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JFK Medical Center Specialist Offers Sound Advice for Sound Sleep

 

guptaThe National Institutes of Health reports that between 50 million and 70 million Americans have ongoing sleep disorders.

As increasing numbers of people work more, worry more, and weigh more, they are sleeping less — to the detriment of their short-term and long-term health, says Divya Gupta, MD.

Dr. Gupta, a sleep medicine specialist at the JFK Neuroscience Institute in Edison, recently talked with nj.com about America's "sleep deficit" and how individuals can do their best to get their rest.

Q. How significant an issue is the so-called 'sleep deficit'?

A. Very significant. Chronic partial sleep deprivation is becoming epidemic in this country. The National Institutes of Health reports that between 50 million and 70 million Americans have ongoing sleep disorders and that nearly 40 percent of adults have reported falling asleep during the day without intending to at least once a month. In ongoing surveys conducted by the Centers for Disease Control and Prevention (CDC), between 7 percent and 19 percent of adults report not getting enough rest or sleep every day. And while those statistics focus on adults, we know that significant numbers of children and teenagers also are not getting sufficient sleep.

Q. Besides not having as much energy or being as focused as you might like, to what extent does lack of sleep affect a person's health over the short term?

A. Lack of sleep can have a significant negative impact on both health and quality of life in the near term. It's not just a matter of being tired, irritable, cranky, or unable to concentrate, although those are very real issues. The CDC reports that between 5,000 and 6,000 fatal car and truck crashes each year may be caused by drowsy driving. The agency conducted a study of almost 150,000 adults and found that 4.2 percent reported they had fallen asleep at the wheel while driving at least once in the past 30 days. Other serious accidents, including falls in the elderly, can result from sleep deprivation and deficiency. In addition, inadequate sleep has a negative impact on mood and emotional well-being, school and work performance, and interactions with others.

Q. What about the long-term health effects of inadequate rest and sleep?

A. Several studies in the medical literature have shown a connection between sleep deprivation and increased risk for cardiac arrhythmias, hypertension, congestive heart failure, stroke, dementia, and other serious conditions. In children, growth curves and learning can be affected by untreated sleep disorders.

Q. What can the average person do to get sufficient sleep each night?

A. First and foremost, establish and stick to a regular sleep schedule. Try to minimize variability in the times when you rise in the morning and go to bed at night so that your body gets into a rhythm and routine. Additionally, don't curtail sleep in favor of 'doing more.' In the hours before you go to bed, avoid substances — such as caffeine and alcohol – that may keep you up at night. Similarly, aerobic exercise in the late afternoon or early evening can help you get a good night's sleep, but exercise within four hours or so of going to bed can work against you getting to sleep.

It also is important to have a transitional period of 15 to 20 minutes, if not longer, before bed when you're not looking at computer screens or subjecting yourself to other stimuli that can interfere with sleep. In the same vein, your bed should be reserved for sleep – not for talking on the phone, watching television or working on your laptop. While your bedroom should be dark while you're sleeping, studies have found that waking to bright light in the morning helps improve sleep the following night.

Q. What if a person follows all of those good practices but still has trouble sleeping?

A. There are two things they should not do. The first is to decide to "just live with it" and to accept the diminished quality of life and the health issues that are associated with sleep disorders. The second is to take a "Band-Aid" approach to the problem. For example, sleeping pills do not address the root cause of a sleep disorder and can create issues of their own unless used at the direction and under the supervision of a physician following a thorough evaluation.

What people should do is talk with their physician and see if referral to a sleep center for evaluation may be warranted.

Q. What are some indications that evaluation by a sleep center may be in order?

A. Difficulty staying awake at work, school, or while driving is a key indication. Other indicators are snorting or loud snoring during sleep, restless sleep, jerking leg movements, and sleep walking. In many cases, a spouse will urge – or insist – on an evaluation. In other cases, people will wake to find their bed sheets all tangled on the bed or floor and realize just how restless their sleep has been.

Q. What does an evaluation entail?

A. It depends on the nature of the patient's situation. At the JFK Neuroscience Institute here at JFK Medical Center in Edison, we take a multidisciplinary approach to considering each patient and his or her sleep problems. We start with a detailed history, and then select tests based on that history and any findings on physical examination. When a sleep study is indicated, a physician writes a prescription for the study, just as he or she would for any other diagnostic test that was warranted on the basis of a patient's history and exam findings. We then conduct the study in our sleep laboratory, which has six beds with video cameras and other fully digitized equipment to monitor a patient's sleep. At our lab, which is accredited by the American Academy of Sleep Medicine and staffed by certified technicians, we individualize each evaluation. For example, if a patient or his or her bed partner reports experiencing a hand tremor during sleep, we'll add an extra channel to track hand movements.

While many sleep clinics and sleep laboratories focus primarily on sleep apnea, our program is a comprehensive one that entails diagnosis and management not only of sleep apnea but also of restless leg syndrome, narcolepsy, insomnia, shift-worker disorder and circadian rhythm disorders, sleepwalking, the sleep problems that can accompany Parkinson's disease and other conditions, and a whole range of other sleep disorders.

Most sleep disorders are highly treatable, and once we've identified the cause of the problem we devise and implement an individualized treatment plan that typically leads to significant improvement in a relatively short time.

Q. What types of treatments are involved?

A. Again, it depends on the nature of the disorder and the patient's overall health. For sleep apnea, we often prescribe devices that provide positive airway pressure. Medication regimens can be effective for restless leg syndrome and for some of the sleep problems experienced by people with other movement disorders, such as Parkinson's disease. For insomnia, we frequently work with cognitive behavioral therapists who are experienced in treating people with sleep disorders so that we can get to the root cause of the insomnia rather than have an ongoing reliance on sleeping pills.

For more information visit the Sleep Disorders and Treatment Program at the JFK Neuroscience Institute  or call (732) 321-7010.

Note:
The NIH and CDC statistics cited in the answer to the first question are from nhlbi.nih.gov/health/health-topics/topics/sdd.

The CDC statistics cited in the second answer are from cdc.gov/features/dsdrowsydriving/.