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Sleep’s key role in health: Americans sleeping less, research increasing

FNS Photo by David Samson Tim Clark of West Fargo shows the machine and mask that he uses for sleep. Clark is a truck driver and was having problems staying alert from not getting enough uninterrupted rest.

WEST FARGO — Tim Clark found himself nodding off during his long days behind the wheel as an over-the-road trucker.

The daytime drowsiness settled in even with a noon nap. He was chronically tired and sapped of energy.

But not anymore.

At the suggestion of his doctor, Clark went in for a sleep study and learned he had a condition called obstructive sleep apnea.

In the Sanford Sleep Medicine Clinic, Clark’s sleep was monitored for evaluation. It didn’t take long to discover something was wrong. Seriously wrong.

After 2½ hours, Clark was awakened by sleep clinicians who were putting a mask on his face so a stream of air could help his breathing.

He had stopped breathing 109 times in the approximately 150 minutes of sleep. His oxygen levels dropped to dangerous levels, especially during the rapid eye movement phase, a period of deep sleep and dreams.

“I couldn’t believe it,” Clark said, recalling his reaction when he was shown the results of his sleep study. “I said, ‘Are you serious?’”

The 54-year-old West Fargo resident is one of the many Americans who suffer from sleep deprivation or sleep disorders.

Insufficient sleep is a public health epidemic, according to the Centers for Disease Control and Prevention. In a public health tracking survey, almost 38 percent of respondents reported unintentionally falling asleep during the day at least once in the previous month, with 35 percent reporting they had less than seven hours of sleep.

Sleep is increasingly recognized as important to public health, and sleep insufficiency is linked to motor vehicle crashes, industrial disasters and medical or other occupational errors, according to the CDC.

A growing body of research shows that sleep deprivation is bad for your health. Insufficient sleep has been linked to developing chronic diseases including diabetes, heart disease, obesity and depression.

As awareness of the medical problems caused by insufficient sleep has increased, so has the availability of medical services.

Primary care physicians and the public are becoming more aware of the problems associated with insufficient sleep, experts agree. As a result, more people are turning to sleep specialists for help.

Fargo-Moorhead has three sleep medicine centers with board-certified physicians: North Dakota Center for Sleep has four beds, Sanford Sleep Medicine Clinic has 10 sleep study beds and Sleep Wellness Center has two beds.

Among adults with sleep disorders, by far the most common is obstructive sleep apnea, the condition that caused Clark to repeatedly wake up because of breathing problems.

A 2005 poll by the National Sleep Foundation of more than 1,500 adults found that more than one in four, 26 percent, met criteria indicating a high risk of sleep apnea, and risks increased with age.

Local sleep specialists estimate 80 percent or more of the patients who are diagnosed with sleep disorders have sleep apnea. Between 2 percent and 4 percent of the population could have the condition, according to estimates.

“It’s a very common problem,” said Dr. Saif Mashaqi, a sleep medicine doctor at Sanford, and the physician who is treating Clark. “It keeps growing more and more because of the lifestyle, because of the obesity. It’s going to keep growing more and more.”

Short duration sleep causes changes in the body linked to obesity. A sleep-deprived brain responds more strongly to junk food, and also is more likely to succumb to temptation.

Studies show that people eat more on days following nights with shortened sleep. Sleep deprivation also has been linked to an increase in a stress hormone and inflammation markers, according to research.

Although obesity is a risk factor for sleep apnea, people of any size can develop the problem, because of the anatomical structure of their upper airways.

“Women are very much unrepresented in this group,” Dr. Seema Khosla of the North Dakota Center for Sleep said of the stereotype of the overweight, middle-aged man as being the typical sleep apnea patient. “A lot of women present differently.”

Her own mother, a physician, was reluctant to consent to a sleep study, but finally was persuaded and learned she had sleep apnea, Khosla said. Now she’s off her blood-pressure medication and feels better.

Since his diagnosis, Clark now sleeps with a device called a CPAP — continuous positive air pressure. Air is pumped through a mask to keep his airway open, allowing uninterrupted sleep.

It took Clark about a week to get used to wearing the mask at night. Through trial and error, he was able to adjust the fit and air pressure setting.

He quickly noticed the difference from getting a good night’s sleep.

“Within 24 hours I was up, I woke up. I felt great. I was up and ready to go. I didn’t feel tired,” he said.

No more noon naps. No more getting drowsy while driving.

He’s also adopted healthier eating habits and lost some weight. His cholesterol is down, with help from medication and possibly his CPAP-improved sleep.

“It’s a combination of a number of things that have helped,” he said. “Getting better sleep helps. I’m in a much better mood. My concentration level I think has gone up tremendously.”

He added: “When you’re not getting enough sleep you kind of go into a ‘daze phase.’ I don’t do that anymore.”

Dramatic improvements such as those Clark has experienced are common among sleep apnea patients who comply with their treatment, Mashaqi said.

It takes time, however, to get used to wearing a mask. Some patients are resistant.

Khosla once tried sleeping with the mask to gain insight into what her patients experienced.

“It probably took me four nights before I could go to sleep with a CPAP,” she said. “It’s an air compressor strapped to your face.” But a greater variety of mask styles and sizes now are available, so everyone can have a mask that fits, sleep specialists said.

Also, proper follow-up with patients to see if they are wearing their masks helps to ensure compliance and good results, said Laurie Stewart-Hanson, a sleep technologist at Sleep Wellness Center.

But more and more people are learning that treatment can make them feel much better and improve their health she said.

“People have been tired for years and they’re finally realizing there’s something you can do about it,” Stewart-Hanson said.

Although sleep apnea is the most prevalent sleep problem, others include insomnia and circadian rhythm sleep disorders, or taking too long to fall asleep.

Many sleep problems are caused by poor habits, sleep specialists said.

Those bad habits include failing to go to bed and wake up at the same times, staying up too late, watching television or playing video games before going to bed at night.

The screens are doubly bad because light produces a hormone that interferes with sleep, and many activities on screens — games, texting, emailing — actively engage the brain at a time when people should be calming down.

Sleep specialists work with patients to adopt good “sleep hygiene,” and sometimes prescribe medications.

Mashaqi himself has a circadian rhythm sleep disorder. He’s a “night owl,” and has to fight a tendency to stay up too late, which delays his sleep phase, resulting in a lack of rest.

As for Clark, he said he wishes he’d gotten diagnosed sooner. “It seemed like a hassle,” he said of going in for a sleep study. “Go in and get checked, because it’s well worth it.”

Lack of sleep a public epidemic

Adults reporting insufficient sleep during a two-week period:

- Minnesota: 25.7 percent

- North Dakota: 22.9 percent

Sleep hygiene tips:

- Go to bed each night and rise in the morning at the same time.

- Moderate physical activity can promote sleep, but avoid vigorous exercise a few hours before bed.

- Avoid large meals before bedtime.

- Avoid caffeine and alcohol close to bedtime.

- Avoid nicotine.

The sleep environment:

- Your bedroom should be quiet and dark, neither too hot nor cold.

- Remove all TVs, computers and other gadgets from the bedroom.

V Your bed should be comfortable and used only for sleeping, not for other activities, such as reading, watching TV or listening to music.

Sources: National Center for Chronic Disease Prevention and Health Promotion and Behavioral Risk Factor Surveillance Survey, 2008-09

Patrick Springer

Patrick Springer first joined the reporting staff of The Forum in 1985. He can be reached by calling 701-241-5522. Have a comment to share about a story? Letters to the editor should include author’s name, address and phone number. Generally, letters should be no longer than 250 words. All letters are subject to editing. Send to