Health: Drowsy America

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A typical adult needs about eight hours of shut-eye a night to function effectively. By that standard, millions of Americans are chronically sleep deprived, trying to get by on six hours or even less. In many households, cheating on sleep has become an unconscious and pernicious habit. "In its mild form, it's watching Ted Koppel and going to bed late and then getting up early to get to the gym," says Cornell's Pollak. In extreme cases people stay up most of the night, seeing how little sleep will keep them going. They try to compensate by snoozing late on weekends, but that makes up for only part of the shortfall. Over the months and years, some researchers believe, the deficit builds up and the effects accumulate. "Most Americans no longer know what it feels like to be fully alert," contends Dr. William Dement, director of Stanford University's sleep center. They go through the day in a sort of twilight zone; the eyes may be wide open, but the brain is partly shut down.

Single parent Dianna Bennett, 43, works as a nurse at a correctional facility in Gardner, Mass. To be able to spend time with her three children during the day, she works the night shift, a schedule that usually allows her no more than four hours of sleep. "My kids tell me I'm always tired," she says. Amy Schwartzman, 35, a law student at Tulane University, gets up at 9 a.m. and, what with classes, moot court and work as a research assistant, often does not get home until 10 p.m. That's when she studies or unwinds. Nights of tumbling into bed at 3 a.m. make her feel "as if my brain isn't moving as quickly as it should," says Schwartzman, noting that the circles under her eyes keep getting darker. "My mother told me I look like a raccoon."

One sign of sleep deprivation is requiring an alarm clock to wake up. Another is falling asleep within five minutes after your head hits the pillow. Well-rested people drop off in 10 to 15 minutes. A third clue is napping at will. "People like to boast about their ability to catch 40 winks whenever they want," explains Dement, "but what it means is that they're excessively sleepy." On the other hand, when people get enough rest, they remain awake no matter what the provocation: droning teachers, boring books, endless roads, heavy meals, glasses of wine -- even articles about sleep.

Perhaps the most insidious consequence of skimping on sleep is the irritability that increasingly pervades society. Weariness corrodes civility and erases humor, traits that ease the myriad daily frustrations, from standing in supermarket lines to refereeing the kids' squabbles. Without sufficient sleep, tempers flare faster and hotter at the slightest offense.

But there are far grimmer effects. Harrowing tales are told by interns and residents, many of whom routinely work 120-hour weeks, including 36 hours at a stretch. Some admit that mistakes are frighteningly common. A California resident fell asleep while sewing up a woman's uterus -- and toppled onto the patient. In another California case, a sleepy resident forgot to order a * diabetic patient's nightly insulin shot and instead prescribed another medication. The man went into a coma. Compassion can also be a casualty. One young doctor admitted to abruptly cutting off the questions of a man who had just been told he had AIDS: "All I could think of was going home to bed."