By Dawn Brazell
Public Relations

The world would be a much better place if people would get more sleep.

That's what Fitzgerald Drummond, M.D., and staff at MUSC's Sleep Disorders Center believe. Drummond would like physicians to take sleep disorders more seriously, assessing patients on the quality of their sleep just as they gather information on other health markers, such as weight and blood pressure.

Recent studies indicate that nearly one in three adults in the U.S. reported getting less than seven hours of sleep per night, and about 50 to 70 million Americans suffer from chronic sleep disorders. Sleep specialists are finding chronic sleep loss to be associated with a wide range of health issues, including obesity, diabetes, high blood pressure, stroke, cardiovascular disease, depression and other psychological disorders.

What Joe Secondary, sleep technologist at MUSC, finds is that most people aren't aware of the huge impact the quality of their sleep has on the quality of their waking hours.

Sleep technologist Joe Secondary enjoys educating patients about sleep.
For information on the Sleep Disorders Center, visit
http://www.muschealth.com/sleeplab/ or watch a video at
http://tinyurl.com/74aj5xv.

"Sleep is a necessity, not a luxury. It's just as important as nutrition. It's just as important to sleep better as it is to eat better. One of the things that we're sacrificing big time in our busy, busy lifestyles is our nutrition – our obesity rates are higher. We're sacrificing our nutrition, and we're sacrificing our sleep as well. We're shaving time here and we're shaving time there. Now we're getting less sleep, and we're seeing more sleep disorders."

A common sleep disorder, obstructive sleep apnea (OSA), affects more than 18 million Americans. MUSC soon will be offering portable sleep testing studies to evaluate adult patients for this condition, which is characterized by repeated episodes of upper airway collapse during sleep.

Secondary said the studies will allow testing to be done in the comfort of people's homes, providing more screening and evaluation options and almost doubling the testing to be done in the comfort of people's homes, providing more screening and evaluation options and almost doubling the number of patients who can be treated.

The MUSC sleep center has purchased two portable units and will be initiating inpatient tests within the next few months to evaluate the procedure for home use. Ultimately these portable tests will reduce costs to insurance companies and patients.

"It's an advantage of the patient to be in their home as opposed to being in a strange environment. There's less equipment to wear. These studies are for obstructive sleep apnea patients specifically, which is the majority of our patients. It looks at respiration, oxygen levels, pulse and EKG. It's four channels as opposed to 18."

The field of sleep study compared to other medical specialties still is in its infancy. The first continuous positive airway pressure or CPAP devices began being used in the 1980s, he said. Now specialty areas are developing including research into pediatric sleep disorders and into the rising number of people who suffer from insomnia.

Andrei B. Vedeniapin, M.D., assistant professor in the Department of Psychiatry and Behavioral Sciences and one of MUSC's insomnia experts, said there is no magic pill so far to cure chronic insomnia. Chronic insomnia is more complicated than a case of sleep deprivation or poor sleep related to a condition such as sleep apnea. It's a separate medical diagnosis, he said.

Chronic insomnia may lead to daytime sleepiness and fatigue and contribute to developing anxiety, depression or substance abuse. The patient is advised on good sleep hygiene rules, but sometimes following these rules still is not enough to give patients suffering from chronic insomnia a good night's sleep where they awaken feeling rested.

"Then, sleep medicine together with psychology and psychiatry may provide important help to patients with chronic insomnia."

MUSC has a Sleep Research Data Repository Project that is collecting comprehensive sleep-related information on people with sleep disorders, with one focus area being insomnia. This repository will provide information for future research projects in this area. There also are weekly sleep research meetings at the Department of Psychiatry and Behavioral Sciences that are dedicated to discussions about new sleep-related research being conducted within the department and worldwide. The meetings are for all professionals interested in sleep research and sleep medicine, he said.

A problem for many people, whether they have chronic insomnia or not, is sleep deprivation. The National Sleep Foundation recommends that adults receive between seven to nine hours per night; school children age 5 to 12, 10 to 11 hours; and adolescents, 11 to 17 years old, eight and a half to nine and a half hours.
Secondary said the more consolidated REM or rapid-eye movement sleep happens during the second half of the night, more in the early morning hours. Electronic stimulation and busy lifestyles make it harder to get to bed earlier, so that REM sleep often gets sacrificed.

Other important factors are medications that can interrupt sleep and substances such as alcohol and caffeine. "In REM your brain is very active. That's where the brain is preparing for the new challenges of the day. Alcohol as a sedative makes you sleepy, but it can lead to a more fragmented and less restorative sleep. It also can increase apnea problems."

Secondary likes to educate the public on healthy sleep habits and the latest treatments, medications and devices – such as customized CPAP machines including a smaller one for women that's now available. One of the new treatments is a clinical trial studying the effectiveness of a new therapy for patients with moderate to severe obstructive sleep apnea. MUSC is participating in the STAR clinical trial that uses an implantable therapy that works with the body's natural physiology to prevent airway obstruction.

Secondary said it's important that more research is being done about sleep disorders, especially given the rise of sleep disorders in children. In some cases, children are being medicated for such conditions as ADHD when their symptoms could be solved by addressing their sleep deprivation. It's important that parents realize that children need more sleep than they may think. Some states have pushed back school start times in recognition that students need later start times, he said.

"I wish people knew how important sleep is to their long-term health. You sacrifice sleep, and you sacrifice years off the end of your life. If you sleep better, you're going to live better. You're going to have more energy during the day, and you're going to feel more rested, and you'll function better. It's a general building block of your life."

Tips for Sweet Dreams
Here are sleep technologist Joe Secondary's suggestions for a great night's rest.

1. Train the brain that the bed's for sleep. It's a psychological factor. You want the brain to know it's not your office or play area. It's not your Facebook time. You want to train your body so that your sleep hormones initiate properly.
   
2. Create a dark environment.
   Turn off the TV and other electronic equipment. The bursts of light from electronic sources can disrupt people's circadian rhythm.
   
3. Limit nicotine, caffeine and alcohol before bed. Alcohol and caffeine can affect the quality of sleep. You can have increased arousals and fragmentation, and it decreases rapid eye movement sleep.
   
4. Set up a sleep schedule.
   Make sleep intentional and adjust your schedule to allow the mind to wind down. Try to settle issues before going to bed and have a relaxing routine before bed. Any relaxation technique – breathing exercises or yoga – can help. "A lot of people find their minds are racing – there's too much going, too much thinking – and they can't wind down."
   
5. Avoid exercise too close to bedtime.
   
6. Try keeping a sleep diary. You can download one at http://yoursleep.aasmnet.org/pdf/sleepdiary.pdf. Pay attention to your fatigue levels during the day. "People have gotten so used to it that they don't realize they are fatigued. Track what's going on."