Hamlet longed “to sleep, perchance to dream." Bobby Lewis sang of “Tossin’ and Turnin’” and “didn’t sleep at all last night.” And F. Scott Fitzgerald wrote, “The worst thing in the world is to try to sleep and not to.”
They are hardly alone. Man has been complaining of a lack of sleep ever since his head hit the pillow – and long before there were pillows.
The medical profession has started to pay attention. The treatment of sleep disorders – with insomnia leading the list – has become a very busy field.
Dr. Adam Shapiro, director of the St. Thomas Sleep Center as well as an ear, nose and throat specialist, said when he was in medical school in the 1980s, there was “about 15 minutes” devoted to sleep disorders. But in recent years, research has determined they are not only widespread, they can be very debilitating and actually damaging.
He estimated, “based on the literature,” that close to 50 percent of people will have a sleep disorder at some point in their lives, and many will have more than one.
Often a disorder is a sign of another health problem. For instance, an enlarged prostate or a hyperactive bladder can lead to a person waking frequently at night to go to the bathroom. Conversely, some sleep disorders can lead to physical health problems and/or exacerbate some mental disorders. A lack of sleep can even lead to weight gain because when a person is not sleeping well, his brain secretes a hormone that stimulates the appetite.
Serious consequences can result from obstructive sleep apnea, the condition in which airway passages narrow during sleep, interfering with normal breathing and causing a patient to wake frequently throughout the night. The condition carries with it a risk of high blood pressure, heart attack, stroke, diabetes and depression, according to information published by the Sleep Center.
Signs of sleep apnea include loud or frequent snoring, daytime sleepiness or tiredness, morning headaches, and choking or gasping during sleep. People who are overweight and/or hypertensive are at increased risk of sleep apnea, and it is most common in men over 40 and women over 50.
While sleep apnea and insomnia may be the most common disorders, the textbooks are replete with other types: restless legs syndrome, narcolepsy, (excessive daytime sleepiness) bruxism (teeth-grinding,) hypopnea syndrome (shallow breathing) rapid eye movement sleep behavior disorder (such as acting out dreams as they occur) and many others. Problems are not confined to adults.
“A lot of children have sleep disorders,” Shapiro said. Most common are types that are classified as parasomnias, things such as sleep walking, bed wetting and night terrors. Night terrors differ from regular nightmares in that the child may be crying or screaming, but is in such a sound sleep he is almost impossible to waken. The next day, he will have no recollection of the incident.
Shapiro said Attention Deficit Disorder is often linked to a child’s sleep disorder.
The first line of investigation when a child is diagnosed with ADD should be to check for a sleep disorder, Shapiro said, but “it’s very overlooked.” He added that in ADD cases that do involve a sleep disorder, about 75 percent of the time, a correction of the disorder will eliminate the ADD.
Untreated, a child’s sleep disorder can lead to disease in adulthood, including an increased risk of cancer, he said. So although many problems may not be serious, or a child may outgrown them, it doesn’t pay to ignore warning signs.
That goes for adults too, who are often ignorant of their problem. Some 92 percent of women and 85 percent of men who are diagnosed with sleep disorders, didn’t know they had them, Shapiro said. Often it is their sleep partner – tired of listening to the snoring or dodging blows as the patient acts out a bad dream – who insists they go to the doctor.
While there are telltale signs that indicate a problem, actual diagnosis involves a polysomnogram, a test performed while the patient sleeps. Tests are performed at the Sleep Center, generally overnight. A technician controls the test all night long, monitoring brain waves, heart rate, oxygen saturation, air flow, muscle function, chest excursion, and other factors.
The center has two cozy-looking bedrooms equipped for the tests, and Shapiro said most nights there are tests conducted in both of them. They are also used during the day for nap testing and to monitor people who do shift work and sleep during the day.
Each room has a private bath, TV set, and room temperature controls – plus an inviting, comfortable bed. Patients are encouraged to bring a favorite pillow, stuffed animal, or special blanket if they have one. There’s even a cushioned chair for Mom to sleep over, or for the patient’s spouse or friend – whatever will put the person at ease.
“Most times we can improve and cure sleep problems,” Shapiro said.
The most common treatment for sleep apnea is CPAP therapy, he said. This involves the patient wearing a mask attached to a machine that provides Continuous Positive Airway Pressure during sleep, so the patient’s throat doesn’t collapse and narrow the airway.
“I sleep with one and it’s not a big deal,” Shapiro said, adding he didn’t realize he needed it until someone pointed out that he hadn’t been tested for a sleep disorder for nine years, and he took his own advice and had himself checked out. Sure enough, he had sleep apnea.
With rare exceptions, the vast majority of adults need between seven and eight and a half hours of sleep per night, he said. Yet the average person today gets six.
Not everyone has an actual disorder. But there probably isn’t an adult who hasn’t experienced a bit of trouble sleeping now or then.
Shapiro and the Sleep Center offer some commonsense advice:
Give yourself time to unwind before going to bed. Keep your sleep schedule regular, even on weekends. Don’t watch TV or read on an electronic device in bed. (“There’s a biochemical reason” according to Shapiro; their screens emit wavelengths that signal your eyes that it’s day time.) Avoid alcohol and limit caffeine to the morning. Don’t take a nap after 3 p.m. and don’t take one for longer than an hour. If you aren’t asleep within 20 minutes of going to bed, get up and do something until you feel tired.
And remember, as Benjamin Franklin observed, “Fatigue is the best pillow.”
