Escape the sleepless trap

By Peggy O'Farrell
Gannett News Service

Fatigue can take a heavy toll, but life changes and treatment can help. Gannett News Service

Or make that four hours, 20 minutes.

Americans are tired, and our growing national sleep debt contributes to errors at work and on the road: The National Highway Traffic Safety Administration estimates that driver fatigue contributes to 1,550 traffic fatalities, 71,000 injuries and 100,000 police-reported crashes a year.

But experts have restful news: For many of us, medical treatment and lifestyle changes will do the trick.

Most patients who see sleep specialists either suffer from sleep apnea or insomnia, says Dr. Steven Scheer, medical director of the St. Luke Sleep Disorders Center in Cincinnati.

Sleep apnea occurs when something interrupts breathing during the sleep cycle. When the blood oxygen level drops low enough, the brain causes the patient to wake up briefly.

For some patients, apnea is neurologically based. For most, the airway is physically blocked. This is often caused by the person being overweight. In some cases, enlarged tonsils or blockages of the sinus cavities can also interfere with the airway.

A continuous positive airway pressure machine, which feeds air into the airway via a mask, can help. Some patients might require surgery to correct apnea. Others rely on dental appliances that realign the jaw or tongue, allowing the airway to remain open.

Insomnia can be trickier to treat than sleep apnea. Prescription and over-the-counter medications usually work well for short-term bouts of insomnia. But the chronically sleepless need to re-educate themselves on how to fall asleep.

Many of us fall into the trap of what sleep specialist Dr. Victoria Surdulescu, director of the University of Cincinnati's Center for Sleep Medicine, calls "psycho physiological insomnia."

It's what happens when, at bedtime, we start reliving today's disasters and anticipating tomorrow's crises instead of sliding into restful slumber.

Eventually, the subconscious learns that, once the lights go out, it's time to worry, not sleep, and the conscious brain starts staring at the clock radio.

"I tell patients, use the bedroom for sleep and sex and nothing else," she says. Read, watch TV, write in your journal and stew about work or family someplace else.

Dr. Virgil Wooten, a sleep medicine specialist and medical director of sleep and alertness centers in the Midwest, calls sleep deprivation "a fairly big societal problem."

A 2000 survey by the National Sleep Foundation found that 43 percent of respondents reported that daytime sleepiness interfered with their normal daytime activities, including work.

For many of us, sleep is expendable. Because there are only 24 hours in the day, the easiest way to squeeze in more activity is to trim the number of hours allotted for sleep. But over the long haul, not getting enough sleep takes a serious toll. It's been linked to high blood pressure, heart disease, suppressed immune systems and depression. Recent studies implicate sleep deprivation in diabetes.

And it's almost impossible to make up for lost sack time, Wooten says. "Undersleeping during the week and trying to sleep in on the weekend has not been shown to fully rest people. A recent study showed that people were still pathologically sleepy and sleep deprived after the weekend when they thought they had caught up with their sleep."

Tips on getting enough sleep: Get plenty of exercise, relax

Here are the National Sleep Foundation's top tips for paying off your sleep debt.

• Keep a regular sleep schedule. Get up and go to bed at the same time every day.
• Avoid caffeine.
• Avoid nicotine.
• Don't eat or drink too much close to bedtime.
• Exercise at least three hours before bedtime to promote healthy sleep.
• Use relaxing bedtime rituals, such as a bubble bath, massage or reading, to promote sleep.
• Make sure your bedroom invites sleep. It should be cool, quiet, dark and comfortable. Use earplugs or "white noise" machines to block out noise. Masks and window coverings can block out excess light.
• Associate the bed with sleep and sex only. Don't watch TV, read or pay bills there.
• Limit sleepless time in bed. If you lie awake for more than 10 to 20 minutes, get up and try a relaxing activity, such as reading. Get back in bed when you feel sleepy again.

What disrupts your sleep?

The usual suspects include:

• Psychological factors: Work and family stress, depression and grief.
• Lifestyle issues: Caffeine, exercise or mental stimulation too close to bedtime.
• Shift work: Constantly switching from day to night shift throws off the body's circadian rhythms, disrupting the natural sleep cycle.
• Jet lag.
• Environmental factors: A bedroom that's too bright, cold, hot or noisy disrupts the sleep cycle. So do interruptions from children and other family members, not to mention sleeping next to someone who snores or tosses and turns.
• Physical factors: Arthritis and other diseases that cause chronic pain or discomfort can disrupt sleep. So can hormonal changes associated with menopause and menstruation.
• Medications: Decongestants, steroids and medications for high blood pressure, asthma and depression can cause sleeplessness.

When to get help

If sleep problems last more than a week or if sleepiness during the day interferes with work, driving or other activities, it might be time to talk to your doctor.

• Some experts recommend keeping a sleep journal for 10 days to record problems and help the doctor diagnose your problem.
• If falling asleep or staying asleep is the issue, the doctor might recommend lifestyle changes, such as giving up caffeine or establishing a regular bedtime and wakeup schedule.
• If sleep apnea or another disorder is suspected, the doctor might order a sleep study. A technician will observe you while you sleep, and your heart rate, respiration and neurological activity will be monitored.

Sleep disorders

• Sleep apnea: The disruption of breathing during the sleep cycle, leading to continued awakenings throughout the night — sometimes as many as 60 times an hour.
• Insomnia: The inability to fall asleep or stay asleep.
• Narcolepsy: The inability to stay awake. "Sleep attacks" might last 30 minutes and can occur at any time.
• Restless-legs syndrome: A need to move the legs to relieve feelings of restlessness, tingling or pain.
• Periodic movement during sleep: Twitching or jerking of the limbs (usually the legs or feet) during sleep.

Sources: National Sleep Foundation; The National Institutes of Health; Sleepnet.com