1. Go to Sleep!
Sleep Disorders and How to Combat Them
Maria Bennett
Julia Calman stepped out of the Empire City Casino in Yonkers more slowly than one would expect,
given that the septuagenarian from Nanuet had just won two hundred dollars playing a penny machine.
“I'd give it all back for a good night's sleep,” she sighed. Calman's wish is disturbingly common
nowadays, with the National Sleep Foundation reporting that there are anywhere from thirty to seventy
million Americans suffering with some type of sleep disorder, ranging from the occasional lack of
shuteye to full-blown insomnia, which the NSF says involves “difficulty falling asleep, waking up too
early, frequent awakening, and waking unrefreshed.” In Calman's case, the problem occurs primarily as
a result of her hard-to-control diabetes, since rapidly rising or falling blood sugar levels can disturb
even the hardiest sleeper; according to specialists, most sleep problems are secondary to other
illnesses,with Parkinson's, hormonal disturbances, Alzheimer's, and heart disease as major players.
These diseases can set up a nasty feedback loop for a sufferer, too, since the insomnia caused by the
illness may cause its symptoms to become more severe. Since we spend one-third of our life at night in
the arms of Morpheus, what's new in the growing area of sleep science and how can we combat sleep
problems more effectively?
According to WebMD, there are nearly one hundred types of sleep disorders, ranging from the
common (Sleep Apnea and Restless Leg Syndrome trouble twelve and eighteen million Americans,
respectively) to the highly unusual (Nocturnal Sleep-Related Eating Disorder, in which a patient wakes,
eats, and then returns to sleep, having no recollection of the activity in the morning). Lack of proper
sleep has been cited as the cause of the Three Mile Island, Chernobyl, and Exxon Valdez catastrophes,
as well as the recent I-95 bus crash, and over twenty eight percent of American workers perform poorly
on the job due to lack of proper sleep, according to the 2008 Sleep in America study. So what's keeping
us up? “We live in a 24/7 society,” says Dr. Carl Hunt, director of the National Center on Sleep
Disorders Research at the National Institute of Health. “There are many more opportunities to do things
other than sleep-cable TV, the Internet, email, plus long work shifts.” In these days of economic trials
and tribulations, the problem for many may also be work-related worry and stress, issues Dr. Arun
Agarwal sees in his patients at Putnam Hospital's Sleep Disorders Center: “Sleep problems have
always been there, but one of the biggest problems nowadays is the cycle of too much work leading to
not enough sleep, and then a bad quality of life as a result.”
Long gone are the days when a physician could carry all he needed in a little black bag; high-tech
sleep labs frequently offer hotel-like comfort to patients undergoing an overnight sleep study, complete
with EEG hookups and polysomnography devices which assist certified Sleep Technicians to read
brain, muscle, leg, and arm movements during sleep in the attempt to pinpoint the source of a patient's
sleep disorder. What sleep specialists term “the architecture of sleep” is crucial to the understanding of
how our bodies are refreshed each night. We pass through five phases of sleep: stages one through
four, and finally REM (rapid eye movement) sleep, and this cycle lasts ninety minutes on average,
repeating itself throughout the night. We go from a stage of light sleeping in stage one and transition to
stage two, where our body temperature drops and our breathing and heart rate regulate, and then stages
three and four take over, relaxing muscles, releasing growth hormone, and ensuring tissue growth and

2. repair (Mom was right when she called it “beauty sleep”, and her admonition to “sleep on it” when
faced with a troubling matter makes perfect neurological sense, since sleep deficit impairs cognition).
Then, REM takes over and dreams begin (novelist Kurt Vonnegut used to set his alarm clock so he
could wake up during this phase, as he believed it helped him write more vividly), our bodies become
super-relaxed, and our immune system gets recharged. Appetite-controlling hormones leptin and
ghrelin are regulated as well at this time, so if you've noticed that you pack on the pounds when sleep is
disturbed, this may be a factor. The first sleep cycles each night have relatively short REM periods and
long periods of deep sleep, but as the night goes on, REM periods increase while deep sleep decreases.
As they approach the waking hour, people spend almost all their time in stages one, two, and REM.
At the Edythe Kurz Center for Sleep Medicine at Nyack Hospital, Dr. Benjamin Chang, Medical
Director, has found that Sleep Apnea, or the cessation of breathing for short periods during sleep, is a
common cause of insomnia, and one that needs to be taken seriously, as it renders a patient three times
more likely to develop hypertension, atrial fibrillation, stroke, and diabetes. Apnea can occur if the
neurons that control breathing malfunction, but it more frequently happens due to fat buildup and loss
of muscle tone, often as a part of the aging process. When muscles relax during sleep, the windpipe
collapses and breathing is disturbed, causing loud snoring. “Apnea has been historically under-
recognized and under-treated, and will continue to be a growing problem in this country as obesity
becomes more and more prevalent,” says Chang. After polysomnography confirms this problem,
patients can then opt for simple solutions such as weight loss and sleeping on the side rather than the
back, or go for what Dr. Rochelle Waldman of Lawrence Hospital's Center for Sleep Medicine calls the
“Gold Standard” of treatment: the CPAP (Continuous Positive Airway Device), a face mask with tube
that keeps the airway open. Some patients are reluctant to wear the CPAP to bed, since it's not exactly
attractive or comfortable, but Waldman suggests that sufferers need “to take time to get used to it and
try many on in order to get a proper fit.” There's also the new Pillar Procedure for those hesitant to try
the CPAP; it's a fifteen-minute operation done under local anesthetic which implants rods in the soft
palate of the throat, hardening the tissues so the palate doesn't totally relax during sleep, but Waldman
adds, “It's not the first line of therapy for this problem.” She also stresses that patients may not even be
aware of their Apnea, so it's important to pay attention to a partner's snoring as a red flag of something
serious. “Go ahead and record your husband at night if he says he doesn't snore,” she laughs.
Even though giraffes may be able to go without sleep for three weeks, we humans need our nightly
date with the Sandman. The “good night's sleep” that Julia Calman is seeking can range anywhere from
five to ten hours a night, according to the National Institute of Health, and sleeping like a baby really
does merit some thought, since the average infant requires about sixteen hours in a daily cycle. “On the
bell curve of normal people,” notes Dr. Agarwal, “about seven hours a night is average, with a
deviation of an hour and a half or so. The most important question to ask in determining adequate sleep
is, 'Do I feel refreshed?' when awakening.” As a way to ensure optimal sleep, theorists suggest that we
pay attention to our sleep environment. Sounds as low as forty decibels can keep us awake (remember
that bird chirping at 4 a.m. outside the bedroom window?) and temperatures above 75 or below 54
degrees can disrupt normal sleep; room-darkening shades or an eye mask also help, since light is a no-
no for proper sleep. And avoid the 2 a.m. e-mails and pre-bedtime video games, since they can cause
neurons to race and the glow from a digital screen delays the production of melatonin, a hormone
necessary for sleep, according to researcher Heather Hatfield, M.D..

3. So what to do if you're wide awake at 4 in the morning and what Shakespeare called the “balm of
hurt minds” and “chief nourisher in life's feast” is nowhere to be found? Believe it or not, counting
sheep may have some merit, according to Montefiore Medical Center's Dr. Shelby Harris, Director of
the Behavioral Sleep Medicine Program at its Sleep Wake Disorders Center, established in 1975. “It
sounds silly, but a process like counting sheep can help a patient stay on task for one thing at the
moment and focus, and this promotes sleep.” The Tarrytown native practices Cognitive Behavioral
Therapy with her patients, and finds that its techniques help them learn how to wind their bodies down
and reset an off-kilter sleep clock, putting away the worries and eternal “to-do” lists that keep them up.
“When we can't turn our minds off, it's frustrating. But our bodies have a natural sleep function, and
after three days of trouble sleeping, it'll kick in. We use the mantra,'If not tonight, then tomorrow, and if
not then, the third night' as a way of helping a patient relax into sleep.” Rather than start off with a
prescription for Ambien or Rozerem, Dr. Harris first works with simple behavioral changes that can
make a big difference in the quality of sleep: 20-30 minutes of exercise 5 to 6 hours before bedtime and
reducing excess weight both have profoundly positive effects, she notes, and a small snack of carbs and
protein can help you sleep through the night. And even though NASA has a nap room, she cautions that
although a siesta refreshes some patients, it's not generally a good idea for true insomniacs. The jury is
out on a glass of warm milk, however; it may contain sleep-inducing tryptophan, but “It could also
make you wake up to pee!” she jokes.