Can’t Sleep?

Quality of Zzzzs, not just quantity, essential to overall health

Written by Anthony Panettiere, M.D.

It seems there isn’t enough time in a day to complete the never-ending checklist. At this pace, feeling tired can become part of your regular routine. But what if there’s something more serious making you so tired? An estimated 15 percent, or one in six, Americans suffer from sleep disorders.

Defining exactly what constitutes a sleep disorder is difficult because there are so many different types and each disorder carries its own set of symptoms. The most common sleep disorder is obstructive sleep apnea; other frequently treated conditions are narcolepsy, insomnia and periodic limb movement disorder.

Q. What are the signs of a sleep disorder?
A. While everyone experiences bouts of fatigue, people with some sleep disorders may feel exceptionally tired even after eight hours of sleep. The key to understanding sleep disorders is realizing that the quality of your sleep is just as important as the quantity. If you are getting quality sleep, you should feel refreshed and fully awake after a full night’s rest.

Q. Are there risk factors?
A. Men experience sleep disorders more often than women. Anatomical factors also contribute to increased risk, such as having a large neck or a small airway. If you are over 60 years of age, overweight or have a family history of sleep disorders, you may be more likely to develop a disorder. Because of the link between the conditions, anyone who has had a heart attack or stroke should be considered for a sleep apnea evaluation.

Q. How are sleep disorders diagnosed?
A. If you think you may be suffering from a sleep disorder, a sleep medicine physician can help provide a definitive diagnosis. But you’ll want to be prepared to answer his or her questions. Before your appointment, have someone observe your sleep patterns. Ask a spouse or friend to note whether or not you snore, stop breathing or do anything else while sleeping that seems unusual. Your spouse may be thrilled at the chance to help get your disorder treated—snoring spouses cost their partners 90 minutes of sleep a night!

Sleep disorders are diagnosed using full medical and family histories, a physical examination and, if recommended, a sleep study.

Q. What happens during a sleep study?
A. Sleep studies take place in a lab, which is more like a hotel room designed for you to feel as comfortable as possible. You will arrive at the study between 8 and 9 p.m., and your sleep technician will help you fall into a deep sleep for the night. You will be wired to machines, but the wires are lightweight and most patients don’t notice them.  You will spend the night alone in your room; trained specialists will monitor your sleep patterns throughout the night. Nothing about a sleep study is painful. Your study concludes at 6:30 a.m. the following morning. The results of your study are used to determine the best treatment option for you.

Q. What treatments are available?
A. Treatment of sleep disorders depends on the type and severity of the disorder. Many sleep disorders can be treated with behavior modification, such as losing weight, exercising regularly and avoiding certain foods or drinks. Beyond lifestyle changes, a second treatment option is CPAP, or continuous positive airway pressure. This treatment is applied using a quiet machine that expands the airway. (A narrow airway decreases the amount of oxygen to the brain, preventing deep sleep.) There are also several surgical options to treat sleep disorders, including tonsil removal and uvula modification. Oral appliances may also be recommended to increase the size of the airway by bringing the lower jaw forward.

It’s important to recognize the distinction between feeling tired due to a sleep disorder and feeling tired due to an inadequate amount of sleep. To know how much sleep you require to feel well rested, keep track of your sleep patterns the next time you have several days without a predetermined waking time. When you don’t need to set an alarm, record how many hours of sleep you get before waking up. After four to five days, you should have a good gauge how much sleep you need for optimal wellness. And, as a general rule, waking up before your alarm clock is an indication that you are getting enough sleep.

______________________________________________________________________________________
Anthony Panettiere, M.D., is a neurologist and sleep medicine physician with Riverside’s Hampton Roads Neurology & Sleep Disorders Clinic.