Perchance to Dream: When a Good Night Sleep is Elusive

For millions of people with chronic sleep problems, it would be a dream to return to the days of sleeping like a baby. Research shows that 40 percent of Americans have difficulty sleeping a few times per week; while 1 in 3 says insomnia strikes nearly every night. Although insomnia is the most common complaint, there are several other sleep disorders that can have adverse effects and may initially go undiagnosed. Even children are not immune to sleep disturbances.

"A sleep disorder can last for a few nights, causing minor inconvenience, or become a pervasive illness affecting all aspects of a person’s daytime life," says Mangala Nadkarni, M.D., of The Kazmir Center for Sleep Disorders at Saint Barnabas Medical Center, which opens in June 2003.

WHEN INSOMNIA BECOMES SERIOUS

As we all know, transient insomnia can follow a stressful event in life, such as a death in the family. Insomnia is actually considered to be a physiologic response to grief. However, in some individuals, this problem can turn into chronic insomnia. Dr. Nadkarni explains that individuals with chronic insomnia (defined as sleeplessness that has lasted for three months or more) develop habits that perpetuate their inability to sleep.

"The individual begins to fear going to bed and actually has ‘performance anxiety’ associated with his or her inability to sleep," says Dr. Nadkarni. "The thought of nighttime turns into a nightmare itself." She recommends that anyone with extended insomnia should seek medical attention before the condition becomes chronic, as chronic insomnia is "very difficult to treat."

Lack of sleep can have serious consequences. Research has shown that people who are sleep deprived perform as poorly on driving tasks as those who are operating at the legal alcohol limit. Insomniacs have sleep problems that generally fall into three areas:

COMMON SLEEP PROBLEMS

Sleep Apnea (also called Sleep Disordered Breathing) is one of the primary sleep disorders. These patients actually stop breathing while asleep, generally for more than five times per hour and for longer than 10 seconds per occasion. The problem is more common in women and in those who are overweight—especially in men with a collar size greater than 16 inches.

While patients may not necessarily wake up during the episodes, the quality of their sleep is poor. This can lead to symptoms such as sleepiness during the day, lack of energy, memory problems and, often, can manifest as a mood disorder. Apart from the symptoms themselves research has shown that patients with severe sleep apnea are more likely to have high blood pressure that is difficult to treat, heart attacks and strokes.

Patients with untreated sleep apnea are also likely to get involved in motor vehicle accidents. A diagnosis of sleep apnea is made through a sleep study performed at the Sleep Disorders Center. The general treatment is a specialized sleep mask that applies pressure to the airways. A weight loss program and possible referral to an ear, nose and throat specialist may be recommended, depending on the severity of the condition.

Women are the primary patients who suffer from a sleep disorder called Upper Airway Resistance Syndrome. Although the individual does not stop breathing during sleep, loud snoring affects her quality of sleep. Diagnosis and treatment would be the same as for an individual with sleep apnea.

In children, enlarged tonsils and adenoids can cause poor sleep quality and resultant symptoms that mimic Attention Deficit Disorder (ADD). The treatment would be removal of the tonsils and adenoids.

Restless Leg Syndrome or Periodic Leg Movement Syndrome occurs when the individual has prickly sensation or cramps in the legs during evening hours and when the person kicks spontaneously. If the kicking continues during sleep, it can be problematic for the bed partner.

Dr. Nadkarni says these individuals need to be evaluated to determine the particular cause of the condition, which can vary from simple iron deficiency to a condition that requires medications.

In the REM stage of sleep, the body experiences paralysis so that the dreamer does not act out his or her dream. Those with REM Behavior Disorder do not experience this paralysis. One of Dr. Nadkarni’s patients dreamed that he was being chased and then suffered a severe injury after leaping over his bed while sleeping. This condition occurs in REM sleep, unlike those who sleepwalk during a non-REM stage. Patients may need to undergo a sleep study to confirm the diagnosis and can be treated with medications.

Last but not least, Narcolepsy is the most disabling sleep disorder of all. It can result in excessive sleepiness during the day, with the person even falling asleep in mid conversation in severe cases. Patients may even think they are hallucinating as dreams start to enter their waking moments. Many times patients are embarrassed to talk about these unusual symptoms for fear of being labeled as a psychiatric case.

Narcoleptics are generally treated with medication. Being robbed of sleep can have a disastrous effect on a person’s life as well as the lives of those around them. Patients who have successfully sought treatment through the Sleep Disorders Center feel rejuvenated by their new sleep patterns, which results in a better quality of life during the day.

"They tell me that they have never felt this awake before during the day," says Dr. Nadkarni. "Their nighttime problems no longer adversely affect their daily lives and the lives of their families."

For more information about the Institute of Neurology and Neurosurgery at Saint Barnabas Medical Center, please call (973) 322-6600.