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Health Spotlight


For Good Health, Get Some Z's: Sleep Disorders

a man falling asleep in odd hours

For most of us, a good night's sleep is critical to a productive day. And while almost everyone has the occasional sleepless night, many people suffer from insomnia (inability to sleep) 1 to sleep apnea (stopping breathing while sleeping)2 to other more serious sleep disorders.

How much sleep you require each night varies from person to person3. Some people can function well on as little as six hours, while others need at least 10 hours or more. On average, however, most of us get about 7 ½ hours per night. But the evidence is growing that fewer and fewer people get even that much sleep-and when they do, they may not be getting good quality sleep.

The impact of sleep on health is important, but researchers are still learning about this connection. However, evidence is growing that suggests an irregular sleep pattern has been associated with a number of chronic diseases, including high blood pressure, diabetes, and depression4. And for those with chronic sleep disorders, there is still more data5 to suggest a strong connection between lack of sleep and poor health.

Related Resources

About Sleep Disorders

Sleep disorders are considered chronic conditions that regularly interrupt both sleep quality and quantity, and which continue for a prolonged period of time. The most common sleep disorders include:

  • Sleep apnea. This is a condition in which a split-second interruption in normal breathing causes a gasp for breath. Many people with sleep apnea are not even aware they have it; the pause in breath isn't enough to wake them, but it does cause changes to sleep quality.
  • Insomnia. One of the most common sleep disorders, insomnia is the inability to fall or stay asleep. The compound lack of sleep can wreak havoc on daily life.
  • Restless leg syndrome6 . This fairly new diagnosis consists of an unpleasant creeping or tingling sensation in the legs. People with restless leg syndrome may also experience sudden cramps or muscle aches severe enough to awaken them.

Sleep Hygiene: Setting the Stage for Sleep

One of the first things physicians recommend when dealing with common sleep disorders is to develop good sleep "hygiene." Good sleep hygiene includes7 :

  • establishing a regular time to go to sleep and a regular time to rise;
  • removing all distractions from the bedroom area, e.g., no television or computers;
  • using light-blocking curtains to create a dark space; and
  • keeping the bedroom at slightly cooler temperature than the rest of the house.

If you're still not getting a good night's sleep after taking steps to ensure that you are practicing good sleep hygiene, consider talking with your doctor. He or she may want you to be observed in a special "sleep lab" to learn more about your sleep problems.

HSR&D Research

Because regular sleep is such an important part of maintaining good health, VA researchers are investigating sleep disorders and their impact on the health of our nation's veterans. Here are a few examples of that research.

Improving Sleep Disorders with Specialty Consultation 8

In this current study, researchers at the VA Medical Center in Durham, North Carolina are investigating the incremental benefits of adding a one-time sleep specialty consultation (SSC) to usual primary care for reducing sleep disturbance.

Investigators understand that sleep disorders are prevalent health problems that reduce quality of life, increase risks for medical disease, and enhance healthcare costs/utilization. However, only a small proportion of these cases are diagnosed in primary care. The study will focus on 300 veterans with sleep complaints. Participants are randomly assigned to SSC or Wait List Control (WLC) conditions. Measures of sleep, mood, quality of life, and patient satisfaction will be obtained at enrollment and at 5- and 10-month follow-up.

Pilot data from this study suggest that sleep disorders are not adequately managed in a primary care setting: 33% of veterans with an insomnia complaint had an undiagnosed primary sleep disorder (e.g., sleep apnea), and 50% were prescribed pharmacologic treatment for insomnia by their primary care providers. The study is ongoing and will conclude in 2010. Investigators hope that findings will show that patients who receive an SSC with feedback to their primary care providers will have greater improvements in sleep, mood, quality of life, and patient satisfaction, as well as larger reductions in health care utilization than will those who receive usual care alone.

Modifying Insomnia Treatments for OIF/OEF Veterans with TBI 9

Traumatic brain injury (TBI) is one of the hallmark injuries for veterans of Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF). Insomnia is a prevalent concern of many OIF/OEF veterans with TBI, and in this study, investigators sought to examine outcomes using a common and effective insomnia treatment -cognitive behavioral therapy (CBT).

The study examined both the barriers to, and preferences for CBT for insomnia, as well as veterans' ability to report and use objective sleep measures. Participants received a one-time structured interview, and were then asked to take home, use and complete a daily sleep diary, as well as wear a wrist actigraph nightly over a two-week period.

Findings showed that the insomnia treatment preferences expressed in the study have the potential to impact the success of insomnia interventions throughout VA, and may enhance the rehabilitation process and improve quality of life for OIF/OEF veterans.

Non-Pharmacological Interventions in Sleep Disorders In Rehabilitation 10

For older individuals recovering from an acute illness, there is a high prevalence of sleep disturbance. Given that excessive daytime sleeping is associated with poor quality nighttime sleep, and may contribute to less functional recovery, investigators are looking at the whether treatment without medication can improve abnormal sleep patters in those undergoing post-acute rehabilitation.

The study combines structured sleep assessment, environmental interventions, and elements of cognitive behavioral therapies to be performed during the post-acute rehabilitation stay. There are no findings as yet, but investigators believe that a variety of non-pharmacological approaches may be effective in improving sleep quality in a post-acute rehabilitation setting. These findings may have considerable impact throughout VA in the form of cost-effective treatment for patients in post-acute rehabilitation facilities.

Telecommunications Support for Sleep Apnea 11

One of the most common sleep disorders is obstructive sleep apnea syndrome (OSAS), a condition in which sleep is disrupted by short intervals of breathing cessation, followed by gasping or snorting. Often, patients suffering from OSAS are not even aware they have the condition until they are monitored in a sleep lab. Typically, OSAS sufferers are prescribed nasal continuous positive airway pressure (CPAP) treatment. However, many patients do not use CPAP therapy. In this recently concluded study, investigators sought to examine the benefit of telecommunications technology to support CPAP use, as opposed to a more conventional, expensive nurse-administered patient education program.

Investigators enrolled 250 adults with OSAS and randomized them to either TLC-CPAP or an attention control group. The TLC-CPAP group showed higher nightly CPAP use when compared to the control. Findings were clear: by using a telephone-linked communications (TLC) system in conjunction with other important health behaviors, investigators showed that this technology offered an effective, low-cost, easy-to-use method of providing improved CPAP-adherence. These findings can have broad application across VHA, and may serve to improve the health and well-being of veterans coping with OSAS.

References

  1. Centers for Disease Control & Prevention website. "Sleep and Sleep Disorders". Atlanta, GA: US Department of Health and Human Services, CDC; 2007.
  2. Mayo Clinic Family Health Book. Larson, David E., et al, ed. (Morrow, New York, NY. © Mayo Foundation for Education and Research, 1990). Part IV, pg. 1028
  3. Centers for Disease Control & Prevention website. "Sleep and Sleep Disorders". Atlanta, GA: US Department of Health and Human Services, CDC; 2007.
  4. ibid
  5. Centers for Disease Control & Prevention. "Sleep and chronic disease." Atlanta, GA: US Department of Health and Human Services, CDC; 2007.
  6. Centers for Disease Control & Prevention website. "Sleep and Sleep Disorders". Atlanta, GA: US Department of Health and Human Services, CDC; 2007.
  7. ibid
  8. Edinger, J. PhD. Sleep Specialty Consultation: Improving Management of Sleep Disorders. VA Medical Center, Durham, NC. (January 2007 - December 2010)
  9. Epstein, D., PhD, RN. Modifications to Insomnia Treatments for OIF/OEF Veterans with TBI. Phoenix VA Health Care System, Phoenix, AZ. ( August 2007 - February 2008)
  10. Alessi, C. MD. Non-Pharmacological Interventions on Sleep in Post-Acute Rehabilitation. Greater Los Angeles VA Health Care System, Sepulveda, CA. (July 2006 - June 2009)
  11. Sparrow, D.W., DSc. RCT of a Telecommunications System in Sleep Apnea. VA Boston Health Care System, Boston, MA. (April 2004 - March 2008)