curb jarred Katy Miller awake. She had nodded off at the wheel of her SUV with her 1-year-old twin daughters fast asleep in the back seat. The SUV drifted across the center line, rumbled over the opposite curb and slammed into a tree.

“My first reaction was shock and dismay,” says the Angie’s List member from Kingsport, Tenn. “I was so embarrassed and upset.”

Miller estimates she got less than four hours sleep on each of the three nights leading up to the accident. She says she’s saddled by guilt for putting her daughters in harm’s way.

Our sleepy nation

She’s hardly the first to risk life and limb over insufficient sleep. About 100,000 car crashes and 1,500 deaths in the U.S. each year are associated with drowsy driving, according to the National Highway Traffic Safety Administration, and our sleep problems only appear to be getting worse.

Twenty percent, or about 60 million people, are now getting fewer than six hours nightly, according to a 2009 National Sleep Foundation survey, up from 12 percent in 1998. As a society, we’re getting older, fatter, taking more medications, working long hours — often into the night — unplugging later and plugging in earlier, all of which conspire to wreck sleep.

In addition to those willfully skimping on zzz’s, many say they’re struggling with sleep disorders and experts believe the trend toward less sleep could have grave health consequences.

“Recently it has been uncovered that people who sleep less than they should or have poor quality nocturnal sleep, have a higher risk of heart disease, high blood pressure, diabetes and even stroke,” says Dr. Antonio Culebras, a prominent sleep researcher based in Syracuse, N.Y.

On average, those polled by the National Sleep Foundation got six hours and 40 minutes a night, down from about seven hours in 1998. Experts recommend adults get seven to nine hours, depending on individual need, and say getting less can raise your risk of premature death by causes ranging from car accidents to stroke.

“If you develop a sleep debt, one day you will pay for it,” Culebras says.

You can't pay back sleep debt

Before the accident in April last year, Miller, a nurse anesthetist, shrugged off colleagues’ urging to get more rest, even after she caught herself head-bobbing in the operating room. She suffered only minor injuries in the accident and her daughters, Cassandra and Caroline, weren’t hurt. Unbelievably, they slept through it all.

But the accident left its mark in another way. “It changed the way I feel about sleep,” Miller says.

She started getting less sleep when her daughters, now 2, were born. Averaged over the course of a week, she still gets just five to six hours nightly. But since the accident, Miller aims to get seven or eight hours of sleep three nights each week and limit back-to-back nights where she gets less.

“That was just such a huge wake up call for me — pardon the pun,” she says.

Sleep doctors caution against banking too much on makeup sleep and trying to leverage a sleepy weekend to undo a sleepless week.

“Two nights is not going to makeup for five,” says Richard P. Allen, a clinical psychologist board certified in sleep medicine, and an associate professor at Johns Hopkins University in Baltimore. “It’s more likely that five nights would make up for one.”

Little sleep creates big health concerns

To complicate matters, some of us — according to genetic research — are born poor sleepers, prone to sleep less and arouse more easily. Narcolepsy, which can sometimes cause a person to fall asleep at random, and restless leg syndrome, which can make it hard to still limbs while laying down, both appear to run in families. Other sleep disorders also undermine efforts to get ample shut-eye.

Paige Garberding, a public defender self-described as “sleepless in Seattle,” says she was always a light sleeper. But for the past 15 years, she’s suffered from insomnia, which she blames mostly on work stress. She’s even nodded off in the courtroom.

“Thank God I don’t snore or drool,” she deadpans.

But she’s troubled by research that shows sleep deprivation may be damaging her heart. “It’s not just a matter of being tired,” she says. "It’s the constant reminder that I’m probably shortening my life.”

Garberding only sleeps about an hour or so in a stretch before waking up, and says she gets about five or six hours total in a night. She’s taken medication and tried to follow sleep tips but concedes that she often brings work to bed.

Modern-day living has us wired

In today’s 24/7 wired world, it can be hard to break away, says Dr. Susie Esther, a sleep center medical director at highly rated Charlotte Eye Ear Nose & Throat Associates in North Carolina. But, she says, it’s important to know how many hours of sleep you need to feel refreshed and make time to get it.

“The hour before bed — or at least 45 minutes — you need to have some down time and turn off the electronics,” she says.

The National Sleep Foundation’s chief program officer Darrel Drobnich believes the Internet is the latest technological affront to our sleep, after the light bulb artificially extended the day and the TV began competing for our nights. According to the foundation’s 2009 survey, 20 percent of Americans say they’d get an hour more of sleep if they didn’t have Internet access.

“I think it’s impacting not only our sleep, but I think it’s also part of the obesity problem,” Drobnich says.

'A vicious circle'

Most experts believe obstructive sleep apnea, in which the airway becomes blocked and disrupts breathing during sleep, is on the rise — and weight gain is a factor.

“As obesity has gone up, I’m sure that sleep apnea has,” says Dr. Lisa Shively, a highly rated Chicago sleep specialist. To make matters worse, sleep apnea — and insufficient sleep alone — can trigger hormones that increase people’s appetite.

“It’s a vicious circle,” says George Longoria, a retired phone company supervisor and Angie’s List member in San Antonio who’s had sleep apnea for at least 20 years. He uses a CPAP, or continuous positive airway pressure, machine that blows air through a tube into his throat, to keep it open while he sleeps.

It’s helped, he says, but after awhile, the mask that holds the tube in place shifts and he wakes up gasping for air, his heart pounding.

“Occasionally, I get some good sleep and, man, I can accomplish a lot the next day,” Longoria  says. “Then I fall back into my old trap.”

As a younger man, he was somewhat overweight at 235 pounds but active.

“Now I weigh over 300 and the weight gain started with the sleep apnea,” says Longoria, 67. He adds that extra pounds led to diabetes, another condition associated with sleep apnea and sleep deprivation.

A pillar of good health

The association between sleep problems and health problems is reflected on a broader scale in the so-called “Stroke Belt.” Residents in the loose grouping of mostly Southern states have higher rates of stroke, diabetes and cardiovascular disease. And new data from the Centers for Disease Control and Prevention reveal a higher proportion in the region report insufficient sleep as well, compared with the rest of the country.

Apart from being tired, Longoria says he’s not as sharp as he once was. Bruce Corser, a highly rated sleep specialist and medical director of the Sleep Management Institute in Cincinnati, says the profound effects sleep loss has on the brain, such as memory loss and trouble concentrating, are well established and we’re now learning more about long-term effects.

Sleep is one of the three pillars of good health, along with diet and exercise, Corser says: “It’s a basic physiologic  need of the human body, and if we don’t achieve sufficient sleep, there’s a number of adverse consequences that follow.”

Gary Barton, an Angie’s List member in Cincinnati, took that message to heart after being diagnosed with sleep apnea. He installed blinds in his bedroom with magnetic strips that seal out light. He doesn’t consume caffeine before bed, turns off the TV about two hours before turning in, keeps a regular sleep schedule and has lost more than 125 pounds.

He visits Corser annually for a checkup and uses his CPAP machine.

“I feel great,” says Barton, a far cry from the man who used to just sleep when he could. Now Barton says he makes time for sleep. “If you don’t give [your body] what it needs, you’re going to be in trouble."

Have you seen a doctor who specializes in sleep medicine or recently had a sleep study done? Submit a report about your experience.