31 May 2021 Get the sleep of your dreams

By John Patton

A sleep disorder can be as simple as snoring that keeps others awake or as complicated and serious as an illness that causes someone to fall asleep while driving.

 Fifty to 70 million people have some form of a sleep disorder in the United States, according to the American Sleep Association (ASA). The ASA adds that insomnia is the most common sleep disorder — 30 percent of adults have short-term issues — and 25 million adults in the U.S. have obstructive sleep apnea.

 Tim Freyaldenhoven, MD, PhD, and one of his associates, Keith Schluterman, MD, are neurologists and sleep medicine specialists at Conway Regional Neuroscience Center. Dr. Freyaldenhoven and Dr. Schluterman have been treating sleep disorders for nearly 20 years each. According to these physicians, the average person who visits them is simply trying to overcome sleep issues that affect their work performance or home life.

 While common, sleep disorders should be taken seriously. Drowsy driving is responsible for 1,500 vehicle fatalities and 40,000 nonfatal injuries in the U.S., according to the ASA. Sleep deprivation can also cause a person’s overall health to deteriorate. 

Schluterman explains, “Sleep deprivation adversely affects overall health and well-being, including lowering our immune system function, increasing weight, increasing blood pressure, and increasing the risk of diabetes and heart disease. Inadequate sleep also affects cognitive function and memory, learning, and emotional well-being. It has been linked to an increased risk of dementia as well.” 

How does someone know if they are not getting enough sleep? 

The ideal amount of sleep can vary depending upon an individual’s genetics and age, according to Freyaldenhoven.

“Newborns sleep half of the time, average adolescents require about nine hours, and adults can range from four to 10 hours,” he said. “Most people will require between seven to eight hours.”

Sleep Debt 

“In a perfect world, you wake each morning having slept off your ‘sleep drive,’ he said. “Every moment you are awake through the day increases your drive to sleep. To avoid falling to sleep, your circadian system, or internal clock, counters this drive. When it starts to get dark, melatonin turns off the circadian opposition to allow you to sleep. The timing of your internal clock creates your sleep/wake cycle.”

Freyaldenhoven explained, “Sleep erases the accumulated sleep drive. In that same perfect world, you awaken having slept away the drive to sleep. When that occurs, you wake up spontaneously.”

If someone is waking to an alarm clock or is awoken by someone else, they are not getting enough sleep.

“Your brain will carry over that remaining sleep drive and can accumulate up to 40 hours or so. The best way to know that you are getting enough sleep is to allow enough sleep time in your schedule for you to wake each morning spontaneously,” Freyaldenhoven said. “If you have accumulated additional sleep debt, you won’t be fully rested until you have slept it off. That means your body’s nightly requirement plus all the accumulated sleep debt.”

Most sleep disorders are treatable with medicine, lifestyle changes, the use of CPAP machines or other medical devices and procedures.

Schluterman said it is crucial to have a routine sleep schedule, avoid daytime naps, avoid caffeine and alcohol late in the day, and avoid spending excessive time in bed when not sleeping.

Good sleep habits 

There are proactive lifestyle changes that can improve sleep, Schluterman said, including: 

• Maintain a regular sleep schedule, including a routine bedtime and wake time.

• Avoid daytime naps, as this will adversely affect the ability to sleep at night by eliminating the “sleep debt /sleep drive” that builds up during the course of the day during wakefulness.

• Avoid caffeinated drinks in the evenings.

• Do not use the bed for things other than sleep, such as reading, watching TV, or looking at cellphones.

• Do not stay in bed too long if you are struggling to fall asleep. Arise and only return to bed when you are sleepy.

• Maintain a quiet, comfortable bedroom with a calm pre-bedtime routine. This may include warm baths or meditation.

• Avoid alcohol in the evenings since it fragments sleep, particularly in the latter half of the night.

• Exercise early in the day and not before bedtime.

• Hide the clock if you are a “clock watcher” at night.

How do you know if you have a sleep disorder? 

Freyaldenhoven: Symptoms of sleep disorders pertain to dissatisfaction with the sleep experience, daytime sleepiness, or both. Periods of insomnia are a common complaint but usually resolve spontaneously. Ten to 30 percent of people can develop chronic insomnia. Most people with insomnia do not report daytime sleepiness despite complaints of poor sleep.

How do you diagnose sleep disorders? 

Freyaldenhoven: After discussing medical history and performing a physical exam, the polysomnogram (sleep study) is the primary tool. It is usually an overnight test that measures several sleep-related variables. An EEG is used to determine when the brain is asleep and in which stage. Air flow, oxygenation, pulse, limb movements, chin motor activity, snoring, and movements of the abdomen and chest are typically measured. These can be used to diagnose sleep disorders as well as to find an appropriate treatment, such as titrating the CPAP pressure.

There are now home variations of this test, which have validated uses in certain populations. There are other specialized tests to measure a person’s degree of sleepiness or lack thereof.

What should someone do if they think they have sleep apnea?

Schluterman: The initial step would be to discuss this with their primary care provider or seek an appointment with a sleep specialist. If the history and examination suggest that sleep apnea is a good possibility, then a sleep study will be arranged to evaluate the quality of their sleep. This allows us to diagnose a variety of sleep disorders.