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Sleep Disorders: Common but Treatable
B. Tucker Woodson, MD
Medical College of Wisconsin Otolaryngologist;
Director, Sleep Disorders Program
Named one of the "Best Doctors in America®" 2004 by Best Doctors, Inc.
According to a recent poll, getting a good night's sleep is hard for many adults and that often means poorer health, lower productivity on the job and more danger on the roads. In fact, three-quarters of adult Americans say they frequently have a sleep problem, such as waking during the night or snoring. B. Tucker Woodson, MD, talks about how a lack of sleep affects people and what can be done to help them sleep better.
Q. How does not getting enough sleep affect people?When the brain is sleep deprived, it slows down and does not function as well. Individuals that chronically get a lack of sleep often think they're doing fine, but their level of complex functioning is decreasing. When people are awake, they accumulate a sleep debt, and when they sleep, they pay it off. It can be equated in some ways to a credit card. If a person only gets five hours of sleep a night for five nights in a row, that individual has accumulated a sleep debt equivalent to going 24 hours without sleep. And that's equivalent to a blood alcohol level of .08 to .10. So they're functioning at the same level as someone who is legally intoxicated. But as with many chronic problems, people get used to it and it becomes their normal way of functioning.
But not getting enough sleep can have a substantial effect. People feel excessively sleepy and can have mood and personality problems. They can have decreased memory or fall asleep unintentionally. A European study estimated that 20 percent of fatal motor vehicle accidents are related to sleepiness. Lack of sleep also can affect people's health. There's a relationship between sleep loss and an increased risk of hypertension, hormonal problems, obesity and stress and strain on the heart and lungs.
Q. What are the main reasons people have trouble getting enough sleep?There are a large number of sleep disorders with a broad range of symptoms and causes, but generally they are classified into three types: problems with poor quality sleep that causes excessive daytime sleepiness; problems initiating sleep or staying asleep, what we call insomnia: and parasomnia, where there are other activities going on during sleep such as sleep walking or night terrors.
The most common reason people seek medical evaluation is complaints about snoring. Snoring is a major factor in poor quality sleep and is often related to sleep apnea. Sleep apnea is a disorder in which a person's upper airways become partially or completely blocked during sleep and interrupt breathing. Every time the airways become blocked the person wakes up, resulting in sleep fragmentation and sleepiness during the day.
Insomnia is very common; we've all experienced it. In an acute, stressful situation it's normal, but in some people it's not just a short-term event, but a chronic problem. In these situations, medical evaluation is warranted.
Restless leg syndrome can also disrupt sleep. It's a discomfort in the legs that's associated with the symptom of wanting to move the leg. There's a great urge to move the leg, just like being tickled, and movement makes the sensation better. It tends to be worse at night.
Q. How are these more common sleep disorders treated?
If patients have obstructive sleep apnea, the mainstay of treatment is a small mask that fits on the nose or face and provides positive pressure or air support to the upper airway to keep it from collapsing during sleep. Sleep apnea may also be treated with an oral appliance that holds the tissues of the throat open. In some cases, surgery may be required to reconstruct areas where there is a blockage. We also evaluate and treat patients for other underlying medical disorders that may contribute to the problem, such as allergies or obesity.
The best treatment for chronic insomnia is behavioral therapy. Over time, people develop bad sleep habits, and we work to correct those habits. These habits differ among individuals, but often people toss and turn all night and try hard to sleep. We tell them that is not a good thing, that if they can't sleep they should get up and get out of the bedroom and go to a different room until they feel tired. The bedroom should be associated with sleep and be quiet, dark and comfortable. We eliminate things like eating and watching television in bed and using the bed to worry about bills and the events of the day. We also tell patients to eliminate caffeine and alcohol and limit exercise and meals right before they go to bed. In severe forms of insomnia, we also check for other underlying medical reasons or causes, since insomnia is often associated with mood disorders, depression, anxiety and substance abuse.
Restless leg syndrome is probably hugely under diagnosed. There are some factors that can make it worse, such as sleep deprivation, caffeine intake and anemia, but generally the syndrome is treated with medications.
Q. What should people do if they have a chronic sleep problem?
Living with a chronic sleep problem is a miserable existence and often people are unaware of underlying causes. That’s why they should seek a medical evaluation from their primary physician or from a specialty clinic such as Froedtert & Medical College of Wisconsin’s Sleep Disorders Program. Our team includes clinicians from neurology, otolaryngology, oral surgery, psychology, pulmonology and bariatric medicine. We’re the only facility in southeastern Wisconsin to provide this multidisciplinary approach to sleep medicine.
Author: B. Tucker Woodson, MD Source: Every Day Date: May-August 2005 |