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- Written by Jeffrey B. Roth Jeffrey B. Roth
In Tigers and Traitors, Jules Verne wrote: “Though sleep is called our best friend, it is a friend who often keeps us waiting!”
Verne was expressing a common human problem: lack of quality sleep.
“We’re in the midst of a global sleep crisis,” Dr. Rachel Salas, a sleep neurologist and associate professor at Johns Hopkins Medicine, said.
“The National Sleep Foundation notes that 80 million Americans suffer from poor-quality sleep; 60 million experience chronic poor sleep; and a bit more than 40 million actually meet the diagnostic criteria for sleep disorders.
“There are actually over 80 different types of sleep disorders, and the cost of poor-quality sleep is $80 billion a year—in accidents caused by people who fall asleep while driving or from missed work and poor productivity.”
At least 50 percent of individuals 65 and older meet the diagnostic criteria for sleep disorders but are undiagnosed and untreated, Salas added. The negative impact of poor-quality sleep spans many domains of healthcare. Individuals who have been diagnosed with sleep disorders—such as sleep apnea, which involves breathing problems while sleeping—are at a higher risk for strokes and heart attacks, as well as other arrhythmias of the heart.
Men with sleep apnea may experience erectile dysfunction. Lack of quality sleep may contribute to acid reflux disease, diabetes, and high blood pressure.
People suffering sleep apnea are five times more likely to be involved in auto accidents, Salas noted.
“What happens is people have what we call micro-sleep, where your brain can fall asleep for one to two seconds,” Salas said. “If you’re driving on the highways, traveling at 70 miles per hour, you can see it can definitely make the difference between life and death.
“Poor-quality sleep ... can affect your mood. You can be more irritable. Things bother you more than they should. It can make you look older, and it can make you gain weight.”
Individuals with poor-quality sleep break down sugar and store fat differently, Salas said. Even if the individual is eating right and exercising, it’s going to be harder to lose that weight.
Research has shown the typical American sleep environment is not conducive for quality sleeping. Environmental factors can negatively affect the body’s circadian rhythm—the internal clock that controls when to sleep and when to be awake.
“In our society, we have really become 24/7,” Salas said. “The human brain was not meant to see light (at night) in the blue and green domains, which we could see earlier in the day.
“We’re getting a lot of that stimulation now from LED lighting from all of our electronic use, and it’s having a negative impact on our sleep-wake schedules and our behavior patterns.”
Surprisingly, even if individuals are getting enough sleep, if it’s not in line with the body’s internal clock, they may act like a sleep-deprived person. Consistent sleep is more important than quantity of sleep.
“Many Americans are going to bed at different times of night and waking up at different times,” Salas said. “In some cases, people are not getting any exposure to the sun. The result is that their biological clocks are out of whack.
“Truthfully, many Americans are falling asleep at night simply because they are exhausted. Another process that is as important as the circadian rhythm is the homeostatic or sleep drive.”
For the average person who gets enough sleep, there is no need to take a daytime nap. Around 11 p.m. is when the circadian rhythm and homeostatic drive converge, providing the highest opportunity of falling asleep, Salas said.
During sleep paralysis, a common sleep problem, the body is not smoothly experiencing the stages of sleep. Sleep paralysis often involves the feeling of being awake but being unable to move or to speak, Salas said.
Narcolepsy is a chronic brain dysfunction characterized by sleep paralysis, excessive sleepiness, and hallucinations.
Older people have a higher risk for sleep disorders caused by everything from medical conditions, such as arthritis, to breathing problems and restless leg syndrome.
About one in 10 adults suffer from restless legs syndrome, or RLS, a neurological disorder characterized by throbbing, crawling, and other unpleasant sensations in the legs and an uncontrollable, overwhelming urge to move the legs, according to the National Sleep Foundation.
Madison Madore, a neurological physician’s assistant at the PinnacleHealth Sleep Center in Harrisburg, said patients with sleep problems first go through an extensive interview process. The interview includes an entire sleep history to quantify the patient’s sleepiness—how long it has occurred and whether there are any triggers.
“My supervising physician, Dr. Francis J. Janton III, did his fellowship in sleep medicine,” Madore said. “We see sleep complaints ranging from sleep apnea, insomnia, narcolepsy, restless legs syndrome, and periodic limb movement disorder to other parasomnia.”
Depending on the results of the sleep history, a sleep study at the center or at the patient’s home may be ordered. Once a diagnosis is reached, a treatment plan is initiated. Similar treatments are prescribed for various sleep disorders.
Iron levels are also checked, Madore said. A low iron score can contribute to symptoms.
“After that, then there are a handful of medications we can use,” Madore said. “The first category of medicine we reach for is the dopamine agonist—Requip® (ropinirole), Mirapex® (pramipexole), or a patch called the Neupro® patch …
“The last-line therapy is narcotics like hydrocodone or Vicodin. They work really well with restless legs, but a lot of times, [patients] are [leery] about being on regular narcotics.”
RLS affects more females over 50 than males over 50, Madore said.
For more complex sleep disorders, individuals should consult a neurologist who specializes in sleep disorders.