ITSMN Articles

In Search of Sleep

Author: Kathy McCleary | Posted: 2007-03-22

Confession time: My husband has actually uttered the words “I’d rather take a nap than have sex.” Is our marriage on the rocks? No, like 75 percent of adults, our problem is sleep—he has insomnia, I snore.

We seem to be too busy to get enough sleep. On average, Americans sleep roughly 7 hours a night, 1 to 2 fewer hours per night than they did 40 years ago. And when we do hit the sack, sleep doesn’t necessarily follow. No wonder my husband and I sometimes feel like zombies. Worse, there could be serious health repercussions due to our lack of shut-eye. Here’s the latest research on how sleep deprivation affects your body and mind, and what you can do to solve the most-common sleep problems—from insomnia and snoring to apnea and restless legs syndrome.

Do you have a sleep disorder?

How much sleep each person needs varies, though the differences may not be as great as you think, says Eve Van Cauter, PhD, professor of medicine at the University of Chicago. Studies have shown that sleep capacity—how long you’ll sleep if you go to bed and get up whenever you want—is about 8 hours and 45 minutes for healthy young males (the group that’s been researched most). In three separate studies, that amount varied less than 30 minutes from person to person. “A lot of people who believe they need only 4 hours of sleep are unconsciously depriving themselves,” Van Cauter says.

Most people need 7 to 8 hours a night, according to Lawrence Epstein, MD, regional medical director for Sleep HealthCenters in Boston and former president of the American Academy of Sleep Medicine. “The idea shouldn’t be to get into bed, fall asleep instantly, sleep a set number of hours, and wake up never having had your sleep disturbed,” he explains. “The target should be to get an adequate amount of sleep to feel rested during the day.”

How do you know you’re not getting enough z’s? “If you’re falling asleep in 1 or 2 minutes, you’re probably sleep deprived,” says Thomas Roth, MD, director of the Sleep Disorders and Research Center at Detroit’s Henry Ford Hospital. On average, it takes most people about 15 minutes to fall asleep, though Roth notes that “it takes some people more time, some people less.”

Another way to tell if you’re not sleeping enough is to monitor day-time sleepiness. Chronic daytime sleepiness is not normal, says Michael Twery, PhD, acting director of the National Center on Sleep Disorders Research. “People can live for decades and never appreciate that they have a sleep disorder and how it’s affecting their lives.”

The downside of running on empty?

Scientists are finding more evidence that sleep deprivation can affect appetite, weight gain, diabetes risk, the strength of your immune system, and even your chance of developing depression.

In 2004, University of Chicago researchers restricted a group of men to only 4 hours of sleep per night. After just 2 nights, the men had an 18 percent decrease in leptin, a hormone that tells your brain when you are full, and a 28 percent increase in ghrelin, a hormone that triggers hunger. These results were reinforced last October by a study of almost 10,000 adults that found that people who slept fewer than 7 hours a night were more likely to be obese than those who got 7 hours of shut-eye.

“Chronic sleep deprivation causes changes in metabolism that produce a state that stimulates hunger,” Epstein explains. Sleep deprivation can also affect how your body handles insulin; insulin resistance puts you at risk for weight gain and diabetes.

In a study that’s still under way, Van Cauter and her colleagues are looking at chronic sleep loss in a group of normal-weight men and women under age 30. Over 6 months, those who slept fewer than 6.5 hours a night were more insulin-resistant than normal sleepers who logged 7.5 to 8 hours per night. The short sleepers, the study shows so far, need to produce 30 to 40 percent more insulin to dispose of the same amount of glucose. Still other studies suggest that over time, sleep loss may play a role in the development of depression. “Positive moods are lower in people with sleep loss,” Van Cauter says, “and mood isn’t stable over the 24-hour cycle. People have lower moods in the morning. They also have higher levels of cortisol, the stress hormone. All those changes are typical of clinical depression.”

But your sleep issues don’t have to doom you to depression, diabetes, or a bigger dress size.

Counting Sheep: Sleep Apnea

Snoring occurs when your breath moves through a passage that’s too small. During sleep, your throat muscles relax and your tongue falls backward. The walls of your throat become “floppy,” according to the National Sleep Foundation, so they vibrate as you breathe. If something (your tongue, enlarged tonsils, a deviated septum in your nose) narrows the passage in your throat, you snore. “If you blow up a balloon then pinch the end of it and release the air, it makes noise,” Roth says. “That’s what happens when air passes through a passage that’s not big enough.”

Snoring isn’t necessarily a health risk (unless you consider the death threats from your bed partner). The danger comes when not enough air can get through your nose or mouth and you stop breathing for a few seconds—a condition called sleep apnea. That signals the brain to wake you up to get your breathing going again. You may not even be aware of these mini-awakenings, but your body is. As a result, most people with this disorder are sleepy during the day.

Sleep apnea has been linked to a higher risk of stroke and death from any cause, according to a 2005 study of more than 1,000 patients at the Yale Center for Sleep Medicine. And, according to Rush University Medical Center’s Crisostomo, it increases the number of “inflammatory mediators” in the body that are associated with heart disease and diabetes. Scientists look at how many times per hour people with sleep apnea stop breathing during the night. “Even with just five per hour, the odds of developing high blood pressure are significant,” Crisostomo explains.

Before menopause, a woman’s risk of developing sleep apnea is 10 to 50 percent lower than a man’s. It “goes up dramatically after menopause,” Roth explains, probably because estrogen is a stimulant that encourages breathing. When your estrogen level decreases after menopause, so does this breathing boost. The hormonal changes that occur during pregnancy also increase your chances of developing snoring and sleep apnea.

How can you tell if your snoring is dangerous? “A bed partner will usually tell you if you snore loudly or stop breathing. You may feel tired during the day, or not as well rested as you used to be with the same amount of sleep. These are signs you need to talk to your primary care doctor or see a sleep specialist,” Epstein says.

What you can do

Spend a night at a sleep center. Your doctor can refer you to a sleep facility, where you’ll spend a night being observed by experts. A 2005 study found that medical history and a physical exam are not enough to distinguish people with sleep apnea from people with plain old snoring.

Lose weight. A 2005 study of more than 2,500 men and women found that even modest changes in weight, say 10 pounds, decreased sleep problems.

Be a side-sleeper. Crisostomo tells patients to hit the hay wearing a T-shirt backward with a tennis ball in the pocket; the uncomfortable hump discourages back sleeping. Raising the head of your bed just a few inches can also alleviate snoring.

See a dentist. A dentist can create a retainer-like device that pulls your lower jaw and tongue forward when you sleep to increase the air space at the back of your throat. Such devices are very effective in treating mild to moderate apnea and snoring. Be careful, though: “You want someone with specific training in sleep and snoring,” Crisostomo says.

Mouthpiece Devices

ENT specialists (or otolaryngologists, as they are known to those who can spell) are not the only ones to treat snoring. Your dentist can help too, and may suggest a special type of mouthpiece.

Mouthpiece devices -- also known as dental appliances, or mandibular advancement splints -- have been effective for many snorers, including those suffering from mild or moderate obstructive sleep apnea. They are usually small plastic devices worn in the mouth during sleep to prevent the soft throat tissues from collapsing and obstructing the airway. They do this by bringing your lower jaw forward and/or by lifting your soft palate. Some devices also stop the tongue from falling back over your windpipe.

Your dentist will usually be the one to fit these special appliances to meet your individual condition. Typically they will take a mold of your mouth and then either send off for a custom mouthpiece or fashion it themselves.

You can find a dentist who specializes in sleep dentistry at the Academy of Dental Sleep Medicine website. Do mouthpieces work? A recent study in Switzerland found oral appliances effective in treating sleep apnea. Side effects were only "mild": mucosal dryness (6% of patients), tooth discomfort (5%), and excessive salivation (5%).

A similar study in the UK of 25 heavy snorers found that use of "mandibular advancement appliances," i.e., mouthpieces, was effective in reducing snoring loudness for 84 per cent of the subjects while 76 per cent said they were snoring on fewer nights per week.

Will mouthpieces mess up your beautiful smile?

Probably not. Researchers in Sweden found few problems in patients, especially those using soft plastic mouthpieces. However, a study of 630 people who were fitted with mandibular advancement devices found that nearly one-quarter of the people abandoned it. The author commented that some participants may have experienced side effects such as excess salivation, shifting of teeth positions or other tooth and mouth problems. So you should certainly check back with your dentist after sleeping with a mouthpiece for a few months.