SLEEP DISORDERS: A SILENT EPIDEMIC By Jeffry H. Jones, MD In an age when we work more and sleep less, it is estimated that 4 to 10 percent of the population has a primary sleep disorder. Insomnia, obstructive sleep apnea, restless legs syndrome, and sleep fragmentation secondary to other medical conditions represent the majority of these sleep disorders. Many people don't understand the significance of untreated sleep disorders. And although Sleep Medicine has recently received a considerable amount of media attention, it is a relatively new field of medicine. Because of potential serious health consequences, recognizing and treating a sleep disorder is important. In addition to drowsiness, loud snoring and difficulty concentrating, patients with sleep disorders have a higher risk of motor vehicle accidents, hypertension, depression, stroke, heart disease, and job loss from impaired work performance. Therapy for sleep disorders can improve a person's quality of life; but only a small number of sufferers, less than one in eight, have sought care. They are either unaware that a problem exists or they think that nothing can be done. Daytime symptoms of sleep loss may be misdiagnosed as depression or illness. Others may attribute excessive daytime sleepiness to normal aging or being "just in my nature", but excessive somnolence is never normal at any age. Often, a specialist must observe a person's sleep habits and symptoms to help determine whether or not a sleep disorder is present and if so, how to diagnose and treat it. Polysomnography, or diagnostic sleep study, will assist in clarifying the patient's sleep problem. For some, simple techniques such as improving one's "sleep hygiene", the rituals and behaviors preceding bedtime, may be all that is needed. For others, assistive devices such as CPAP (continuous positive airway pressure), oral appliances, somnoplasty (outpatient high frequency therapy), or surgery may be needed to treat the patient's sleep disorder. Different sleep disorders appear at different times in development. Children may be affected by sleepwalking, nightmares, night terrors or obstructive sleep apnea due to enlarged tonsils. Adolescents are more likely than any other age group to develop delayed sleep phase syndrome. This syndrome, a circadian rhythm or internal clock abnormality, is characterized by very late bed times and awakenings. Conversely, the elderly have problems with advanced sleep phase syndrome. They tend to go to sleep and wake extremely early. People who work odd shifts may also have circadian rhythm abnormalities. Common syndromes which exist in adulthood include insomnia, central sleep apnea, restless legs syndrome, periodic limb movement disorder, and narcolepsy. Obstructive sleep apnea, the cessation of breathing during sleep due to obstruction, is one of the most common adult sleep syndromes. It is caused by a blockage of the airway, usually from the soft tissue in the rear of the throat collapsing and closing during sleep. As we sleep, our muscles progressively relax. Patients with sleep apnea may have total obstruction of their throat/airway related to this muscle relaxation. When the obstruction occurs, the patient will have either a brief awakening and/or falling oxygen level. The result is fragmented sleep. As soon as the person with this disorder reaches restorative sleep they rouse again, spending little time in quality deep sleep. The body is stressed by the repetitive low levels of oxygen, which can lead to hypertension, heart disease, and stroke. According to the National Institute of Health, sleep apnea is as common as adult diabetes, and affects more than 12 million Americans. Risk factors include being male, overweight, and over the age of 40. The vast majority of patients with sleep apnea remain undiagnosed. Symptoms include excessive daytime sleepiness, loud snoring, prolonged respiratory pauses with sleep, and gasping for breath during sleep. Sleep apnea treatments include CPAP, oral appliances, somnoplasty, and throat surgery. All work by opening the back of the throat/airway. With CPAP, a mask connected to a compressor is placed over the patient's nose while he or she sleeps. Continuous positive air pressure applied throughout the respiratory cycle prevents the collapse of the airway. It is the most effective therapy and poses minimal-to-no risk. With the advent of new technologies, the majority of patients can now tolerate CPAP therapy. Wearing an oral device to bed or removal of excess tissue by somnoplasty or surgery may be needed for patients who are intolerant of mask therapy. Jeffry H. Jones, MD practices pulmonary and sleep medicine at the Sacramento Heart Center. For more information about sleep disorders call the Sacramento Sleep Center or Dr.Jones at (916) 423-6806. For more information about the Sacramento Heart Center, visit www.sacheart.com or call (916) 830-2080.