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Rest: It's required

The alarm clock in Thom Stys' bedroom goes off at 4 a.m. every weekday, a scant four to five hours after his head hits the pillow. 5 a.m., he's left his Chino Hills, Calif., home for the freeway, and before the sun is up, he's at his desk in Long Beach, making a round of phone calls to clients in Europe. "If I left later, it would take me an hour and a half to get to work," says the 57-year-old vice president of an aerospace forging company. "I simply can't afford to spend time caught up in freeway traffic."

Most working blokes know that the more they work, the less they sleep. What they may not know is that the more time they spend in their cars, the less they sleep. Drive time &

not television viewing, computer addiction or exercise &

is second only to hours on the job as a reason people don't get the shut-eye they need.

"The most deadly combination," says David F. Dinges, chief of the division of sleep and chronobiology at the University of Pennsylvania School of Medicine, "would be long commute time, long work hours and living in a place where you have to get in the car and drive to get anything."

The combination is deadly because a good night's sleep now appears to be every bit as important to good health and long life as a nutritious diet and regular exercise.

"Sleep is in the top three," says Dinges. "And I think it's No. 1. Sleep is a biological imperative and not getting enough has health-related costs."

In April, the Institute of Medicine issued a report confirming links between sleep deprivation and an increased risk of hypertension, diabetes, obesity, depression, heart attack and stroke.

Some scientists are exploring possible connections between inadequate sleep and a decline in immune function.

The Archives of Internal Medicine devoted its Sept. 18 issue to the relationship between sleep and health. An editorial called for assessment of sleep habits as a standard part of all medical checkups.

That's because short sleep can hasten the arrival of the inevitable long sleep. The largest study of sleep duration and mortality was published in February 2002 in the Archives of General Psychiatry. The Cancer Prevention Study II of the American Cancer Society followed more than a million participants for six years. The best survival was found among those who slept about seven hours a night, the worst among those who slept less than 4.5 hours. Too much sleep &

nine hours or more &

also was associated with a higher risk of mortality.

In the last decade, researchers have begun studying sleep based on today's reality: a country open for business virtually 24/7, and a populace increasingly unwilling or unable to call it a day. Sleep needs vary slightly, but the vast majority of people, experts agree, need just about eight hours of sleep each night to fully recover from 16 hours of being awake.

Yet Americans are racking up sleep debt like a college kid with a credit card. About 40 percent of Americans say they get fewer than seven hours of sleep on weekdays, and most &

71 percent &

get fewer than eight hours of sleep, according to a 2005 survey by the National Sleep Foundation. Even on weekends, they sleep about 7.4 hours &

better, but not enough to pay back the week's loss. Every hour they fall behind is considered an hour of sleep debt, and Americans accumulate about two full weeks of personal sleep debt a year.

Sleep researchers have a name for the way the vast majority of people in this country sleep: volitional chronic sleep deprivation, and it is a lifestyle disorder.

Without enough sleep, the cost in reduced memory, focus, concentration and reaction time is well established. Incidents in the lore of sleep research include the Exxon Valdez oil spill and the Chernobyl nuclear power plant disaster. In each, key decisions were made by people who were sleep-deprived.

But it's only in the last half a dozen years that studies have begun to link chronic partial sleep deprivation to serious physical health consequences.

Adequate sleep may be essential for good health but it's every bit as hard to pull off as eating a healthy, well-balanced diet or finding an hour a day to exercise.

"The most common sleep disorder is insufficient sleep," says Dr. Dennis Nicholson, director of the Pomona Valley Hospital Medical Center's Sleep Disorders Center in Pomona, Calif.. "People come in and say they're sleepy. It's because they're not getting enough sleep." The connection seems like a no-brainer, but many people don't see it, he says. They want a sleep study and a pill.

Sleeplessness in America is a safety issue and a health problem. "Sleep is as important as breathing, drinking and eating," says Dr. Meir Kryger, a sleep scientist at the University of Manitoba. "Animals who are deprived of sleep die, but they don't die because their memory is poor. They die a metabolic death: Their fur falls out, they lose weight. Things that happen are over and above just the brain being sleepy. It's critical to health, but it takes longer to notice."

So far, Thom Stys hasn't noticed any health consequences. As he wraps up his work day, the European clients he called in the morning are long asleep. He ends his day with a round of phone calls to his Asian clients, who are just getting to their offices. Then he's back on the highway to Chino Hills, to dinner, family and a bit of work before falling instantly asleep around midnight.

At 4 a.m., his alarm goes off.