Article published Sep 13, 2004
For most Americans, it's a dream

Good morning. How did you sleep last night?

If you tossed, turned, snored, listened to your spouse snore, walked, talked and/or acted out your dreams, you're not alone.

There are about 90 diagnosed sleep disorders, and the National Sleep Foundation estimates that 40 million Americans suffer from at least one.

While it's not usually a hot topic of daytime conversation, experts want more light shed on the issue.

''People need to pay more attention to their own sleep habits and not just accept the sleepiness they feel in the daytime,'' said Marcia Stein, spokeswoman of the Washington, D.C.-based foundation.

Awareness of sleep, or the lack of it, is on the rise, experts say, as research continues to find links between the quality of our sleep and the quality of our lives.

''If you're tired, you're a grouch. You're a grump. You don't perform well at work,'' said Shari Angel Newman, manager of the Sleep Center at the Spartanburg, S.C., Regional Medical Center. ''And, socially, you fall asleep at inappropriate times, so it's embarrassing.''

It's probably no surprise that most of us are sleep deprived. Most people need seven to nine hours of sleep per night, many only get five or six.

''We don't value our sleep,'' said Stein. ''There seems to be a badge of honor for people bragging how they can get along on a few hours of sleep, but we can't cheat on our sleep.''

And many folks continue to build up a sleep deficit, ''until you finally crash,'' said Robert Evelyn, clinical director of the Center for Disorders of Sleep and Fatigue. ''Then all of a sudden, you're enormously fatigued.''

But it's not healthy to ''catch up'' on those lost hours by napping or sleeping late on Saturday.

''Sleep's not like money. You can't save it up,'' Newman said. ''You need it every night.''

MANY DANGERS
Sleepiness can have tragic consequences. Experts say driving while sleepy can be just as dangerous as driving while drunk.

Fatigue contributes to more than 100,000 police-reported highway crashes, causing 71,000 injuries and 1,500 deaths each year in the United States alone, according to the National Sleep Foundation.

All states - except Alabama - have existing laws where drivers who cause a crash or fatality after falling asleep at the wheel can be punished. In 2003, New Jersey went a step further, said Darrel Drobnich, senior director of government affairs at the National Sleep Foundation. It passed a law that specifically addressed drowsy driving, making it a crime to drive in the Garden State while sleepy. The statute - known as Maggie's Law after a 20-year-old college student killed in 1997 by a van driver who had been awake for 30 hours - mandates charges of vehicular homicide, punishable by up to 10 years in prison, and a fine of $100,000. Similar laws are also in the works for New York, Michigan and Massachusetts.

People with sleep apnea are more than five times as likely to have a car accident than other drivers traveling the same streets, said Dr. John McBurney, medical director for the Center for Disorders of Sleep and Fatigue in Spartanburg, S.C.

Some sleep disorders, like insomnia, can be triggered by stress. But stress is transient, and when the situation passes, so does the sleeplessness.

On the other hand, sleep apnea - where breathing repeatedly stops during sleep - is a physical condition that can strike people of any age, gender and size. And to compound the problem, the sleepiness it causes can trigger overeating, McBurney said. Sleep apnea is also linked to diabetes and high blood pressure. And snorers have a higher risk of heart problems in general.

''Snorers die sooner than people who don't snore,'' Newman said. ''A new study shows that snorers have a greater risk of heart attack than smokers.''

Even sleepwalking and sleep talking can be dangerous - or at least embarrassing. One patient jumped through a plate-glass window in his sleep, Newman said. Another admitted to having an affair. One woman found out she had been eating raw bacon and cigarette butts in her sleep.

HOW CHILDREN REACT
Children commonly have attacks of insomnia, sleepwalking, sleep talking and night terrors.

''A lot of what they're doing in their sleep is processing what they learned during the day,'' said Dr. Sheri Byrd, a specialist in pediatric sleep disorders in Spartanburg. ''Everything happens during their sleep. That's why it's so incredibly important.''

Whatever the cause, children who don't sleep well tend to do badly in school.

''We're seeing children with learning problems because they're not sleeping,'' Newman said.

Byrd said that while she has seen an increase in pediatric patients, sleep disorders in children aren't a new thing.

''It's probably something that's always been there. We're just recognizing it more now,'' Byrd said. Researchers have also learned a lot more about children and sleep in the past decade, she said.

Byrd said that by age 5, one-fourth of all children experience a sleep disorder.

''More than half of those, I'm sure, are limit-setting problems or circumstantial,'' she said.

Some sleep disorders in children are the result of unstructured bedtimes. Other children have trouble falling asleep because they have specific ''needs,'' like being rocked to sleep or cuddling with a doll, toy or blanket.

While it's difficult to break those habits, experts agree that it's important to establish good sleeping patterns early. When a sleep disorder is not treated in childhood, it might never be resolved, Byrd said.

''We tell parents to teach their children to sleep like you teach them to walk,'' Newman said. ''It's a skill they'll carry with them into adulthood.''

But other sleep disorders in children are caused by chronic problems, rather than longstanding habits.

Between 13 percent and 15 percent of all children experience breathing disruption, ranging from simple snoring to severe sleep apnea or obstructed breathing, Byrd said. While tonsillectomies are a common remedy, about 20 percent of children don't respond to the surgery and need different treatments.

A sleep disorder can also contribute to behavior problems. While an adult feels sluggish after a poor night's sleep, a child becomes hyperactive, Byrd said. They also can't concentrate well, can't handle problem solving and can't handle relationships with their peers.

On the other hand, excessive sleepiness is also a problem in children.

''If you have a 6- to 10-year-old who is sleepy all the time, there is something wrong with that child and it needs to be checked out,'' Byrd said.

SLEEP TREATMENTS

Severe cases will require a sleep study. Most are done overnight in a sleep lab, but some tests on shift workers or those suffering from narcolepsy are done during the day.

A patient usually arrives at the sleep lab between 8 and 8:30 p.m. The first hour or two are spent explaining the tests and hooking up the patient to more than two dozen electrodes all over his body.

The electrodes measure brain waves, eye activity, jaw dropping, leg kicking, snoring and breathing. A video camera also records the patient's activity during the night. A technician watches the video and the monitors to assess how the patient is sleeping.

''All that data gives us good architecture for what their sleep pattern is,'' Evelyn said.

While many sleep disorders can be solved without surgery or machinery - such as moving children to sleep in their own bed - sleep apnea solutions might include throat surgery, and jaw or nose reconstruction.

Aaron Cantrell has a happy ending to his sleep problem. The 37-year-old Spartanburg man wears a Continuous Positive Airway Pressure mask to bed that delivers a constant stream of air to keep his airway open. Before using the mask, he had trouble waking up in the mornings and was sleepy until after lunch. His wife, Kim, and their children were also tired from listening to him snore all night. But Kim Cantrell was also scared when she heard him stop breathing at night.

''It wasn't the loudness of the snoring, it was the silent times. It was the breaks and then the gasps of air that were scary,'' she said. ''As a respiratory therapist, I was ashamed of myself because he would wake up and look a little blue.''

But since he's been using the mask, his overall health has improved. He has lost weight and has been able to eliminate one of the blood pressure medications he was taking. And since he's sleeping better, he performs better at work, he said.

''It's made a world of difference,'' Aaron Cantrell said. ''I dreaded the test, all the wires they hook up to you. It's not the most comfortable thing, but after getting the machine, it was worth it.''
(Bridget Winston writes for the Herald-Journal in Spartanburg, S.C. Joanna Hernandez, an editor for the NYT Regional Newspapers, contributed to this report.