Experts shed light on common sleep disorders, solutions

By: Cortney Casey | C&G Newspapers | Published September 14, 2011

 Dr. Gary Trock, co-director of sleep evaluation services for Beaumont Hospital, Royal Oak, said less than half of people get the amount of sleep that they need. Addressing the problem could mean anything from improving “sleep hygiene” to cognitive therapy to medical interventions.

Dr. Gary Trock, co-director of sleep evaluation services for Beaumont Hospital, Royal Oak, said less than half of people get the amount of sleep that they need. Addressing the problem could mean anything from improving “sleep hygiene” to cognitive therapy to medical interventions.

Photo by Cortney Casey

Everyone needs it. Most don’t get enough of it. And for those it eludes, it may become an obsession.

With the end of summer, students back in school and shorter days, people’s routines may be a little light on a valuable commodity: sleep.

Less than half of people get it in the quantity and quality their bodies need, said Dr. Gary Trock, and disorders minor and severe can hinder what should be an act that occurs effortlessly and in abundance.

“People should get at least seven hours — adults, at least,” said Trock, co-director of sleep evaluation services for Beaumont Hospital, Royal Oak.

Toddlers can sleep 12-14 hours, he added, while teens could use a rarely achieved eight to 10.

The ramifications may extend far deeper than crankiness, raccoon eyes and a propensity to swill coffee. According to the Centers for Disease Control and Prevention, insufficient sleep is associated with the onset of chronic problems such as diabetes, cardiovascular disease, obesity and depression, and it interferes with their treatment.

Insomnia — inability to fall or stay asleep — is most common among adults, said Trock. Many instances stem from poor “sleep hygiene,” as people begin to associate their bedroom with activities like text messaging, playing video games, watching TV and working, he explained.

“The bedroom should be a sanctity, just for sleep,” he said, “and then if you’re an adult, for sex.”

When counting sheep doesn’t cut it, insomniacs shouldn’t linger in bed, praying for unconsciousness. After 20-30 minutes of sleeplessness, leave the room and do something else until sleepiness strikes, said Trock.

“You should not lie in bed for hours, looking at the clock,” he said.

Some patients make a misguided attempt to head off insomnia by turning in early, thinking they’ll compensate for the hours it’ll take to fall asleep, but “that actually makes things worse,” said Dr. Joseph Mardelli, medical director for both the Mount Clemens Regional Health Center Sleep Medical Center and the Henry Ford Macomb Sleep Medicine Center. “Try to restrict your ‘bedtime’ to your ‘sleep time.’”

Trock advised avoiding heavy meals and exercise within two hours of bedtime, and ceasing consumption of caffeine, which remains in the bloodstream for 12 hours, by noon.

Alcohol may improve the ability to fall asleep, but can fragment the resulting rest. As it breaks down, it can suppress transition from the lower levels of sleep, N-1 and N-2, to the physically and mentally restorative stages, N-3 and rapid eye movement, explained Trock.

People who become convinced of their inability to sleep can get sucked into a vicious psychological cycle. Trock suggested cognitive behavioral therapy, “the best therapy over the long term for insomnia,” through a therapist or self-help recordings offering guided relaxation.

The intensity and causation of insomnia can vary with age.

Teenagers are “some of the worst offenders for sleep hygiene,” texting and playing video games in bed, said Trock. Hormonal changes also tend to trigger “delayed sleep phase syndrome” among teens — which is why it often seems they’d function better if they went to bed around 2-3 a.m. and slept until 10 a.m.-noon, he said, though, school schedules typically make that impossible.

Even infants can develop “behavioral insomnias,” spurred by doting parents who get in the habit of lulling them to sleep by holding and feeding them, he said.

“Children should be put to bed awake, with the parent leaving the room,” said Trock.

Sometimes, the problem stems from a more serious disorder. Eighty-five percent of people with sleep apnea — which collapses the upper airways, causing slow or shallow breathing — go undiagnosed, said Mardelli.

“The most common symptom with sleep apnea is loud snoring, which is usually noticed by the bed partner,” he said.

While apnea often is fodder for jokes, it can cause high blood pressure, heart attacks, strokes and dementia, said Trock, and the daytime fatigue it triggers can be deadly.

“Next to alcohol, the most common cause of fatal car accidents is sleepiness,” he said.

Apnea sufferers may be oblivious to their nighttime snoring or choking, but might notice morning headaches, dry mouth, loss of concentration and inability to function, said Mardelli.

Higher body mass indices (over 27 for men, 26 for women) and large neck circumferences (17 inches or more for men, 16 for women) are major risk factors, said Trock.

Treatments include Continuous Positive Airway Pressure machines, which administer pressure- and humidity-regulated air via a mask, and dental appliances that extend the tongue and jaw, creating space in the back of the throat, said Mardelli.

Restlesss leg syndrome — inherently harmless but causing sudden urges to move the legs — is another frequently occurring contributor to sleeplessness, especially among women and the elderly, he added.

In rare cases, narcolepsy could be to blame. Narcoleptics may still feel unrested after sleeping 15-16 hours, and while there’s no cure, there are treatments available, said Mardelli.

Some sleep-starved people attempt to self-medicate away their problems, but over-the-counter pills, “for the most part, promote the N-1 and N-2 sleep, which is not quality sleep; it’s a short-term solution,” said Trock. And Mardelli said scientific data on herbal remedies is scant.

Inability to sleep for two weeks, said Mardelli, probably merits a trip to the doctor.

Trock and Mardelli recommend a precursory trip to a primary care physician, though confirmation of sleep apnea and narcolepsy typically require visits to a sleep center. There, patients spend the night in hotel-like rooms while attached to electrodes that measure eye and leg movement, heart rates and breathing.

The CDC recommends keeping a “sleep diary” for 10 days prior to the doctor’s appointment, recording what time you get in bed, fall asleep, wake up and get out of bed; nap periods; exercise; and consumption of alcohol and caffeine.

For more information, visit www.cdc.gov/sleep.