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Solving the mysteries of sleep.

Rip Van Winkle slept for 20 years, but many individuals would give anything just to sleep peacefully through the night. According to the National Commission on Sleep Disorders Research, approximately 40,000,000 Americans have a chronic sleep disorder, and another 20,000,000 experience occasional sleep disturbances.

Steep disorders are estimated to cost the U.S. $15,900,000 per year in direct medical costs. In addition, a host of other conditions are associated with sleep problems, ranging from loss of productivity to higher mortality and accident rates. The International Classification of Sleep Disorders has divided them into four categories by possible cause: intrinsic sleep disorders, parasomnias, circadian rhythm sleep disorders, and extrinsic sleep disorders.

Intrinsic sleep disorders originate or develop within the body. Insomnia is the most common complaint, affecting more than 60,000,000 Americans, 35,000,000 of whom have suffered from the condition for a lone time. It plagues almost everyone at some point, often for the first time as children, too excited to sleep the night before a birthday party or major holiday. Insomnia varies with age and sex, occurring roughly 1.5 times more often in the elderly than in younger adults and affecting approximately 40% of women and 30% of men.

Transient, or short-term, insomnia can arise from a headache, indigestion, a cold, or being away from home. The cause of long-term insomnia is more complex and can be more difficult to determine. Often, insomnia points to a medical condition, such as asthma, diabetes, arthritis, heart disease, or ulcers -- or even another sleep disorder -- that must be diagnosed and treated before the insomnia will abate. Tips for combating insomnia include:

* Get in the mood for sleep with meditation, a hot bath, a glass of milk (it contains the amino acid tryptophan, which is associated with sleep), or a cup of herbal tea.

* Establish a sleep pattern by getting up at the same time every day, even on weekends.

* Reserve your bed for sleep, not for chatting on the phone or paying bills.

* Stop napping during the day.

* Cease smoking, Nicotine is a powerful stimulant.

* Watch what you eat and drink. Try to avoid heavy food, alcohol, and caffeine right before bedtime.

* Exercise at some point during the day, but not right before going to bed.

* Try not to take your worries to bed with you. Instead, make a list of problems and possible solutions at the kitchen table.

Sleep apnea is the most common cause of excessive daytime sleepiness diagnosed by sleep centers. The most prevalent form is obstructive sleep apnea. which occurs due to upper airway obstruction and prevents breathing for 10 seconds or longer. Symptoms of sleep apnea include loud snoring, excessive daytime sleepiness, and frequent awakenings at night to gasp for air. It typically strikes middle-aged men who are overweight or have thick necks. The most common medical treatment for obstructive sleep apnea is a mask-like device that keeps breathing passages open with air pressure.

Narcolepsy is the second leading cause of excessive daytime sleepiness. Although 50,000 Americans have been diagnosed with the disorder, it is estimated that the vast majority of narcoleptics are undiagnosed, probably raising the number to 250,000-375,000. Obtaining a proper diagnosis of the disease is difficult since patients with narcolepsy have been misdiagnosed with diseases ranging from epilepsy to schizophrenia and from depression to hypothyroidism. The average length of time between onset and diagnosis is 15 years, and the mean number of doctors seen is five.

Symptoms of narcolepsy include excessive daytime sleepiness (even dropping off to sleep at any time, whether it be watching TV or driving a car), cataplexy (brief episodes of muscle weakness brought on by strong emotion), sleep paralysis (inability to move occurring at the moment of failing asleep), and hypnagogic hallucinations (dreamlike images that occur at sleep onset).

Narcolepsy incurs large costs for patients, who often lose driving privileges or even jobs, and to society, estimated at more than $60,000,000. There is no cure for narcolepsy, though tricyclic antidepressants can help symptoms of cataplexy and dreaming, and stimulants can alleviate the symptoms of excessive daytime sleepiness.

Restless legs syndrome often inhibits sleep by causing a mild pain and crawling sensation in the feet, legs, and knees. Sufferers feel compelled to get up and walk around, only to have the urge disappear as soon as they get out of bed. Treatment includes exercising during the day and refraining from caffeine and other stimulants.

Periodic limb movement disorder involves frequent, strong jerks of the legs and sometimes of the arms. These can occur hundreds of times per night, every 20 to 40 seconds, and episodes can last minutes or hours. This disorder most often strikes those with diabetes, apnea, poor circulation, kidney disease, narcolepsy, and people taking or withdrawing from medication. No real cure exists, but symptoms may improve by treating the underlying disease and following the sleep hints listed above.

Parasomnias are physical phenomena that take place during sleep, occurring mostly in children. Sleepwalking afflicts about 15% of all children between the ages of five and 12. Sleepwalkers may sit at the edge of the bed and move their hands in repetitive motions or get up and walk around the house with their eyes open, performing a simple activity like setting the table.

Sleep terrors usually occur during the first third of the night and affect mostly children, who let out a blood-curdling scream and bolt upright in bed. Gasping for breath, the youngster will sweat heavily and appear petrified with fear. Attempts to calm him or her will be of little use, since the child is still asleep and will remember little if anything of the episode the next morning.

Nightmares are common in kids, but also strike 50% of adults at least once a year. Unlike sleep terrors, nightmares are remembered vividly the next morning and often involve themes such as fear, failing, danger, confusion, and being assaulted or chased.

Sudden infant death syndrome (SIDS) occurs in two of every 1,000 babies born, 90% before six months of age. Most babies are assumed to be asleep at the time of death, with the vast majority of them in good health. The cause of this tragic disorder has not been found yet, and proposed risk factors are unsubstantiated.

REM (rapid eye movement) sleep behavior disorder happens when the normal paralysis of REM sleep fails and people act out their dreams, often injuring themselves or their bed partners. This disorder typically strikes middle-aged men, one of whom dreamed his wife was a wild animal and tried to choke her.

Circadian rhythm sleep disorders occur when events disrupt the body's biological clock. Nocturnal asthma diminishes the quality of sleep for many individuals with asthma. The body's production of cortisol steroids, which control lung inflammation, drops at night and peaks in the morning. Air flow drops to its lowest point at 4:00 a.m., thus explaining why people with asthma often have nocturnal problems.

Jet lag afflicts travelers, disrupting sleep and daytime functioning. The body's circadian rhythm becomes "out of sync" with the new time zone's pattern of light and dark, taking up to several days to realign itself. Tips for overcoming jet lag include drinking plenty of water, fruit juice, or other non-carbonated beverages before and during the flight; taking off your shoes on the plane; getting up and moving around the plane every so often; and adopting the schedule of the new time zone as soon as you arrive.

Shift worker's sleep disorder occurs among those who work at night or on rotating shifts. Readjusting the body's clock to different schedules plays havoc with the natural circadian rhythm that responds to light and dark, making body temperature lowest at night and highest during the day. Shift workers are twice as likely as nine-to-five employees to report sleep disruption.

Seasonal affective disorder, also known as the winter blues, leads to depression, drowsiness, and carbohydrate cravings. People suffering from SAD report longer periods of sleep, indicating that this disorder may be a circadian disturbance due to the shorter days of winter. Certain hormones are released during periods of darkness (normally at night while we sleep) that make us feel sleepy. Light therapy has been shown to offset the dark days of winter. breaking the desire to "hibernate" in more than half of all those in treatment.

Extrinsic sleep disorders come from causes outside the body. The source ranges from problems with alcohol that affect sleep to disorders in sleep habits and practices. Dealing with the external factors that are harming the sleep pattern often solves the problems.

Dr. Rickard is director of respiratory medical affairs, Glaxo Wellcome Inc., Research Triangle Park, N.C.
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Title Annotation:sleep disorders
Author:Rickard, Kathleen A.
Publication:USA Today (Magazine)
Date:Jul 1, 1997
Words:1457
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