Getting Some Z's

Staff Writer
Columbus CEO

Some people look at sleep as a luxury, or as an unwelcome interruption in the busyness of life. But in truth, sleep is a vital part of life that allows our bodies and brains to restore themselves.

There are a host of serious sleep disorders ranging from sleepwalking and sleep talking to insomnia to narcolepsy, victims of which can fall asleep at any instant. Doctors say the most common problem by far is sleep apnea, in which the sleeper is awakened for just a few seconds many times each night, which means the brain is never allowed to get enough deep, restorative sleep. The brief arousals happen when the brain sends a signal to the body that there isn't enough oxygen getting through, generally because the tongue has slipped too far backward and is blocking airflow.

Dr. James Metz, a diplomate of the American Board of Dental Sleep Medicine, treats obstructive sleep apnea in his dental practice. He says treating apnea can mean the difference between a full life and an early death. "If you are diagnosed and you are severe-which a lot of people are-the probability that you will live another 18 years is 57 percent," he says. "If you do not have apnea or your apnea is properly treated, your chance of living another 18 years is 96 percent."

As a dentist, Metz does not perform soft tissue surgeries or prescribe machines to improve airflow during sleep. Instead, he uses customized dental appliances to reposition the jaw and keep a patient's airway open. "There are lots of devices available on the Internet that will treat snoring, but that doesn't necessarily relieve the apnea," he says. "Getting rid of the noise doesn't solve the real problem."

Sleep apnea can cause a host of serious medical conditions. Metz says 57 percent of all stroke victims have apnea. According to the Wisconsin Sleep Cohort Study, now in its 21st year, 83 percent of apnea patients have drug-resistant high blood pressure, 50 percent have diabetes and 77 percent are obese. Apnea is often exacerbated by weight gain, but poor sleep makes the problem worse, creating a spiral of deteriorating health.

"Another factor that grabs men in particular is that apnea causes erectile dysfunction," Metz says. The impact of apnea on overall health and even emotional well-being is enormous. At least one in five adults over the age of 40 suffers from apnea, and many have gone undiagnosed, experts say.

Even children may suffer from sleep apnea. Many children who have been diagnosed with attention-deficit/hyperactivity disorder, or ADHD, also have sleep apnea, often due to enlarged tonsils. Because they are waking during the night, they aren't getting sufficient stage three sleep, and that contributes to hyperactivity, Metz says.

"If you hear heavy breathing from your kid while he sleeps, see a doctor," Metz says. Many children who suck their thumbs do so to reposition their jaw and keep their airways open; fixing the apnea can prevent costly orthodontist bills later.

Dr. Markus Schmidt, medical director of the Ohio Sleep Medicine Institute, says sleep apnea occurs in 9 percent of the general population and rises to 25 percent in individuals over the age of 65. "It gets worse with age," he says.

Doctors-even those not in the sleep medicine field-are becoming more aware of the connection between sleep disorders and other serious health problems. Still, many sufferers fail to follow their doctor's advice. "Apnea will take five to seven years off your life if untreated," Metz says. He shows patients a slideshow of several years of holidays, gatherings and other experiences from his own life to illustrate what they could be missing. "I ask my patients how much they like their grandkids," he says. A personal illustration generally gets the point across that any inconvenience is worth the prize of more time with loved ones.

Obstructive sleep apnea can be treated with a dental appliance or with a continuous positive airway pressure (CPAP) machine, the gold standard in apnea treatment. The device blows pressurized air through a facemask; a variety of mask types can be used to provide maximum comfort for the wearer. The mask is tethered by hoses to a small module that can sit on a bedside table. A dental appliance (a thin, strong mouth guard) holds the teeth firmly and moves the lower jaw (and therefore the tongue) forward to allow air to pass. "It takes two to three weeks to get used to them, but after that, you couldn't buy them back from the patients," Metz says.

Quality of Life

Sleep deprivation affects not only physical health, but also enjoyment of everyday life.

According to a 2008 study by the National Sleep Foundation, 36 percent of people in the general population have reported driving drowsy or falling asleep while driving; 29 percent have fallen asleep at work; 20 percent have lost interest in sex; and 14 percent missed family or work events due to sleepiness.

Dr. Aneesa Das, a board-certified sleep medicine physician with Ohio State University Wexner Medical Center, says many people are unaware they have a problem, in spite of the fact that their spouses have said they snore or stop breathing during the night. "The majority of people do not awaken to the point of cognition," she says.

Schmidt agrees. "People may say they are aware of waking three or four times a night, but when a sleep study is done, it shows they are waking three or four hundred times a night," he says. "There is a major disconnect there."

Following treatment, many patients are surprised to find that they didn't feel as good as they thought they did. "It's like they had been that way for so long, their lives had hit a new plateau," Das says. "They didn't realize what life could be like."

Marsha Parmiter suffered for years from some type of health problem that doctors couldn't pinpoint. Her husband, Steve, had been diagnosed with sleep apnea; he was prescribed a CPAP machine after he fell asleep while driving and narrowly escaped being in a serious automobile accident. Parmiter had given up her work as a nurse due to poor health, chronic pain, tingling fingers and terrible fatigue, but three sleep studies showed no clear signs of sleep apnea.

"I was on oxygen, but it was like putting a Band-Aid on a break," she says. "When I breathed in, I was getting some oxygen, but that didn't keep me from not breathing."

After 13 years of worsening health and waking up at night gasping for air at her bedroom window, she attended a routine appointment with her husband at Schmidt's offices. She told Schmidt her symptoms and he found sleep apnea where others had not. Parmiter was prescribed a bilevel positive airway pressure machine (BiPAP), which assists the sleeper with both inhaling and exhaling. She says the diagnosis and device have changed her life.

Her chronic fatigue, depression, insomnia and fibromyalgia symptoms have disappeared. She has returned to work and to a normal life as a wife, mother of nine and health-care professional. "Every aspect of my life is better," she says. "I use my BiPAP every night, and I don't even notice it anymore."

Schmidt says a comprehensive approach to treating sleep apnea patients is necessary, since patients often have several sleep disorders wrapped up in one. Often, patients experience restless leg syndrome as an associated symptom with apnea, and all the tossing and turning makes them hesitant to tether themselves to a machine. About 25 percent of people over age 65 have restless legs, Schmidt says. Sometimes when the apnea is treated, the associated problems clear up on their own. Other times, doctors prescribe drugs to help alleviate the symptoms.

Assessing the Problem

Jim Kissell, chief technologist at MidOhio Pulmonary & Sleep Associates, says many people are bewildered at the way they feel after long bouts of sleep deprivation. "As far as they know, they are getting all the sleep they need when their head hits the pillow at night, but in the morning, they feel like they've fought a war."

He says excessive daytime sleepiness is the No. 1 sign that apnea may be a factor. To determine the root of a patient's sleepiness and fatigue, physicians may order a sleep study. A technician monitors the patient for six to eight hours to see how often his or her oxygen level drops. Although the study takes place in a strange environment filled with wires and sensors, Kissell says patients typically have no problem falling asleep, just because they're so tired.

Diagnostic tests and the associated equipment to treat apnea are generally covered by insurance, sleep experts say. A number of physicians and sleep centers are moving toward at-home sleep studies, which offer greater comfort for the patient and also cost less to perform.

Sleep Deprivation and Insomnia

In today's fast-paced culture, sometimes people are just too distracted to sleep. The culprits may be work and family pressures, health concerns or the omnipresence of technology and entertainment, which can make it hard to unplug and unwind.

Schmidt says chronic partial sleep deprivation is a big problem in America, and is caused simply by going to bed too late and getting up too early. "Over time, you accumulate a debt that you probably don't ever repay in full," Schmidt says. But trying to repay some of the debt with longer bouts of sleep and better sleep habits is helpful. Those who don't try to balance the scales may be looking at a host of health problems.

"Sleep apnea triples the risk of heart attack, high blood pressure and stroke, quadruples the risk of developing diabetes and is a factor in erectile dysfunction," he says. "It has a huge impact on overall health."

Other people may suffer from insomnia, where the mind remains active when it is time to sleep. The condition can be caused by stress, overstimulation, chemical factors in the brain or a combination of these things. Dr. Jim Fulop, corporate medical director for OhioHealth, says insomnia can be overcome with the implementation of proper sleep habits.

"People can learn to manage their insomnia by learning to control their stress and their thought processes," Fulop says. Having a calm, predictable evening routine is a good place to start. Fulop recommends keeping electronics out of the bedroom. Noise from a television, cell phones and other devices can disrupt sleep patterns and keep sleepers from sinking into the deeper levels of rest their bodies require.

A fairly regular bedtime and waking time will help the body set its internal clock. If you have a late night, drag yourself out of bed anyway to keep things on track. Exercise is key. It's not so much the physical benefits of exercise as the mental ones that restless sleepers need, Fulop says. "Regular, low-grade exercise can have a tremendous mental benefit," he says.

Other tricks: Don't consume any caffeine beyond the early afternoon, and eat a healthful dinner several hours before bedtime to give the body time to digest and get into sleep mode.

Insomniacs must also learn to flip the switch on stressful situations. "You've got to set those stressful things aside, and tell yourself you'll pick them up again tomorrow," Fulop says. Writing down stressful thoughts helps some patients alleviate the worry. Those who are well-rested will do better dealing with stress in the long run, he says.

Fulop recommends the tried-and-true relaxation technique of releasing tension in the toes and moving systematically upward. "Invariably, if you are dedicated to it, by the time you get to your hips you are already asleep," he says.

It is essential to address insomnia as soon as it shows signs of developing. "A week of bad sleep habits can turn into six months," Fulop says. He recommends getting back to basics and approaching sleep like a child. "When you are 5 years old, you take a bath, get into your pajamas, read a book and fall asleep," he says. "A routine like that solves insomnia in most cases."

Solving sleep problems can help more than just the patient. Sleep disorders can have just as great an impact on those who share a bed with the sleeper, leading to aches, pains, depression, memory impairment, weight gain and sexual dysfunction.

"So many ailments are related to a lack of deep sleep, but these problems are easily treatable," Metz says.

Kristin Campbell is a freelance writer.

Reprinted from the October 2012 issue of Columbus C.E.O. Copyright © Columbus C.E.O.