Monday, July 4, 2022

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Cover Story

Dead tired
Not getting a good night’s sleep isn’t just harmful to your overall well-being — it can be deadly, too


Todd Rullestad was used to getting the elbow in the middle of the night from his wife, Ashley. Not an accidental, rollover tap, but the “You’re snoring, wake up, stop it,” version. But it wasn’t just her husband’s snoring that concerned Ashley — he also seemed to stop breathing.

At his next routine doctor’s visit, Todd mentioned his wife’s observations, and he was referred to a sleep center and tested for sleep apnea. After an overnight sleep study, he was diagnosed with moderate obstructive sleep apnea.

“I had 24 ‘events’ an hour,” Todd said about the number of times he would stop breathing in his sleep during a normal night, which explained his lethargy most days, especially at work.

“I used to be really dragging by midafternoon,” he said.

After the diagnosis, Rullestad decided it was time to address the situation and was fitted for a Continuous Positive Airwave Pressure (CPAP) device, which would help him regain a normal breathing routine during his sleeping hours. The results were immediate. He now sleeps better, thanks to the device, which he wears around his head each night.


“Now my sleep is more restful and productive,” he said.


The value of sleep

Rullestad’s condition is not unique. Many people suffer from some form of sleep condition or disorder that is preventing them from getting the necessary amount of rest each night. Fortunately, new information is being learned about just how important sleep actually is.

If you’re not sleeping well, you’re probably struggling, and according to Centers for Disease Control and Prevention (CDC), 35 percent of adults in the United States don’t get enough sleep. If you’re not getting enough quality sleep, your ability to focus will be severely hindered, you’ll feel groggy, cranky and irritable, and your risk of suffering serious health problems like heart disease, diabetes and/or a stroke are elevated.

If necessary, patients will be monitored overnight at a sleep lab like this. Take-home monitors are also common. Photo courtesy of Iowa Sleep.

If necessary, patients will be monitored overnight at a sleep lab like this. Take-home monitors are also common. Photo courtesy of Iowa Sleep.

Well-rested people generally feel happier, get more done in a shorter amount of time and maintain better relationships, according to the CDC. These well-rested people are also less likely to be stressed or burned out, and most experts agree that getting adequate sleep will enable people to do better at work, with their family and at life in general.

All this begs the question: Are you well rested?

If not, hope is here. Effective treatment options are available, and they are easier than one might think.


Serious as a heart attack

“Many people don’t know that sleep deprivation in an animal leads to death,” said Mark Eric Dyken, M.D., a professor of neurology at the University of Iowa and the director of the school’s Sleep Disorders Program. “What happens is the basal metabolic rate goes sky high, the core body temperature goes real low, neurogenic legions occur across the back and the animal just shrivels up.

“If you sleep deprive an animal, it dies.”


Dr. Mark Dyken, M.D.

Dyken is referencing a sleep deprivation study by the University of Chicago that was completed on rats. He’s quick to note that no humans have actually been reported to have died as a result of sleep deprivation, though.

“There really are no reports of people being sleep deprived to death, because (eventually) you will fall asleep,” he said.

But while no one is known to have died as a result of too little sleep, Dyken does say that having a sleep abnormality is dangerous indirectly.

“The thought is if you get too little sleep, or if you get too much sleep, when you look at the bell-shaped curve, people who are on those sides tend not to live as long,” he said.

The science on sleep is still evolving — and there is still a lot that isn’t known — but one thing is for certain.

“There is something restorative (about sleep),” said Dyken. “And we all know that.”


Lack of sleep

Teresa Aoki, M.D., and a professor at Des Moines University, says she emphasizes sleep to her students and wishes the public’s awareness level was higher about what can happen if you don’t get enough of it.


Dr. Steven Zorn, M.D. specializes in helping people sleep well. Photo courtesy of Iowa Sleep.

“It has to matter,” she said about sleep. “We sleep about eight hours of our day — or 30 percent of our lives are spent sleeping. It has to matter. So whatever happens when you sleep, it affects the other two thirds.”

Aoki goes on to say that lack of sleep brings about other negative consequences.

“Chronic lack of sleep is related to obesity, increased risk of hypertension, which can lead to higher risk of diabetes, cardiovascular diseases, strokes, heart attacks, et cetera,” she said. “Sleep is just as important as diet or exercise.”


How to know if you’re sleeping right

Everyone is a bit drowsy upon waking, but how do you know if you’re sleeping properly and enough?

“A patient generally knows,” said Dyken. He said you’ll be tired, sleepy, lethargic and even grumpy and irritable. Depending on the duration of your sleep problem, he said you could also experience health problems that would alert you, or an inability to concentrate is also a red flag.

“Most people know if they’re sleepy or not,” Dyken said. “If you’re getting seven to nine hours a night, and you’re still sleepy, then you know, and then you go see a health care professional.”

Dyken points out that during the “siesta period” in the early afternoon hours, the body experiences a normal “sleepy period,” where a person could feel a little sleepy despite being well rested.


How much?

Both Dyken and Aoki affirm that seven to nine hours of sleep is the general norm for an adult. Their recommendations are in line with the National Institute of Health, which suggests 10 hours or more for children in grammar school, nine to 10 hours for teenagers and seven to eight hours for adults. The institute also says that good health is linked to quality sleep, and that regularly getting less than seven hours per night increases the risk of diabetes, stroke, high blood pressure, heart disease, obesity, poor mental health and even death.

The CDC reports that 35 percent of adults in the United States don’t get enough sleep. If you’re one of those, you might be wondering what to do about it.

“People that are sleep deprived often get angry, a bit depressed,” said Dyken. “They feel down, low on the mood. For some reason people that are sleep deprived get gastrointestinal upset. For some reason, they tend to turn to alcohol to help a little more to help them get the deeper sleep, and paradoxically it has the sympathetic effect and ruins the last few hours of your sleep. You start turning to medications or amphetamines or sedatives.”

If you’re feeling negatively affected by a lack of sleep, according to Dyken and Aoki, it’s time take a look at your sleep hygiene.

Sleeping with the enemy

Certain sleep enemies can be eliminated, and along with enacting some positive sleep practices, together, this can often lead to a return to the ranks of the well rested.

In the sleep world, regular efforts to aid and improve consistent, healthy sleep is known as “sleep hygiene.”  Aoki gives some pointers that include the following:

EXERCISE: Exercising regularly will usually make it easier to fall asleep, and it also contributes to sounder sleep. But be warned, exercising sporadically or immediately before bed actually makes falling asleep more difficult.

ROUTINE: Going to bed each night at the same time, then getting up at the same time every morning, will help you sleep better.

RELAX: Humans sleep best when in a relaxed environment. It should be quiet, dark and at a suitable temperature. Along with that, make certain your mattress and pillow are comfortable and facilitate rest. But don’t get too comfy; it’s important you only use your bed for sleeping. Don’t do other non-bed activities; it’s better if your body gets conditioned to know that bed equals sleepy time.

DON’T EAT TOO MUCH: Eating large meals too close to bedtime can hinder a good night’s rest.

TURN IT OFF: You should remove TVs, computers and cell phones from your sleeping area. Electronic devices stimulate brain activity and make it difficult to sleep.

CUT THE CAFF: Avoid caffeine, nicotine and alcohol before bedtime.


Dr. Stephen B. Grant, M.D. of Iowa Sleep, helps people with narcolepsy rise and shine. Photo courtesy of Iowa Sleep.

“Sleep has many enemies,” said Aoki. “I think the biggest enemy is ourselves because we are not giving it the importance it deserves; we’re always stealing time. And we always steal from sleep. We say, ‘I have this meeting, I have this… I’m not gonna take my nap,’ for instance. It takes a toll on us.”

If you’re feeling negatively affected by a lack of sleep, according to Dyken and Aoki, that’s when it’s time to see someone about the problem.

“Seven to nine hours is what you need,” said Dyken. “And if you’re getting tired (during the day), then it’s time to see a health care professional. See someone reputable who has the expertise to do the basis of all medicine, the patient’s medical history and a physical exam… ask the questions and look under the hood.”

Dyken said to be prepared to answer some simple questions.

When do you go to bed at night?

Is it a regular bed-time?

Once your head hits the pillow, how long does it take to get to sleep?

Once you fall asleep, do you have a restful or restless sleep?

If it’s restless, why?

What time do you wake up?

And how do you feel when you wake up?

Do you have a headache?

Do you feel rested?

During the day, how do you feel? Do you take naps?

Do you snore?

Do you wake up often at night?

Are you sleepy during the day?

Each individual is different, but Dyken notes that the temperature that is comfortable is what the temperature should be.

The bedroom should be used for sleep and nothing else, that way your body knows that when it’s in that room, it’s conditioned to fall asleep.

Dyken leaves reading material next to his bed. He said that alcohol and caffeine should be eliminated in the sleep utopia.

Some can have static noise; others need absolute quiet, he says. Whatever works for you is fine. If it’s working, even if the experts say to nix it, he said to retain it anyway.

He said after getting answers to these questions, your  physician will usually do a physical exam that will include measuring your BMI. BMI and obesity are linked to sleep problems.

“If your BMI is greater than 40, studies show you have a 50 percent chance of having sleep apnea,” Dyken said.

He added that if your neck circumference is greater than 40, or your waist size is equal to or more than 42 for men, and 37 for women, you’re at an elevated risk for sleep apnea.

“If the risk factors point to sleep apnea,” said Dyken. “Then it’s time to do a sleep study to determine for certain.”

Dyken said to start with your primary care practitioner if you suspect you aren’t sleeping properly.

“If they think you need a specialist, they will refer you,” said Dyken. He said that many times your primary care doctor will be able to treat the problem.


Sleep debt

Some people who aren’t getting enough sleep don’t have a sleep disorder, and they don’t have a drug or alcohol problem. Some people are just pushing themselves too hard, trying to be overachievers. These people may have all their bills paid, but they are experiencing something called “sleep debt.”

You lost three hours of sleep last night because of the Lynard Sknyard concert. And that’s on top of the two hours every other day of last week that went bye-bye because of last week’s project due date that needed to be wrapped up. But you slept nine hours last night, and you feel pretty solid this morning and didn’t even hit the “snooze button” one time.

You’ve lost more sleep than you’ve clocked, and despite that pep in your step, you’re still suffering from “sleep debt.” According to Aoki, there isn’t an exact mathematical formula, but when you’re in the hole, there is only one way out.

“You gotta pay with sleep,” she said.



Nap hygiene

“Happy people should nap,” Aoki said, but added that you cannot nap away excessive sleep debt. Instead, it’s like paying the interest. She said it can be a good thing to do but recognizes it’s difficult for most Americans, including her, and just isn’t feasible at work.

But if possible, Aoki said she’d recommend a nap to anyone.

“They (a scientific study) had a group of nurses take 20 minutes of quiet time and realized the ones who took that break performed better,” she said, adding that while many people believe they’ll be too sleepy after a nap, the reality is that it depends on how you do it.

“As the day advances,” she said. “The sleep pressure starts going up. And then it’s the highest at bedtime, and it goes down when you go to sleep. There is (also) a little peak right after lunchtime, and it’s not related to the meal or what you eat. There is this area (in the) afternoon that’s the perfect time for a nap.

She warns that the longer you sleep, the higher the chance that you will reach deep sleep and REM. And if you’re forced to awake out of deep sleep, you will feel groggy, which means you will wake up and feel worse than before. If that happens, it’ll take about 40 minutes to completely get awake. It’s sleep inertia, and your body wants to stay asleep.

She says to nap properly, it’s best to be lying down — and earplugs will help, too.

For some, napping is a good strategy, and for others, it’s better to delay sleep until bedtime so you can get a lengthy quality rest. Ultimately it depends on the person and situation. When naps are appropriate — such as long road trips where sleeping a full length isn’t feasible, but staying awake and pushing through is dangerous — Dyken suggests a napping strategy to ensure the proper length of nap.

“You ever take the nap that you sleep so long that you feel worse than before you took the nap?” Dyken asks. “That’s ‘sleep inertia.’ ”

In order to avoid this, Dyken suggests a power nap strategy.

“Drink 12 ounces of coffee at the beginning of a nap,” he said. “Then set the alarm for a half hour, since it takes about a half hour for the caffeine to kick in. About the time you reach the point of getting into the deeper stages of sleep, your alarm will sound, the caffeine will be working,  and you’ll have slept enough.”

But Dyken warns not to drink too much caffeine, and to only use this strategy as necessary.



Dr. Steven Zorn is the medical director of Iowa Sleep. He said while insomnia is the most prevalent sleep disorder, and that there are more than 80 disorders in all, the most commonly-treated sleep disorder is sleep apnea.

Apnea exists in different forms, but it essentially is a condition that forces the airway shut while a person sleeps. People are generally genetically predisposed to the ailment.

“If you have a first line blood relative (who has sleep apnea), like your mom or dad, you have a 50 percent chance of having sleep apnea,” said Zorn.

After being properly diagnosed, it can be treated by way of attaching the sufferer to a CPAP device or auto pap that forces air down the throat and keeps the airway open. Prices vary on machines for sleep apnea, but in general they range from $1,000 to $1,500.

Todd Rullestad

Todd Rullestad

The doctor said if you are not refreshed in the morning, if you’re snoring a lot while sleeping, or if you generally feel sleepy or run down during the day, the cause may be a sleep disorder.


Happy ending with hope

With treatment, people with a sleep disorder can return to getting the rest they need. Insurance will often pay for most of the doctor’s visits, and, depending on the carrier, at least part of the cost of the CPAP machine. That was the case for Rullestad.

Rullestad said he had to pay his normal, nominal copayments for each doctor’s visit, and he now pays for 20 percent of the cost of his machine. He said it’s worth it, and he is feeling better and getting restful sleep again.

“I don’t snore anymore,” he said. “I can now sit and relax without immediately feeling drowsy.”

His wife, he said, is sleeping better, too.

And the best part? No more elbows. CV

Sleep Statistics

Approximately one-third of a person’s life is spent asleep.

Approximately 80 million Americans suffer from some form of sleep disorder. Of that 80 million, approximately 30 percent — or 26 million — suffer from sleep apnea.

The Highway Safety Commission estimates that 40,000 people die each year, and another 250,000 are injured, due to falling asleep while driving.

The Department of Transportation estimates there are approximately 200,000 sleep-related highway accidents each year, which averages out to 550 accidents each day.

Sleep apnea affects 2 percent of adult females and 4 percent of adult males and may be as high as 30-40 percent prevalence in truck drivers.

Approximately 25 percent of children between the ages of 1 and 5 experience some sort of sleep disorder. These disorders can lead to hyperactivity, Attention Deficit Disorder (ADD), excessive sleepiness, etc.













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