On the fourth floor of one of the many buildings that make up UVA’s health matrix is a room that is painted a palliative green. On the wall is a hotel-esque picture of a peaceful lake. There is a comfy chair and a bed. On the duvet, nestled into the pillows, is a wide-eyed teddy bear with a bunch of electrodes attached to its head. While this may resemble the setting of a budget horror flick, it’s actually one of eight rooms that compose the Sleep Disorders Center. Here, using highly sensitive machines that measure heart rate, brain waves and blood oxygen, doctors explore the state where we spend a third of our lives and continue to chart this widely misunderstood territory.
Getting by on little sleep, or sleep deprivation, has long secured bragging rights for the disheveled college student to the high-powered lawyer. Staying up late, pulling all-nighters, means you’re out there, making piles of money, soldiering through the battlefield of life and being productive while everyone else is lolling in their dreams. But new evidence suggests this attitude is far more damaging than previously thought.
“Not everyone realizes how important sleep is,” says Paul Suratt, a pulmonologist and internationally known sleep expert. Suratt started the UVA Health System’s sleep clinic, now in its 25th year, almost by accident. In the pulmonary lab one day, he noticed that a sleeping patient seemed to be having trouble breathing. He ran to find an oximeter (a machine that clips to your finger and measures blood oxygen), hooked the patient up and observed that not only did he stop breathing for up to 40 seconds at a time, but his oxygen levels would plummet.
“So I decided to study it,” says Suratt. He appropriated a hospital bed and accumulated instruments that measured breathing. Things were rocky at first. Patients were scarce and the technician actually quit. Eventually, though, they grew from a makeshift clinic to a fully outfitted, eight-room sleep lab that now has the equivalent of a five-star rating from the American Academy of Sleep Medicine. It has all the accoutrements of a comfortable-enough hotel and the equipment necessary to create individual sleep portraits that tell us what is going wrong in our off hours.
Upward of 40 million Americans suffer from clinical sleep disorders, but it’s a telling sign of our priorities that 70 percent of people who have trouble sleeping don’t discuss it with their doctor.
And a lot is going wrong.
Almost two-thirds of Americans voluntarily—willingly, even—get less than the prescribed eight hours of sleep per night, and almost one-third get less than seven hours, according to the National Sleep Foundation. Sixty-eight percent suffer from decreased concentration and 66 percent experience difficulty handling stress as a result. Upward of 40 million Americans suffer from clinical sleep disorders, but it’s a telling sign of our priorities that 70 percent of people who have trouble sleeping don’t discuss it with their doctor.
“Our most common complaint is excessive sleepiness,” Suratt says of the patients who enter the clinic. “Another widespread thing is snoring loudly. Spouses don’t like it and they’re worried about it.”
The center also sees people who suffer from periodic limb movements and seizures in their sleep. And “people who do strange things in the night, jumping out of bed and ramming their head against the cabinet,” says Suratt, ticking off the list. “People who have nightmares. We treat infants all the way up to old people.”
Patients come from all over Virginia. In 2007 alone, the center conducted more than 1,900 sleep studies. Its medical team includes four physicians who are board-certified sleep doctors specializing in pulmonology and pediatrics. Joining them are doctors from neurology, behavioral medicine, and ear, nose and throat surgery.
Recently, it’s the children who have been interesting Suratt the most. According to the National Sleep Foundation, 90 percent of American parents think their children are getting enough sleep—though children themselves say otherwise. Some 60 percent of high schoolers report extreme daytime drowsiness; more than 25 percent fall asleep in class at least once a week.
In one study of children, UVA sleep expert Paul Suratt found that the degree of cognitive impairment from sleep apnea was similar to the degree of impairment from lead poisoning.
While researching youngsters with large tonsils and adenoids, Suratt observed that many of them snore, a condition largely attributed to sleep apnea—the narrowing of the air passages—which causes the patient to wake up repeatedly during the night, losing sleep. “We’ve found that the children in this group who have sleep apnea have impaired cognitive function, and that the degree of impairment from sleep apnea is similar to the degree of impairment with lead poisoning,” he says.
The abnormality bears out in vocabulary tests, which are known to be the best indicator of a child’s IQ. What’s most alarming is that the ill effects of not getting enough sleep may be irreversible. “We suspect that it could cause permanent damage,” says Suratt.
These findings have put UVA at the forefront of a widening field of research concerning the consequences of sleep deprivation. Not only is there a correlation between lower IQs and lack of sleep, but it’s also being linked to rising obesity rates. What’s more, the effect it has on people’s outlook is striking, says Suratt. “People are just not very positive about things,” he says, and when it comes to making decisions, “What seems to be impaired are complex, executive functions that require creativity, judgment and interacting variables.”
As part of their quest to identify at-risk children, UVA researchers are now testing a device that records breathing sounds during sleep at home. A key goal is to predict which children with sleep disorders are most likely to develop cognitive impairment or develop behavioral problems.
Caffeine, television, energy drinks and stress are some of the factors contributing to a population that doesn’t get enough sleep. A booming sleeping pill market (now a $3.7 billion business) and the prevalence of specialized mattresses also attest to the problem and a growing “sleep racket” as Forbes magazine described it.
Is sleep going the way of water? Where only rarefied and stylish versions of it—such as sleep aids and expensive beds—make you forget that this basic life source can come directly from the tap?
“I thought I was dying,” says Jeff Cutruzzula, an administrator at UVA. “I thought I had Alzheimer’s. I thought I was depressed. I really couldn’t get a handle on what was happening.” It took Cutruzzula a while to realize that his problems might be sleep-related. He finally talked to a pulmonologist, who referred him to Suratt. He then went in for a sleep study.
The sleep clinic might be a little intimidating if you don’t know what to expect. “It’s not a glass booth, like you might think,” says Benjamin Crandall, the chief technician. Most patients come in for a preliminary session to learn what will happen and to ask questions. “They spent a lot of time teaching me about the procedure,” Cutruzzula recalls, “actually going through the steps that they would be doing with me, showing me the monitoring equipment.”
Cutruzzula arrived in the evening and was met at the door by a staff member, who escorted him up to the clinic and helped him get settled into a room. Once in pajamas, he was outfitted with electrodes attached to his scalp, arms, legs and waist.
These electrodes run to various machines that monitor brain waves, heart rate and breathing patterns. The data is then filtered and compressed through a computer program to create a polysomnogram, a sort of topography of the patient’s sleep state that allows the technician to see how everything interacts and to identify patterns—“How the chest is breathing and what the heart is doing,” says Crandall.
In Cutruzzula’s case, the diagnosis was fairly obvious. He had sleep apnea, a condition that afflicts 10 percent of women and 20 percent of men. “When I went to med school, nobody had heard of sleep apnea,” says Suratt. “Everyone assumed that if you didn’t stop breathing during the day, you wouldn’t at night.” The disorder is finally getting some recognition. “It seems like it’s reached critical mass,” says Crandall, referring to the number of people who come to the sleep clinic with the condition. “Someone saw someone on Oprah who had it.”
Treating sleep apnea requires a Continuous Positive Airway Pressure (CPAP) machine, which attaches to the patient’s face as a mask and blasts air through their passageways, preventing them from collapsing. “It was life-changing for me,” says Cutruzzula. “My performance of even the most minimal tasks to putting thought processes together was so compromised that I thought there was no return from this. But with the CPAP, I learned that an obvious problem with sleep can be remedied.”
Then there are the people who don’t have sleep apnea, but whose nocturnal disorders are possibly due to lifestyle and who constitute a national tide of sheets being pushed back in frustration in the middle of the night. According to Suratt, there are a number of things one can do to ensure a good night’s rest. They include having a fixed schedule for going to sleep; avoiding alcohol, because it can cause you to wake up in the middle of the night; exercising during the day but not immediately before bed; avoiding caffeine; and knocking off stressful activity during the evening.
As for kids, it’s important for parents to put their foot down. “A lot of parents are not aware of the necessity of enforcing bed- times,” says Suratt. “You have to make a conscious effort.” It comes down to appreciating the time your body and mind need to reboot and understanding how integral sleep is to overall health. Go to bed a little earlier, says Suratt, and “you lose one hour of having fun, but you gain 16 hours of feeling good the next day.”
The Lost Hour
Impact of sleep deprivation is worse on children
A number of studies show that children are getting about an hour less sleep each night than they did 30 years ago. Unfortunately, it’s not getting the attention it deserves, sleep researchers say, and many parents and educators remain skeptical about the importance of that lost hour.
With the benefit of functional MRI scans, researchers can better discern the debilitating effects of sleep loss on a child’s brain, which continues to develop until the age of 21—much of it during sleep. Yet a major study by the National Sleep Foundation found a startling disconnect between the amount of sleep that parents thought their children were getting and what children actually got.
Clearly, sleep experts say, sufficient sleep needs to be a family priority. They recommend these measures:
Follow a nightly routine
Bedtime rituals make it easier for children to relax, fall asleep and sleep through the night.
Make bedtime the same every night
Inconsistent bedtimes desynchronize the body’s systems that regulate sleep.
Make sleep a priority
Make compromises when it comes to your child’s extracurricular activities instead of when it comes to sleep.
Encourage children to fall asleep on their own
Studies show that the child who falls asleep on his or her own will be better able to return to sleep during normal nighttime awakenings.
Learn to recognize warning signs
The most common sleep disturbances in children include difficulty falling asleep, nighttime awakenings, snoring, stalling and resisting going to bed, having trouble breathing, and loud or heavy breathing while sleeping.
Nightly sleep recommended for particular age groups
18 months-3 years: 12-14 hours
3-5 years: 11-13 hours
5-12 years: 10-11 hours
Teens: 9.25 hours
Source: National Sleep Foundation