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Stop Trading Good Sleep for Great TV: DVR Jon Stewart and <em>The Colbert Report</em>

All this late night entertainment can have a significant impact on healthy sleep, one of our most fundamental biologic needs.
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Americans love television.

Me too.

(Especially when its time for Mr. Jon Stewart who is so funny he could almost be British and his erstwhile colleague, the inimitable Mr. Stephen Colbert. Both are (in my opinion) potent non-pharmacologic mood boosters- really sometimes I think they should be 'doctor-recommended'!

Indeed, in this economy, staying in to watch a favorite show trumps more expensive activities but even TV in new formats like is rapidly growing in popularity. In sum, more Americans love television than ever before.

What is less known is that all this late night entertainment can have a significant impact on healthy sleep, one of our most fundamental biologic needs. Ariana and Cindi in their recent blog coined a phrase I shall use in my office tomorrow when I talk to my patients about their 'wicked TV addiction'. Indeed, it is perhaps the most important behavior to target if women (and their favorite men) are going to sleep their way to the top.

Step one is easy. I tell all my patients the same thing: DVR your favorite shows while you sleep your way to the top.

This is not just common sense. Watching less TV is a recommendation based on hard data. In 2009, Dr Mathias Basner at the Philadelphia School of medicine published the findings his group had been working on in the leading journal defining our field: "SLEEP". (You can read his work for yourself in the 6th issue of the 22nd volume of this journal published in 2009, page 747 ). The results made for a fascinating study which immediately grabbed my attention. His paper, wittily entitled "Dubious Bargain: Trading Sleep for Leno and Letterman" was a standout. Reading it, I felt compelled to tell my patients about it. After a couple of visits to my office, most of them now know the shtick well enough to preach it, verbatim, to their bed partners.

Basner collated data from the American Time Use Survey, a Federally administered survey collected over the phone by the US Census Bureau. Amazingly, our government cares deeply about trends revealing how we squander our pressured time. The survey covers all Americans over the age of 15 living in the 105 million households which constitute this nation. Active service men and women, nursing home residents and prisoners are therefore not included, but the rest of the sample is pretty representative of what those in your home or my home might be doing at any one time. I wondered how I would compare.

The telephone interview was administered to each household once over a 15 to 20 minute period. Subjects (as study participants are termed) were evaluated between 4 am on the day prior to the interview and 4 am on the day of the interview. Participants therefore had to recount their activities for the recently ended 24 hour window. Basner chose to merge the databases for 2004, 2005 and 2006. It's quite possible with the rise of affordable broadband, on demand Netflix and YouTube that time use has changed even more in America even in the last three years and we understand publications tend to lag a little behind the status quo. Nonetheless the reading was compelling and highly relevant to us at the start of a new decade.

Over 60,000 people were surveyed in this study sample. (When the government evaluates something it tends to be big). But Basner and colleagues decided to select a certain group of these people, eliminating those people who had been interviewed prior to, or just after, a holiday. Weekend interviews were also kicked out. In both cases , erratic changes in sleep routine which are often associated with such changes in schedule were what investigators sought to avoid. As a result, the study was left with a sample of almost 24000 people who had been interviewed during the work week and independent of a recent or forthcoming public holiday.

One of the findings was particularly interesting. When Basner grouped subjects according to the length of their work day, he found they had starkly different total sleep times. Those who worked less than an eight-hour work day were termed 'short workers', and those who worked more than eight-hours were called 'long workers'. Another group, who didn't leave home to go to a workplace were termed 'non-workers'. Men and women were represented in both groups. The American Time Use Survey showed that long workers slept on average 7hrs and 32 minutes whereas short workers slept more, averaging around 8 hrs and 7 minutes. Those who didn't leave the home to work at all slept the most, averaging 8hrs and 50 minutes, almost ninety minutes longer than the long workers. Working a long day, Basner found, cuts sleep time dramatically.

How did the long workers eliminate so much sleep time? By waking up early. On average long workers woke a full 40 minutes earlier than their short working colleagues. Interestingly, bedtimes were no different. The long workers were merely burning the candle at both ends - going to bed late, even though they had to be up significantly earlier.

So what are the activities that Americans engage in? Basner focused on the activities which occupied the last two hours prior to sleep onset, i.e. what Americans are doing in the last two hours before they hit the sack. Activities included doing homework with children, grooming pets and everything else in between. But the number one activity Americans engage in the final two hours of the day? You guessed it.

Watching TV.

68.1% of this huge sample reported watching TV in the last two hours of wakefulness. On average, Americans devote 55.6 minutes of the last two hours before bed to watching TV. Amazingly this was consistent whether or not the subject worked long or short days or not at all. The precise concession the long worker made when going to bed late in anticipation of waking at least 40 minutes earlier than his short working colleagues was to kill the remote a mere 2.6minutes earlier. Long working Americans, tired as they maybe clearly do not sacrifice quality engaged in screen worship.

So what should we do about this?

In their joint commentary, Ariana and Cindi articulate what we discuss every day in my office: women need more sleep. Men too, I would hasten to add. So as a first step toward health in a new year, tonight, think of targeting a new behavior: its time to curtail screen time. Limit the time you, your family, your loved ones spend engaging in television and computer time. Take advantage of a marvelous DVR and watch those shows on a weekend, during the day. Such a brilliant invention, there is really no reason to be sleep deprived pursuing our favorite occupation. DVRs have changed that forever and are such a potent behavioral tool they should practically be available on prescription!

Clearly Basner's data show there are at least 55 minutes that could be recovered from TV-precious time to unwind, relax and prepare for the ultimate power boost: a good night's sleep. Will this be difficult? Without question, like every lifestyle change it will take commitment, focus, and a family-centered approach. But controlling late night television intake will help you minimize the 'social jetlag' that accumulates through the week as you seek later bedtimes and become more and more sleep deprived moving from Monday to Friday. Late night TV drives up an increasingly hard-to-bear sleep debt. Literally, families, relationships and sheer joy buckle under the pressure of sleep deprivation. Reclaim your time; recharge your lives. Stop trading sleep for Leno and Letterman, for Stewart or Stephen. Instead, DVR these lovely men - their humor and wit for sure is good for our mental health- and instead watch them on a lazy weekend afternoon.

Remember in making this change you are not alone. According to recent Nielsen data, there are 105.7 million American viewers watching Prime Time on any of the 312 million television sets in the United States. Over 111.4 million residences possess more than one TV broadcasting 96.5 channels per viewer available 24/7. Yet the biggest audiences are watching between 2000h and 2300h precisely when men and women should be sleeping their way to the top.

The next time you pick up the remote, hit your own pause button and ask yourself: how about I trade TV for some sleep? You may find yourself just a hair sharper picking up Jon's razor wit or, god forbid, anticipate Colbert's genius animus. Let's see how funny they are when you are wide-awake...

Only one way to find out right now. Wherever you are, whether on your MacBook or your Flatscreen, on your iPod or your FlipCam, just hit SLEEP and catch up on your dreams.