Setting the Sandman Straight : Sleep clinics: America’s frenetic society is blamed for a variety of disorders that have led to a demand for specialized centers.
Billie Jean Valenzano never had a problem falling asleep. In fact, a nod of the head always came at the most inconvenient times: in the middle of the day, while taking a test or talking to a friend, during a meal or even while driving.
When Valenzano, 23, sought help, she was told she was depressed, lazy and uninterested in life. But other symptoms bothered her. She fell down a lot, had short-term memory loss and mixed up words in conversations. She would awaken at night, convinced there was a huge, black spider crawling up her back or that a strange man was lurking in the doorway.
She was certain there was a reason for her disturbances, which had started when she was 12. Doctors initially dismissed her descriptions as overly imaginative. Determined to nail down some identifiable disorders, she searched medical journals. What she found would makeeven Stephen King shudder: Sleep terrors. Hypnopompic hallucinations. Automatic behavior. Sleep paralysis. Narcolepsy. Cataplexy. Microsleeps.
Her research eventually led her to North Valley Sleep Disorders Center in Mission Hills, the first such center in the nation associated with a community hospital. The center, founded in 1979 at Holy Cross Medical Center, moved across the street in 1988 to operate as a private business because of lack of space at the hospital.
Valenzano is just one of about 80 million Americans--about one-third of the nation’s population--with sleep disorders, according to the National Institute of Mental Health. Problems range from simple insomnia and snoring measured in decibels, to apnea (a nighttime breathing disorder) and narcolepsy, which the North Valley Center diagnosed Valenzano as having.
Narcoleptics commonly experience hallucinations and daytime sleep attacks or “microsleeps” lasting up to several minutes, which rob them of deep, nighttime sleep. Cataplexy, a symptom triggered by strong emotions, such as anger, laughter or sadness, is also common. The emotions are followed by a partial or complete muscular collapse. Valenzano, who lives in Camarillo and is a senior majoring in speech communications at Cal State Northridge, said she remembers falling down the stairs in her residence eight times in one month.
Narcolepsy, often inherited, is caused by a chemical imbalance in the brain that triggers the Rapid Eye Movement (REM) portion of sleep to overlay the waking state. REM sleep is when most dreaming occurs.
Some blame America’s 24-hour society as one of the causes of less severe sleep disorders. Other contributing factors include medications and stimulants such as caffeine, unusual shifts (20% of Americans work at night or rotate night shifts), longer working hours and the belief that spending about 20 years under the covers is a plain nuisance to a full life.
All that tossing and turning has been good for the sleep business. The number of sleep disorder clinics accredited by the American Sleep Disorders Assn., founded in 1975 in Rochester, Minn., has grown from 15 centers 10 years ago to 176.
“Sleep disorder centers have cropped up to meet the demand of restless Americans,” said Dr. Dennis McGinty, director of the neurophysiology research laboratory at the Sepulveda Veterans Administration Medical Center. “The North Valley center provides expertise that every community and neighborhood should have.”
San Fernando Valley centers, all founded in the past three years, include those at Northridge Hospital Medical Center and Glendale Adventist Medical Center. The North Valley center is the Valley’s only accredited clinic, although the clinics in Glendale and Northridge are applying for accreditation. A center at the Lombard Medical Group in Thousand Oaks specializes in apnea.
The North Valley center is headed by Michael Stevenson, a psychologist, and Dr. Elliot Phillips, a psychiatrist. “With so many Americans experiencing sleep disorders, even Congress has gotten involved,” said Stevenson, referring to the recently formed National Commission on Sleep Disorders Research. “The commission is taking testimony from doctors and patients, trying to determine how the government should spend money to alleviate the problem.”
The center, like other Valley sleep clinics, operates a sleep evaluation lab, staffed by one technician during weekday nights who monitors patients’ sleep patterns. Patients suffering apnea or narcolepsy are usually referred by physicians; the majority of insomniacs seek out the center on their own.
The lab, consisting of two bedrooms and an equipment room, is stocked with video cameras, closed-circuit televisions, polygraphs, stacks of fresh linen and two beds equipped with Sears O’Pedic Imperial Elite mattresses. Patients with chronic disorders check in about 8:30 p.m. and depart at 7:30 a.m. The center performs about 25 sleep evaluations every month, each costing $1,150. The procedure is usually covered by health insurance.
As preparation for an overnight evaluation, electrodes are applied to a patient’s head, eye and face muscles as well as legs, ear and nose. The various wires measure brain waves, rate of breathing and muscle movement, all indicating which stage of sleep the patient is in. “The worst part is getting up to go to the bathroom,” said Valenzano who has spent two nights at the lab. “They have to unhook you.”
The evaluations help Stevenson and Phillips diagnose patients and determine a treatment plan. Medication is prescribed for disorders such as narcolepsy, but with insomniacs, patients are quickly weaned from sleeping pills, which often rob sufferers from the deepest and most beneficial stages of sleep.
“The act of falling asleep is partially a learned behavior,” said Stevenson, 50, who joined the center in 1981. “The chronic use of sleeping pills can interfere with that. The brain becomes lazy, artificially sedated, and you forget how to fall asleep yourself.
“Instead of pills, we prescribe ways to relax--deep breathing, regular exercise and light therapy,” during which patients are exposed to light sources, helping to reset biological clocks, or circadian rhythms that dictate the 24-hour wake-and-sleep cycle.
Valenzano first visited the North Valley center four months ago. Cylert and eventually Ritalin were prescribed to calm her symptoms.
Although the drugs have caused her to lose more weight than she cares to, Valenzano, who now clocks up to seven hours of sleep a night, said the trade-off is worth it.
“Narcolepsy affects your work, school, family and all relationships,” said Valenzano, who said she once slept through a final at CSUN. While driving on California 118 in 1986, she dozed momentarily, then awoke and quickly fastened her seat belt. Several minutes later she awoke again--this time in a ditch after hitting two embankments and flipping her car eight times.
Other behaviors, termed “automatic,” include performing tasks without conscious awareness, such as driving down the wrong side of the street. Valenzano also remembers getting in her car to travel to Camarillo, with her very next memory that of being in Thousand Oaks. “It’s like I arrive instantly,” she explained.
She also mixes words during conversations: “I’ve told my kids to put their dinner dishes in the trash can and to go brush their room. Once, when I had just heard someone call their husband ‘Burt,’ I told the kids that it was getting cold outside, and that they should go put on their Burt.”
Such behaviors are not the norm among those with sleep disorders. Phillips and Stevenson’s typical patient is a woman over the age of 50 who experiences some degree of insomnia. Older people, contrary to popular belief, require only slightly less sleep--not hours less--although they do experience an increase in restless nights.
Besides illness, stress and worry are the most common complaints that keep the elderly tossing and turning, Stevenson said.
Beatrice Weingart, 78, of Van Nuys, paid a visit to the North Valley center one year ago after seven years of restless nights. The stress of losing her husband and younger son to cancer within a two-year period kept her up at night.
Weingart had no trouble falling asleep, but two or three hours later she would awaken for the duration of the night. “I would lie in bed wide awake and think about all the things I could have done to prevent my son’s death,” she said. “Maybe if I would have done this, or gone there to see a specialist, or had known about the latest treatments. I was getting really jumpy and wasn’t able to function. Now I’ve learned to accept the fact that I did everything I could.”
Weingart, an avid traveler, who always shunned sleeping pills, underwent a sleep study and has since learned how to relax, focus her mind and visualize peaceful surroundings while falling asleep.
“Every day is precious when you reach my age. Now, all I do is blank out my mind and visualize the clouds in the sky above Africa. It’s always been my favorite scene of all the traveling I’ve done. And now it’s my favorite way of falling asleep.”
