“All I want to do is fall asleep,”says Matt (not his real name), a new Charlottesville resident. Since moving to town, Matt describes his sleep pattern as “very intermittent. I can’t seem to fall into a deep, sustained sleep.” After a restless night, when morning comes he says he feels tired and “resigned that I have to wake up because it’s time to go to work.” The long nights are starting to take a toll. “On a scale of 1 to 10, this is around a 7,” he says.
Matt’s in good (bad) company. According to the National Sleep Foundation, nearly two-thirds of Americans get fewer than the recommended eight hours of sleep per night, and nearly one-third get less than seven hours. Throw in the popularity of “power naps,” the skyrocketing sales of caffeinated energy drinks, and the increased use of over-the-counter and prescription sleep aids, and a troubling picture of America’s sleep habits emerges. Why are we a stressed-out, puffy-eyed nation staring at the ceiling at 3am, desperate for some sweet dreams?
Thankfully for Matt and other budding insomniacs, Charlottesville is drawing sleep medicine experts to the area with the recent opening of Martha Jefferson Hospital’s Sleep Center and a Sleep Disorders Center at UVA that doubled its patient-care capacity just more than a year ago. Both enterprises reflect how the study of sleep has become one of the hottest new fields in the medical profession, a testament to both an over-worked, sleep-deprived population and recent advances in our understanding of why sleep is essential to good health.
The impossible dream
Sleep has become such a precious commodity that in Manhattan, weary workaholics can purchase a 20-minute nap for $14 in one of MetroNap’s private “pods”—individual space-age reclining chairs complete with sleep-inducing music piped in through headphones.
Charlottesville doesn’t currently boast any fancy pods, and ultimately it doesn’t matter. While a nap may help you get through a long workday, it’s no substitute for a full night of rest. Skimping on sleep can carry serious health consequences, as medical research shows that lack of sleep factors into weight loss, heart disease and can incapacitate drivers much like alcohol when behind the wheel.
And then there’s the mental fatigue. Studies have shown that sleep-deprived people have a harder time staying focused and productive at work. In one study, conducted at the University of California, in San Diego, neurologists examining the brain’s ability to handle various problems found that overtired patients fared worse on most questions, including simple arithmetic, than when tested after a good night’s rest.
How can you tell if you’re getting enough sleep? If you wake feeling refreshed and your sleep is of good quality, then you’re getting the right amount of shut-eye. While most experts recommend eight hours a night, the amount of sleep you need depends on your natural sleep rhythm, or circadian clock, which signals your body when it’s time to sleep and wake up. Everyone has his or her own clock, set to their individual schedule.
“You can’t fool that clock,” explains Dr. Will Hammond, a local pulmonary and sleep medicine specialist affiliated with Martha Jefferson Hospital. “That’s why people experience jet lag and why some people have trouble working the night shift.”
Hammond says most people’s “clock” dips between 4pm and 6pm, which helps explain the tradition of afternoon siestas (or as the case may be here in Charlottesville, the daily run to the coffee bar for a shot of caffeine). A similar drop happens between 4am and 6am, when most people are in deep sleep.
Many teenagers have a “delayed” clock, a cycle that explains their tendency, if allowed, to sleep until noon. “Teenagers will go to bed at 2am, but they’re up at noon. Elderly people may go to sleep at 7pm and be up at 4am,” Hammond says. Elderly people have an “advanced” clock that allows them to be up at sunrise, fully rested and refreshed.
If you’re sleepless several nights in a row—traveling, taking care of a child, or partying, whatever the case may be—you’ll begin to build up adenosine in your brain, a chemical that signals your body that it’s finally time to sleep. Caffeine is a miracle pick-me-up because it works by blocking the receptors for adenosine, temporarily putting off the urge to sleep. But that double Americano won’t keep you up forever.
The good news for the seriously sleep-deprived is, “You can make up a sleep debt,” Hammond says. “If you stay up three days in a row, instead of sleeping eight hours, you might sleep 11 hours for two nights. You can make it up within days.”
When you can’t make it up, when prolonged sleeplessness occurs, it’s time to see the professionals. Dr. Chris Winter, an energetic young neurologist, presides over the Martha Jefferson Sleep Lab. His interest in sleep medicine first developed as an undergraduate at the UVA, where he studied with renowned sleep medicine expert, and founder of the American Sleep Apnea Association, Dr. Paul Suratt.
“There’s just such a demand in this community,” says Winter, who sees patients with irregular sleeping patterns, sleep apnea, restless legs and insomnia. In response, Martha Jefferson Sleep Center will soon be opening more of their overnight rooms to reduce the current two- to three-month wait time for an appointment. Even though Winter just began working at the Sleep Center, “expansion,” he says, “is the first order of business.”
Martha Jefferson’s new Sleep Center is located in a renovated historic home on quiet, tree-lined Lexington Avenue behind the hospital. The hospital located the Sleep Center in the old home because it is “more comfortable for the patients, and more representative of a normal night’s sleep,” says Terri Bream, manager of Sleep Medicine Services, who has been working to make the Sleep Center a reality since the idea was first conceived in 2000.
Bream has gone to great lengths to make the Sleep Center welcoming, including planting tulips bulbs outside, ordering a porch swing and adding faux finish to the walls. The result is a remarkably different approach to studying sleep disorders that may make patients feel more like they’re spending the night at a bed and breakfast than a medical facility.
The ABCs of gettings ZZZs
Many people experience temporary insomnia during their lifetime, but prolonged insomnia is rare, and as Winter notes, “Insomnia is a symptom, it’s not a diagnosis.” The causes of insomnia vary, but are often directly related to our emotional or psychological well-being. “Depression is a big cause of insomnia,” explains Winter, “A lot of times people have an event, they lose a spouse or a job.”
Sleep aids like Sonata or Ambien are often prescribed in extreme cases of insomnia, but doctors like Winter say prescription sleep aids “are not a solution on a long-term basis.” Hammond agrees, saying he will only use sleep aids in “the lowest dose, for the least amount of time, while searching for a cause.”
Sometimes simple changes to your sleep environment can be the difference between tossing and turning and pleasant dreams. “Don’t make your bedroom into an office,” advises Hammond. Take out all beeping, blinking and buzzing electronics, which can distract would-be snoozers. The same holds true for pets, whose “clocks” are often not matched well with their owner.
“Going to bed at 11, but not falling asleep until 2—that’s a sign of anxiety,” explains Winter. People who have trouble falling asleep are often worrying or doing what Winter calls “running the list,” fretting over all the things they need to do the next day, instead of relaxing to drift into sleep naturally. To clear your mind, Winter suggests writing down a to-do list at least an hour before bed. [See sidebar on page 17 for more tips on getting a good night’s sleep.]
Contrary to popular belief, falling asleep at the movies or during your lunch hour doesn’t necessarily mean that you’re a “good sleeper.” In fact, it could signal a much more serious problem. “People should be able to go to bed, get enough sleep, wake up refreshed and not have to take a nap,” says Hammond.
If you have daytime drowsiness and suspect that a poor night’s sleep is to blame, you may end up in the capable hands of Ruth Guchu, the chief technologist at UVA’s Sleep Disorders Center. Nearly 20 years ago, when Guchu became a board-certified sleep technician, she was one of only 153 board-certified sleep technicians in the country. Today, there are thousands of certified polysomnographic technicians, trained to “read” patients sleep behavior.
One of Guchu’s biggest areas of concentration is sleep apnea, a common sleep disorder that more than 12 million people suffer from. Simply put, sleep apnea is your airway collapsing while you sleep. Your body wakes itself in an attempt to breathe, and this can happen repeatedly, in some cases hundreds of times a night, leaving the person tired the next day from constantly interrupted sleep.
Sleep apnea sufferers may not even know they can’t breathe, because they fall back asleep quickly after regaining their breath, and are only left with a few telltale signs of apnea—daytime sleepiness, a dry mouth from snoring all night or morning headaches. Often, it’s the bed partner of someone with sleep apnea who first notices the loud snoring and disrupted breathing of their mate. The only surefire way to tell whether you have a case of harmless snoring, or a more serious case of sleep apnea, is to spend the night at one of Charlottesville’s sleep centers.
The eight overnight rooms in the UVA Sleep Disorders Center are sparsely decorated yet comfortable, with a television and private half bathroom. An infrared camera in the ceiling of each room, as unobtrusive as a smoke alarm, gives sleep technicians a way to monitor both the equipment and the patient from a nearby computer station. In one room, a sleep technician tapes wires onto a large teddy bear, to demonstrate to a patient how multicolored wires and sensors will allow technicians to read a 22-channel recording, in real time, of a patient’s heart rate, brain waves, muscle tone and other sleep indicators.
“We aim to get between six to eight hours of recording,” Guchu explains. Most patients arrive for an overnight stay around 8pm, lights are out between 10 and 11:30pm, and patients can leave as early as 7am the next morning.
Guchu shows me the chart of a sleep study patient. Though the name has been taken off the file to protect the person’s identity, we can still see, in lines that jump across the screen like a needle on a lie-detector’s polygraph, where the patient stopped breathing momentarily. Normal breathing looks like a regular, rhythmic pattern of deep drops and rises, but when sleep apnea occurs, the lines at once become jagged, compressed and alarmingly shallow. Guchu points to the screen, “Here, they are using 20 percent or less of their normal breath,” she says, describing an episode of sleep apnea.
The most commonly recommended treatment for sleep disordered breathing, or sleep apnea, is a CPAP (continuous positive airway pressure) mask worn during the night that provides a “mild stream of air that prompts your airway open to breathe while asleep,” explains Guchu. Although the mask is a desirable option when compared to surgery, “it is a learned process,” says Guchu, and people often need time to get used to it. “When I first came here, it was a really hard sell, but now it is getting to be common knowledge, or people know someone who is using a CPAP mask, and that has really helped us.”
You don’t have to be stuck channel-surfing, counting sheep or putting up with a snoring, kicking bed partner; sleep problems are definitely worthy of treatment. For example, the snoring associated with sleep apnea is often viewed as an “annoyance,” Winter says, “but we now know that sleep apnea has very far reaching effects on health.”
Doctors now say that a good night’s sleep is essential to good health, as important as maintaining good dental hygiene or regular exercise. Although the mysteries of sleep’s restorative powers are still unraveling, Hammond reminds us, “Sleep is an active process,” a process we should do our best to not interfere with.
How to book an appointment with local sleep docs
If you think you might have a sleep disorder, talk to your primary care physician about your predicament before booking an appointment at one of Charlottesville’s medical sleep centers. After seeing your doctor, “then they would refer you to a sleep physician,” explains Terri Bream, manager of sleep medicine services at Martha Jefferson Sleep Center.
A sleep physician can rule out any other causes of your sleep problem and, if necessary, book you an overnight appointment at a sleep center.
The cost of an overnight stay at one of Charlottesville’s sleep centers can range from $1,800 to $2,400, although “Generally, it costs about $2,000 per study,” says Bream.
The good news is that most health insurance companies will pay for a sleep study. The bad news is that many insurance companies require pre-authorization, warns Bream. So to avoid getting stuck footing the bill, be sure to follow the rules of your health insurance provider.
Even if you think you can self-diagnose your problem, having your primary care physician make a referral is “the simplest and most general way,” to get an appointment at the Sleep Center, says Ruth Guchu, chief technologist at the University of Virginia Sleep Center.
Once you’ve survived the complicated process of getting referrals and have secured an appointment, the rest is easy. “For most patients, they can be studied and treated in one night,” says Bream.—K.W.
Assume the position
On your back? On your belly? The best body bet for a good rest
“I recommend side or back,” says Paul Stangil, a local chiropractor and nutrition consultant, on how to lie for the best night’s sleep.
“Side is a semi-fetal position, and you can put a pillow between your legs to keep legs parallel, “ he says. “If your legs aren’t parallel, one leg folds over, and that twists the spine.”
Sleeping on your stomach may be comfortable, but this position can put unnecessary pressure on your neck and back. Due to the number of nerves coming out of your neck, “turning your head to the side and sleeping on your stomach can affect the alignment of your spine,” Stangil says.
Having a good mattress that keeps your body properly supported can help, although Stangil warns, “It’s a misconception that you need the stiffest mattress out there. The bed is supposed to dip a little bit; your body is not flat.” He recommends a “medium to firm mattress.”
If you have an extra $12,000 to spend, you can follow in the footsteps of Oprah Winfrey, the British royal family, Luciano Pavarotti and Russian President Vladimir Putin and purchase the Hypnos mattress, a 2,000-coil temple to sleep, made of cashmere, silk and lamb’s wool. We bet any position would somehow be comfy on that bed.—K.W.
Ten easy tips for getting a good night’s sleep
Cut out caffeine
No Big Gulps before bedtime. Instead, try caffeine-free, low-sugar drinks, or herbal tea. Leave at least five to six hours between your last cup of coffee and bedtime.
If you’re napping during the day, but having trouble sleeping at night, you should forego the nap to get a full night’s worth of deep, restorative sleep.
A workout can get your body revved up, and although you may feel relaxed, even tired, post-workout, you should leave plenty of time—three to four hours—between exercise and bedtime for your body temperature to drop and for your muscles to unwind.
Make a list
If you’re lying in bed worrying about all the things you need to do the next day, try writing down a to-do list before bed. Getting in the habit of writing down your list before sleeping should help clear your mind and allow you to drift off to a night of worry-free sleep.
Stick to happy hour
Drinking into the wee hours of the morning can disrupt your sleep. Call it quits a few hours before retiring since alcohol can disturb your normal sleep pattern and cause you to wake more frequently during the night.
Don’t pig out
Light snacking is O.K., but big meals before bedtime are not. Digesting a late-night dinner is not relaxing for your body, so keep your snacks healthy, and to a minimum.
Clear the clutter
If your bedroom resembles an office or a Radio Shack, now is the time to change. Take anything that could be distracting out of the room, including electronics, work-related papers and pets.
Make it dark
Too much light can keep your body up, so invest in some proper window shades or change the lighting in your bedroom to help you sleep soundly.
Ever notice how tired you are after orgasm? The rush of endorphins during orgasm can leave both men and women feeling relaxed and sleepy.
Treat yourself to soft, high thread-count sheets, supportive pillows, or even a new mattress if you need to. Going to bed each night should be something you look forward to.—K.W.