THE IMPOSSIBLE DREAM?; NOW, SLEEP APNEA PATIENTS CAN BREATHE EASY - AND GET A GOOD NIGHT'S REST.

Byline: Carol Bidwell Daily News Staff Writer

Sleeping. Nodding off. Catching some Z's. Whatever the term, it describes that sensation of floating off into nothingness, leaving the pressures and cares of the day behind as you cuddle under a comforter or bundle beneath a blanket.

Most humans spend about one-third of their lives sleeping - or trying to.

Although dropping off to sleep seems the most natural thing in the world for most of us, an estimated 40 million Americans suffer from chronic sleep problems. They either can't get to sleep or can't stay asleep; and some - afflicted with a potentially dangerous disorder called obstructive sleep apnea - stop breathing while they're asleep.

Another 20 million to 30 million people have occasional bouts with one or more of 84 other sleep disorders ranging from insomnia, which affects almost everybody occasionally, to narcolepsy, a rare disorder that causes people to fall asleep at inappropriate times, according to the National Commission on Sleep Disorders.

Despite what seems to be a pretty fatigued nation, it's only been in the past decade or so that doctors have considered sleep problems to be serious medical disorders - and taken steps to cure or at least manage them.

``(The practice of) medicine does not stop when a patient goes to sleep,'' said Dr. Kasey Li, a Stanford University Medical Center surgeon whose research was largely the clincher in convincing the U.S. Food and Drug Administration in November to approve a new surgical procedure. Somnoplasty, pioneered at Stanford, is designed to treat sleep apnea, which doctors consider the most dangerous form of sleep disorder.

Doctors like Li - in more than 170 sleep disorder centers throughout the United States - have concluded that sleep apnea and other sleep problems can be a major cause of medical problems, including depression, impotence and high blood pressure, as well as life-threatening heart attacks and strokes.

Although about one-third of the U.S. population is sleep-deprived most of the time, about 95 percent never seek medical help.

The result is that bone-tired workers and sleepy students are irritable, have difficulty concentrating on their work, become forgetful and may doze off in meetings and classes, at the movies or while watching television.

And there are more tangible costs. As many as 63 percent of night-shift workers report falling asleep on the job at least once a week, and drowsy drivers caused 100,000 auto crashes, killing 1,500 people and injuring 76,000 more, reported the commission in 1998. It estimated that sleep deprivation costs the United States $15.9 billion annually.

The human and monetary costs are so high, the National Commission on Sleep Disorders recommends that more nonspecialists should be trained to recognize and treat sleep disorders, there should be more public education about sleep disorders, and Congress should establish and fund a national sleep center within the National Institute of Health to study the problem. Congress has yet to consider the recommendation.

It's generally a wife's nagging - and a bit of fear that something may really be wrong - that brings men to a sleep center for help, said Michael Stevenson, who heads the San Fernando Valley's oldest sleep center, North Valley Sleep Disorders Center in Mission Hills.

Men snore more than women because of the structure and texture of the tissues in their throats. Snoring usually becomes worse with age and as a man gains weight. And snoring is often the most obvious symptom of sleep apnea, said the sleep specialist.

It never occurred to George Winard, 79, of Sherman Oaks that he had a sleeping disorder. After all, he fell asleep nearly the moment his head hit the pillow.

True, he snored like a buzz saw. But that bothered only his wife, Marilyn, who suspected something was seriously wrong and implored him to get a doctor's help.

``He snored terribly - and I could hear him stop breathing,'' she said. ``He would let out a great big snore and kind of choke, and then, utter silence. Sometimes, I'd shake him so he'd wake up and breathe. I was afraid he'd die if I wasn't there to make sure he was breathing.''

It wasn't until the couple took a Mediterranean cruise three years ago, and Winard dozed off whenever activity waned and he sat down for a moment, that he began to wonder if his wife was right.

Back at home, he spent a night snoozing in Stevenson's sleep clinic bedroom with electrodes hooked to his head and body. Winard was surprised at the results of the test.

``He said, `In the six hours you slept, you had 323 episodes of not breathing,' '' marveled Winard. ``He said I stopped breathing anywhere from eight seconds to a minute and 23 seconds.''

Every time he stopped breathing, he had awakened. The waking moments were so brief, Winard wasn't even aware of them. But they kept him from entering the deep-sleep state doctors say is so important to resting the brain and recharging the body's energy.

He had obstructive sleep apnea, Winard was told, the same sleep disorder that plagues an estimated 5 percent of Americans, most of them men.

Apnea - which literally means ``cessation of breathing'' - occurs when the sleep-relaxed muscles in the throat close in, obstructing a sleeper's airway and depriving the heart and the brain of oxygen for brief periods.

``Trying to breathe with the airway collapsed at the back of your throat is like trying to suck a thick milkshake through a paper straw that collapses,'' Stevenson said.

Apnea has more dangerous consequences than just snoring and daytime sleepiness, Stevenson said. Normally, a person's blood contains 94 percent to 98 percent oxygen. Repeated cessation of breathing during sleep can lower the rate of oxygen in the blood by 3 percent to 30 percent, triggering heart attacks, strokes and high blood pressure.

A few men with sleep apnea simply stop breathing and die, Li said.

For years, sleep specialists have prescribed CPAP (Continuous Positive Airway Pressure) for Winard and other apnea patients.

Before going to bed, Winard straps a clear plastic mask, held in place by flexible straps, over his nose; the mask is attached to a flexible plastic tube that fits into a bedside machine the size of a large clock radio. It generates an air current strong enough to keep his throat muscles from collapsing and interrupting his breathing.

``It took me a little while to get used to it,'' Winard said. ``But it's not that bad. I get a good night's sleep now. And the good thing is that Medicare pays for the machine.''

CPAP helps 70 percent to 80 percent of apnea patients, the doctors say.

Many of those who can't get used to sleeping with a mask clamped over their faces - an estimated 20 percent to 25 percent of apnea patients - choose to have traditional surgery instead.

Doctors cut away the uvula (``that little punching-bag-type thing at the back of the throat,'' Li calls it), part of the soft palate and throat tissues and perhaps part of the back of the tongue. The procedure, which involves an overnight hospital stay, generally costs $1,800 to $4,000 (which may be covered by Medicare or insurance if prescribed by a doctor), gives the patient an excruciatingly sore throat for two to three weeks - and often doesn't solve the problem, Li said.

The new somnoplasty procedure, which has been performed on 300 to 400 patients at Stanford and a few other university hospitals in the past year and a half, also is considered surgery, but no cutting is involved.

Instead, surgeons insert a needle into the tissues of the soft palate, throat and back of the tongue, and radio waves heat the needle to 85 degrees Celsius, burning the tissues. The scar tissue that develops beneath the surface in the ensuing three to six weeks tightens the airway so it no longer collapses as a sleeper relaxes, allowing him to breathe normally.

A second treatment may be required because surgeons are wary of subjecting a patient to too much heat during the initial treatment, which would cause pain during healing. The entire procedure, which costs about $4,000, is done on an outpatient basis.

``The surface (of the throat tissues) is not injured, so the pain is less,'' Li said. ``Many patients go out to dinner that night after they've had surgery.''

Although the FDA has approved the new surgery, insurance companies still consider it experimental, refusing to pay for it, the doctor said. But that may change as more patients undergo the procedure.

``We feel that it's hopeful we'll be able to widely apply this technique, but I don't think it'll replace CPAP,'' Li said. ``There are always patients who won't want to have surgery.''

Winard is one of them. He says he'll stick with his air-blowing machine, even though the noise of the machine has driven his wife to sleep in a separate bedroom.

``I can finally get some sleep,'' Marilyn Winard said. ``I'm not afraid he'll die in the middle of the night anymore.''

Feeling sleepy?

Are you sleep-deprived? Here's a test - called the Epworth Sleepiness Scale - that sleep specialists use to determine whether you're getting enough sleep.

Rate the following situations with a number corresponding to the state of sleepiness described below:

0 - no chance of dozing off

1 - slight chance of dozing

2 - moderate chance of dozing

3 - high chance of dozing

Sitting and reading.

Watching TV.

Sitting in a public place (theater or meeting).

Being a passenger in a car for an hour without a break.

Lying down to rest in the afternoon.

Sitting and talking to someone.

Sitting quietly after a lunch that didn't include alcohol.

Driving a car, stopped a few minutes in traffic.

Score:

1-6 - You're getting enough sleep.

7-8 - You're about average, meaning you could use an extra hour of sleep or so a night.

9 plus - Seek the advice of a sleep specialist.

For more information on sleep disorders, contact the National Sleep Foundation, [phone]; the National Heart, Lung and Blood Institute Information Center's National Center on Sleep Disorders Research, [phone]; or the American Sleep Apnea Association, [phone].

Source: Stanford Primary Care Sleep Education Project

Sleep problems from A to Z-zzzzzz

Here are a few of the most common sleep problems recognized by the National Commission on Sleep Disorders:

Insomnia. The inability to fall asleep or to stay asleep. Short-term sleeplessness can be the result of excitement, bereavement or jet lag; long-term problems may be linked to medical, behavioral or psychiatric difficulties. Treatment often includes medication and behavioral changes.

Narcolepsy. Sufferers of this disorder - described as excessive sleepiness - can fall abruptly asleep when excited, angry or experiencing any strong emotion. Vivid dreams fill sleep episodes. Catalepsy - a temporary decrease or loss of muscle control - can cause narcoleptics to fall. Can be treated with medication and therapy.

Restless legs syndrome. Restless sleep is filled with frequent jerking of the lower extremities. Patients often describe tingling, prickling or crawling feelings in their legs, relieved only by movement. Treatments include massage, hot showers, medication.

Parasomnias. Can include sleepwalking, sleep talking, sleep eating, nightmares and night terrors. Sufferers are usually not aware of their behavior while asleep. Those who suffer from night terrors often wake abruptly, screaming and in intense fear, confused and unsure where they are; attempts to flee from imagined terrors can result in injury to themselves or people who try to wake or restrain them. Treatments vary from medication to therapy to behavioral changes.

Bruxism. Grinding of teeth while sleeping is the result of anxiety, tension and dental problems. Treatment includes dental repairs and relaxation therapy.

- Carol Bidwell

CAPTION(S):

2 Photos, 2 Boxes

Photo: (1--Cover--Color) The buzzzz on getting a good night's sleep

David R. Crane/Daily News

(2) At bedtime, George Winard straps on a plastic mask attached to a tube that fits into a bedside machine. It generates an air current strong enough to keep his throat muscles from collapsing and interrupting his breathing.

Michael Owen Baker/Daily News

Box: (1) Feeling sleepy? (See text)

(2) Sleep problems from A to Z-zzzzzz (See text)