Common disorders can interfere with body getting essential rest

Tyrone Walker
The Post and Courier

Richard Bailey, who has a sleep disorder, is hooked up to electrodes connected to a computer that monitors his brain activity, breathing and heart after he falls asleep at Roper Hospital.

Whenever Richard Bailey sat still for more than 10 minutes, he dozed off. He caught only bits and pieces of his favorite TV shows. He worried about going to see a movie alone for fear he'd fall asleep and snore.

About five years ago, Bailey participated in a sleep study and learned that he woke up more than 40 times an hour because of a condition called sleep apnea.

The common sleep disorder occurs when people's breathing is interrupted, forcing them to wake up and denying them the restorative benefits of deep sleep.

The Goose Creek resident got a breathing device called a BiPAP that keeps his airway open at night. That helped for a while, but the daytime nodding off started again. So he returned to the Roper St. Francis Sleep Wake Disorder Center to fine-tune the machine's settings.

Bailey is one of the 40 million Americans who suffer from more than 70 different sleep disorders, according to National Sleep Foundation surveys.

Other typical sleep disorders include insomnia and restless leg syndrome, a condition causing prickling or tingling in the legs and feet that is relieved by moving. Narcolepsy, a hereditary condition marked by uncontrollable sleepiness during waking hours, also is common.

Sleep is a vital human need required for survival. Rats deprived of sleep will die in about two to three weeks, the same time it takes to starve to death, according to a study reported by the National Institutes of Neurological Disorders and Stroke.

"Sleep is indispensable for all mammals, including human beings," said Dr. Shyam Yallapragada, a pulmonologist and sleep disorders specialist affiliated with Trident Health System.

Most people know missing a few hours of sleep can affect mental acuity and judgment. Up to 60 percent of adults report sleep problems a few nights a week or more.

If people go for long periods without restful sleep, mood swings and hallucinations can occur. Sex drive is affected. Mental disorders such as depression, anxiety and mania all may be exacerbated.

Psychiatrist Steven Lopez, medical director for Palmetto Behavioral Health, starts sessions by asking about sleep and appetite. Nearly all people with mental disorders experience sleep problems, Lopez said.

Sometimes, the reverse is true. Trouble sleeping can create symptoms resembling a mental disorder. Lopez recalled one child he met who was diagnosed with attention-deficit hyperactivity disorder. Lopez asked the boy's mother about medication and sleep problems.

His mother said he had trouble sleeping before he started any medication. Lopez prescribed a sleep regimen, and the symptoms resolved. "It's part of doing a really thorough psychiatric evaluation," he said.

On the physical side, heart disease and hypertension are connected with sleep problems. This month, a U.S. research team reported a link between disturbed sleep and diabetes.

It's no surprise, then, that area sleep clinics are keeping busy.

Dr. William T. Dawson Jr., director of the Roper St. Francis Sleep Wake Disorder Center, said demand for the six-bed clinic is high, which is in line with the national trend. Demand for evaluation and services in sleep medicine is going up 10 percent to 20 percent annually, he said.

East Cooper Regional Medical Center's Sleep Disorder Center moved into a new building on the hospital campus about a year ago. Clinic coordinator Jennifer McKenzie also has seen a rise in demand over the past two years.

"As the public becomes more aware that sleep disorders cause many types of serious health problems, the demand for sleep has risen," she said.

The Medical University of South Carolina has an eight-bed clinic, and Trident Health System has six beds. Clinics independent of hospitals also exist.

The high prevalence of sleep apnea is one factor driving demand. "The whole obesity epidemic is increasing poor sleep quality," Dawson said.

Obesity is the best documented risk factor for obstructive sleep apnea, according to the academic health journal UpToDate. During sleep, a person's effort to breathe creates a suction effect and collapses the windpipe.

Air flow is blocked for a few seconds or up to a minute, until the brain wakes up the sleeper enough to open the windpipe. Snoring interrupted by snorts or gasps is associated with apnea.

Anoter type of apnea can occur when brain function controlling breathing malfunctions.

Bailey's recent sleep study revealed the apnea was back with a vengeance, waking him more than 80 times an hour. By manipulating his BiPAP settings, his apnea slowed to about 12 awakenings an hour, an above-normal frequency but one that satisfied his doctor.

A restful night's sleep could help him cut the caffeine from his diet, a move that would please his cardiologist. Being wakeful also may bring him out into the world a little more.

After his wife died two years ago from ovarian cancer, his returning apnea became isolating. "I live by myself," he said. "Now, I don't do things because I don't have her there. Now, I have no elbower."

Most common sleep disorders

--Sleep apnea: Obstructive sleep apnea is the most common and frequently occurring sleep disorder. It is more common in men than in women. Sleep apnea is a medical term for frequent and prolonged episodes when breathing stops during sleep, resulting in disturbed sleep.

--Narcolepsy: An inherited disease associated with periods of uncontrollable sleepiness during waking hours, often beginning in young adulthood. Other signs and symptoms include vivid nightmares, sudden loss of muscle tone and momentary paralysis upon awakening.

--Restless leg syndrome: Sudden jerking of the legs during sleep. Frequent awakenings can result in a complaint of excessive daytime sleepiness or insomnia. Patients also may complain of a crawling or restless sensation in the legs.

--Insomnia: Difficulty in initiating or maintaining sleep may result from a variety of disorders. Drug usage, including prescription drugs, alcohol use and ill- ness may be causes of insomnia.

Good sleep habits

1. Set up a relaxing bedtime routine, such as reading a book or listening to music.

2. Go to bed when you are sleepy. If you are unable to sleep after 15 to 20 minutes, get up and do something else, such as reading. Then when you feel sleepy, go back to bed. Repeat the procedure if needed. Don't watch the clock.

3. Avoid worrying, thinking or planning in bed. Such mental activity makes sleeping difficult. It may be helpful to write down your problems before going to bed.

4. Maintain a regular bedtime and rise time, even on the weekends.

5. Keep naps to 20-30 minutes per day and no later than 3 p.m.

6. Arrange a good sleeping environment:

--Use the bed for sleeping only (no paperwork).

--Control noise with ear plugs, white noise, heavy curtains or relaxing music.

--Keep the room dark and cool.

--Use a good mattress and comfortable pillows.

7. Exercise daily. Exercising in the late afternoon helps promote deeper sleep. Exercising raises body temperature and is associated with a drop in body temperature about five to six hours later, which helps prompt sleep. Avoid exercising too close to bedtime.

8. Consume less or avoid caffeine. Avoid nicotine. Don't eat a heavy meal before bedtime.

9. Alcohol can make you fall asleep faster, but you may wake up more often during the night. Limit consumption, and avoid using at least several hours before bedtime.

Reach Jill Coley at 937-5719 or jcoley@postndcourier.com.

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