Finding sleep for the weary: Once diagnosed, problems are treatable

For years, Janice O'Brien of New Fairfield woke up tired, but chalked it up to age and a stress-filled job. But after repeatedly being told she snored, waking up at 4 a.m. and not being able to get back to sleep, and the 30-minute naps she was taking on her days off, she decided it was time for a check-up.

Her doctor sent her to Stamford Hospital's Center for Sleep Medicine, and after a night hooked up to electrodes and wires, she found she had 84 sleep apnea episodes in one hour. "That news really scared me," O'Brien says.

"The effects of not sleeping can be devastating," says Dr. Steven Thau, associate director at Stamford Hospital's sleep center. "Lack of sleep affects all age groups, from pediatrics through geriatrics. If you are not sleeping, and it's been going on for more than a month, you know it's time to seek help."

The study of sleep began to take shape two decades ago as sleep disorders were identified, researchers started studying these problems, and doctors started embracing sleep as their specialty. And not a minute too soon, if you consider these statistics:

• The National Sleep Foundation's Sleep in America poll reports 60 percent of Americans have driven while sleepy; 37 percent admit they fell asleep at the wheel.

• The National Highway Traffic Safety Administration estimates drowsy driving results in 1,550 deaths, 71,000 injuries and more than 100,000 accidents annually.

• Lack of sleep contributes to hypertension, heart disease, stroke, poor performance in school and work, and sexual dysfunction.

We're talking real sleep disorders, the kind that no amount of soothing baths and calming teas will ever cure. Some people have no trouble falling asleep, but wake in the middle of the night and cannot fall back asleep. For others, it's the opposite: They can't fall asleep.

Dr. Jose Mendez, medical director at the Sleep Disorders Center at Danbury Hospital, explains that there are many reasons people don't sleep well, but the most common sleep disorders are sleep apnea, insomnia, narcolepsy, restless leg syndrome and parasomnias -- night terrors, nightmares, sleep walking, teeth grinding and bedwetting.

Sleep apnea: 18-million Americans are diagnosed with sleep apnea. There are two types: Obstructive sleep apnea, where breathing is briefly and repeatedly interrupted during sleep; and central sleep apnea, in which the brain doesn't control breathing during sleep. Snoring, although a symptom, does not necessarily mean sleep apnea. Other symptoms include obesity, sleeplessness, difficulty concentrating, depression, irritability, sexual dysfunction, learning and memory difficulties, and falling asleep at work or while driving. If not treated, it can lead to high blood pressure, heart attack, congestive heart failure, cardiac arrhythmia, stroke and depression -- not to mention increasing your risk of car crashes.

And yes, it's very common in post-menopausal women. Aren't wrinkles, thinning hair and belly fat enough of a burden?

"We don't really know why it's more common in post-menopausal women," Dr. Stasia Wieber, director of the Fairfield County Sleep Center in Fairfield, says of obstructive sleep apnea. "We think it has something to do with hormones and as you reach menopause your hormones look more like male hormones (because of the drop in estrogen and progesterone)." Male hormones, she adds, are thought to play a role in decreasing the muscle tone of the upper airway.

Thau continues: "In sleep apnea, the brain has to decide whether or not it wants to stay asleep or breathe. Fortunately, the brain decides to wake up to breathe, and once you start to breathe again, you fall back asleep. You keep doing that all night. I liken it to opening up the door of your dishwasher -- never allowing the dishwasher to go through the proper cycles and clean. With sleep apnea, you wake up feeling like a wet rag."

The most common treatment for sleep apnea is a continuous positive airway pressure (CPAP) machine. A mask fits over the nose and/or mouth, and the device gently blows air into the airway to help keep it open. After O'Brien's sleep apnea diagnosis four years ago, she was fitted for her CPAP, which she has worn every night except for three. "I sleep through the night, and never get up to go to the bathroom anymore. And no more naps. My job is still stressful, and there are days that I am tired, but I know the CPAP is helping my heart."

Today's CPAPs are smaller and quieter than past generations, producing a sound likened to white noise. "It's so much better than listening to someone snore," adds Laura DeFelice, coordinator at Stamford Hospital's sleep center.

Still, some patients are less than enthusiastic when told they need it, Wieber says, adding the most common issues concern the comfort and pressure of the facial mask, most of which can be addressed. And for the small percentage of patients who just can't adjust to sleeping with a CPAP, other options include oral appliances and surgical procedures.

Insomnia: According to Mendez, insomnia is treatable, and many patients are referred to psychologists or psychiatrists for behavioral therapy, stimulus control, cognitive therapy or relaxation training. Sleeping pills may also be prescribed.

"The older you are, the more likely you are to develop insomnia," Wieber says. "Women are more likely than men (to have it) and any life-stressor can be a trigger -- a death, a move, a wedding."

She warned against prolonged use of over-the-counter sleep medications, most of which use an antihistamine as the active ingredient. "So they're promoting the side-effect (drowsiness) of another drug and combining it with (ibuprofen), which can cause kidney problems, or (acetaminophen), which can cause liver problems."

Narcolepsy is a neurological disorder in which the brain cannot regulate sleep-wake cycles. Sufferers fall asleep suddenly, and have insomnia, dream-like hallucinations or cataplexy -- a quick loss of muscle tone triggered by an emotion, such as laughter or anger. Treatment is usually a combination of behavioral therapies, counseling and medication.

Restless leg syndrome: According to Thau, this is another common diagnosis, characterized by the urge to move your legs when they are at rest. NSF says 10 percent of adult Americans suffer from RLS. Mendez says there are a number of medications doctors can use to treat RLS, in addition to checking for anemia. "Iron deficiency can make it worse," he adds.

And although behavior modification can't always help, the NSF offers these steps to make their bedroom sleep friendly:

• Keep your bed for sleep and sex.

• Maintain regular bed and wake schedules seven days a week.

• Establish a bedtime routine: soak in a hot tub or read a book or listen to music -- just not in bed.

• Keep your room cool, quiet, dark and free of interruptions. Consider blackout shades, eye masks, ear plugs, white noise.

• Use a comfortable mattress and pillows.

• Finish eating and exercising three hours before bedtime.

• Avoid all caffeine for three to five hours before bedtime; some people need 12 hours for caffeine's effects to leave their system.

• Nicotine, a stimulant, can lead to poor sleep.

• Alcohol might make you fall asleep, but disrupts sleep.

"If you have had trouble sleeping for more than a few weeks, go see your primary doctor," Thau advises. "There's a lot of people not sleeping, especially when you consider that the sleeping pill industry is a $3-billion business. Get evaluated. Have a sleep study, which will diagnose your problem. Great sleep will give you your life back." HL

One woman's bedtime tale

My sleep has been horrid for decades, but nothing, I reasoned, that a calmer, less stressful life couldn't fix. When people suggested I have a sleep study done, I shrugged off the suggestion, partially because I always imagined a sleep clinic as a big, sterile room, lighted so patients could be observed, with bed after bed of sleeping giants tossing and turning, lulled to sleep by the nocturnal orchestra called snoring.

Recently, I checked myself into Stamford Hospital's Center for Sleep Medicine and soon learned how wrong I was about what was causing my sleep issues and the ambiance of a sleep center. I'm greeted by Registered Sleep Technician Meghann Peters, my guide for the night, who brings me to my large room, decorated in tones of bronze and green, with a private bath, oversized recliner, a TV, and one of the most comfortable queen-size beds I have ever slept in, thanks to a 2-inch memory foam mattress topper that Laura DeFelice, coordinator of the Sleep Center, bought for every room on Overstock.com. I also spot the hidden camera on the ceiling, a saucer-like dome that is Peters' eye into my private domain.

Unlike the other five patients sleeping in their private rooms that night, I am here to do a story, and am accompanied by a photographer. As Peters attaches almost 30 electrodes, belts and monitors to various parts of my body and the camera clicks away, I keep thinking of Katie Couric exposing her colon to the world; it's little comfort.

"Each one of these monitors performs a different function," Peters explains. She begins attaching tiny discs to my body, each with its own wire, which will record brain waves, face twitches, teeth grinding, leg and eye movement and heart activity. In addition, there's a nasal airflow sensor; chest and abdomen belts; a finger oximeter to measure blood oxygen; a video stream to record body positioning and movement; and finally, my favorite, the snore microphone. I want to cry. My snoring, in stereo! Is nothing sacred?

Forty-five minutes later, I look like a science experiment. And I'm tired. I've been up since 4 a.m., and it's time for sleep, which comes easily around 9:30 p.m. I did fine, until 1:12 a.m., when Peters comes in to adjust the dislodged nasal airflow sensor. I decide this is the perfect time for a bathroom break, normally a quick process, but not this night. Peters hooks my wires to a portable unit, which takes mere minutes but seems like hours, a process she repeats in reverse when I return to bed -- wide awake. I sleep on my side, but the loop around my ears that attaches the nasal airflow sensor is digging into my skull, forcing me to move from side to side ­-- not easy with all these wires. I keep expecting Peters to pop in again, wanting to reattach something else I have dislodged. That never happens, but neither does sleep. This is a perfect Lifetime movie night, but I don't want Peters to learn about that guilty pleasure. The TV remains dark.

At 6 a.m. I hit the shower, grab a cup of java to kick-start my body, and am ready to face the day ­-- exhausted as usual. Peters, ever the pro, is mum about my study, although she does reveal I snore. Nothing new here: My husband has been telling me this little tidbit for years.

A week later DeFelice calls with news I've actually been expecting: I have a mild case of sleep apnea and need a continuous positive airway pressure (CPAP) machine. Of the 8 hours, 24 minutes the lights were out, I slept 4 hours, 35 minutes. And I wonder why I am always tired? I'm half relieved/half scared.

Relieved, because my insomnia has a name. Scared, because it's disconcerting to know I stop breathing 12 times each hour. I'm also excited, thinking soon I will wake each morning feeling refreshed. What a concept.

And one more thing: Now that I have the diagnosis, and know that losing weight will only help my sleep apnea, I am more determined than ever to shed some pounds. This is more than a New Year's resolution. It's my life we're talking about, and I plan to be around for many years to come.