07 February 2009

Science of Sleep

Sleep disorders are common in U.S., and experts are concerned

Billie Jean Hemelstrand, 65, of Christmas Valley, settles in for the night last week at the High Desert Sleep Center in Bend. Hemelstrand underwent her second sleep study at the center to test the effectiveness of a continuous positive airway pressure machine to prevent her sleep apnea. Experts say millions of Americans are getting their sleep problems checked out, reducing the risk of serious health complications.

During a sleep study, doctors attach electrodes to the patient to track heart rate, breathing and brain waves. The results can be used to diagnose what might be preventing patients from getting a good night’s sleep.

Technicians at the High Desert Sleep Center in Bend fit an oxygen mask on Billie Jean Hemelstrand last week. The mask helps keep her airway open. Patients with untreated sleep apnea can wake up 200 times a night, leaving them far from rested the next morning.

Dr. Theresa Buckley, one of the doctors of the High Desert Sleep Center

Tips for a good night's sleep
Set a schedule: Go to bed at the same time each night and get up at the same time each morning. Sleeping in on weekends disrupts your sleep cycle and makes it much harder to get up on Monday morning.Exercise: Try to exercise 20 to 30 minutes a day. There’s conflicting evidence whether exercising later in the day interferes with sleep.Avoid caffeine, nicotine and alcohol: Caffeine, in coffee, sodas and some medications, is a stimulant that keeps people awake. Smokers tend to sleep very lightly and often wake up early due to nicotine withdrawal. Alcohol robs people of deep sleep.Relax before bed: A warm bath, reading or other relaxing routine can make it easier to get to sleep.Sleep until sunlight: If your schedule allows, wake up with the sun or use very bright lights in the morning. Sunlight helps the body’s internal clock reset itself.Don’t lie awake in bed: If you can’t get to sleep, get up and do something else until you feel tired. The anxiety of being unable to fall asleep can contribute to insomnia.

Control your room temperature: Extreme temperatures may disrupt sleep or prevent you from falling asleep.See your doctor if your sleeping problem continues: If you have trouble falling asleep, night after night, or if you always feel tired the next day, you may have a sleep disorder. Talk to your primary care physician about a referral.

Every morning, millions of Americans roll over to turn off the alarm and dig deep to find the motivation to drag themselves out of bed. Tired, sleepy, even downright exhausted, they plod their way through another workday, another round of shuttling kids to after-school activities, another evening of the myriad tasks that must be completed before bed. Then the few hours of the night that remain — the spare change left of the day’s dollar — they give to sleep.

Sleep experts warn that America has become a sleep-deprived society and is suffering significant health and economic consequences. “With Americans working such long hours — on top of their other responsibilities like childcare and household maintenance — something has to give. Unfortunately that something is usually nighttime sleep,” said Darrel Drobnich, acting CEO of the National Sleep Foundation. “People tend to give up sleep, when getting a good night’s sleep should be at the top of everyone’s list to ensure maximum daytime performance both at work and home.”

According to the National Institute of Neurological Disorders and Stroke, the widespread practice of burning the candle at both ends in Western industrialized societies has created so much sleep deprivation that what really should be abnormal sleepiness has become the norm.

Now sleep specialists are making a push to educate Americans about how crucial it is to get sufficient sleep and how to identify bad habits or sleep disorders that are getting in the way. Your health and well-being, they say, depend on it.
“That time might be the most important of your entire day,” said Dr. David Dedrick, a sleep disorder specialist at the High Desert Sleep Center in Bend. “You may have done everything right, in terms of exercising and (eating a healthy diet), but if you didn’t get the right quantity and quality of sleep, you may have really missed the boat.”

Pillow time
Dedrick said most people need seven to eight hours of sleep a night. Yet, in a recent survey by the National Sleep Foundation, adults said they sleep on average only 6 hours and 40 minutes per night, about three hours less time than they spend working.

Nearly two-thirds of those forgoing sufficient sleep said they just accept their sleepiness and keep going, while another third rely on caffeinated beverages to get them through the day. More than half said they try to catch up on their sleep during the weekend.

But Dedrick said the notion that you can catch up on sleep is a fallacy. “Once the brain has gone through a night of insufficient amount of sleep, there is probably a measurable, albeit small, loss in neurological function,” he said. “It’s small, but over cumulative amounts of time, if you’re somebody that consistently does this, you’re doing damage to your brain.”

Studies document that insufficient sleep leads to worse productivity and more absences from work or school, a higher risk of work-related injuries, and a severe toll on well-being. A poor night’s sleep can negatively affect mood, attitude, energy, memory and overall outlook on life.

People suffering from sleep deprivation test worse on driving simulators than those who are intoxicated, and the National Highway Traffic Safety Administration estimates that 100,000 motor vehicle accidents and 1,500 deaths each year can be attributed to driver fatigue.

Shortchanging yourself on sleep has been linked to serious health consequences, including a higher risk for diabetes, heart disease and obesity.
Meanwhile, getting extra sleep seems to provide tangible benefits. Swiss researchers analyzed 20 years of health records and found that the number of heart attacks dropped on the Monday after daylight savings time ends. The researchers said the dip could be due to the extra hour of sleep. Mondays typically have higher rates of heart attacks, and many sleep experts believe that reflects changes in sleep schedules over the weekend. When people sleep in and stay up later on the weekend, the 6 a.m. alarm on Monday mornings might be particularly taxing for the body.

How sleep impacts the body is still poorly understood. Many sleep experts believe that sleep provides the opportunity for brain neurons used while we are awake to shut down and repair themselves. Without sleep, neurons may become so depleted of energy or so polluted with byproducts of normal cellular activities that they can’t function normally.

Dedrick likens the body to a skyscraper in which workers toil away during the day and a cleaning crew comes in during the night to vacuum, take out the trash and fix the broken equipment. If that nightly support staff goes on strike, soon the equipment breaks down and the trash piles up. “If you don’t give enough time for your night crew to come in and do their job, you’re not going to be able to work very well,” he said. “People often think of sleep as this passive process where your body is not doing anything. Actually, your body is incredibly active.”

The National Center on Sleep Disorders estimates that 50 million to 70 million Americans suffer from sleep problems. As a result, millions of people go through their day wondering why they can’t stay awake or go to bed wondering why they can’t fall asleep.

“People are notorious for underestimating how sleepy they are,” said Dr. David Kuhlmann, medical director of sleep medicine at Bothwell Regional Health Center in Sedalia, Mo., and a spokesman for the American Academy of Sleep Medicine. “People assume that their disrupted sleep and level of sleepiness when awake is normal for their age.”

Dedrick said that sleep patterns do change as people age. From ages 20 to 40, people tend to sleep pretty well in the absence of poor sleep habits or medical problems. From ages 40 to 60, sleep quality tends to decline, with less deep sleep and more awakenings during the night. “From age 60 and beyond, your sleep should be at baseline what it is, and it should be relatively good,” he said. “If it’s not, you can’t blame your age.”

Like father, like son
And it’s not just adults who aren’t getting enough sleep. A study published this week by researchers from the University of Montreal found that at least 30 percent of children between 6 months and 6 years of age have difficulty sleeping six consecutive hours. Those that got less sleep were more likely to be obese or hyperactive.

The researchers found that 25 percent of children who slept fewer than 10 hours were overweight, compared with 15 percent who slept for more than 10 hours, and 10 percent among those that slept at least 11 hours.

“When we sleep less, our stomach secretes more of the hormone that stimulates appetite,” said Dr. Jacques Montplaisir, a lead author of the study. “And we also produce less of the hormone whose function is to reduce the intake of food.”
And, Montplaisir said, unlike adults who just get sleepy, children get overly excited when they are tired. The study found that 22 percent of children who slept for less than 10 hours were hyperactive, double the rate of those who slept 10 to 11 hours per night.

Insufficient sleep also affected their performance on cognitive tasks. Some 41 percent of the children who didn’t get enough sleep scored poorly on a cognitive test, compared with 17 percent to 21 percent of children who slept 10 or 11 hours per night.

Many sleep experts believe that a certain percentage of children diagnosed with attention deficit/hyperactivity disorder may simply be short on sleep. And when those children are medicated, it often further disrupts their sleep patterns.
Most teens aren’t getting anywhere near the eight to 10 hours of sleep recommended either. Their tendency to stay up late, get up early and try to make up the sleep on the weekends is a recipe for disaster, said Dr. Ruth Benca, co-director of the sleep research center at the University of Wisconsin School of Medicine and Public Health.
“Kids who have an ongoing shift in their sleep patterns often have poor school performance and problems with depression and cognition,” she said. “Kids who go to bed earlier during the week feel better and perform better in everything they do.”
Benca said the body’s circadian rhythms, the cycles that govern sleeping and waking, start to change during puberty. Teens naturally become “night owls,” she said. But societal factors exacerbate the problem. Evening activities, as well as late-night Internet surfing, texting and TV time, often keep teens up even later. And with more activities outside of school, such as sports or clubs, many kids are getting up earlier as well.

“Some kids are getting up at 5 a.m. to fit these activities into their schedule,” Benca said. “Needless to say, they’re getting pretty sleep-deprived.”

Identifying problems
Dedrick said many sleep problem for adults and children can be linked primarily to bad habits. For example, many of his patients spend time checking their e-mail right before going to bed.

“What happens is you get on the computer and the bright light from the computer screen tricks your brain into making you think it’s daytime,” he said.
Other people turn to alcohol as a nightcap to help them sleep. That’s another bad idea, Dedrick said.

“The problem with any drug, alcohol included, is the withdrawal of the drug leads to an opposite effect,” he said. “Alcohol is a sedative and it may help you fall asleep, but when it wears off, it’s opposite sedation, it’s activation.”
As a result, people fall asleep fine, but at 2 a.m. are wide awake.
Dedrick said other strategies for getting a good night’s sleep involve getting plenty of exercise, which boosts blood flow and oxygen to the brain, and establishing a regular schedule for sleep.

“We have a very callous attitude toward sleep, that sleep is a waste of my time, that it cuts out of my productivity at work. All of that is horribly wrong,” Dedrick said. “We’re sort of shooting ourselves in the foot.” Doctors like Dedrick can also identify more serious medical conditions that could be interfering with sleep. One in seven Americans, when they fall asleep, have trouble keeping their airways open, shutting off their supply of oxygen. The condition, known as sleep apnea, forces the brain to wake up to re-establish airflow.

“If you have unstable airflow while you’re asleep, it becomes de facto almost impossible to get a good night’s sleep,” he said. “Because the brain, instead of totally checking out and resting, is having to wake up over and over and over again.”
The awakenings are so brief that most people are not aware of it, but they break up sleep quality.

“It’s not unusual for us to find that 200 to 300 times per night,” Dedrick said.
Doctors have come to realize that untreated sleep apnea can be lethal, often leading to heart failure and sudden death. A study published earlier this year suggested that people with severe, untreated sleep apnea have five times the risk of dying from a heart problem. And often, patients are unaware they are affected.
Marta Izo, a surgical floor nurse at St. Charles Bend who is in her 50s, said she never really felt she wasn’t getting a good night’s sleep, but went for a sleep study at the High Desert Sleep Center after her husband told her she was snoring more at night.

There, technicians wired her to track her heart rate, oxygen flow and brain waves during the night. “Evidently, I had very bad sleep apnea, my pressures were super duper high,” she said. “I never really felt like I was sleep deprived. I wasn’t falling asleep during the daytime. I wasn’t doing what typically you would think a patient would do that had severe sleep apnea.”

Izo was given a continuous positive airway pressure machine, which provides a flow of air that keeps the airway open. It took some time to get used to the machine and the noise it made. Izo had to work with technicians at the sleep center to find the right combination of machine, mask and fit. “I do think my quality of sleep is much better. I dream now, which I was never dreaming before,” she said. “I think probably mentally I’m a little bit sharper.”

As a nurse, Izo sees many patients that suffer from sleep apnea and are overweight or obese. But Izo said she’s run across just as many people with reasonable weight, just like herself, who have sleep apnea. And despite her medical training, she said she never realized just how dire the consequences of not treating sleep apnea could be. “My husband, he complained about the fact that I snored, and then he complained about the sound of the machine, I just told him what the doctor told me. ‘Would your husband rather be taking care of you after you have a stroke?’” she said. “That made me sit up and take notice. I don’t want him to have to take care of me after I have a stroke.”

It’s worth talking to your doctor if you suspect you might have a sleep problem, she said. Most health insurance plans cover the cost of such sleep studies, although most require a referral from a primary care physician. Home sleep testing is also available, but it generally records less information and focuses solely on sleep apnea. While public awareness of sleep apnea is increasing — Dedrick said referrals spiked after former professional football player Reggie White died of sleep apnea several years ago — public health experts say most people still aren’t getting potential sleep problems checked out.

Two years ago, the Institute of Medicine issued a report calling for more attention
and research into sleep disorders. The group said the nation has neither the understanding nor the capacity to fully treat the 50 million to 70 million Americans with sleep disorders. “What your grandma told you about getting a good night’s sleep, what seems to be good common sense, is now panning out in the scientific data to be far more important than we’ve ever been aware of,” Dedrick said. “It’s kind of an amazing health revolution that’s going on right now.”

1 comment:

  1. Wow thank you for this article. I know how important sleep is because I can feel the results the next day. Either I feel energized and great, or completely lagging. Has there been any studies about sleeping longer than the basic 8 hours of sleep? I've gone 9-10 hours of sleep and felt really good, but then again my eating and exercise habits were lacking at the time. I guess everything all ties in together.