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In Modern Times, a Good Night's Sleep Struggles

New York (Apr 19, 2011)

Illustration, fairy sleeping on a moonbeam

Getting a good night's sleep is arguably the most important part of anybody's day. But for a growing number of people, normal nighttime rest is becoming more and more elusive. The NIH National Center on Sleep Disorders Research estimates that some 70 million Americans suffer from debilitating sleep disorders.

It is clear that our modern lifestyle has brought about sleep changes which are affecting the population as a whole. A century ago, most people rose with daylight, exerted themselves all day and crawled into bed when the sun went down or the candle burnt out. Then came electric light, which extended people's days and shortened sleep but left few ill effects.

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Fast forward to the world of the last 50 years. Now the mechanics of sleep have been disrupted by a variety of distractions including radio, television, all-night cable, and internet connectivity. At the same time, many more of us are sedentary, with little physical activity to make us tired. This has all led to fewer hours of sleep and, over time, less ability to sleep. Less ability to sleep has led to sleep disorders, and sleep disorders have led to the emergence of sleep centers.

When someone's sleep patterns are persistently broken, the result is more than just "feeling a little tired," says Ana C. Krieger, M.D., the Medical Director of the Center for Sleep Medicine at NewYork-Presbyterian/Weill Cornell Medical Center. "Lack of adequate sleep can lead to daytime drowsiness, memory problems, hyperactivity, sleepwalking, behavioral issues, and sudden sleep attacks."

Ana C. Krieger, M.D.
Ana C. Krieger, M.D.

Both medical and behavioral factors can contribute to disrupted sleep. Neurological disorders like insomnia (difficulty falling or staying asleep) and narcolepsy (a central nervous system disorder which causes extreme daytime sleepiness), psychological issues including depression, and serious conditions like sleep apnea (caused by airway obstructions that interrupt breathing) can all play a role. Restless leg syndrome (periodic limb movements during sleep) and brain abnormalities, including seizure activity, may also lead to abnormal sleep patterns.

Excess alcohol consumption, undue stress, and anxiety can also interfere with normal sleep. So can late night television or internet surfing, physical activity right before bedtime, and reading late into the night. If a person is elderly, inactivity and frequent daytime napping can make it difficult to sleep through the night. As Carl W. Bazil, M.D., Ph.D., the Director of the Comprehensive Epilepsy Center and Sleep Disorders Center at NewYork-Presbyterian/Columbia University Medical Center, puts it, "An inability to sleep brought on by poor nighttime routines is often a learned behavior – your body learns bad sleep habits against your will."

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Sleep medicine is recognized as a medical sub-specialty by the American Board of Medical Specialties. Thousands of such centers now exist, with various levels of expertise and accreditation. NewYork-Presbyterian's two facilities, the Weill Cornell Center for Sleep Medicine and the Columbia University Sleep Disorders Center, are among the largest in the country. The Centers use a multidisciplinary approach: patients may be treated by specialists in neurology; internal medicine; pulmonary medicine; ear, nose and throat (ENT); pediatrics; psychiatry; psychology; bariatric surgery; nutrition; and endocrinology.

Diagnosis and treatment begin with a full assessment. Patients with a diagnosis of insomnia will be directed toward behavior modification therapy. In most other cases, the patient will be observed overnight for a sleep study, also called polysomnography (PSG), which is the most effective method of diagnosing sleep disorders and determining treatment. During a PSG, sleep specialists place several non-invasive electrodes on the skin and scalp and use sophisticated monitoring equipment to record changes in brain activity, respiration, oxygen levels, heart rhythm and muscle activity in the face, arms and legs during sleep.

Carl W. Bazil, M.D., Ph.D.
Carl W. Bazil, M.D.,
Ph.D.

Once the initial diagnosis is made, the patient will have a series of office visits. "This is a process," notes Dr. Krieger. "Treating a sleep disorder requires constant follow-up and feedback." Dr. Bazil concurs: "You can't force sleep – it's not like turning on a switch. Overcoming a sleep disorder requires a very motivated patient."

Fortunately, there are a variety of effective treatments for sleep disorders and most patients benefit from a sleep center consultation. For example, patients diagnosed with sleep apnea may be given a machine called a CPAP (Continuous Positive Airway Pressure), that connects a small mask over the nose to air pumped from an attached machine. The air pressure keeps the upper airway and windpipe open during sleep. Some patients will find they actually need treatment for some other condition – like a mood disorder – that could be causing sleeplessness.

Other patients will simply need to adjust their habits. It could be as simple as turning off the television after the evening news, limiting nighttime emails and Facebook chats, and closing the shades. They may experiment with relaxation techniques or try a different sleeping position that facilitates better breathing or allows for more comfort.

"The body needs regular cycles of light and stimulus in order to function at its best," says Dr. Krieger. The job of sleep center specialists is to help patients regulate those cycles so they can enjoy what everyone deserves – a good night's rest.

Contributing faculty for this article:

Ana C. Krieger, M.D. is the Medical Director of the Center for Sleep Medicine at NewYork-Presbyterian/Weill Cornell Medical Center and an Assistant Professor of Medicine at Weill Cornell Medical College.

Carl W. Bazil, M.D., Ph.D. is the Director of the Comprehensive Epilepsy Center and Sleep Disorders Center at NewYork-Presbyterian/Columbia University Medical Center and the Caitlin Tynan Doyle Professor of Clinical Neurology at Columbia University College of Physicians and Surgeons.

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