AGMASleep

AGMA has been working with the Department of Otolaryngology of the Montefiore Medical Center/Albert Einstein College of Medicine to create an Institute For Human Communications that would address the vocal concerns of opera singers from a comprehensive medical perspective. Dr. Marvin Fried, Chairman of the Otolaryngology Department of Montefiore Medical Center and Professor of Medicine at Albert Einstein College of Medicine in New York, is a world-renowned expert in head and neck surgery and related laryngological issues. Pam Harvey, also on the faculty of both Albert Einstein, is a Certified Voice and Speech Pathologist and Director of Voice Pathology Services for the Division of Otolaryngology of Brigham & Woman’s Hospital in Boston. Both Dr. Fried and Ms. Harvey are, of course, devoted opera aficionados. This is the first in a series of articles for OperaOnline that will deal with issues affecting singers’ vocal health. This article is not intended to offer medical advice. If you have a sleep problem, consult your physician or health practitioner. This article draws heavily on original research done by Keith Saxon and Pam Harvey. For a complete bibliography and a copy of a survey you may take on your own, e-mail AGMA SLEEP SURVEY @ AOL. COM.

When opera singers learn about sleep, it can be a real awakening. Sleep deprivation among singers jeopardizes their creativity, productivity, safety and their well-being. The importance of restorative sleep to vitality and health and the dangers of even short-term sleep deprivation warrant a central place in the consciousness of every performer, regardless of the current stage of their career.

In today’s health conscious society it would be unlikely to learn of a singer repetitively bragging about gorging on high fat meals loaded with sugar. Yet it remains perfectly acceptable, even admired, to trade stories of performing with little or no sleep. Smart singers, their teachers, and the physicians who care for them, stress that sleep curtailment and sleep deprivation should not be worn like a badge of courage. The fact is, Dale Carnegie was wrong when he said in his famous self-help text: “If you can't sleep, then get up and do something instead of lying there worrying. It's the worry that gets you, not the lack of sleep.”

In fact, it’s the lack of sleep that will diminish your vocal health. Your voice may crack on only one note out of thousands in a three-hour opera, but in the brutal world of opera, that's all it takes for tongues to wag and knives to come out, and for a singer's sense of self-worth to crumble when the reviews announce that “A star has fallen from the heavens." The pharmaceutical industry anticipates that, by the end of this decade, sales of prescription insomnia medication will top $6 billion dollars a year. Recent studies show that 60% of American adults report sleep problems, 70% get less than the recommended eight hours of sleep per night and, in a survey at one major opera house, 96% of the singers reported that they frequently had trouble falling to sleep and, when they did, they never got enough sleep.

Many singers are already aware of the need to understand the impact of reflux problems and the importance of hydration to vocal function and overall vocal hygiene techniques. Obviously, singers also need to have a basic knowledge of sleep and the consequences of poor sleep. This month, we will deal with providing a basic understanding of sleep itself, and what can interfere with it. It also contains an admittedly unscientific singers’ survey that will give you a chance to analyze your own level of sleepiness.

To a significant extent, the demands of the opera world (auditions, rehearsals, working second and third jobs, frequent travel, maximum pre-sleep vocal exertion and the inherent stress of performance) are incompatible with relaxing for sleep. The subject of sleep and its importance to singers has not yet been extensively explored, despite preliminary research which indicates that sleep deprivation may alter respiratory function and affect speech patterns, particularly intonation, precision and rate. The prevalence of these issues among opera singers has broad implications for their well-being, their voice training, and their treatment. Unfortunately, too many sleep deprived vocal performers are regarded as ‘normal’ when, in fact, it may be that when a singer struggles with voice technique, what they may need instead of more practice is a good night’s sleep.
Even in the current professional voice literature, references to sleep are limited to admonitions “to get enough sleep” in discussions of general vocal hygiene and warnings about potential sedating side effects of medications.

What Is Sleep? The dictionary defines ‘sleep’ as “the rest afforded by a suspension of voluntary bodily functions and the natural suspension of consciousness.” Once thought of as an unproductive period of inactivity and regarded, even by medical professionals, as a time when mind and body are simply “turned off”, sleep is now understood to be an essential element of human existence which effects mood, thinking, problem solving, memory, performance, productivity, accident rates, and general health.

While an exact medical definition of ‘sleep’ is difficult, sleep has five identifying characteristics: It’s a process that’s generated internally by the body. You can do things to help yourself relax, but you can't make yourself fall asleep; It’s a condition where some sensory input (like sounds and smells) is diminished; It follows certain identifiable rhythms or cycles set by the body’s ‘internal alarm clock’. Most interesting to performers may by the fact that these rhythms are significantly altered by exposure to light. Knowing this, it follows that singers who rehearse and perform under bright lights report sleep disturbances, because light diminishes the release of melatonin, a hormone which is produced during the hours of darkness, that assists in regulating sleep onset; It rhythmically oscillates between REM (Rapid Eye Movement) and four stages of progressively deepening non-REM sleep, with each cycle lasting approximately 90 minutes. The sleep cycle is repeated 4 to 6 times during a 7-8 hour sleep period. Some studies indicate that it is not the length of sleep that determines its restorative value, but the number of complete sleep cycles that occur each night; and its easily ‘reversible’, in that normal wakefulness is rapidly achieved.

HOW MUCH SLEEP IS NECESSARY?
Sleep needs vary from person to person. Generally, studies describe “short sleepers’ as those who habitually sleep 6.5 hours or less per night, “normal sleepers” as obtaining 7-8 hours of sleep and “long sleepers” as those sleeping 9 hours or more. In the ‘real world’ few if any working people get anything like that. There is also a newer theory which proposes that a 4-5 hour period of core sleep is essential, but additional sleep is optional and could be progressively shortened without significant increase in daytime sleepiness or decreases in cognitive function. Supposedly, however, the functions of a number of body systems are optimized with approximately 8.25 hours of sleep. Do any of you know anyone who gets 8 hours of sleep?

EFFECTS OF SLEEP DEPRIVATION
Sleep deprivation may occur because of common problems like insomnia or obstructive sleep apnea, or because of an intentional curtailment of sleep duration. Either way, lack of sleep causes a wide range of consequences including mood shifts, diminished concentration and reaction time, impaired short and long-term memory, decreased logical reasoning, decreased response time and impaired ability to understand and to think.

Sleep is also crucial in the regulation of the body’s internal systems, in maintaining glucose tolerance, and in preventing decreases in growth hormone. Sleep researchers speculate that the long term chemical consequences of sleep deprivation may include depletion of the immune system, accumulation of body fat rather than muscle, acceleration of the aging process, potential memory impairment and increased risk for depression.

Fatigue has an inescapable biochemical basis, and so a singer cannot simply will themselves out of the next day’s sluggishness or “off” performance. Insomnia is also a contributing factoring a significant number of traffic accidents. Singers, often finishing rehearsals and performances late in the evening, need to exercise extreme caution in driving. They should also realize that the same amount of alcohol which previously had no discernible effect on judgment and reaction times may be fatally sedating when paired with already existing fatigue and lack of sleep.

Of perhaps the greatest concern for working singers, some recent studies have linked sleep to brain functions associated with learning, and the formation of memory. It seems likely that for optimal learning to occur, you must not only be well rested before training, but that post-learning sleep, particularly the first sleep that occurs after learning something new, is essential to actually ‘learn and remember’ new things or demonstrate improvement. A reminder of the importance of this post training sleep may help a chorus learn new material or a singer master an aria.

Singers who follow the Buddhist doctrine: “Let no sleep fall upon thy eyes till thou hast thrice reviewed the transactions of the past day. Where have I turned aside? What have I been doing? What have I left undone, which I ought to have done? “might also want to consider the veracity of advertisements for popular prescription sleep medications as well.

To test yourself, take the following survey to determine if you are getting anough sleep.