Wake-Up Call

Long- and short-term effects of sleep disorders go beyond just feeling groggy

By Lexi Trimpe

Before being treated for narcolepsy, Rebecca Lesser was constantly exhausted. The Oak Park resident, 51, would sit “and poke a pencil in my leg in meetings trying to keep myself awake.”

Lesser struggled with exhaustion for most of her life. Before she was diagnosed and treated, she was a computer programmer and had to be at work by 9 a.m.

Lesser says even if she woke up at 6 a.m., she would feel lost all morning long, causing her to always be late for work. “Luckily they came up with flex time, but even with that, sometimes if it was a bad day, it was a very bad day,” she says.

Lesser isn’t alone. According to the National Institute of Neurological Disorders and Stroke, some 40 million Americans suffer from chronic sleep disorders annually. An additional 20 million experience occasional sleeping problems. Common disorders include sleep apnea, narcolepsy, insomnia, and restless legs syndrome.

The long- and short-term effects of these disorders go beyond than simply feeling groggy.

Miller Morgan of Wayne, 50, can attest to that. A few years ago, Morgan, who travels frequently for work, began to experience crippling exhaustion and depression. He felt terrible all the time, and “every day was a battle,” he says.

After trying a variety of treatments with his doctor, including antidepressants, he was instructed to take part in a sleep study, which found Morgan stopped breathing up to 95 times per hour. He was diagnosed with obstructive sleep apnea.

According to Dr. Hillary Loomis-King, a sleep specialist at the University of Michigan Health System, obstructive sleep apnea is described as the narrowing or closing off of the airway during sleep, caused by a variety of factors including obesity. This obstruction causes a lowering in blood-oxygen levels, resulting in disruptions to the sleep cycle and increased cardiac stress. Obstructive sleep apnea is by far the most common sleep disorder Loomis-King sees.

Soon, Morgan was fitted for a continuous positive airway pressure therapy (CPAP) machine, which supplies a constant and steady stream of air through a facial mask, which is used while sleeping.

Using his CPAP, Morgan experienced a lifestyle change that extended way beyond his sleeping habits.

“My whole life changed when I started using the machine,” he says. “You feel better when you’re rested. You want to do more things. You want to take care of yourself. You want to go places.” With a new handle on life, Morgan has begun watching what he eats and losing weight, 20 pounds so far. He even recently began going to the spa.

But what does sleep do for us beyond making us feel rested? And why is it so important?

Dr. Luisa Bazan, who specializes in sleep medicine at Henry Ford Hospital, says one theory for why we sleep is memory restoration.

“Some studies have shown that the toxins that are produced in the brain are actually cleared through our sleep,” Bazan says. “Some of the toxins, or some of the proteins, that are there and we clear are related to different types of dementia.”

Loomis-King adds other cognitive issues include problems with attention. Studies show that people’s physical abilities to do things that required coordination and concentration were impaired “after a very short period of sleep deprivation, whether that be from sleep apnea or from just not sleeping enough, in general,” she says. Research has also linked sleep deprivation to obesity, diabetes, hypertension, and cardiac problems.

How much sleep we need can vary from person to person, with a variety of determining factors, including age and gender. “Typically, our sleep time, if we look at studies, should be eight hours and 15 minutes, but it can vary,” says Bazan. “If you are sleeping seven hours and feel refreshed, that should be OK. Some people need nine hours to feel refreshed, and that’s what they should achieve.”

In February, the National Sleep Foundation refreshed their recommendations for the number of hours of sleep needed, breaking down the age groups into new categories. Young adults ages 18-25 and adults ages 26-64 should be getting 7-9 hours of sleep per night. Older adults ages 65 and older should be getting 7-8 hours.

In Michigan, the Centers for Disease Control and Prevention found in a 2008-09 survey that 28 percent of adults reported not getting enough sleep on more than 14 days in the previous 30 days. The survey also found that the prevalence of self-reported insufficient sleep was higher among women than men.

Operating a car or machinery while sleep deprived is a major concern. Dr. Gary Trock, a sleep specialist and neurologist at Beaumont Hospital, cites excessive sleepiness as the second most common cause of fatal car accidents, next to alcohol. “The Exxon Valdez (oil spill) was caused by the person falling asleep when they were driving the boat. A lot of major accidents, major industrial and truck accidents, are caused by sleepiness.”

The National Highway Traffic Safety Administration estimates drowsy driving causes more than 100,000 crashes a year, resulting in 40,000 injuries and 1,550 deaths. The NHTSA also explains it is widely recognized that drowsy driving is underreported as a cause of crashes.

Proper sleep hygiene is the first step toward restful, restorative sleep. Specialists recommend maintaining a normal sleep pattern, even on weekends, avoiding caffeine in the evening, and not using technology like cellphones and tablets before going to bed.

Although our increasingly busy lives make sleepiness commonplace, it’s important to not ignore it. While there may not be a magic number of hours of sleep needed, or a be-all end-all cure for sleep disorders, there is an important rule of thumb: If you’re drowsy to the point that it affects your day-to-day life, seek help.

That’s what Morgan did. He says he “laid around for a year and half” before a doctor helped him from hitting bottom.

“I know I couldn’t go on living like I was,” he says. “ … Now I can do anything. Now I’m like a normal person.”



Mistaken Identity

Is it ADHD, or could it be a sleep disorder?

By Alexa Stanard

Six-year-old Yousef Mohammed was having trouble focusing in school. The Detroit resident sometimes lacked the energy to finish his assignments, and he also had a bad temper, getting upset quickly.

“His teacher said he was a very smart student,” says his 20-year-old sister, Zahra. “When he had the energy, he was doing very well.” Yousef also had trouble breathing at night, sometimes stopping breathing altogether and then choking on his breath. When he was 4 years old his mother, Sawsan Marae, took him to a specialist, who told her the problem might resolve itself.

That didn’t happen, so Marae took him to Children’s Hospital of Michigan to be evaluated. Yousef took a sleep test, which revealed severe sleep apnea — just 70 percent of the available oxygen was reaching his brain.

In an age of increasing diagnoses of attention deficit hyperactivity disorder (ADHD) and other mental and behavioral disorders in kids, sleep problems are a growing area of interest. That’s because the symptoms of sleep deprivation in kids — hyperactivity, trouble focusing, moodiness, temper — look a lot like the symptoms of ADHD and other disorders.

In fact, a host of studies are demonstrating a correlation between sleep problems and diagnoses of ADHD. A study of 11,000 British children, published in the journal Pediatrics, found that kids with sleep issues like snoring, mouth breathing, and apnea were 40 percent to 100 percent more likely to develop behavioral problems resembling ADHD.

The causes of poor sleep in children are multiple, says Dr. Ibrahim Abdulhamid, clinical director of the Children’s Hospital of Michigan Pediatric Sleep Center.

Sleep apnea is one of the most common disorders, appearing in about 2 percent of otherwise healthy children. Apnea is typically caused by enlarged tonsils and adenoids, and can be tricky to spot. Though it’s associated with snoring, children with even severe sleep apnea may not snore or do so very lightly.

“These children present with snoring, or with mouth breathing, restless sleeping, sweating at night, sleeping with the neck extended,” Abdulhamid says. They may choke or cough, or wake up crying and then resettle.

“They can be irritable, moody, hyperactive, aggressive — the cognitive performance at school will not be good,” he says. “You’ll be surprised how this behavior improves after adenoids and tonsils are taken out.”

Indeed, a 2013 study of 464 children by the National Institutes of Health found that removing the tonsils and adenoids in school-age children with sleep apnea improved behavior and quality of life.

In September, Yousef had surgery to remove his adenoids. The change was immediate. “He’s been doing way better,” Zahra says. “His participation in class has been noticed by his teacher, and he received an award for improvement. He has way more energy, and he’s getting interested in joining sports.”

Physiological disorders like apnea aren’t the only causes of poor sleep. Toddlers who resist going to sleep or wake up during the night may be chronically under-rested. A loss of as little as 30 minutes of needed sleep can manifest in hyperactivity and poor focus.

In teens, poor sleep quality can look more like it does in adults, with fatigue and sluggishness replacing hyperactivity. But the poor focus and irritability are often still present.

“One of the most common sleep problems in teenagers is delayed sleep phase syndrome,” Abdulhamid says. “Teenagers have problems falling asleep — their brain doesn’t shut down until later in the night versus adults. It gets worse with phones, gadgets, iPad … they maintain arousal. The other precipitating problem is use of caffeine.”

Chirece Webb’s son, Brian, was sluggish and “borderline lazy” as he moved into his teen years. His school performance was poor. At 14, he started snoring loudly.

“I thought maybe it was a growth spurt, or because of his weight,” Chirece says. (Brian was 6 feet 1 inch and weighed about 250 pounds.) “Then he would get sick a lot, with colds and strep throat — he kept getting it. And he would get tonsillitis, which was when the snoring really kicked up. It was horrible.”

Chirece decided to take Brian, now 16, for a sleep study. The study found he stopped breathing so often during the night that he was referred for emergency surgery to remove his uvula, tonsils, and adenoids.

Since the surgery, Chirece says, Brian “has tons of energy. He’s doing so well. He wants to go everywhere, get more involved. He’s lost weight, and his confidence level went up.

“Sleep is the key to everything,” she says.