November 14, 2004

Can't Sleep? Change Towns, Not Sheets

IS downtown Detroit industrial America's answer to the Roman Forum, a haunting necropolis of ruins of the industrial age? Or is it an urban comeback in the making, the Boston Red Sox of American cities?

I had no shortage of time to ponder those and other ethereal questions as I tossed and turned in bed one night last week, for the simple reason that for me Detroit was an iffy place to get a night of sleep. And sleep was the reason I was there in the first place.

I had gone there after reading the results of a report called "Sleep in the City" — one of the many that rank American cities as best, worst or in between — that called Detroit the worst of 50 metropolitan areas in the United States for getting a good night's rest. It was a dubious distinction, certainly, but in one sense it also placed Detroit in the vanguard of life in America, where more and more people seem to get less and less rest. The National Sleep Foundation estimates that 60 percent of adults have trouble sleeping at least a few nights a week. New sleep-related crises are continually being declared: one recent study insists that millions of Americans go untreated for "restless leg syndrome." (The study was financed by a company that makes a drug for the condition.)

Insomnia is sometimes described unscientifically as epidemic, and it even seems that sleeplessness is almost chic these days: look no further than Christian Bale's coolly existential performance as a man who has been sleep-deprived for a year in the new film "The Machinist." If the 1990's was the decade of "Listening to Prozac," when an antidepressant became a cultural as well as a medical phenomenon, the current decade might be one of listening to Ambien, the best-selling sleeping pill in a market estimated at $1.5 billion a year.

"One of the big causes of insomnia is stress," said Dr. Meir H. Kryger, a former president of the American Academy of Sleep Medicine and now a professor of medicine at the University of Manitoba. "Right now in the United States, there is a lot of stress for various reasons: the election, the war in Iraq, the economy. People are watching the news constantly, and most of it is bad."

Detroit has no shortage of stress inducers. Its rates of poverty and crime and divorce were all factors in its ranking at the bottom of the new sleep report. The report was compiled by a company called Sperling's BestPlaces, in partnership with the makers of Ambien.

The report was based on a collation of a broad array of data gathered by the Centers for Disease Control and Prevention and other federal agencies. It concluded that the chief factor in getting a good night's sleep is also one of the most abstract and elusive: happiness. "What we found was that, almost in exact correlation, the more sleep people got, the better they felt physically and emotionally: basically feeling happy," said Bert Sperling, the president of Sperling's BestPlaces, best known for its "best places to live" reports for Money magazine. "We can't go ahead and say good sleep makes you happy or that being happy makes you sleep better, but we do know that there's some correlation between the two. It is a measure of quality of life."

The reasons for Detroit's poor showing are familiar: the contraction of the automobile industry, for example, and the decline of the population by roughly 50 percent over the past half century. In April, after another quasi-scientific report in Men's Fitness magazine named Detroit the nation's fattest city, Mayor Kwame M. Kilpatrick began a yearlong health education program called Movement for Life.

"We're No. 1 in sleep, too?" Pamela Moore, a coordinator for the program, said with a chuckle, after learning of the sleep-deprivation report. She added that Movement for Life had already planned to focus on sleep and stress management beginning in January.

But there is another side to Detroit as well, a city whose downtown is being slowly rebuilt. Comerica Park, the splashy home of the Detroit Tigers baseball team, opened in 2000, followed quickly by a Hard Rock Cafe. Nearby stands the new Ford Field, home of the Detroit Lions football team and the 2006 Super Bowl. Residential lofts are starting to fill in some of the vacant skyscrapers.

"I sleep incredibly well," Jeanette Pierce, 24, a waitress at a restaurant in the downtown section known as Greektown, insisted a bit defiantly. On Monday night, Ms. Pierce was mingling with friends at the Beaubien Street Saloon near the gleaming Renaissance Center office tower. "I can sleep through anything, and you have to with all this construction going on."

In Detroit, everything has edge: the music, the hockey fans, even the bed-and-breakfasts. I stayed in a charming one called the Inn on Ferry Street, comprising four regentrified Queen Anne-style mansions (and two carriage houses) so meticulously restored and quaint that they looked like a Bob Vila fantasy. Not long ago, they were rundown eyesores.

Maybe that edge, in some small way, has something to with the apparent restlessness in the city. Even a casual visitor like me is hit immediately with a broadside of conflicting emotions: anxiety, exhilaration, wistfulness, hope.

Even as a resident of frenetic New York — which ranked only five notches higher than Detroit, just above New Orleans and below Las Vegas — I found it a potent brew. I was still stirred up when I finally drifted off to sleep around 2 a.m.

ALTHOUGH the news media sometimes describe insomnia as epidemic, that is imprecise. Insomnia is a sleep disorder, an inability to fall asleep or stay asleep when one wants to; it becomes severe or chronic when it persists for several nights a week and months on end.

"Sleep deprivation" can refer either to insomnia or to the more common problem that results when people try to squeeze too much into the day. There is often a vast gray area between the two, Dr. Kryger said. Even so, he said, the number of sufferers in both camps are huge: 40 million to 80 million in the United States. Like many other experts, Dr. Kryger maintains that the problem is getting worse, particularly as people embrace new technologies that help wring more play and more work out of each day.

Another reason that more people seem to suffer from sleeplessness is simply that far more attention is being paid to the issue by both doctors and patients, said Michael L. Perlis, the director of the Sleep and Neurophysiology Research Laboratory at the University of Rochester.

One reason for the new concern is that, increasingly, sleeplessness is seen by physicians as a possible contributor to afflictions like depression and hypertension. As recently as the 1970's, Dr. Perlis said, most sleepless Americans tended to suffer in silence, or perhaps to drop the occasional barbiturate like Tuinal, which could be habit-forming.

"The bottom line is, I don't care if it's an epidemic," Dr. Perlis said. "Too many people have this problem. It's a wrong perspective to say, `If you can't sleep, tough.' Treatment is available."

Short of prescription sleeping pills — newer ones are generally considered by experts safer than drugs from earlier decades — many other products and services have been introduced to appeal to a nation in search of shut-eye.

Doctors continue to pioneer subniches in sleep research and often process their research into self-help sleep books. Hundreds of sleep treatment clinics exist across the United States.

In response to surveys indicating that half of business travelers complained that they did not get enough sleep on the road, the Crowne Plaza Hotels & Resorts chain introduced the "sleep advantage" program, putting cushier pillows and mattress tops on beds, designating some floors as quiet zones from Sunday through Thursday and even providing a "sleep CD" of soothing jazz and Bach in the player by the bed.

So I checked into the Crowne Plaza hotel in downtown Minneapolis, which the report ranked No. 1 for getting a good night's sleep. This is a city that takes its sleep seriously: in 1997 it pushed back high school starting times to 8:40 a.m. from 7:15, citing research that teenagers needed to sleep in to do well academically and stay healthy.

Last year Minnesota changed closing times for bars to 2 a.m. from 1 a.m., to little interest. "Only about 10 percent of the bars followed," said Jeremy Kummings, a manager at Murray's restaurant and cocktail lounge in Minneapolis. "Usually it'll be last call by midnight."

Maybe it was the first chill of winter on the hotel window, but I wasn't thinking of anything so much as the word "hibernation" in my night there. I slept well in part because I felt secure and enveloped in those silky white sheets. Then again, I felt wonderfully secure and enveloped when I wandered outside, too.

That's the odd thing about Minneapolis: it's entirely possible to live life at a perfect 72 degrees, an oasis in snowdrift country. Yes, the natives are quick to point out that they are an "outdoors" people — Patagonia jackets are everywhere — but they are smart enough to keep the outdoors out when it doesn't suit them. Much of downtown is connected by its network of glassy skyways linking office buildings. It's a human Habitrail, a city reimagined as a cocoon from the elements.

"Minneapolis is renowned for having a balanced lifestyle: people are into exercise and nutrition here," said Bill McLaughlin, president and chief executive of Select Comfort, a Minneapolis company that makes the Sleep Number bed, whose firmness is adjustable at a button's touch.

And that — balance — appears to be the secret ingredient behind the happiness behind good sleep. "People in Minneapolis have a very good sense of who they are," Mr. Sperling said. "They aren't subject to vast booms or busts — maybe by being isolated from either coast and the frenzy that goes on there — the winds of change. They have a sense of taking care of their own business and people."

The whole idea is to find the porridge that's just right.

Dr. Mark Mahowald, medical director of the Minnesota Regional Sleep Disorders Center in Minneapolis, concurred. "Generally, if you're feeling pleasant and satisfied you're going to sleep better, and Minneapolis is a pretty stress-free city," he said. "I don't know what that says about Detroit," he added with a chuckle. "But I'd rather sleep in Minneapolis."