Sleep: People Can't Get Enough

FRESNO, Calif. -- Got sleep?

Count yourself lucky if you get a good night's worth.

Many Americans long for sleep and simply don't get enough of it.

An article in the Feb. 27 issue of Forbes magazine refers to sleep as the new sex: "People want, need it, can't get enough of it."

Sleeping problems have spawned a cottage industry raking in billions selling slumber in the form of pills, sleep centers and other specialty devices.

Americans spent about $2.1 billion and filled more than 35 million prescriptions for sleeping pills in 2004, according to Medco Health Solutions, Inc. And new prescription sleeping pills -- known as Z pills -- like Ambien and Lunesta, continue to hit the market. Even popular over-the-counter pain reliever Tylenol, comes in a PM form (including Vanilla flavor) that promises to take away pain and help you sleep.

Sleep centers -- where patients are hooked up to monitors in an effort to detect sleep disorders -- are also on the rise.

The sleep disorder problem is real. The National Institutes of Health estimates about 70 million Americans suffer from sleep problems, and some 60 percent have a chronic disorder with serious health implications.

Sleep disorders, including deprivation and sleepiness add an estimated $16 billion to the national health-care bill, according to the NIH. And the problem affects more than just the person suffering from a sleep disorder. It translates to about $50 billion in lost work productivity and can contribute to life-threatening accidents.

Dr. Greg Warner pulmonologist who specializes in sleep disorders, has helped run the sleep lab at Kaweah Delta Hospital in Visalia for 20 years. He says sleep disorders are not a new problem, but they have been getting more attention.

Warner says the death of Green Bay Packers football player, Reggie White, helped spotlight the issue much like Magic Johnson did for HIV/AIDS. White, whose weight hovered around 300 pounds, died in December 2004 from complications associated with sleep apnea, a condition that restricts breathing while sleeping. He was 43.

Although sleep apnea gets the most attention, a long list of problems can affect sleep. "The majority of our patients are sleep apnea, but we also see patients with narcolepsy, restless leg syndrome and other problems," Warner says.

Until recently, there were few sleep labs in the central San Joaquin Valley, but that has changed. More than a dozen sleep centers, some part of hospital programs, now compete for patients.

Warner not only diagnoses Visalia-area patients but analyzes sleep lab data from patients in nearby Hanford where a sleep apnea center affiliated with Central Valley General Hospital opened this month.

At the Hanford sleep lab, patients are hooked up to equipment and monitored overnight. Warner and colleague Robert Hinds provide the medical expertise and diagnosis.

Sleep problems can range from restless leg syndrome, a condition marked by periodic leg movements that interrupt sleep, to narcolepsy, a chronic neurological disorder caused by the brain's inability to regulate sleep-wake cycles normally.

Fresno resident Steve Frasier says he hasn't had a good night's sleep in at least two years, and it has begun to wear on him.

"I'm used to going to work, working a full day and coming home and doing things around the house ... having all kinds of energy.

Then, all of a sudden I started having difficulty," he says.

An inspector for Pacific Gas & Electric Co., Frasier says he routinely felt fatigued, like he was "dragging himself around." He says he didn't even have the energy to finish rebuilding the 1952 military Jeep he bought about a year ago, the one he couldn't wait to get his hands on.

"I figured it would be done by now, ready to enjoy the summer, but that hasn't happened yet," he says.

He talked with his doctor, and they thought it might be a problem with his diabetes medication, but that was later ruled out.

Then his doctor decided to have Frasier's sleep patterns monitored and referred him to the Renaissance Sleep Center in Fresno.

Frasier has undergone two lab sessions. The first showed he may have sleep apnea. The second, which he underwent Tuesday, had him sleep with the aid of a CPAP (Continuous Positive Airway Pressure) machine hooked up through his nasal passages. The machine is often recommended to help patients with sleep apnea breathe through the night.

The day after the test, Frasier says he felt rested for the first time in a long time.

Raman Dang and his brother, Gagan Dang, own the Renaissance Sleep Center and Rest Easy Medical, which sells durable medical equipment like the CPAP machine in Fresno. Their father is a doctor in Los Angeles. Raman Dang says they recognized the growth of the industry when they opened the sleep center two years ago.

The center, which has three labs or bedrooms, conducts testing on patients who have been referred by their doctors.

In general, sleep lab assessments -- which involve overnight monitoring -- cost between $1,500 to $2,000, but, medical insurance usually covers the bill.

Dang says Renaissance Sleep Center does the testing and the results are read by a Los Angeles doctor specializing in sleep disorders who recommends a course for treatment.

The center receives about 50 to 60 referrals a month. Many referrals are for overweight patients whose doctors want to verify health conditions such as sleep apnea, to justify weight-reduction surgery for an insurer. Many insurance companies require a patient have a related health condition before paying for a weight-loss procedure.

Dang says Renaissance is so busy that it just opened a second location in Bakersfield.

Many of the patients who end up at Renaissance don't realize they have a sleep disorder, he says. Most end up at the center because a doctor, or a spouse has suggested they be monitored. It is often a spouse who first spots a potential sleep disorder.

In the sleep labs, patients are typically hooked up to wires attached with sticky patches that monitor heart rate and breathing patterns. Wires are attached to a patient's head, near the eyes, chin and even on a finger to measure oxygen in blood. Abdominal movement is also tracked.

At Renaissance, the rooms look like hotel rooms. They have television sets, night stands and air mattresses that patients can adjust to their comfort level. A camera on a wall and aimed at the bed records the sleeping subject.

"Ninety percent of the patients end up having sleep apnea," Dang says. If so, a CPAP machine is recommended. The machines cost about $1,500.

Michael Twery, with the National Center on Sleep Disorders Research Center, part of the National Institutes of Health in Bethesda, Md., says although more is learned about sleep disorders every day, research still needs to be conducted. Twery is helping to develop research programs at the national center to help understand what has become a serious health issue.

"There are new findings that are linking sleep disorders to things that people recognize as serious health issues," he says.

"Like sleep apnea has been found to be associated with hypertension, obesity and risk for diabetes. These are the kind of things that affect people in a visible way."

It's difficult to know whether sleep disorders are on the rise, or if they are getting easier to recognize, he says. "We don't know if it's the chicken or the egg. We are certainly working longer hours, there is more pressure on our time, more stresses."

Part of the problem is we live a 24-hour-a-day society, he says.

Entertainment is available around the clock in the form of television and video, and work can be done any time of the day or night. All of these things can take away from sleep, Twery says.

These modern devices weren't around in 1910 when people got an average of nine hours of sleep each night, according to an NIH report on healthy sleep. Today, Americans say they sleep less than seven hours a night and a third of adults report daytime sleepiness so severe that it interferes with work and social functioning at least a few days each month.

The bottom line is that people who feel tired day after day, should be talking with their doctor, Twery says.

Bobby Krause, a retired crop duster pilot, did just that and has been on a CPAP machine for about five months now. "I feel like a new man," he says.

Before testing and treatment, he says he always felt tired. The 74-year-old says he passed it off as age, but his wife thought it was a sleep disorder after catching the heavy snorer gasping for breath at night.

His diagnosis wasn't immediate. First, his doctor thought he might have Valley Fever. He underwent a CT Scan which failed to uncover a problem. It wasn't until the sleep disorder was detected and he began using a CPAP machine at night, that he got his energy back.

"It's a world of difference," Krause says.

(Copyright 2006 by The Fresno Bee. All Rights Reserved.)