“He’d plant a seed and then I’d go home and consider it. He was encouraging,” says James. “It’s kind of like having a mentor. If you figure out how to do it yourself, you own it.”
James cut down caffeine and alcohol consumption in the evening. He must turn the TV off one hour before bedtime. Together they decided on consistent bedtime and wakeup times for James. If he decides to stay up past his bedtime, he still must keep waking up at the usual time. He also started going to church, which was his idea. After a year of therapy with Wickwire, James says he’s decreased his sleep medicine from 150 milligrams to 25 milligrams.
“It’s a weight off my shoulders. I’m a lot less anxious. I’m happier and more optimistic,” says James.
Cognitive behavioral therapy is considered the best practice for insomnia, according to the American Academy of Sleep Medicine.
“No pill is going to train your body to fall asleep,” says Wickwire.
Sylvia, 72, struggled with insomnia for 40 years before seeking help. She was only getting four hours of sleep a night, sometimes less. She justified it as the result of many years of stress, from divorce, emigrating from another country, raising children and long hours on the job.
After retiring as a technical adviser five years ago, the Columbia resident took stock of her chronic insomnia. She was getting regular exercise and had tried all kinds of over-the-counter sleep aids without success.
“I had reached my limit of physical endurance,” says Sylvia, and asked her general practitioner to refer her to a sleep specialist. It took different approaches to find the right sleep recipe for Sylvia and required some changes in her habits. She had to give up reading in bed. She’s increased her sleep time by two hours each night and does not need any medication to sleep.
“I enjoy life more,” she says. “I know now, more or less, that I can control this.”
Kate, 41, is a busy working mom with three children. A smoker and overweight, she knows she snores.
She lost about 50 pounds two years ago and hoped it would help with her snoring. She doesn’t have any trouble falling asleep and sleeps through the night without interruption. Still, she’s exhausted when she wakes up every morning.
“No matter how long I sleep, I feel like I haven’t slept at all. Occasionally, the exhaustion is so profound I feel that I could fall asleep while driving,” she says. A Columbia resident, Kate commutes 90 minutes each way to work and has relied on cigarettes to keep her alert while on the road. She’s trying to quit smoking; instead she chews gum and sings to the radio while driving. She says she’s also trying to eat better and go to bed earlier. But her exhaustion persists.
She has two relatives with restless leg syndrome who rely on prescription medicine to sleep. But she doesn’t think that’s what she has. Her doctor referred her to a sleep study, which she did, and she is waiting for the results.
“Snoring in all cases is abnormal,” says Timothy Lady, administrator for the Sleep Disorders Center at Howard County General Hospital. “The most prevalent problem in sleep is insomnia, but it’s not the primary reason for a sleep study,” he says. The primary reasons, he says, are snoring, gasping or stopping breathing, leg kicks and cramping, inappropriate napping and excessive daytime tiredness.
The center at HCGH was the first nonacademic sleep center in the state, says Lady. The facility has six hotellike rooms and offers clinical, diagnostic and treatment services. It also has the only pediatric sleep specialist in Howard County, Laura Sterni, on staff. The majority of the sleep studies conducted there are polysomnograms (PSGs), which measure brain and eye activity, breathing, oxygenation and limb movements; Continual Positive Airway Pressure (CPAP) Titration to determine how much pressure it takes to treat sleep apnea; and Multiple Sleep Latency Test, which tests excessive daytime sleepiness.
Patil says that sleep problems are an increasing trend in America. “It’s time to take stock from a societal safety issue and from a personal health issue that we start to take this seriously.”
“Still, the bottom line is what kind of patient are you,” says Patil. “Do you believe in a quick fix, or are you willing to make behavior modifications? It takes work.”
Editor’s note: The names of patients in this story were changed to protect their privacy.