A woman lies on a bed in what looks like a motel room, complete with a bad seascape painting and a fake plant. It looks as though a spider with metallic gold feet has nested on her head. Two black wires run out of her nose, two more lead from her temples, some poke out from behind her ears, and more cling to her face and neck. All lead back to machines that monitor brain waves, eye movements and other factors. Belts around the woman's waist measure her every breath. Despite all this -- and the fact that three strangers are watching her from the next room on television monitors -- she's asleep.
What resembles a sci-fi nightmare is actually part of a study at the Tulane University Hospital Sleep Disorders Center, where researchers are working to understand more about the state in which we spend nearly one-third of our lives. Though scientists have formally studied sleep for 50 years now, there are just as many questions about sleep today -- if not more -- than there were five decades ago.
What we do know is that sleep has an impact on our waking state, much more so than we tend to realize. In fact, neurologists have declared a nationwide "sleep epidemic," saying a lack of sleep is probably the biggest health issue among Americans. Sleep disorders have even been linked to major health defects from immune system deficiencies and sickle cell anemia complications to diabetes and heart disease, according to Jimmy Renfroe, a certified respiratory therapist at the Tulane sleep facility.
"People who restrict their sleep do not manage their blood glucose levels well and can actually stimulate diabetes," adds Dr. Elizabeth Bouldin, medical director of the Ochsner Clinic Foundation Division of Sleep Medicine.
Additionally, people suffering from sleep disorders often don't realize the symptoms of poor sleep quality and overcompensate with stimulants or alcohol, Renfroe says, which can exacerbate the original problem.
Some factors in sleep deprivation include depression, anxiety, stress or use of stimulants. The most common sleep disorder in adults, though, is apnea -- a word that comes from the Greek term meaning "without breath." According to the National Institutes of Health, more than 12 million Americans experience sleep apnea, about the same number of people in the country who suffer from diabetes. "People who have apnea are at risk for all kinds of factors that are associated with heart disease, because of disturbances in heart rhythms and low levels of oxygen in the blood," Bouldin says. "There is a growing body of evidence that suggests that they impair their immune system."
The most prevalent form of this disorder is obstructive sleep apnea, in which a person's stomach pushes on the diaphragm, creating shortness of breath, Renfroe says. For that reason, overweight people are more prone to this affliction, though Bouldin emphasizes that anyone can suffer from apnea. "Apnea is not just in overweight, middle-aged guys that snore," she says. "One of the things that we're beginning to appreciate is that it doesn't always relate to body weight. It is not just a male disease, and it's not just an adult disease. We're finding it in post-menopausal women, in children."
Apnea sufferers actually stop breathing in their sleep, and their brains then send a signal for them to wake up so they will start breathing again. Because of the constant interruptions, persons with apnea are often unable to progress through the stages of sleep to the fifth and most important stage, known as the REM (or rapid eye movement) cycle, where dreaming occurs. This is the stage of sleep necessary for complete rest. A good night's sleep will contain several REM cycles.
Other characteristics of sleep apnea include chronic snoring during the night and fatigue during the day. The poor sleep quality caused by apnea contributes to a lack of concentration during waking hours, says Bouldin, which can lead to a range of problems from job impairment to distraction while driving.
Increasingly, obesity has been targeted as a major health problem in American culture, and researchers say sleep problems may contribute greatly to unhealthy weight. Evidence shows that because people with sleep disorders are not well rested, they often crave high-calorie, fatty foods to boost their energy levels during the day. The corresponding weight gain can, in turn, aggravate apnea.
Scientists have also found a correlation between sleep disorders and learning disabilities. "We find that kids who snore don't necessarily do well cognitively," Bouldin says. "This is something that has been under-recognized in the past. When you have apnea, you have a collapse in your airway; you drop your oxygen saturation. This is not good for your brain, and it may actually have some effects on learning." In rare cases, it can cause craniofacial anomalies in children and young adults. According to Bouldin, the condition is "a remodeling the shape of the face if there is a continuing problem in an increased effort to breathe."
Perhaps the most troubling recent discovery, say local sleep researchers, is that more and more adolescents are getting less and less sleep -- which can lead to health and cognitive issues that grow worse as they age. Bouldin says that young adults aged 12 to 25 are just not getting the amount or quality of sleep their bodies require, putting them at the highest risk among age groups for poor sleep habits and health-related consequences.
"We do find that kids sleep less than they did 20 years ago because of all the other environmental distractions," she says. "This affects their ability to focus, to stay calm. The most at-risk population is the high-achieving kid who is involved in after-school activities and also has a part-time job. They've got a million other things pulling at them. They've become little bitty adults, but they also have an increased sleep need." Bouldin also says many parents do not notice their children aren't getting enough sleep, in part because "they are busy sleep-depriving themselves."
Adolescents need at least 10 hours a night, specialists say, due to their rapid growth spurt during puberty. Oschner's Dr. John Barrios agrees that many children who are inattentive at school are often misdiagnosed as having attention-deficit disorder, when in fact the culprit is a sleep disorder. "You need to look at a sleep-hygiene issue of the child" in today's society, he says. "The kids stay up extremely late."
Other sleep disorders can wreak havoc on a person's life. There's the alarming condition called narcolepsy, in which a sufferer will suddenly drop off to sleep at any given moment, without warning -- a dangerous and even potentially deadly occurrence when it happens in situations such as driving a car. There's also Periodic Limb Movement Syndrome, a repetitive jerking of limbs during sleep. And a common problem is the "mid-afternoon dip," familiar to many day-working adults who become fatigued after lunch.
A more rare condition known as REM behavior disorder has been acknowledged in men over the age of 50; it causes sufferers to actually get up and act out their dreams while asleep, a potentially dangerous phenomenon. "There is a substantial number in that population that will go on to develop other problems, such as Parkinson's disease," Bouldin says. Like Parkinson's, REM behavior disorder appears to be hereditary, but there are also theories that link it to abuse or post-traumatic stress disorder.
Sleep problems and their treatments are usually diagnosed with an overnight stay at a sleep lab. Patients generally remain from about 8 p.m. to 6 a.m. in a designated room, hooked up to equipment that will determine if apnea or other conditions are present. Machines monitor brain waves, heart rate and breathing patterns, while an infrared camera will survey and record movements during the night. Researchers also have to appreciate that their subjects' sleep might be thrown off by the unfamiliar surroundings and the restrictive equipment, says Renfroe. "There is something called the 'first-night factor' ... we have to account for all of that."
The biggest contributor to sleep disorders are societal in nature, says Bouldin. "If you're sleepy during the day and you can't prove that you were up all night doing something worthwhile, like delivering babies, then you're lazy," she says. "If you can stay up all night, then you're macho, then obviously you can plow through anything. It becomes a value judgment." The answer, experts say, is for Americans to reevaluate the priorities and attitudes that can lead to, or perpetuate, problems with sleep, a most important component in creating a healthy lifestyle.