Are you tired, run-down, listless? The answer to your problem is probably not in a little brown bottle. It could be as simple as a good night’s sleep. But for 45 million Americans, that’s an elusive dream. Even worse, sleep deprivation, insomnia and untreated disorders such as sleep apnea are leading Americans down a slippery slope to early mortality, increasing their risk for obesity, stroke, hypertension, diabetes and cardiovascular problems. And that’s not even counting the danger of falling asleep at the wheel.
“As a society, it’s a safe assumption that we are chronically sleep-deprived,” says Emerson Wickwire, a behavioral sleep medicine specialist and co-director of the Center for Sleep Disorders at Pulmonary Disease and Critical Care Associates in Columbia. The center opened two years ago and offers diagnostics and treatment. It’s one of the few places in the region that offers cognitive behavioral therapy to treat insomnia. Johns Hopkins Hospital is another.
In Maryland, 28 percent of adults reported not getting sufficient sleep for 14 days during a 30-day period in 2008-2009, according to a report from the Centers for Disease Control and Prevention. Thirty percent were women, 26 percent men. The highest concentration occurred in the Baltimore-Washington corridor and westward. The lowest percentage reporting sleep insufficiency was on the Eastern Shore.
It’s not just adults having trouble with sleeping. Statistics show that more than two million children in the United States suffer from sleep disorders and that an estimated 30 percent to 40 percent of children do not sleep enough.
“It’s a public health epidemic,” says Wickwire.
Why is sleep so powerful, and how are Americans sabotaging their overall quality of life with shorter nights in the sack?
“Sleep is the missing link between diet and exercise,” says Wickwire. “There’s nothing that we do that we can’t do better after a good night’s sleep.”
When we sleep, our bodies slow down and cool down. The heart rate slows in a rhythmic disengaging from our active day, intended to mirror the natural circadian rhythms of the earth -- dawn to day to dusk to night. During sleep, the body goes through 100-minute cycles of levels of sleep; the deepest occurs the earliest, in the first third of the sleep. During this time, the body physically restores itself, including muscle growth and hair growth. As sleep gets shallower throughout the night, the body enters into a cycle known as Rapid Eye Movement (REM). This is when the muscles are paralyzed but the sleep is shallow. We dream in REM because this is when the body goes through cognitive restoration, processing emotions and memories, storing or discarding them. The longest period of REM occurs at the end of sleep. This is why we remember our dreams so vividly.
If the body is deprived of either one of these cycles, the result is not just physical impairment but cognitive and emotional impairment as well. In short, a person is tired, moody, lacks judgment and patience and can’t concentrate. Worse, the body can’t make up for sleep loss, either. Sleep debt occurs and is banked every time we lose sleep in a 24-hour period, according to the National Sleep Foundation, an organization dedicated to educating and advocating for better sleep.
“One night of sleep loss is the same as driving over the legal limit,” says Susheel Patil, clinical director of The Johns Hopkins Sleep Medicine Program in Baltimore. Three thousand patients sought help from JHU’s sleep center last year; 1,500 of them were new patients. JHU had one of the first sleep labs in the country, founded in the late 1970s.
For a small percentage of people, about 1 percent of Americans, sleep isn’t about habits, or stress, or being parents of a newborn baby. Conditions like sleep apnea (interrupted breathing during sleep), narcolepsy (uncontrolled sleep attacks) and idiopathic hypersomnia (requiring an inordinate amount of sleep, perhaps 13 to 15 hours a day, to function) are physiological problems and have specific treatments involving medication and equipment to aid in breathing and sleeping. But that’s not where the majority of Americans fall.
“We sacrifice our sleep so we can do more, especially as we move into a 24/7 society,” says Patil.
Conversely, having chronic insomnia is considered a personal failure by some, leading to embarrassment or job loss, such as in the case of a commercial driver needing to renew his or her license every two years or repeated tardiness to work.
Whether sleeplessness is a physiological problem or the result of years of stress, anxiety or just poor sleep habits, there is help.
A 37-year-old engineer living in Carroll County, James started suffering from insomnia four years ago. That’s when several family members were ill and the stress took its toll on him.
“My brain just went into overdrive thinking of all the things that could go wrong,” he says. He had trouble falling asleep and staying asleep. At its worst, he was getting only two to three hours of sleep each night. He tried several medications but wasn’t satisfied.
“I used to dread going to sleep,” he says.
Two years ago he decided to try cognitive behavioral therapy with Wickwire. After a sleep study showed no physiological problems, like apnea, James began seeing Wickwire once a week. Together they discussed James’ sleep routine, his personal history and diet. James had to keep a journal.
“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.
Tips for Sleeping Smart
- Establish regular bed and wake times.
- Avoid nicotine altogether, and avoid caffeine close to bedtime.
- Avoid alcohol.
- Exercise regularly (but complete the workout at least 3 hours before bedtime).
- Establish a consistent relaxing “wind-down” bedtime routine.
- Create a sleep-conducive environment that is dark, quiet and comfortable.
- Discuss the appropriate way to take any sleep aid with a health-care professional.
Where you can get help
The Center for Sleep Disorders at Pulmonary Disease and Critical Care Associates,
Howard County General Hospital’s Sleep Disorder Center, 800-937-5337, www.hcgh.org
Johns Hopkins University’s Sleep Medicine Program, 443-287-3313, www.hopkinsmedicine.org
The Sleep Center at Franklin Square Hospital, 443-777-8382, www.franklinsquare.org
Sleep Medicine Services at Laurel Regional Hospital, 301-251-5905, www.dimensionshealth.org
According to the National Sleep Foundation’s Sleep in America poll:
60% of Americans have driven while feeling sleepy, and 37% admit to falling asleep at the wheel in the past year.
48% of Americans don’t talk to doctors about sleep problems because they’re afraid of sleep aids.
60% don’t think their sleep problems are serious.
40% don’t think they have a sleep problem.