Physician Focus: Special
by Sanford Auerbach, M.D.
Some 70 million people in the U.S. are affected by sleep
disorders, such as insomnia, sleep apnea, and restless leg
syndrome. These conditions take a heavy toll. Lack of sleep
can lead to fatigue, poor functioning, and health problems, from a
weakened immune system that makes one more susceptible to illnesses
such as colds and flu to damage to the heart and lungs.
Lack of sleep also has an economic impact: a Harvard Medical
School study found that one in four workers in the U.S. has
insomnia and that workers too sleepy to function properly on the
job cost the country $63 billion in lost productivity. Also,
conditions as drowsy driving pose serious public safety
hazards: The National Highway Traffic Safety Administration
estimates that 1,500 deaths and 71,000 injuries result each year
from driver fatigue.
Our bodies have a biological system - the so-called 'circadian'
rhythm or internal body clock - that dictates when and how we sleep
over a 24-hour period. While there's a lot of variation in humans,
how much sleep we need generally depends on how old we are.
Newborns, for example, need about 18 hours a day; pre-teens about
10 hours, and adolescents and adults, anywhere from 6 to 9 plus
hours a day. Those numbers are merely guidelines. The
right amount of sleep for any given individual is determined by how
much sleep that person needs within a 24-hour period to function at
an optimal level.
Insomnia - difficulty falling or staying asleep - should be
thought of as a 24-hour problem, as the lack of sleep impairs one's
ability to function properly during the day, such as inability to
concentrate or dozing while driving. The causes of this disorder
are varied; pain, anxiety or depression, medical conditions such as
asthma or arthritis, or medications can prevent sleep.
Worries about family, job, or the economy can also
contribute.
Obstructive sleep apnea, another widespread disorder, affects an
estimated 12 million people. Patients with this condition
actually stop breathing during the night, as a result of the
muscles in the back of throat blocking the airways. Snoring
is a major component of sleep apnea, as is sleep deprivation.
But sleep apnea also may have serious physiological effects,
because it can place extra stress on the heart and lungs and raise
the risk of high blood pressure, which can lead to heart disease
and stroke.
Restless leg syndrome (RLS) is characterized by an aching or
burning sensation or feeling of "pins and needles," usually in the
legs, and is associated with an urge to move the legs. It occurs
more commonly late in the day and can affect people of almost any
age.
Many different types of interventions exist for sleep disorders,
and the particular one selected depends on the specific
problem. Physicians may prescribe medications, carefully
tailored to the needs o f the individual patient and targeting
specific issues, such as anxiety or pain. They may also recommend
behavioral approaches, which allow patients the power to correct
the problem themselves. At other times, a combination of medicines
and behavioral approaches may be best. For severe sleep
apnea, for example, a breathing mask may be prescribed. For
insomnia, teaching people behavioral and cognitive ways to lower
their anxiety and help them relax is a primary intervention.
Patients must remember that sleep is vitally important; it
restores our energy, and its most important purpose is to help us
function at an optimal level during the day. For more information
on sleep and sleep disorders, visit the National Sleep Foundation
at www.SleepFoundation.org
Sanford Auerbach, M.D. is Associate Professor of Neurology,
Psychiatry and Behavioral Neurosciences at Boston University School
of Medicine and Director of the Sleep Disorders Centers at
Boston Medical Center.
