To nap or not -- subject is no snoozer among docs

For what seems to be a restful subject, naps have become controversial.

Very generally, people who study sleep think occasional naps for adults can be OK, particularly short naps. For healthy seniors, naps can increase concentration and total sleep, a Cornell University study showed. But specialists differ over how long naps should be, whether they interfere with nighttime sleep and when they conceal some deeper health problem.

"They really are hotly debated," said Dr. Bradley Vaughn, chief of the division of sleep and epilepsy in the department of neurology at UNC-Chapel Hill School of Medicine. "The argument in the sleep world is whether we should be proponents of napping or opponents."

In our 24/7, sleep-deprived society, naps can work as a short-term fix, but as a long-term habit, they should be eyed with concern as a possible red flag for underlying illness, Vaughn said.

"It's more fair to say that it may be a marker of a risk," said Dr. Dan G. Blazer a psychiatric geriatrician at Duke University Medical Center and co-author of the article "Risk of Napping: Excessive Daytime Sleepiness and Mortality in an Older Community Population."

"There may be people who take 30 to 45 minute naps every day and still sleep at night," Blazer said. "There may may be individuals who take much longer naps that may lead to far more difficult problems."

Signs of unhealthy napping could include snoring, not feeling refreshed upon waking and periods of irresistible urges to sleep, Vaughn said.

At the Whitaker Mill Senior Center in Raleigh last week, opinions were divided, although along slightly different lines. Several residents were asked whether they nap.

"You're dang tootin' I do," said Ed Burt, 77. "I like 'em. I get up from a nap and get right in bed and sleep like a log."

Not so for Trudy Conrad.

"If you catch me taking a nap, I'm sick," said Conrad, 74. "I've never taken a nap in my entire life. I'd rather read or take a walk."

Overall, Americans' sleep time is decreasing, but it remains crucial to health. Specialists say it should be recorded as a vital sign like blood pressure and temperature.

Veteran researcher Blazer, along with Duke colleague Judith Hays, explored sleep habits among Piedmont residents older than 65 in a 1996 paper. That study, along with numerous others, raised a controversial, chicken-and-egg question: Do some people take naps because they are unhealthy, or do they become unhealthy because they nap too much?

"It's something that older people often bring in as a question," Blazer said. "They'll say, 'I take a nap. Is that good for me or is it not good for me?' "

W. Vaughn McCall, director of the sleep laboratory at Wake Forest University Medical Center, said less napping could result in better daytime functioning for older people with insomnia. He examined naps as part of a study he conducted on a sleep medication.

"We didn't pretend that napping was so awful that we should chemically eliminate it," McCall said. "But I will tell you clearly if you are asleep and taking a nap you can't be doing other things to improve yourself -- like exercising."

A study last year by Cornell University sleep researcher Dr. Scott Campbell and others carries better news for nappers.

Testing by Campbell and several colleagues found that naps generally don't affect nighttime sleep, can increase total sleep time and can improve mental skills after the nap and into the next day.

"There's very little evidence that napping disturbs nighttime sleep," Campbell said in a phone interview. "It's an old wives tale that is not supported by the data."

Controversy over whether and how long to nap seems unlikely to end soon. Campbell reported that a sleep research meeting he attended in Austria last month devoted a half-day seminar to a discussion of naps. Last year, NASA tried to resolve the question of how well naps relieve fatigue by commissioning an analysis of the existing studies on the matter.

"Although there is general agreement that naps may be useful fatigue countermeasures, there is less consensus on how naps should be managed as an effective operational strategy," the authors said in their introduction.

In the end, perhaps predictably, doctors recommend that people with serious questions about naps consult a doctor.

After that, if all goes well, it may be time to hit the couch -- just not for too long.