Sleep Disorders Keep Americans Up All Night

Changes in treatment are on the horizon

illustration by darren gygi

Joni Lerum suspected she had sleep apnea after her husband expressed concern over how her breathing would stop at night. Lerum was chronically tired, often exhausted during the day. No matter how much she slept, she never felt rested. “I was dragging,” she remembers. “And I was getting more and more tired as time went on.”

Ironically, it took Lerum’s husband being diagnosed with sleep apnea—a condition in which breathing stops and disrupts sleep, usually without the sufferer’s awareness—for her to become a patient at the Minnesota Sleep Institute.

An estimated 40 million Americans suffer from chronic sleep disorders each year—a broad category encompassing the common insomnia and sleep apnea, along with an array of more unusual conditions called parasomnias including sleepwalking and night terrors. All can seriously impact daytime alertness and quality of life; patients with sleep apnea are also three times more likely to be involved in a car accident. Research has also linked sleep disorders to serious health problems including obesity, Parkinson’s, Alzheimer’s, cardiovascular and kidney disease, stroke, and diabetes.

Sleep medicine was only designated a specialty in 2005, but Hennepin County Medical Center has been on the front lines of the field for decades. HCMC’s Minnesota Regional Sleep Disorders Center brought many of the field’s pioneers to the Twin Cities, where today sleep centers number more than half a dozen. Dr. Conrad Iber, medical director of Fairview Sleep Centers, describes nightly rest as not just perfunctory amid increasingly busy lives—it’s actually critical to survival. “There’s simple things we have to do [to live], like eating and exercising,” Iber says. “Sleep is one of those things.”

Dr. John Damergis, medical director at Noran Neurological Clinic’s Sleep Centers in Minneapolis, points out that anxiety and sleep disorders “powerfully fuel” one another—a recent study linked apnea to an increased severity of PTSD among Iraq and Afghanistan veterans.

Apnea and parasomnias can require a sleep study, in which patients are monitored overnight in a laboratory or at home. Once the condition is assessed, doctors look to lifestyle changes, as well as technological and pharmaceutical solutions.

Vitamin and mineral deficiencies, insufficient light exposure, and bad “sleep hygiene” (caffeinating after 3 p.m., inconsistent bedtimes) can contribute to disturbances. Sometimes insomnia’s root cause can simply be an offset internal clock (often the case with teens), or higher levels of adrenaline and stress hormones. In those cases, Iber says he works with patients to adjust their schedule whenever possible, or helps them adopt cognitive approaches such as mindfulness and meditation to encourage relaxation.

For sleep apnea sufferers, the CPAP mask—a Darth Vader-looking apparatus worn on the face at night—hit the market in the 1980s and is still the most common treatment. Today, sufferers also have a surgical alternative. The Inspire device, FDA approved in mid-2014, is implanted in a patient’s chest and delivers mild stimulation to airway muscles to keep breathing regular—the pacemaker concept applied to respiration. Damergis says that only a handful of surgeons perform the implantation of Inspire devices in the Twin Cities so far, but that results look promising.

A new class of insomnia medication is also in the research phase that works by inhibiting a peptide—a natural chemical in the body—that is lacking in narcoleptics and leads to their uncontrollable sleep. Here the treatment aims to reduce alertness in those suffering sleeplessness, versus the traditional approach that stimulates sleep receptors but can lead to grogginess the next day. Recent research also points to cognitive behavioral therapy (CBT) as a fruitful insomnia treatment.

For those suffering sleep disorders, relief leads to overall health improvement. “Now, if I don’t have my CPAP, I can’t sleep,” Lerum says, adding that on their summer camping trips she and her husband make sure to find campsites that offer electricity for their masks. “How cute is that?” she asks with a laugh.