By Helen K. Kelley
From ATLANTA Medicine, Vol. 85, No. 5
Sleep disturbances and disorders can cause, and are often intertwined, with a myriad of health issues, including hypertension, diabetes, obesity and more. Physicians who specialize in sleep medicine evaluate, diagnose and manage conditions such as sleeplessness, sleepiness, fatigue and abnormal behaviors during sleep.
Sleep Disorders by the Numbers
Scott M. Leibowitz, M.D., a board-certified sleep medicine specialist with Laureate Medical Group, which has six metro Atlanta locations, cites the most common sleep disorders as classic insomnia, obstructive sleep apnea, circadian rhythm disorders, restless leg syndrome, narcolepsy and parasomnias. Many of these disorders, he says, are markedly common.
“Sleep problems can affect about 35 to 40 percent of the general population at any one time,” he says. “And there are certain populations in which we see an increase in the prevalence of sleep-related complaints.”
According to Dr. Leibowitz:
- Between 10 to 15 percent of the general population experience chronic insomnia, defined as difficulties falling or staying asleep with subsequent daytime symptoms such as fatigue or reduced cognitive function.
- The elderly have the greatest number of sleep-related complaints.
- Adolescents also have a significant number of sleep disorders.
- Women are at greater risk for sleep disorders than men.
- Roughly 40 percent of people age 60+ complain of insomnia or disrupted sleep.
- Sleep apnea is prevalent in post-menopausal women, and the incidence nears that of men at that same age.
Additionally, several diseases and conditions carry increased risks associated with sleep pathology, including heart failure, irregular heartbeat, hypertension, sleep apnea, stroke and diabetes.
Sleep deprivation poses health risks to people of all ages. Robert J. Albin, M.D., who specializes in pulmonary disease and sleep medicine with North Atlanta Pulmonary and Sleep Specialists, says that lack of sleep not only causes or exacerbates many health problems, but also affects critical thinking, which can influence a person’s ability to judge risks and make decisions.
“Many accidents and man-made disasters have been linked to sleep deprivation. For example, Three Mile Island, the Exxon Valdez oil spill, Chernobyl, the tugboat accident in New York City … these were all caused by someone who fell asleep at the switch or had impaired judgment,” he says. “There’s a lot of speculation now about single car crashes – that they may be related to sleep deprivation. Both quality and quantity of sleep can affect decision-making.”
Sleep performs several critical health functions, including repairing neural damage and consolidating thoughts and memories. Chronic sleep deprivation can result in decreased performance and alertness, memory and cognitive impairment, stress, reduced quality of life and even physical injury.
“Sleep is somewhat like rebooting or restoring a computer,” Dr. Albin says. “If we’re not sleeping well, we’re not repairing our hard drive properly.”
While drug therapy, cognitive-behavior modification and CPAP and other mouth devices remain the primary treatments for sleep disorders, there are some new medications that hold promise for people experiencing sleep deprivation. These medications, such as Baclofen and Belsomra, allow for more targeted treatment of specific disorders.
Baclofen, a drug used to treat muscle spasticity for more than 50 years, is undergoing testing in mice by researchers at SRI International. Their findings show that Baclofen, which targets a deficiency of the neurotransmitter hypocretin, works better at treating narcolepsy than the best drug currently available for the disorder.
Belsomra (suvorexant) is a medication recently approved by the U.S. Food and Drug Administration for use as needed to treat insomnia. An orexin receptor antagonist, Belsomra is the first approved drug of this type. Orexins are chemicals that help regulate the sleep-wake cycle and play a role in keeping people awake. Belsomra alters the signaling of orexin in the brain.
Research suggests the growing possibility of a link between lack of sleep and obesity. In fact, a recent study conducted by MassGeneral Hospital for Children in Boston found compelling evidence that chronic sleep deprivation increases both obesity and adiposity in children as young as seven.
According to Dr. Albin, sleep abnormalities contribute to the abnormal regulation of neurohormones, which control appetite.
“Ghrelin is the hormone that signals hunger, and leptin is the hormone that signals satiety,” he says. “People with sleep disorders frequently have increased ghrelin levels and decreased levels of leptin, and the result is weight gain.”
Another growing trend in sleep disorders in both adults and children is related to technology. While it’s certainly not a new trend, Dr. Leibowitz says that sleep deprivation has evolved and escalated continuously since the invention of electricity.
“Everyone has an internal biological clock that determines his or her optimal window for sleeping and waking. Light has an affect on these circadian rhythms,” he says. “When we introduce light that is in close proximity to our eyes – from sources like computers, cell phones and televisions – it signals our brains to suppress the output of melatonin, which is a hormone that is critical for regulating our sleep and wake patterns. So we can see a more pronounced delay in the sleep patterns of those people who are addicted to their technology.”
In the news: treating sleep apnea in cardiac patients reduces hospital readmission.
A study of hospitalized cardiac patients is the first to show that effective treatment with positive airway pressure therapy reduces 30-day hospital readmission rates and emergency department visits in patients with both heart disease and sleep apnea.
Results show that none of the cardiac patients with sleep apnea who had adequate adherence to PAP therapy were readmitted to the hospital or visited the emergency department for a heart problem within 30 days from discharge. In contrast, hospital readmission or emergency department visits occurred in 30 percent of cardiac patients with sleep apnea who had partial PAP use and 29 percent who did not use PAP therapy.
The study results are published in the Oct. 15, 2014, issue of the Journal of Clinical Sleep Medicine, which is published by the American Academy of Sleep Medicine.
The study involved 104 consecutive patients who reported symptoms of sleep apnea while being hospitalized for a cardiac condition such as heart failure, arrhythmias or myocardial infarction.