An estimated 50 million Americans — almost one-third of all adults — complain of poor sleep at some point. They may be tired and inefficient during the day, and lack of sleep can even contribute to car wrecks, industrial accidents, poor-quality schoolwork and relationship problems. At its worst, it's a significant health issue.
But most people don't know much about sleep, say Dr. Robert Farney, medical director of the LDS Hospital Sleep Disorders Center, and his colleague, sleep specialist Dr. Tom Cloward. The two will be featured on Saturday's Deseret Morning News/Intermountain Health Care Hotline. From 10 a.m. to noon, they'll take phoned-in questions about sleep and sleep disorders.
People who consistently can't sleep more than six hours, who always take more than a half hour to fall asleep, should see a sleep specialist, they say.
"You can treat sleep disorders," Farney says. "There's usually some combination that works."
For about 10 percent of the 30 percent who experience sleep disruption, the problem is persistent, chronic insomnia, he says.
"They have poor quality sleep or trouble getting asleep. More often the difficulty is staying asleep," he says.
While most people have a sleepless night occasionally, it's cause for concern when the problem affects waking hours and performance, adds Cloward.
Doctors who specialize in sleep disorders try first to identify the cause, including sleep apnea, restless leg syndrome, stress, post-traumatic stress, hormonal issues and illness. Insomnia may have no discernible cause. But it's important to look for possible physical problems, which are common, as well as psychological factors.
They may recommend a sleep study, to see what's happening during the night. It may pinpoint a cause or even find an individual is actually sleeping better than he thinks he is.
Often, people combatting sleep problems have developed bad sleep habits that further contribute to poor sleep, and those must be tackled as well. Bad habits can create persistent problems, Farney says.
Those may include using alcohol to promote sleepiness or ignoring the "window of opportunity" when it's easy to fall asleep. They caution against unproven techniques, including using over-the-counter medicines like antihistamines or natural remedies like kava kava or melatonin, which may work sometimes but are not regulated and may come in different concentrations from one brand to the other. With a variety of proven, tested and approved medications on the market specifically to promote healthy sleep, use of unregulated products makes little sense, Farney says.
Prescription medications often help. Where once sleep aids were prescribed for only a short time, it's now recognized that long-term use may be appropriate.
"Some people have intermittent or daily problems forever, and we do a disservice to patients when we make them feel guilty for taking a sleeping pill," says Farney.
That "irrational avoidance" sometimes originates with patients who are afraid they'll become addicted. While there are people with addictive personalities for whom there's a small risk, generally that's not the case, Farney says.
Restful sleep is a mysterious but steady pattern of non-REM, REM, non-REM, REM, usually in two-hour cycles. While its purpose is not well understood, it's clear that just as a battery needs recharging, so does a human. And sleep is the charger.
Some people sleep well for three or four hours, then wake and can't go back to sleep. Some wake and doze repeatedly. Someone who wakes up at the end of the REM cycle to go to the bathroom, though, may go right back to sleep.
One bedtime strategy is to intentionally limit hours spent in bed. If you only sleep four of the eight hours you're in bed, limit yourself to five hours until you're sleeping most of that time, then creep it up, Farney says. "You'll sleep sooner or later and the sleep is more consolidated, more efficient."
Cloward and Farney offer a final caution: There are a lot of very good sleep labs in Utah and elsewhere in the country. But people need to be sure they choose one of those run by people who are qualified to treat sleep disorders and skilled enough to properly diagnose what's going on. If a sleep study is not done properly or interpreted well, insurance may not be willing to pay for another in a better lab.
Tomorrow: Sleep apnea