Sleep dreams: seven of 10 Americans need better sleep. Sleep disorders are more common--and more dangerous--than many people realize.
SLEEP MEDICINE, ONE OF the newest medical subspecialties, is garnering a lot of attention these days. It's no wonder, when, according to the National Sleep Foundation, nearly seven out of every 10 Americans experience frequent sleep problems. Many people aren't even aware that poor sleep is causing their fatigue and other health problems.
Despite the fact that an estimated 90 percent of Americans with sleep disorders Sleep Disorders Definition
Sleep disorders are a group of syndromes characterized by disturbance in the patient's amount of sleep, quality or timing of sleep, or in behaviors or physiological conditions associated with sleep. could sleep better, feel better and improve their overall health with treatment, sleep disorders are often under-diagnosed and their severity misunderstood.
The predominance of sleep disorders has significant consequences for business. The National Sleep Foundation estimates sleep disorders cost more than $100 billion a year in lost productivity, medical expenses, sick leave and property damage. Some industries are impacted more than others. Approximately 30 percent of truck drivers have sleep apnea--and don't know Don't know (DK, DKed)
"Don't know the trade." A Street expression used whenever one party lacks knowledge of a trade or receives conflicting instructions from the other party. it until they've had "the big accident," says Dr. Marvin E. Vollmer, who is co-director of the Sleep/Wake Disorders Clinic at Community Health Network in Indianapolis and diplomate dip·lo·mate
One who has received a diploma, especially a physician certified as a specialist by a board of examiners.
(dip´l of the American Academy of Sleep Medicine The American Academy of Sleep Medicine (AASM) is a United States professional society for the medical subspecialty of sleep medicine. It was established in 1975. Its membership consists of physicians, researchers and other health care professionals who specialize in the study, . Further, approximately 25 percent of the workforce works the night shift or rotating shifts, both of which are known to wreak havoc with sleep patterns and are the subject of ongoing research.
"Discoveries in the research lab often have a very quick application to the clinic, which is one reason [sleep medicine[ is such an exciting area," Vollmer says. "And, why it is so dynamic from a business point of view. As people did more research into sleep disorders, they started finding out that they explained a lot of medical problems that we had no answers for before."
Community Health Network has 24 beds in its five Indianapolis-area clinics. Around Indiana many sleep labs and clinics have opened to diagnose and treat a variety of sleep disorders. Here is a look at some of them and their treatments.
SLEEP APNEA sleep apnea, episodes of interrupted breathing during sleep. Obstructive sleep apnea is a common disorder in which relaxation of muscles in the throat repeatedly close off the airway during sleep; the person wakes just enough to take a gasping breath.
Sleep apnea, estimated to impact five to 10 percent of Americans, is the most common sleep disorder Sleep disorder
Any condition that interferes with sleep. At least 84 have been identified, according to the American Sleep Disorders Association.
Mentioned in: Insomnia, Night Terrors diagnosed in sleep labs. Once the domain of males, the disorder now affects both sexes almost equally It also affects the very young, even infants.
Obstructive sleep apnea Obstructive sleep apnea (OSA)
A potentially life-threatening condition characterized by episodes of breathing cessation during sleep alternating with snoring or disordered breathing. , the most common kind, occurs when the windpipe windpipe: see trachea. partially or totally collapses during sleep, depriving the person of oxygen. This is followed by an arousal reflex that wakes up the body so it can resume breathing. This cycle can occur hundreds of times each night, making a restful sleep impossible. People with sleep apnea, as with other sleep disorders, feel sleepy and fatigued regardless of how many hours of "sleep" they get.
"If your spouse has sleep apnea, you don't sleep any better than they do," says Valene Roark, manager of Cardiopulmonary Services and Sleep Disorders Lab for Daviess Community Hospital in Washington. "You hear the snoring snoring, rough, vibratory sounds made in breathing during sleep or coma. The noisy breathing is the result of an open mouth and a relaxation of the palate; it is frequently induced by lying on one's back. and the gasping for air, or their legs may jerk." Spouses are often the ones who initiate the trip to the doctor. Daviess opened its two-bed sleep lab in 2006. In its first year it serviced 227 patients. Last year that number increased to 285 patients.
"During an event, when you are obstructing, your oxygen level drops in your bloodstream and your brain gets less oxygen," says Pat Wise, director, Sleep Disorder Center for South Bend Memorial Hospital. "Oxygen levels can fall from 99 or 98 to the 40s, although they usually fall to the low 80s and high 70s. When you start breathing again, your brain is re-oxygenated. But slowly [sleep apnea] works on your blood pressure. It can create high blood pressure and stroke. People don't understand that sleep apnea is not all about being tired. It's also about their cardiac and mental status."
Even mild sleep apnea can contribute to serious health problems, such as, diabetes, heart failure, enlarged heart, irregular heart rhythm, stroke, impotency and high blood pressure, as well as conditions such as increased weight, impaired memory impaired memory Dementia, see there , Attention Deficit Disorder attention deficit (hyperactivity) disorder (ADD or ADHD)
Behavioral syndrome in children, whose major symptoms are inattention and distractibility, restlessness, inability to sit still, and difficulty concentrating on one thing for any and getting up during the night to go to the bathroom. Since many of these conditions are associated with the natural aging process, they are often overlooked.
"Pain management issues are also made worse by any kind of sleep fragmentation, not just sleep apnea," says Dr. Raymond Loller loll
v. lolled, loll·ing, lolls
1. To move, stand, or recline in an indolent or relaxed manner.
2. , neurologist, sleep medicine specialist and pulmonary disease specialist with St. Vincent Health St. Vincent Health is a nonprofit hospital and health care system based in Indianapolis, Indiana. Named for the 17th century Parisian St. Vincent de Paul, St. Vincent Health is the state's sixth largest employer at 11,500 and operates 17 hospital facilities that serve 45 counties .
The Sleep Disorders Clinic at St. Vincent Indianapolis has 10 adult beds and six pediatric pediatric /pe·di·at·ric/ (pe?de-at´rik) pertaining to the health of children.
Of or relating to pediatrics. beds, St. Vincent Carmel has two beds and St. Joseph Hospital in Kokomo has four beds dedicated to sleep studies.
"The number one problem is that people are unaware that [sleep apnea] is a serious systemic disease," says Dr. Thomandram Sekar, medical director of Parkview Hospital's Sleep Disorders Lab and board-certified in sleep medicine and pulmonary disease. "Recently studies have shown that there are changes even at the cellular level. High levels of C-reactive protein C-Reactive Protein Definition
C-reactive protein (CRP) is a protein produced by the liver and found in the blood.
C-reactive protein is not normally found in the blood of healthy people. (CRP C-reactive protein (CRP)
A protein present in blood serum in various abnormal states, like inflammation.
Mentioned in: Pelvic Inflammatory Disease
n.pr See C-reactive protein. ) causes platelets to form a blood clot blood clot
A semisolid, gelatinous mass of coagulated blood that consists of red blood cells, white blood cells, and platelets in a fibrin network. , which correlates with the probability to have a heart attack." Patients with sleep apnea tend to have high CRP levels that improve with sleep apnea treatment and reappear when treatment stops.
Sleep apnea is the most common sleep disorder the Fort Wayne hospital sees. The six-bed lab has a full complement of physicians on staff including adult and pediatric neurologists.
DIAGNOSING TREATING AND CURING SLEEP APNEA
Sleep apnea is diagnosed in a sleep lab. Patients may be asked to complete a questionnaire--such as the Epworth Sleepiness Scale Epworth Sleepiness Scale Sleep disorders A testing instrument used to indicated a person's risk of dozing in specific situations, as well as daytime sleepiness. See Sleep disorder. administered in the Daviess Community Hospital sleep lab--before the non-invasive, painless sleep study begins. Studies generally involve one to two nights in the lab.
At South Bend Memorial Sleep Disorder Center, which has been open for seven years, patients enjoy comfortable, hotel-like surroundings in each of the center's six rooms. They are equipped with a camera and infrared light so patients can be observed during their sleep. Patients are wired up to approximately 16 leads and the heart rate, blood oxygen level, brain waves brain waves Neurology Oscillations/sec that correspond to various types of cerebral activity, as measured on an EEG. See Electroencephalogram. , movement of the stomach, chest, eyes, chin, legs as well as air flow are measured and monitored.
Wise estimates there are probably 25,000 undiagnosed patients with some kind of sleep disorder in South Bend alone. The center is typically open five nights per week, but is flexible. "We work with patients' own private schedules," she says. "Whatever hours they normally sleep, we'll take them into the lab."
If sleep apnea is diagnosed, there are several options. The gold standard is CPAP CPAP
continuous positive airway pressure
Continuous positive airway pressure (CPAP)
A ventilation device that blows a gentle stream of air into the nose during sleep to keep the airway open. , Continuous Positive Air Pressure, a device that keeps the windpipe open by means of pressurized pres·sur·ize
tr.v. pres·sur·ized, pres·sur·iz·ing, pres·sur·iz·es
1. To maintain normal air pressure in (an enclosure, as an aircraft or submarine).
"Some people have a period of adjustment wearing a mask at night," Roark says. "But once they get adjusted to that, probably two weeks at most, they notice the effects immediately"
The effects can be dramatic. "For many people it is a life-changing event," says Vollmer, a pioneer in sleep medicine since 1985. "If you are feeling 99-years-old at age 45, and something makes you feel 45 again, that's a very big deal." Vollmer used to feel bad about diagnosing someone with sleep apnea. "Now I say, 'the great news is that you have sleep apnea. I'm going to make you feel better.'"
CPAP is very effective (in the high 90-percent range), and is usually covered by health insurance. Dental appliances that hold the tongue in place or hold the jaw in a forward position may be prescribed for mild cases, with variable measures of success. Surgery may be required, but is typically a last resort since the success rate ranges from 20 percent to 45 percent and often multiple surgeries are necessary. Insurance may or may not cover dental appliances and surgeries.
Weight loss, even moderate weight loss of 20 to 30 percent of total body weight, is 80 percent effective. "Sleep deprivation sleep deprivation Sleep disorders A prolonged period without the usual amount of sleep. See Driver fatigue, Poor sleeping hygiene, Sleep disorders, Sleep-onset insomnia. , sleep apnea, anything that makes you sleepy, also resets your weight at a higher level," Vollmer says. "The trouble is, as these people develop sleep apnea, their weight has often shot up 50 to 100 pounds in the last year, and it is impossible to get their weight down. So even though weight loss is the long-term goal, we do other treatments in the interim to get them out of trouble, help them feel better and take care of their medical complications."
Another health problem that may contribute to sleep apnea is hypothy roidism (low thyroid). Correction of hypothyroidism hypothyroidism: see thyroid gland. in patients with sleep apnea may make sleep apnea improve or even disappear. "These are the only two situations that can be called a cure," says Sekar, who has worked in sleep specialties since 1986. "In all other situations we are controlling it with treatment."
INSOMNIA AND NARCOLEPSY narcolepsy, a sleep disorder characterized by excessive daytime sleepiness and recurring unwanted episodes of sleep ("sleep attacks"). People with narcolepsy may abruptly fall asleep at almost any time, including while talking, eating, or even walking.
Insomnia, an inability to get to sleep and stay asleep, affects 20 to 30 percent of the population at one time or another (mainly women), making it the most common sleep disorder.
Insomnia can be caused by a number of things, but the No. 1 reason is "good old-fashioned stress"--unresolved issues in work, home, family, finances, says Dr. Michael Levine, neurologist and sleep specialist at Hancock Regional Hospital in Greenfield. "People lay down to go to sleep and start thinking about how to fix everything. Of course, that never happens, and they just lose sleep. The next night they are worrying not only about the original issue; now they are worrying about not getting sleep. After a while, sleep itself becomes the worry," he explains.
There are several ways to treatment insomnia, beginning with basic sleep hygiene sleep hygiene (slēpˑ hīˑ·jēn),
n education with the goal of effecting behavior modification, thus leading to a healthy sleep pattern. . Marcia Alpuche, sleep lab supervisor and
Registered Polysomnographic Technologist for Community Healthcare System in Northwest Indiana, suggests going to bed and getting up at the same time each day, making sure your bedroom is dark enough to induce quality sleep and not eating, drinking alcohol or exercising too close to bedtime.
The Community Healthcare System has a total of 10 beds devoted to sleep diagnosis--four at Community Munster, four at St. Catherine Hospital in East Chicago and two at St. Mary Medical Center St. Mary Medical Center may refer to:
Medication is another common treatment for insomnia. "All of us have life stressors at some time in our life--we might be taking care of an ailing parent or there's a death in the family For the Batman graphic novel/storyline, see .
A Death in the Family is an autobiographical novel by author James Agee, set in LaFollette, Tennessee. He began writing it in 1948, but it was not quite complete when he died in 1955. , and we just can't get to sleep," Alpuche says. "Sleep aids help us transition through that period of time where we have these stressors."
"Every year if you look at the big blockbuster medications they are often sleeping medications," Vollmer says. "That is a good indication of just how prevalent these [insomnias] are."
And what big business they are. So much so that Indianapolis-based Eli Lilly and Company Eli Lilly and Company (NYSE: LLY) is a global pharmaceutical company and one of the world's largest corporations. Eli Lilly's global headquarters is located in Indianapolis, Indiana, in the United States. recently acquired Massachusettsbased Hypnion Inc., a privately held neuroscience drug discovery company focused on sleep disorders, for $315 million. Steven M. Paul, M.D., executive vice president, science and technology for Lilly, says the deal "provides Lilly with a broader and more substantive presence in the area of sleep disorder research."
Hypnion is currently in Phase 2 clinical testing with a new type of sleep drug that uses the natural mechanism of sleep, rather than putting a person to sleep with a sedative sedative, any of a variety of drugs that relieve anxiety. Most sedatives act as mild depressants of the nervous system, lessening general nervous activity or reducing the irritability or activity of a specific organ. .
"It is designed to let you sleep, rather than to make you sleep," says Paul. Early tests show the drug is not addictive, doesn't cause a hangover and increases restful "slow-wave" sleep.
Vollmer stresses that although medications are popular, they are not the answer for all insomnias and all patients. "If you have insomnia and you snore snore (snor)
1. rough, noisy breathing during sleep, due to vibration of the uvula and soft palate.
2. to produce such sounds during sleep.
v. , don't take a sleeping pill until you get checked out," he advises.
A third treatment for insomnia is behavioral therapy, often used in combination with medication. "Psychiatrists sometimes have to get involved to work on the issues and relaxation techniques," Levine says.
Narcolepsy, seen more often in younger people, is characterized by sudden, uncontrollable urges that cause people to fall asleep during the daytime. "Narcolepsy is not common, but it is actually fairly devastating dev·as·tate
tr.v. dev·as·tat·ed, dev·as·tat·ing, dev·as·tates
1. To lay waste; destroy.
2. To overwhelm; confound; stun: was devastated by the rude remark. ," says Dr. Michael Levine, neurologist and sleep specialist at Hancock Regional Hospital in Greenfield. "This is an anatomical brain disorder. These people aren't making enough chemicals to help them stay awake."
Hancock Regional opened its fourbed sleep lab four years ago. Levine says it performs about 800 sleep studies per year, nearly 80 percent of which are diagnosed as sleep apnea.
After a night of testing in the sleep lab, a daytime test is needed to diagnose narcolepsy Patients are put to bed in a darkened dark·en
v. dark·ened, dark·en·ing, dark·ens
a. To make dark or darker.
b. To give a darker hue to.
2. To fill with sadness; make gloomy.
3. room and told to close their eyes. "They tend to fall asleep in an average of 10 minutes after six or seven hours of sleep at night," Sekar says. "The second thing we see in these individuals is that they go into a deep sleep, called REM sleep REM sleep
A stage in the normal sleep cycle during which dreams occur and the body undergoes various physiological changes, including rapid eye movement, loss of reflexes, and increased pulse rate and brain activity. , within 15 to 20 minutes. Normally it should be 75 to 100 minutes."
Narcolepsy is controlled with medications. For years, stimulants (caffeine, Ritalin, amphetamines Amphetamines
Sympathomimetic amines; sometimes called speed; synthetic chemicals that stimulate the central nervous system.
Mentioned in: Weight Loss Drugs
amphetamines ) were used to wake people up. "Stimulants wake you up, but they also push your emergency alarm system," Vollmer says.
Not only would patients sometimes become panicky, but Sekar says they often developed a tolerance to these drugs. Doses had to be increased to the point where patients had to take a "drug holiday" for several weeks before restarting treatment. Newer medications, such as Provigil or Modafinil, don't have those side effects Side effects
Effects of a proposed project on other parts of the firm. .
According to Sekar, successful treatment also involves getting enough sleep and regular sleep, avoiding stimulants at night and things that may induce drowsiness during the day and taking medication at the time it will be most effective. "The third thing we have found [beneficial] is .occasional naps," he says. "This is one of the few areas where sleep physicians actually recommend a nap."
DREAM SLEEP DISORDER
REM sleep behavior disorder (RBD RBD Rebelde (Mexican Novela)
RBD REM (Rapid Eye Movement) Behavior Disorder
RBD RNA-Binding Domain
RBD Required Beginning Date (qualified retirement plans) ) tends to occur in older individuals--90 percent of them male. Loller says these patients lose the signal that shuts down muscle activity during dream sleep. "The muscles are no longer inhibited," he says. "Many times some kind of active aggression may play out in this." Patients may believe they are attacking a lion in their dreams while, in fact, they are attacking their bed-partner, or they may take a walk outside the house.
RESTLESS LEG SYNDROME restless leg syndrome Nocturnal myoclonus Sleep disorders A clinical complex characterized by nocturnal cramping of the anterior calf, restlessness, a feeling of heaviness, aching, painful paresthesia and tingling in legs with uncontrolled twitching, relieved by
By day, the condition is called restless leg syndrome; at night, during sleep, it is called sleep myoclonus myoclonus /my·oc·lo·nus/ (mi-ok´lo-nus) shocklike contractions of a muscle or a group of muscles.myoclon´ic
essential myoclonus . In both, the legs hurt and seem to have a life of their own. Often people have both conditions.
"I've seen people kick their legs 1,000 times and more at night," Levine says. "Obviously they are never getting quality sleep, so the next morning they feel horrible."
Loller feels the condition is more aptly called restless body syndrome, because it can affect more than the legs. "About one to two percent of the population has it," he says. "And at least 10 percent or more of patients with insomnia have it. Combinations are common. Treatment failure often happens because there is another problem that is not recognized. What this means is that the sleep specialist needs to sit down with the patient, talk to him, listen to him and examine him. Many times patients ask me, 'why are you examining my feet, or my nose or my legs?' You need to look at the whole person and go from there."
If an iron deficiency is causing the problem, it can be cured. "However, for 95 percent of the people there is no cure," Vollmer says. "It is a chronic condition that goes on for years."
Fortunately, these conditions respond well to medications, such as, Requip and Mirapex (originally marketed for Parkinson's disease) and muscle relaxants. Loller warns some medications may make the condition worse, even over-the-counter medications such as Benadryl.
Tips for better sleep
* Go to bed and get up at the same times each day.
* Avoid caffeine, nicotine, beer, wine and liquor in the four to six hours before bedtime.
* Don't exercise within two hours of bedtime.
* Don't eat large meals within two hours of bedtime.
* Don't nap later than 3 p.m.
* Sleep in a dark, quiet room that isn't too hot or cold for you.
* If you can't fall asleep within 20 minutes, get up and do something quiet.
* Wind down in the 30 minutes before bedtime by doing something relaxing.
Source: U.S. Food and Drug Administration
Common Sleep Disorders
Lack of Sleep
* Insomnia is the inability to fall asleep. It is a common sleep problem that most people experience at least occasionally.
* Sleep deprivation is not actually a disorder; it simply indicates that a person has not been getting enough steep.
* Sleep apnea is interrupted breathing during sleep.
* Snoring is noisy breathing during sleep.
* REM sleep behavior disorder causes disruptions in the brain during the dream stage of rapid eye movement rapid eye movement
Abbr. REM The rapid periodic jerky movement of the eyes during certain stages of the sleep cycle when dreaming takes place. (REM) sleep.
* Sleep paralysis is the inability to move the arms, legs or entire body that occurs when a person is falling asleep or waking up.
* Narcolepsy is a condition that causes patients to fall asleep uncontrollably throughout the day for periods lasting less than a minute to more than half an hour.