Northwest Health | WINTER 2009 By Pamela Richardson and Ginny Smith

The National Institutes of Health estimates that nearly one in five Americans are shortchanging themselves on sleep. "No big deal," you may say to yourself. But think again. Sleep is essential for good health. In fact, you can't live without it.

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Group Health member Kim Nichols' realization that she had a serious problem almost came too late — when she found herself nodding off at the wheel in rush-hour traffic. "Extreme fatigue had become a real safety issue for me. Plus my husband said I snored. A sleep study confirmed that I had sleep apnea."

"Sleep disorders are very common," says registered respiratory therapist Barbara Erwin, Group Health Outpatient Sleep Apnea Services, "and many people don't even realize they have a problem. They think it's normal to be tired because they're under a lot of stress or feel it's just part of the aging process." Signs of poor sleep include loud snoring, interruptions in breathing during sleep along with gasping or choking, feeling groggy rather than refreshed upon waking, and persistent daytime sleepiness.

If you or someone you love experiences any of these symptoms, this is an article you'll want to read.

The Dangers of Sleep Deprivation

While the exact reasons sleep is necessary remain unknown, we do know that during sleep the body restores balance between different chemicals in the brain, builds bone and muscle, and strengthens the immune system.

Studies have found a link between the quantity and quality of one's sleep and many health problems. For example, insufficient or interrupted sleep affects growth hormone secretion and is linked to obesity. Lack of sleep can increase the risk of hypertension and cardiovascular problems. And it can impair the body's ability to use insulin, which can lead to diabetes.

Without adequate rest, the brain's ability to function quickly deteriorates. Concentration levels drop, decision-making abilities are compromised, reaction times are slowed, and you become more prone to accidents. Severe sleep deprivation can also cause hallucinations.

Sleep experts say most adults need between seven and nine hours of sleep each night for optimum performance, health, and safety. Children and teens need more. When we don't get enough sleep, we accumulate a sleep debt that can be difficult to "pay back."

For all these reasons, it's important to talk to your personal physician if you think you aren't getting enough sleep.

Most Common Sleep Disorders

There are 85 medically defined sleep disorders, but three are by far the most common: sleep apnea, insomnia, and restless legs syndrome.

Sleep apnea. This condition involves the interruption of breathing during sleep. It occurs when the soft tissue in the throat is blocked or relaxes to the point where breathing is interrupted. With no incoming oxygen, the body wakes itself up to gasp for air.

Men aged 40 years or older who are overweight and have a neck circumference of more than 18 inches are at greatest risk for sleep apnea. It's also common among post-menopausal women. Snoring is the most obvious symptom, along with overwhelming daytime sleepiness.

When a person has classic symptoms of sleep apnea, it may be possible to diagnose the condition without doing any tests. For less clear-cut cases, the majority of patients can be diagnosed with a home sleep study. Home tests are currently only designed to check for interrupted breathing. If a home test can't pinpoint the problem, or another type of sleep disorder is suspected, laboratory-based testing may be needed.

Mild sleep apnea can often be managed with lifestyle changes, such as losing weight. For more severe sleep apnea, the most common treatment is a continuous positive airway pressure (CPAP) machine that's used nightly. Sleep technicians work closely with Group Health patients to help them find a style of CPAP mask that's comfortable and fits well. When used correctly and consistently, the CPAP machine is about 90 percent effective.

"The most common misconception among patients with sleep apnea is that the use of a CPAP machine is a temporary, quick fix," says Cristina Ryser, a physician assistant at the Capitol Hill Campus who is specially trained in sleep medicine. "Most patients need to use the CPAP all night, every night, in order to feel rested."

Erwin agrees. "Patients need to think of the CPAP as their best friend. It only works when it's used."

At one time, surgery to remove throat tissue was a common treatment for sleep apnea — but not anymore, says David Lewis, MD, chief of Pulmonary and Sleep Medicine at Group Health. "Although it's occasionally necessary, the success rates have generally been inferior to non-surgical treatments, and the risk of complications is higher."

Insomnia. We've all been there before — wide awake in the middle of the night, staring at the ceiling, thoughts racing. Insomnia is defined as difficulty falling or staying asleep, or waking up too early, for one month or longer. A few medical conditions that may contribute to insomnia include gastrointestinal reflux disease (GERD), fibromyalgia, nighttime coughing, clinical depression, anxiety, and menopausal hot flashes. The effects of insomnia vary from impaired memory and lack of motivation to increased risk for heart disease.

"My patients with insomnia are usually hoping for a miracle pill to solve their sleep habits, but insomnia is the result of several complex factors that usually require behavioral changes," says Ryser.

For example, the National Sleep Foundation offers these suggestions for overcoming insomnia:

• Go to bed and wake up at the same time every day — even on the weekends. This helps you sleep in sync with your biological "circadian" clock.
• Don't smoke or drink caffeine. Both are stimulants.
• Reserve the bedroom for sleeping only. Leave spreadsheets from work and that gripping mystery you're reading in another room.
• Skip the boozy nightcap. It may help you doze off, but you might experience a rebound effect a few hours later.
• Make sure the bedroom is cool, dark, and quiet. If outside noise or light is a problem, use a white noise machine or air filter and wear a sleeping eye mask.
• Sleep alone if a bed partner or pet is disturbing you.
• If you can't fall asleep after trying for 10 minutes, get up. Find a relaxing activity — such as listening to quiet music or a soothing book on CD — that makes you sleepy.

Getting regular exercise and avoiding heavy meals in the evening also seem to improve sleep. If these suggestions don't work for you, treatment for insomnia typically includes prescription sleep medications.

Restless legs syndrome (RLS). An estimated 12 million Americans experience this sleep disorder, which is characterized by distinct creeping, pulling, tugging, or painful sensations in the legs when lying down at night. Iron deficiency has been associated with RLS, but there is no known cause for this neurological condition.

The severity of RLS tends to increase over time, so don't delay in discussing any restless-legs symptoms with your personal physician. "RLS can usually be controlled with medications," says Group Health pulmonologist Jeffrey Sullivan, MD. "Three of the most common medications — ropinirole (Requip), pramipexole (Mirapex), and L-Dopa/C-Dopa (Sinemet) — were originally formulated to treat Parkinson's disease. They increase the levels of the neurotransmitter dopamine in the body."