Dreams Come True in Sleep : All bodies need rest. But to get it, some need the services of the St. Joseph’s Sleep Disorder Center in Orange.
That I may tell pale-hearted fear it lies,
And sleep in spite of thunder.
--William Shakespeare, “Macbeth”
No drug can equal sleep for its ability to erase tension, silence worries and rejuvenate a spirit damaged by the stress of a fast-paced lifestyle. For a billion members of the workaday world, it is the supreme tonic of the industrial age.
And like all natural blessings, its full value is perhaps realized only when the process stops working.
Ron Simons, a 50-year-old college administrator from Villa Park, knows firsthand the danger of a lack of a solid night’s sleep.
“I began falling asleep while I was driving and had numerous close calls,” he said. “It was a frightening period. I almost didn’t want to get in my car and drive. You kid yourself, saying you can shake yourself out of it. But it isn’t true.”
Even when he got to work safely, Simon’s problems weren’t over. “I’d be sitting at my desk, and literally, BANG! my head would hit the desk and I’d be asleep.”
Simons knew he was a restless sleeper and had been waking up a half-dozen times a night, which accounted for part of his daytime fatigue. But it was only after he underwent a sleep study at St. Joseph Hospital in Orange that he realized the extent of his problems.
The nightlong test at the hospital’s Sleep Disorder Center confirmed that he had restless-leg syndrome, which was interfering with his sleep far more often than he realized. Plus, this malady was combining with obstructive sleep apnea, causing him to awaken 80 or 90 times each hour without his being aware of it. The result? Simons’ body was demanding sleep at all costs during the day, even when he was driving a car.
Now a nighttime breathing apparatus and medication are controlling his symptoms and giving him the uninterrupted snooze he requires.
Simons was one of about 240 patients last year at the Sleep Disorder Center, said director Sarah Mosko, Ph.D. Since July 1990, the center has been diagnosing and treating all types of sleep problems, including insomnia, narcolepsy, apnea, bed-wetting and pill dependency.
This year the center will treat about 300 patients, Mosko said, an increase that’s due to a higher awareness of sleep problems among the public and a greater willingness of physicians to refer these disorders to sleep specialists.
Nationwide, the number of sleep disorder centers is on the rise, said Bruce Jordan of the American Sleep Disorders Assn. This group, based in Rochester, Minn., has 218 centers and labs as members, although Jordan estimates there are more than 1,000 hospital-based and free-standing centers in the country.
The association recognizes two types of sleep disorder facilities. Sleep disorder “centers” treat all types of problems, while sleep disorder “labs” treat only breathing problems such as disruptive sleep apnea.
The facility at St. Joseph accepts self-referred patients, but no one under 16. Many patients at the center suffer from obstructive sleep apnea, a disease that affects between 1% and 5% of the adult population, Mosko said.
Apnea, a temporary cessation of breathing, is caused by the upper airway becoming too constricted to continue sending adequate air into the lungs. When the lack of oxygen in the bloodstream reaches a critical level, the air passage opens with a loud snort and the sleeper wakes up, but only for an instant.
Apneas can be dangerous, because the heart slows down as it gets less oxygen and sometimes can stop beating temporarily, Mosko said. One patient, an Orange County physician who had severe apnea, experienced a slowdown to 35 heartbeats per minute and had a three-second stoppage during his sleep study.
Such a condition can be detected only through a sleep study, Mosko says. The outpatient procedure, which costs about $1,300, measures the patient’s heart activity, breathing, blood oxygen, muscle tone, leg movements and brain activity. The tests are also videotaped to help confirm the data.
Under the direction of Mosko and medical director Dr. Ray Casciari, patients arrive at 8 or 9 p.m. to get the various sensors applied to the body by technician Debbie Hotte. Then they go to bed.
“We’ve tried to make the sleep rooms as comfortable as possible, with cheery furniture, double beds, armoires and TVs,” Mosko said. “We ask the patients to try to achieve a normal night’s sleep, then they’re disconnected in the morning. By the next afternoon we’re able to analyze the test.”
A standard treatment for patients with obstructive sleep apnea is nightly use of a Continuous Positive Airway Pressure device.
The $1,200 contraption, called a CPAP, uses a nasal mask connected to an air pump. “It accesses the upper airway through the nose and overcomes the tendency of the upper airway to collapse,” Mosko said.
Often the tricky thing about sleep disorders is that “the person has no access to the fact they’re having these symptoms. Someone else has to tell them,” Mosko said. “We’re poor historians about what’s happening in sleep. You can’t subjectively know.”
Whether patients are referred by snore-weary spouses or come of their own accord, the studies often reveal sleep characteristics that surprise the patients.
“People come to us and say, ‘I haven’t slept in six weeks,’ ” she said. “They’d be dead, of course, if this were true. When we do the sleep study they’re always surprised when we say, ‘Well, you slept for six hours.’ ”
Insomnia is even more prevalent than apnea, with studies suggesting that it affects a third of all adults, Mosko said. Sometimes the insomnia is what sleep experts call “learned insomnia.”
“It’s sort of self-inflicted,” Mosko said. “A stressor can cause insomnia that initially is transient, but then, after the stressor is removed, the insomnia can go on. The person gets in bed and tries too hard to sleep.”
After a while, the bedroom environment itself--pajamas, toothbrush and even the bed--triggers arousal and thus insomnia, she said.
In some cases, the Sleep Disorder Center tries to recondition these insomniacs through a program that includes bed restriction. For example, patients might be asked to spend only four hours in bed and to keep a log of their sleep hours. When they begin to sleep for the full four hours and ask for more, the time is increased gradually.
“It takes a lot of work on the patients’ part, but what it shows them is that they can indeed sleep very efficiently, which they had previously doubted,” Mosko said.
Sleep disorders are often difficult for a person to recognize independently, and the sufferer can quickly learn to live with the problem as a fact of life, Mosko said. This is especially true of high-achieving, busy people.
“They get acclimated to daytime sleepiness and use a lot of caffeine,” she said. “At the other end of the scale, some people who have insomnia tend to ‘ under -stress’ themselves, try to conserve energy all day. They disengage from life and reduce responsibilities. But people who are sedentary don’t sleep well. One prescription for a good night’s sleep is to have an active life.”
Another dangerous sleep disorder is narcolepsy, the irresistible desire to sleep.
Until six weeks ago, Sandy Bertoni of Garden Grove would get what she called “sleep attacks”--two- or three-minute naps that she would take despite getting eight or nine hours’ sleep.
“I would just feel myself not being able to keep my eyes open,” she said. “I sometimes would have to take a nap right after I’d slept all night.”
A registered nurse, Bertoni had read about sleep apnea and thought that was the problem, but a sleep study failed to indicate apnea. Although Bertoni didn’t have other symptoms typical of narcolepsy, Mosko and Casciari suspected she had the affliction and tested it by monitoring Bertoni during a daylong series of nap periods.
“We were looking for an unusual pattern of sleep onset,” she said. “Unlike normal sleepers, narcoleptics go directly to a dream period when they sleep.”
This turned out to be the case, and Bertoni, 46, was put on medication that keeps her awake and alert during the day.
“It’s a relief to know there’s something physically wrong,” she says. “I’m aware of things I never was before. I recently drove to Las Vegas with my boyfriend, and it seemed a longer drive than it used to be. I mentioned this to him and he laughed and said, ‘That’s because you always took a two-hour nap when we drove here before.”’
