Adult Sleep Disorders

WebMD Live Events Transcript

How are American adults sleeping? Meir Kryger, MD, co-chairman of the National Sleep Foundation's 2005 poll task force, joined us on March 31. 2005 to reveal and explain the results of the 2005 Sleep in America poll.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

MODERATOR:
Welcome to WebMD Live, Dr. Kryger. Thank you for joining us today.

KRYGER:
Hello. How are you?

MODERATOR:
Sleep deprived!

KRYGER:
Is that because someone in your home kept you awake last night?

MODERATOR:
Yes it is. How common is this?

KRYGER:
This is the first time this has been looked at by the National Sleep Foundation Sleep in America Poll, and it turns out that about one-fourth of the population of married partners leave the bed or sleep separately because of the bed partner's sleep problem. There are two types of sleep problems that lead to this kind of response. First is the bed partner who has loud snoring or has sleep apnea and the other common type of bed partner is the one who fidgets and twitches and doesn't stop moving when they sleep.

MODERATOR:
So what should I do to get a good night's sleep?

KRYGER:
The most important thing in this situation is to make sure that your bed partner doesn't have something serious such as sleep apnea. The clues that your bed partner has sleep apnea are loud snoring and you observe that they stop breathing repetitively, especially if they're on their back. And during the daytime they may be very sleepy, falling asleep at the wrong time and the wrong place.

It is very important that if you suspect your bed partner has this problem that they see a doctor, so that an accurate diagnosis can be made and the right treatment started. A very important caution is that if someone has sleep apnea, they should not take sleeping pills or use alcohol because both of these can make the problem much worse.

MODERATOR:
Let's talk about sleep apnea.

KRYGER:
Sleep apnea is a condition in which people repetitively stop breathing when they sleep. The most common cause is being overweight, but in children it can be caused by big tonsils and adenoids and can also be caused in other age groups by an abnormally small jaw. If someone in your family, no matter what age, has the features of being sleepy, snoring, and stopping breathing, that's something that should be looked into.

Now, to get back to your question about sleeping with a person with a sleep problem, we mentioned a minute or so ago that it interferes with your sleep . It turns out that such a bed partner of such a person loses almost an hour of sleep, actually 49 minutes, each night. That is about 300 hours per year. Many bed partners of patients have told me how much better they feel when their bed partner's sleep problem has been treated. So a sleep disorder can be contagious. If the person sleeping next to you has a sleep disorder and it is interfering with your sleep, the solution is not for you to take a sleeping pill, but to make sure that your bed partner receives the right medical care.

"If the person sleeping next to you has a sleep disorder and it is interfering with your sleep, the solution is not for you to take a sleeping pill, but to make sure that your bed partner receives the right medical care."

MODERATOR:
What else did the 2005 Sleep Poll look at?

KRYGER:
The 2005 poll showed that about one-half of the American population sleeps well and one-half of the American population sleeps poorly.

The part that sleeps well includes, surprisingly, senior citizens, many of whom actually slept more and felt better during the daytime than many of their younger population.

For the first time the American Sleep Foundation created profiles of sleepers in the poll. What was very interesting about the half that did not sleep well is that there were three groups of such people:

  • One group were what were called dragging duos. These were people who were partnered, employed, and in part, workaholics, doing work activities within an hour of going to bed and getting up early in the morning. About one-quarter of these people said that their intimate relationships were affected because of sleepiness.
  • Another group of poor sleepers were individuals who were overworked, overweight, and over-caffeinated. This group was also workaholic, having the longest work week (47 hours). They often slept less at night than the other groups, averaging 5.2 hours a night and had to compensate by napping during the daytime. This group drank much more coffee, averaging four cups per day. This group tended to be obese, as well.
  • Now the next group that slept poorly, and they made up about 1 in 7 of the population, had medical conditions including depression that played an important role in their poor sleep. They had other medical conditions such as hypertension and diabetes. This group was the most likely to use sleeping pills or sleep aids. Many in this group were females. Many people in this group also had problems with their relationships, including intimate relationships, because of sleepiness. This group had the worst sleep of all five groups that were found.

The point that I'd like to make about the people that don't sleep well is that very often the cause is lifestyle. It is their work, their schedule, their overindulging in caffeine, and in one group it is medical conditions. The last group was more likely to have sleep disorders such as sleep apnea and restless legs syndrome as well.

MEMBER QUESTION:
I have both sleep apnea and I'm bipolar. At night I can't sleep at all but then I can fall asleep on the couch without my CPAP for an hour at a time. Is that OK?

KRYGER:
No. If someone has sleep apnea, they should use their CPAP [continuous positive airway pressure] machine whenever they sleep, unless their doctor tells them otherwise. The reason is that most people with sleep apnea cannot sleep and breathe at the same time and their brain wakes up in order for them to start breathing again, so that a short sleep during the daytime will not usually make them feel any better.

MEMBER QUESTION:
Do you need to lay flat on your back while using a CPAP? Is the humidifier the best CPAP to have? How many hours are considered good for you to have the CPAP on?

KRYGER:
The CPAP should be effective in whatever position you are comfortable in. You don't have to lie on your back for it to be effective. Most doctors recommend that people use the CPAP as much as possible when they sleep. We don't know for sure how many hours of CPAP usage per night would result in the best response but it is believed that you should wear it as much as you can when you are actually sleeping. Humidifiers are now available with most CPAP machines and whether a person needs a humidifier depends on many factors including the humidity of where they are living. So if it is very dry where you are living, there is a greater chance you'll need a humidifier. Different types of humidifiers are available, and this is something you check with your doctor and whoever is supplying your equipment.

MEMBER QUESTION:
I have been very worried about my sleep for a while. I have MS, which does affect my sleep, I know. But I seem to function OK during the day, and then after work, once I sit down after chores, I always fall asleep in my recliner. I can't seem to stay awake. I wake up around 1 a.m., and still have to finish chores (I'm a single mom of a 16-year-old), bathe and give myself my Copaxone shot (MS drug). I get to bed around 2:00 to 2:15 a.m. and have to get up at 5:30 a.m. for work. I also snore, loudly (according to my son, from way down the hall).

I am worried that I have sleep apnea. I do wake up sometimes, but feel it's my snoring that did it. By the way, I am NOT overweight at all. I have been doing this for several years. I am single, so don't have a partner to pay attention to any stopped breathing.

What should I say to my primary care provider? I talked to him already, and he dismisses it as allergies and says the snoring is just from that. He gave me Zyrtec.

KRYGER:
There are many reasons why someone with multiple sclerosis or other neurological conditions may become very sleepy during parts of the day. With some neurological conditions, sleep apnea is common, and the only way to reliably diagnose it is with a sleep test.

People with neurological disorders may also have excessive movements when they are sleeping, and these movements may also actually result in sleepiness during the daytime. This is something else that should be picked up in the sleep test.

People should also remember that sleep is controlled by the brain, and a condition that affects the brain may also lead to sleepiness.

Finally, people should be aware of the fact that their medications may be the source of the problem. When I say medications, I don't mean just prescribed, but also over-the-counter medications which may be making them sleepier. This might include, for example, some antihistamines.

You should discuss all of these issues with your family doctor, and perhaps the next step would be to see a sleep specialist or a neurologist. Sometimes sleep specialists are also neurologists.

"People should also remember that sleep is controlled by the brain, and a condition that affects the brain may also lead to sleepiness."

MODERATOR:
Dr. Kryger, can you explain what is involved in a sleep test?

KRYGER:
In a sleep test, the brain waves are measured to tell the doctor whether you were asleep during the test, how deeply you were asleep and whether you were in rapid eye movement (REM) sleep. It is during REM sleep that sleep breathing problems are usually at their worst.

In addition, the blood oxygen level is measured, and it's determined whether the person is trying to breathe, and whether they are actually breathing -- verified by measurements in front of the nose and mouth. There will be a measurement of the electrocardiogram, and whether the person has excessive movements or twitches in their extremities.

These tests are usually done in a sleep disorder center or in a hospital and increasingly such tests are being done in a home setting. There is a list of sleep disorder centers that are available on the web site of the American Academy of Sleep Medicine (www.aasmnet.org).

Generally, if sleep apnea is found, additional testing is often done on treatment, most often a CPAP machine. This machine generates pressure that's delivered via a mask over the nose, most of the time, and this opens up the breathing passage.

Again, to emphasize the point because it is so important, people with sleep apnea should not use sleeping pills or alcohol.

MEMBER QUESTION:
Why not sleeping pills?

KRYGER:
Sleeping pills can reduce the tone of the muscles in your throat that keep the breathing passage open when sleeping, and can make the problem worse.

MEMBER QUESTION:
Neurontin is what my doctor prescribed for me to take to stay asleep. How does it differ from a sleeping pill?

KRYGER:
There are many products that doctors use to treat sleep problems. Sometimes they will use medications whose side effect is sleepiness, for example, sometimes they might use antidepressants.

The best way for someone to decide whether they are on the right medication, is simply for them to speak to their doctor or to check on the web to make sure they are comfortable with the medication they're using and whether they, in fact, need the medication.

If someone has a chronic problem with their sleep the first thing they'll need is an accurate diagnosis, because the problem could be something entirely different that is interfering with their sleep. They may not require a sleeping pill at all. A few examples are: if someone is having trouble sleeping because of a painful condition such as arthritis or cancer effecting bone, which is quite painful, they might require, for example, anti-inflammatory medicines for the arthritis, and pain medications for the bone problem. People with heart failure may develop an abnormal breathing pattern which interferes with their sleep, and they might need more aggressive treatment of their heart failure or a treatment such as oxygen. If a person's problem is, for example, depression, and problems sleeping are common with depression, it is the depression that needs to be treated. None of the treatments that I've just mentioned include sleeping pills. The important first step for someone who has a chronic sleep problem is an accurate diagnosis.

There is one important cause of a sleep problem which people should be aware of which is that low levels of iron in the body may cause restless legs syndrome. In women, this problem may be there because of heavy menstrual bleeding and in both men and women, the problem may be related to excessive blood donation or even having had a condition in which they have lost a great deal of blood.

I have also seen in my clinical practice in the past few years restless legs syndrome caused by iron deficiency in people who are on an extreme vegan diet who shun virtually all products that may contain iron. If someone is on an extreme diet, they should be careful to make sure they're taking the right kind of supplements to make sure they do not become deficient in iron, and also other nutrients or vitamins including folic acid and vitamin B12.

"The important first step for someone who has a chronic sleep problem is an accurate diagnosis."

MEMBER QUESTION:
Dr. Kryger, I work late -- until 11:30 p.m. -- and usually stay up until 3:00 or 4:00 a.m. and tend to sleep in until 11:00 a.m. or noon the next afternoon. I also wake up with backaches, soreness and stiff. Is this because of sleep patterns or could it be that my body lacks water? I tend to drink nothing but caffeinated drinks all day and hardly a drop of water. Can you explain?

KRYGER:
There are many possible explanations for this sleeping pattern, including this is the way your body clock is. Some people's body clocks seem to function in such a way that the person falls asleep late and wakes up late, and in such people we often hear the term "night owl." The problem with night owls, of course, and this is something we've found in the NSF poll, is that some groups of night owls -- in order to function in the daytime on reduced sleep because they have to get up before their body wants them to get up -- is that they overuse caffeine.

Now, having a body clock out of sync with the rest of the world is not really a disease. That is the way the person is. Most of the time the best approach for someone to take when they have such a body clock, is for them to choose a career that is more in line with their own biology.

I have had many patients over the years that have ended up in the hospitality or entertainment industry because they are able to stay up late and be in sync with their body clocks.

The other side of the coin who is the person who is often called a lark. Such people go to bed very early and wake up early. Often, such people gravitate into jobs that start very early in the morning.

Many teenagers start to have features of being a night owl, and it is amazing that within the U.S. there are many school systems that force high school students to start their school before they are really awake. Interestingly, in the past few years, the National Sleep Foundation has tried to educate school systems and the public in dealing with this important issue. This year, the National Sleep Foundation, for example, presented the Wilton Connecticut Board of Education and League foundation an award because they changed the start time for middle and high schools, which is much more reasonable and in sync with students' biology. As an example, if someone has a school starting time at 9:00 versus 7:00 to 7:30 am., that could have an extremely beneficial effect on the students' ability to learn, and overall mood since they are less likely to be in a state of chronic sleep deprivation.

MEMBER QUESTION:
If I am sleepy all day and even minutes before I go to bed, why is it that as soon as I lie down I can't sleep?

KRYGER:
There are some people that develop a condition that is called psychophysiologic insomnia. This type of sleep problem is quite common, and very often the symptoms that have just been described is what we hear in the clinical assessment. The person is sleepy, gets into bed, and instantly feels wired and alert, their mind races and they can't turn it off.

Very often, this response is "learned" in the same way that Pavlov's dogs learned to salivate when they heard a bell. In such people, it is the sleep environment that they are in that is the culprit. Such people need to learn very often how to fall asleep again and a commonly used treatment that's been studied more in the past few years is called cognitive behavioral therapy, which is a treatment that doesn't involve pills. There is a chapter in my book, A Women's Guide to Sleep Disorders, that is called "Treating Insomnia without Pills" that covers this topic. Such treatment is often administered by a clinical psychologist and can be quite effective.

Very often, such a problem arises as a response to something else that has caused insomnia and the problem may persist even though the original cause is long gone. For example, a person might develop trouble sleeping during a very stressful time in their life, perhaps a divorce, death in the family, and so forth. They may start to develop the behavior of expecting to sleep poorly every time they go to bed. Often long after the initial stress is over the behavior that is perpetuating this insomnia continues and the person starts to expect a bad night every night. Very often such people need to learn how to fall sleep again.

"If your sleep is poor and you're not functioning well during the day, you should do something about it."

MEMBER QUESTION:
What would you say is the best way to get a good night's sleep?

KRYGER:
The best way to get a good night's sleep is to make sleep a priority, to find out why you are not getting a good night's sleep, and then to treat that cause. Sometimes the problem may be with you, in that you may have a sleep disorder, or the problem may be that your bed partner is keeping you awake.

If your sleep is poor and you're not functioning well during the day, you should do something about it. One of the things you should consider is to go onto the web site of the National Sleep Foundation which has a great deal of educational material about sleep that pertains to people of all ages, sleep disorders, shift work, etc. The more you know about sleep the more you'll realize how important it is and how important it is to achieve it.

The National Sleep Awareness week is a time when people hear a lot about sleep. There are many diverse partners that play a role in disseminating this information, including over 100 federal and state agencies, nonprofit organizations and associations including the National Center on Sleep Disorders research, and this year the National Association of Elementary School Principals, the Asthma and Allergy Foundation, the U.S. Coast Guard and the AAA Foundation for Traffic Safety among others.

MODERATOR:
Our thanks to Dr. Kryger for joining us today. And thank you, members, for your great questions. For more information, please visit the National Sleep Foundation on line at www.sleepfoundation.org.



©1996-2005 WebMD Inc. All rights reserved.

Health Solutions From Our Sponsors

Last Editorial Review: 4/19/2005