It's a horrible feeling to be captain of the ship when the ship goes down. That's how Antonina Radzikowski, 55, says she felt after falling asleep while driving down a Maryland highway one afternoon in 1994.

Radzikowski and her husband, Phillip, were heading home after dropping their teen-age son off at a gifted and talented summer program. Roughly 60 miles away from home on I-70 near Hagerstown, Md., the car Radzikowski was driving smashed into the guardrail, flew over it, and fell 30 feet before landing on railroad tracks on the opposite side of the highway. Radzikowski's husband died and she was left with severe brain injuries that shortened her attention span and led to her retirement from teaching.

"I sometimes felt drowsy before, but I never knew why until after the accident," Radzikowski says. A sleep study revealed that she suffers from obstructive sleep apnea, a condition in which her breathing stops for about 10 seconds to as long as a minute while she's sleeping. Her effort to breathe wakes her up, and this stop-and-start cycle of waking to breathe can repeat hundreds of times a night. A person with sleep apnea isn't aware of the frequent awakenings, but is likely to feel overwhelming sleepiness during the day.

There are many reasons for sleep deprivation. Each year, there are about 40 million people in the United States who suffer from sleeping disorders. An additional 20 million have occasional sleeping problems, according to the National Institute of Neurological Disorders and Stroke.

People who work nights, for example, probably never completely adapt because our bodies want to be awake during the day and asleep at night. We are governed by the circadian rhythm, an internal clock that regulates sleep and wake cycles. Sleep deprivation can also result when people choose to skimp on sleep in favor of work, parties or late-night television.

Whatever the reason for sleep loss, research has shown that it takes a toll on us both mentally and physically. While we sleep, our bodies secrete hormones that affect our mood, energy, memory, and concentration. Testing has shown that with a driving simulator or a hand-eye coordination task, sleep-deprived people may perform just as badly as intoxicated people.

Sleep deprivation and fatigue have long been issues for professions that have traditionally held long work hours. Pilots have federal regulations that limit their work hours to eight hours of flying time within a 24-hour period. Truck drivers can't drive more than 10 hours without a mandatory eight-hour break. Physician advocacy groups are pushing for the passage of the Patient and Physician Safety Protection Act, currently under consideration in Congress, that would set limits nationwide on the number of hours worked by medical residents.

According to the American Medical Student Association, residents sometimes work 100-120 hours a week in 24- and 36-hour shifts. Some have reported making mistakes with medication, falling asleep while driving home, and experiencing health problems, such as depression. The bill would limit residents to 80 hours per week with at least 10 hours off between shifts, among other provisions.

Recent research suggests that if sleep deprivation is long-term — whether because of lifestyle choices or sleep disorders — it may increase the severity of age-related chronic disorders such as diabetes and high blood pressure. In a study published in the Oct. 23, 1999, issue of The Lancet, Eve Van Cauter, Ph.D., professor of medicine at the University of Chicago, led researchers who restricted 11 young men to four hours of sleep for six nights, and then recorded their bodily functions. The researchers then allowed the same young men to spend 12 hours in bed per night for six nights, and compared their bodily functions to those recorded earlier. The researchers found negative effects on metabolic and endocrine functions when the men were sleep-deprived similar to those seen in older people as a result of normal aging.

In another study, published in the Sept. 25, 2002, issue of the Journal of the American Medical Association, Van Cauter and colleagues found a marked decrease in the response to flu vaccination in young, healthy people who were immunized after four days of sleep restriction, compared with those whose sleep was unrestricted.

"There's a need to look at sleep on the same level of importance as diet and exercise," says Carl Hunt, M.D., director of the National Center on Sleep Disorders Research, part of the National Heart, Lung, and Blood Institute. "All three are equally important for good health."

Here's a look at some common sleep problems and what you can do about them.

Can't Fall Asleep — Can't Stay Asleep

Most people experience short-term insomnia at some time. Insomnia includes having trouble falling asleep, having trouble getting back to sleep, and waking up too early. Insomnia is more common in females, people with a history of depression, and in people older than 60.

Temporary insomnia can be caused by noise or a stressful event like the loss of a job or a death in the family. A National Sleep Foundation poll of 993 adults over 18 found that close to half of the respondents reported symptoms of insomnia as they tried to sleep in the nights immediately following the terrorist attacks on September 11, 2001.

Certain medications could keep you awake, particularly those that treat colds and allergies, heart disease, high blood pressure, and pain. And some of us practice bad habits that sabotage our sleep. This includes drinking alcohol and eating too close to bedtime, says James Walsh, Ph.D., president of the National Sleep Foundation and executive director of the Sleep Medicine and Research Center in Chesterfield, Mo.

"Alcohol works as a sedative, but it's also metabolized quickly — within two to three hours for moderate doses," Walsh says. "So you'll have a rebound effect. You may sleep soundly for the first couple of hours but then toss and turn later." And large meals in the two hours before bedtime could cause indigestion.

Tags: Sleep

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