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A Prescription for Chronic Disease…or Worse

Think getting six hours of sleep a night is good enough for your body? Think again. As the work world of smart phones and laptops places more demands on our waking hours, the net result is a loss of sleep.

The average American today gets just six and a half hours of sleep a night and, according to the 2009 National Sleep Foundation Sleep in America poll, 20 per­cent of Americans receive less than six hours on average. While the amount of sleep we need is individual – some people require only six hours a night while others may need 10 – sleep ex­perts recommend seven to nine hours of sleep for adults.

But one fact is clear: A good night’s sleep is inte­gral to one’s overall health.

Sleep Needs Over the Life Cycle Infants/babies: 0-2 mos….10.5-18.5 hours 2-12 mos….14-15 hours Toddlers/children: 12-18 mos….13-15 hours 18 mos-3 years….12-14 hours 3-5 years….11-13 hours 5-12 yrs….9-11 hours Adolescents: 8.5-9.5 hours Adults/Older persons: 7-9 hours Source: National Sleep Foundation

Though ex­perts still don’t know why we actu­ally need sleep, they do know that suffi­cient sleep is critical for refreshing the mind and the body. Without adequate sleep, we slowly accrue a sleep debt, notes Robert Schriner, MD, medical director of the Baptist Sleep Disorders Center and Respiratory Care Services at Baptist Me­morial Hospital-Collierville. Sleep debt is the amount of sleep we should be getting each night versus the amount of sleep we actually get. That deficit, like a VISA bill, steadily grows with the minutes or hour of sleep we lose each week.

The short-term effects of chronic sleep loss are foggy thinking and impaired driving. Ongoing sleep debt, if allowed to build over a period of years, can result in obesity, hypertension, heart and cardio­vascular dysfunction, diabetes, and stroke. “All of these things are interlaced with one another,” said Schriner. “Heart attacks and strokes are increased three-fold by underlying sleep apnea,” one of the most common sleep disorders.

Many people who come to the Sleep Disorder Center in Collier­ville are having dif­ficulty functioning during the day be­cause of poor sleep hygiene. When a patient’s daytime activity is affected by a lack of sound sleep, the results can be far reach­ing, from feeling tired, irritable, and unable to think clearly, to more significant events like car crashes and workplace ac­cidents. The most common symp­toms of sleep mala­dies such as sleep apnea, restless leg syndrome, insomnia, and narcolepsy, should be part of a gen­eral medical evaluation. Additional studies may require referral to a Sleep Disorders Center. Patients may be asked to keep a sleep diary or participate in sleep labora­tory testing to identify problems such as sleep apnea, a breathing obstruction that results in loud snoring and continual wak­ing throughout the night due to a form of “controlled strangulation.”

Resources American Academy of Sleep Medicine • www.aasmnet.org National Sleep Foundation • www.sleepfoundation.org National Institutes of Health’s Medline Plus • www.nlm.nih.gov/medlineplus/sleepdisorders.html

According to Schriner, approximately 10 percent of adult males and five to seven percent of women in the Mid-South suf­fer from clinically significant sleep apnea. Schriner says the figure is lower for women because female hormones help protect the development of apnea until menopause and fat deposition in women tends to be in the lower body areas. “We need both an adequate quantity and quality of sleep,” said Schriner. “Many people with sleep apnea may stay in bed nine to 10 hours but don’t feel rested because they aren’t sleeping well.” During sleep, the brain passes through different sleep stages and all appear to be necessary to experience quality sleep. The most important sleep may be delta wave sleep, Stage N3, noted Schriner, which occurs generally during the first half of the night.

More on sleep disorders… • Sleep disorders are underdiagnosed but play a crucial role in the patient’s well-being • Americans are sleeping about 1 hour less per night than we did 100 years ago • Symptoms of nighttime breathing problems, daytime sleepiness, and chronic insomnia should be part of a general medical evaluation • Prevalence of obstructive sleep apnea (OSA) ap­proaches 10 percent of adults in the Mid-South • OSA is a bedfellow with metabolic syndrome (hypertension, hyperlipidemia, DM, and obe­sity), sometimes referred to as Syndrome Z • Those with sleep apnea have 2 ½ times the risk of having an accident over a 10 year period and 3 times the risk of strokes and heart attacks • Treatment of chronic insomnia needs behavioral interven­tions as well as judicious use of hypnotics • Most sleep disorders including OSA are chronic conditions which need regular follow-up

Sleep centers developed out of several medical disciplines: pulmonary to address breathing disorders, psychiatry for insom­nia, and neurology for the study of brain waves and movement disorders. For many years, insomnia was considered almost exclusively a psychiatric condition driven by anxiety and depression. Now, doctors know otherwise. Schriner says roughly 50 percent of the population experi­ences acute insomnia once a year, which can be brought on by temporary pain, a response to medication, or daily stress. Acute insomnia typically lasts several days or a week. Chronic insomnia lasts several months or more. Restless leg syndrome is also fairly common as people age, and oc­curs in approximately 5 to 10 percent of people over the age of 30. Once a patient is identified to have sleep apnea, which is often in conjunction with obesity or heart issues, it is considered chronic disease and must be managed similar to a condition such as diabetes.

According to Schriner, many things can impact sleep; prostate issues can cause frequent urination in older men, meno­pause for women interrupts sleep, chronic pain syndrome or a bad heart – all can equal sleepless nights.

Schriner said many of the over-the-counter medications for sleep might provide temporary relief, but long-term benefits come from lifestyle changes. The importance of getting daily exercise, fol­lowing a bedtime ritual, maintaining regular bed and wake times, and mentally working through problems during the day will provide the rest you need – and the sleep your body craves.

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Baptist Memorial Hospital, Collierville, MD Medical Director of Baptist Sleep Disorders Center and Respiratory Care Se, Robert Schriner, TN Sleep debt Obstructive sleep apnea and metabolic syndrome

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