County Health

Desperately seeking snoozin’ .


County Health


The Science of Sleep


Forty winks feel more like four? Don’t take the problem lying down.



By Nicole Saunders



These days, when you hear people complain that they’re simply not getting enough, you know exactly what they’re talking about: sleep. Approximately 60 million Americans will experience some sort of trouble sleeping this year and, at last count, researchers have noted no fewer than 80 types of sleep disorders.


For some, the trouble may be infrequent, easily solved by hitting the java less often or scaling back on the late-night e-mail sessions. But for about 40 million, trouble sleeping will drag on for months or even years. The recipe for relief may be complicated, and, in some instances, making lifestyle changes may not be enough. The good news: there are treatment options to help manage even the most serious sleep woes.




“Why we spend a third of our lives in a semi-comatose state isn’t that clear,” says Nicholas Rummo, MD, director of Cardio-Pulmonary Services and the Center for Sleep Medicine at Northern Westchester Hospital. Up until the 1950s, sleep was simply seen as a dormant stage for our bodies, the biological equivalent of a shop owner putting an out-to-lunch sign on the door. But now researchers believe our brains use sleep to give some neurons a chance to shut down and repair themselves and also work out others that are less used during waking hours. Other studies suggest sleep is necessary for our nervous and immune systems to function properly or to rest the parts of the brain that control emotion and social interaction for prime functioning when we’re awake.


What is clear, however, is how damaging a lack of sleep can be. Most adults generally require about seven to eight hours of shut-eye a night. Without it, you can function, but not well. In studies where the sleep deprived have  been asked to perform eye-hand coordination tests or  use a driving simulator, they’ve  done as poorly or worse than intoxicated people. The National Highway Traffic Safety Administration cites driver fatigue as one of the leading causes of accidents. Moreover, untreated sleep disorders have been linked to an increased risk of high blood pressure, heart attack, and stroke. Recent evidence suggests that sleep dis-orders may contribute to the development of diabetes and a higher risk of obesity. And sleep disorders have long been tied to increased risk of mental illness.


Researchers are investigating whether some people may have a genetic predisposition to sleep problems. Restless Legs Syndrome, for example, runs in families in up to half of those with the disorder. “And a lot of sleep apneacs will tell you there’s a family history,” reports William Novak, MD, a physician at the Cleveland Clinic’s Sleep Disorders Center in Cleveland, Ohio. Still, Dr. Novak says, it’s unclear what exactly is being inherited. Insomnia is an altogether harder beast to figure out; researchers would have a hard time determining if it’s the result of common habits an entire family might share or genetics.



So how do you treat A sleep disorder? here we look at the three most common ones.




What it is: the inability to get to sleep, stay asleep, or have refreshing sleep, even after clocking in seven to eight hours of shut eye. People with chronic insomnia experience the disorder at least three nights a week for a month.


Treatment options: If you think it simply involves popping a sleeping pill, keep dreaming. Successfully treating chronic insomnia usually means playing detective to figure out whether a health problem is spurring it on, says Dr. Rummo. It’s often triggered by an underlying medical or mental health condition.  If it is, addressing that condition may snuff out insomnia without ever requiring a separate treatment.


But if insomnia persists, or is not precipitated by another condition—for a minority of people insomnia is not related to another health problem—your best bet is cognitive behavioral therapy (CBT). In CBT a therapist helps you correct any poor sleep habits that reinforce insomnia or learn relaxation techniques to assuage it. Studies suggest it may be the closest thing to a cure, helping up to 80 percent of chronic insomnia sufferers. To really benefit from it, three to six one-hour sessions are generally required.


So, then, are there any instances when sleeping pills can be used for chronic insomnia? “A physician may use sleeping pills as a temporary bridge until you can treat the underlying cause,” says Dr. Novak. But the word temporary is all important: most sleeping pills come with the risk of dependency.What’s more, long-term use can cause nasty bouts of rebound insomnia, in which the disorder is actually worsened. There may also be the risk of other side effects such as odd sleep behaviors, e.g.,  sleep eating or even sleep driving.


Newer sleeping pills, such as Eszopiclone (Lunesta) and Zolpidem (Ambien CR), may cause fewer side effects, though there are questions about whether they actually work better than the older ones, such as lorazepam (Ativan).  Last year Consumer Reports, while urging caution with the overall use of sleeping pills, named Ambien its best buy drug, because it is now available as a much cheaper generic.


But stay away from: Dietary supplements valerian and melatonin. The herb valerian has historically been promoted as a sedative, and melatonin is a hormone the brain produces  to help the body regulate sleep. Though studies suggest that both work better than a placebo at helping you fall asleep, experts say there is
insufficient evidence to recommend it for insomnia.


Restless Legs Syndrome


What it is: A neurological disorder in which people experience tingling, burning or other sensations in the legs when they sit or lay down. It can range from irritating to downright painful, and brings an uncontrollable urge to move when resting. Researchers believe the condition may be caused by an imbalance of the brain chemical dopamine. But, notes Dr. Novak, RLS can also accompany other conditions such as iron deficiency, renal failure, anemia, or nerve disorders. In many cases, no known cause exists.


Treatment options: Sometimes treating the underlying condition does the trick—for example, taking iron supplements if you’re iron deficient. If there are no associated medical conditions, you’ll simply have to focus on relieving symptoms, and your doctor may suggest an assortment of medications, including anticonvulsants and central nervous system depressants. The current drugs of choice for RLS are drugs for Parkinson’s disease that affect the levels of dopamine in your brain.


But stay away from: Anti-nausea drugs and calcium blockers used to treat heart conditions. These medications may worsen symptoms of RLS. If you need them for other conditions, your doctor may have to tack on other drugs to help relieve RLS.


Sleep Apnea


What it is: A disorder in which breathing is disrupted or becomes shallow during sleep. Sufferers can stop breathing for 10 to 30 seconds, hundreds of times a night. There are two types of apnea: the most common, obstructive sleep apnea, is often associated with being overweight or the loss of muscle tone that comes with aging, since both can allow the windpipe to be obstructed with extra tissue. A less common type, central sleep apnea, is caused by irregularities in brain signals. Untreated apnea is linked to high blood pressure, irregular heartbeat, and an increased risk of heart attacks and strokes. For some high-risk individuals it may even lead to sudden death from respiratory arrest during sleep.


Treatment options: Most can benefit from losing weight. Some oral devices will help prevent the tongue from falling back into the airway. Or if you experience apnea sleeping on your back, certain devices can prevent you from getting into that position.


Moderate to severe cases often require continuous positive airway pressure or CPAP, a machine that blows pressurized air into a mask forcing the airway open.  In very few cases, surgery may be needed. But Dr. Rummo says it carries a failure rate of 30 percent or more.


But stay away from: Sleeping pills. Not only can they prevent you from awakening to catch your breath, they cause muscles to relax, which could worsen obstruction.


Nicole Saunders is a freelance writer who has written for Essence and Health magazine.




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