7/16/09
Sleep deprivation can kill, according to Española Hospital sleep physician Dr. Sal Narayanan.
More than 70 million Americans have diagnosable sleep disorders, American Academy of Sleep Medicine spokeswoman Kelly Wagner confirmed — and those disorders lead to sleep deprivation, which can cause chronic fatigue, worsen existing chronic heart and lung disease, and contribute to 250,000 motor vehicle accidents a year, Wagner and Narayanan said.
Fatigue can also erode patients’ quality of life in less dramatic ways, Hospital Sleep Diagnostics Center Director Larry Garland said.
“If you don’t get a good night’s sleep, things start happening,” Garland said. “Your metabolism doesn’t work efficiently, your hormone levels change, you wake up with headaches and feeling worn out. There’s a domino effect.”
The Hospital’s sleep lab has helped hundreds of patients over the past five years, Narayanan said.
“We see patients with insomnia, a few cases of narcolepsy, parasomnias like sleep walking and sleep talking, even restless leg syndrome,” Narayanan said.
But most of the Hospital’s patients have one, common sleep-related problem: sleep apnea, or interrupted breathing.
Neck tissues sag and obstruct airways during sleep, particularly in overweight patients, Narayanan said. It’s a common problem, affecting at least 4 percent of men, Narayanan said.
Narayanan even diagnosed Garland with obstructive sleep apnea.
“Getting diagnosed made a world of difference,” Garland said. “I need to wear an oxygen mask at night, but I have more energy. I’m not always tired and falling asleep. My wife can sleep now too because I’m not snoring.”
Anybody who snores likely has obstructive sleep apnea, Garland said.
“Children can be harder to diagnose,” Narayanan said. “They manifest sleepiness in different ways, as irritability or even hyperactivity and attention problems. A lot of children with sleep disorders are misdiagnosed as having Attention Deficit and Hyperactivity Disorder, or ADHD,” Narayanan said.
When a primary care physician suspects a patient has a sleep disorder, he refers the patient to Narayanan, Narayanan said. After a consultation with Narayanan, the patient is usually scheduled for overnight polysomography — a complex study of their sleeping patterns.
Treatment options range from lifestyle changes like weight loss, learning to sleep on one’s side, or avoiding alcohol, sedatives and tobacco, to oxygen therapy and even surgery, Narayanan said.
Narayanan tries to avoid prescribing sleeping pills to patients, however.
“Induced sleep is never good-quality sleep,” he said. “I tend to avoid sleep medications. If we use them, it’s only for brief periods while the patient is in the Hospital. The problem is that all these medicines don’t let patients go into deep sleep.”
Instead, Narayanan relies on oxygen mask therapies and what he calls good “sleep hygiene,” he said. (See box story.)
“Losing weight is a good option, but we’re not talking a few pounds,” Narayanan said. “A patient needs to lose 10 to 20 percent of their body weight.”
The most common treatment for sleep apnea is simply wearing an oxygen mask at night, Narayanan said. About 80 percent of his patients see their symptoms improve with treatment, Narayanan said.
“Continuous positive airway pressure involves a steady stream of air into the lungs,” Narayanan said.
That keeps tissue from obstructing the upper airway and makes sure the body gets enough oxygen at night, Narayanan said.
But newly-married men often refuse to wear oxygen masks at night, Narayanan said.
“The mask and tubes are not exactly romantic,” he chuckled. “(But) if you sleep eight hours a night and live 75 years, you’ll spend 25 years of your life asleep. How can you ignore such a significant proportion of your life?”
Asked about his own sleep hygiene, Narayanan grinned.
“It’s horrible, just horrible,” he said. “I’m badly sleep deprived.”