Tired In Tallahassee

Sleep affects every aspect of your life. Are you getting enough?

Like the air we breathe, the water we drink or the blood that fills our veins, sleep is necessary to live. Maybe you are one of the few people who not only has no trouble sleeping, but also has a schedule that allows you to get your eight hours every night.

We should have a parade in your honor, because more and more people, even kids, aren’t getting the sleep they need. If you fit the other demographic, chances are you fall into one of two other categories: You’re sleep-deprived because you have too much to do and not enough time to do it, or you have a sleep disorder.

Why is sleep necessary, anyway? In this day and age, we have found shortcuts for just about everything – but we have yet to invent a magic pill or product that truly allows us to function without sleep.

Dr. Gregory Holt, owner and director of the Tallahassee Sleep Diagnostic Center, is a Clinical Sleep Specialist certified by the American Board of Sleep Medicine. Sleep is critical, he said.

“It’s necessary to stay alive. You will die without sleep,” Holt said. “The theory is three months without sleep will kill you, but people have suffered long-term effects by forced sleep restriction in much less time.”

Working in the television news world for over a decade, I can give a firsthand account of what sleep deprivation can do to you and the people around you. I have worked every grueling shift: midnight to 9 a.m., 3 a.m. to 1 p.m.; 3 p.m. to midnight, and my current schedule – which requires my alarm to go off at 3:45 a.m. I have witnessed coworkers falling asleep sitting up; I have seen scripts written with nonexistent, made-up words; I have seen the bloodshot eyes, the cans and cans of Red Bull in the trash, and the blank expressions of those who clearly did not get enough sleep before their shift. I shudder to think how they were able to drive themselves home after a stressful day/night/morning/evening on the job.

I plead guilty to a self-inflicted lack of sleep. Once, working at a television station in Tampa, I stayed awake for three days. It was the worst I have ever felt. I couldn’t think straight, my eyes burned, my mind was fuzzy, and I was a hazard to myself and, frankly, everyone around me. I could hardly operate a keyboard, much less drive a car.

I’ll never forget covering a story in Southwest Florida several years ago. A mother was walking her two young children to school in the early hours one morning when they were struck by a car. All three were killed. They had been hit by a nurse who was coming off an overnight shift and had fallen asleep at the wheel. It was a heart-wrenching example of why sleeplessness is just as deadly as driving under the influence.

But what if the reason you can’t get a good night’s sleep has nothing to do with a rigorous work schedule or cramming for a test? What if it’s out of your control?

The Institute of Medicine of the National Academies estimates between 50 million and 70 million Americans struggle with chronic sleep disorders, which cost the nation hundreds of billions of dollars every year in medical expenses, lost productivity, accidents and other costs.

Jan Davis, a Registered Respiratory Therapist, is the operations manager at Barnes Healthcare Services/Optioncare in Tallahassee. She has been working in her profession for 30 years. The sleep disorder she is most familiar with is obstructive sleep apnea. This disorder occurs when the upper airway closes off during periods of relaxation in sleep. Because of this obstruction, there is no airflow and the oxygen level in the blood drops. This decrease in oxygen saturation in the blood causes the body to react in a flight-or-fight response: The heart rate goes up, blood pressure goes up, and the body wakes itself up in an attempt to correct the situation. This action never allows the person to get into deep sleep, which can lead to chronic health problems associated with poor sleep.

Davis said some of the most miserable people she has ever met are people who are suffering from obstructive sleep apnea.

“Just imagine that you have literally been awake for years and no one understands how tired you really are,” she said. “Your friends and family say things like, ‘That man should have plenty of energy. He sleeps all the time!’

“What they do not understand is that when you go to bed you are not getting the quality of sleep that is needed to feel rested and refreshed. They do not know that during your last night in bed your airway obstructed 300 times and that your body woke you up just to keep you alive, and that every time you sit down or stand still very long you are overcome with the desire to lie down and just fall asleep.”

But sleep apnea sufferers don’t have to live in misery – although the solution can seem like an off-putting alternative.

“Imagine that you tell this miserable person that to make them feel better they can have a mask placed on their face and blow tons of air down their airway to blow the airway open, and that they have to wear it every night while they are sleeping and they will probably have to wear this contraption for the rest of their life,” Davis said. “Most people’s first reaction is denial, and then they try the excuses like ‘I am gonna look funny wearing that.’ Well, yes, you will look funny with this on, but you also look funny while asleep at the dinner table or behind the wheel of the car.”

Within a few weeks of starting what is known as CPAP (continuous positive air pressure) therapy, life begins to get better, she said.

“This air that is used to open their airway becomes something that they grow used to, and even consider pleasant,” Davis said. People who have not slept with their spouse for years due to snoring have moved back into the same room and are even enjoying sleeping there again. Their whole life is changed. They now have the energy to do more things.”

How do you know if you have a sleep disorder? Holt defines sleep disorders as abnormalities in accepted sleep patterns that result in diminished daytime function. A good night’s sleep implies feeling refreshed. If you’re not, and the cause isn’t a transient thing, it needs to be corrected. Excessive daytime sleepiness and fatigue are common symptoms of sleep disorders.

“There is an acute or chronic decrease in a person’s anticipated state of alertness,” Holt said. “Other symptoms include diminished cognitive abilities; lack of motivation; memory effects; hypertension control problems; restless sleep; nocturia (increased trips to the bathroom during regular sleep periods); snoring; chronic nasal congestion related to snoring; dry mouth in the morning; headaches in the morning; a family history; taking more than half an hour to fall asleep; finding that naps are more refreshing than an entire night in bed; uncomfortable sensations in legs prior to sleep onset that is relieved by movement or massage; and waking up with bruises or food.”

How much sleep do you need? Holt says there is a range for each age. At birth, infants need about 16 hours a day. By the time we reach adulthood, we need about seven to nine hours.

“‘Normal sleepers’ can be divided simply into short and long sleepers, but generally no less than four hours and no more than 12 hours,” he said. “I’m pretty sure the groups who get less than four and more than 12 hours are dying off faster than those at the accepted eight hours. Easily answered, we need one hour of sleep for every two hours awake. Kids need more.”

Sometimes something as simple as what’s called “sleep hygiene” can mean the difference between a good and bad night’s sleep. Holt has some suggestions.

“Waking at the same time every morning and getting 30 minutes of bright sunlight in the morning and late afternoon are important to setting the body’s normal circadian rhythm and melatonin production during sleep,” he said. “Try controlling environmental factors (TV, reading in bed, computers in the bedroom, clocks, bed partner, kids, dogs, etc.). Don’t stay in bed if (you don’t fall) asleep within 30 minutes. Go to another room and return only when sleepy. Still, get up at the same time every morning. No naps. If you take a nap (and can’t sleep at night), it’s not insomnia.”

Why does sleep play an important role in our health? Davis said that if you’re not sleeping effectively, then nothing else really matters.

“Every facet of our being revolves around our sleeping,” she said. “Our bodies need the down time to recover from the day. If this does not happen, then there is excess wear and tear on the body and on your overall health. I have learned that most rude, demanding and miserable patients are only sleep-deprived, and with the right therapy, they can become pleasant and happy people. It is amazing just how much improvement a good night’s sleep can be.”

Types of Sleep Disorders

When tossing and turning becomes serious.

Snoring It could be benign, but snoring is considered a cousin of the more problematic obstructive sleep apnea. Snoring also can be an environmental sleep disorder for those in annoying proximity to someone who snores.

Sleep Apnea No inspired airflow for more than 10 seconds in adults, usually associated with an arousal, as defined by an electroencephalogram (EEG) reading and a reduction in blood oxygen. Fewer than five apneas per hour is considered normal. There have been patients having more than 400 apneic periods during the night. People can die from sleep apnea – usually from a heart attack, stroke or even motor vehicle accidents related to sleepiness.

Insomnia Difficulty falling asleep or staying asleep. Insomnia is the most common sleep disorder, affecting from 20 percent to 30 percent of the population at some point in their lives. Two things put you to sleep naturally: 1) the amount of time from the last awakening and 2) the body’s normal circadian rhythm (timed by sunlight for most of us), in which twice a day we are more tired and sleepy, divided by periods of being more awake and alert. People usually fall asleep in 10 to 20 minutes. Falling asleep in less than five minutes is an indication of excessive daytime sleepiness. More than 30 minutes is insomnia. Stress, medication and an increased state of alertness as bedtime approaches can cause insomnia. Insomnia may be acute – from a stressful episode (usually lasting days to a few weeks) to a more chronic condition as the initial stressor gives way to perpetuating factors (ruminating about not being able to sleep, for example).

Narcolepsy Relatively rare, this occurs in less that one-half a percent of the population. Symptoms include excessive daytime sleepiness – an irresistible urge to fall asleep.

Sleep Paralysis  A person is conscious but unable to move, because the individual regains consciousness while the body is still under the normal paralysis induced during rapid-eye-movement (REM) sleep.

Hypnagogic Hallucinations Vivid dreaming soon after falling asleep. Normally, dream state or REM sleep usually begins 1½ hours after sleep onset and cycles with increasing duration every 90 minutes.

Cataplexy A loss of muscle tone, related to REM sleep onset, brought on by strong emotions, especially laughter. Individuals appear to be unconscious, but are aware of their surroundings.

Idiopathic Hypersomnia Daytime sleepiness and prolonged periods of sleep without specific cause. Individuals experiencing this may sleep 14 hours a day but still feel sleepy, and generally are irritable with depressive symptoms.

Parasomnias Problems in sleep including nightmares, night terrors, talking, walking, bruxism (teeth grinding), enuresis (bed-wetting), REM Behavior Disorder and Nocturnal Eating Disorders.

Restless Legs and Periodic Limb Movements in Sleep These can occur either as separate sleeping disorders or in combination. Restless Legs Syndrome can be diagnosed in the physician’s office by a fairly specific set of questions. (Basically: Do you experience a strange sensation in your legs when still or first lying down to sleep that is relieved by movement or massage?) Periodic Limb Movements in Sleep can be diagnosed only during an overnight polysomnogram. Symptoms are periodic twitches in the arms, legs or both during sleep that may or may not result in arousing. The individual may have hundreds of these per night and not be aware of it.

Source: Dr. Gregory Holt, Owner and Director of Tallahassee Sleep Diagnostic Center