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Sleeping: International Health Problem
Sleep disturbances place an uncalculated, but enormous, burden on the American public. Many industrial and automobile accidents are related to undiagnosed and untreated disorders of sleep. School and job performance, and even everyday social relationships, are also affected. Most sleep disorders, whether caused by physical or mental factors, can be treated or managed effectively once they are properly diagnosed.
Anxiety, Depression and Sleep
In a recent national survey, 47 percent of those reporting severe insomnia reported a high level of emotional distress. Psychological factors, such as fears, phobias, and compulsions, can so occupy the mind that sleep is delayed, disturbed, or shortened. Chronically tense people are frequently so restless, hyperactive, and apprehensive that they expect not to sleep when they go to bed.
In depressed people, an overwhelming feeling of sadness, hopelessness, worthlessness, or guilt can be associated with abnormal sleep patterns. Often, the depressed person awakens early and cannot return to sleep. Yet, sometimes, just the opposite is true. Some depressed people find relief in sleeping, denying or escaping from the problems of living by sleeping. The loss of a sense of purpose in life may be associated with an overwhelming urge to sleep, a constant feeling of tiredness, or nighttime sleep marked by an irregular sleep/wake pattern.
Many depressed people complain of insomnia without recognizing they are depressed. If you have lost interest in activities you used to enjoy, or if you have feelings of hopelessness or suicidal thoughts, you may be one of them. You should discuss the problem with your physician, who may recommend psychiatric consultation. While the complaint may be insomnia, the underlying depression, not the insomnia, must be treated. Antidepressant medications and/or psychotherapy can produce remarkable improvement, both in mood and sleep patterns.
Snoring
Snoring is a sign of impaired breathing during sleep. The older you get, the more apt you are to snore. Almost 60 percent of males in their 60s and 45 percent of females are habitual snorers--in all, one in eight Americans. Light snoring may be no more than a nuisance. But, snoring that is loud, disruptive, and accompanied by extreme daytime sleepiness or sleep attacks should be taken very seriously. Such snoring may be a sign that a person is suffering from the life-threatening condition called sleep apnea--a blockage of breathing during sleep.
Sleep Apnea
Discovered only recently, sleep apnea is believed to affect at least 1out of every 200 Americans, 70 to 90 percent of them men, mostly middle-aged, and usually overweight. But the condition can afflict both men or women at any age.
People with this disorder actually may stop breathing while asleep-even hundreds of times--without being aware of the problem. During an apnea attack, the snorer may seem to gasp for breath, and the oxygen level in the blood may become abnormally low. In severe cases, a sleep apnea victim may actually spend more time not breathing than breathing and may be at risk for death.
In the most common form of the condition, obstructive apnea (also called upper airway apnea), air stops flowing through the nose and mouth, but throat and abdominal breathing efforts are uninterrupted. The snoring that results is produced when the upper rear of the mouth (the soft palate and the cone-shaped tissue--the uvula--that descends from it) relaxes and vibrates as air passes in and out. This sets up an air current between the palate and the base of the tongue, resulting in snoring. Typically, the individual will wake up, emit a vigorous snort or grunt while gasping for air, then immediately fall back to sleep, only to repeat the cycle.
In another form of the disorder, central apnea, both oral breathing and throat and abdominal breathing efforts are simultaneously interrupted. In a third type of apnea, mixed apnea, a brief period of central apnea is followed by a longer period of obstructive apnea.
Sleep apnea can be recognized by a number of symptoms. As mentioned, loud and intermittent snoring is one warning signal. The person who has sleep apnea may experience a choking sensation, early-morning headaches, or extreme daytime sleepiness, as well. His bed partner or roommate might comment on his excessive body movements or his snorting or gasping for breath during sleep. If the condition is suspected, it should be reported to a physician, who may recommend evaluation by a specialist in sleep disorders. Since sleeping pills may be harmful for people with sleep apnea, they should not be taken if the condition is suspected.
Many people with such conditions as obesity, deviated nasal septum, polyps, enlarged tonsils, large adenoids, or a host of other problems may be particularly likely to develop sleep apnea. Doctors can reliably diagnose the disorder only by monitoring oxygen intake, breathing, and other physical functions while the patient is sleeping.
In mild cases, sleep apnea often responds to medication. Or, in the case of overweight middle-aged males, losing weight may lessen the problem. Another procedure, known as continuous positive air pressure, involves the use of a machine that blows air into the nose during the night, opening the air passages in the throat. Patients with severe sleep apnea may require surgery. One procedure widens the throat. In another, a tracheostomy, which is used in very severe cases, a small hole is made at the base of the neck, below and in front of the Adam's apple. At night, a valve on a hollow tube in the hole is opened so that air can flow directly to the lungs, bypassing the sleep induced upper airway blockage. During the day, the valve is closed, allowing the patient to breathe and speak normally.
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