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To Sleep, Perchance to Dream

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Dr. John Townsend is a neurologist with the Sleep Disorder Center at Christiana Care. Photograph by Thom ThompsonMost people can describe insomnia, but few understand the biochemical components of the most problematic sleep disorder. Yet there’s good news for those who cannot get a good night’s rest: Science continuously reveals new insights.

“There are things out all of the time, like how to get better sleep and how to feel better,” says Dr. John Townsend, a neurologist with the Sleep Disorder Center at Christiana Care. “The key to feel a whole lot better is to recognize the problem and fix it.”

Though the symptom-diagnosis dynamic guided the school of sleep science through its early years, a new drive among researchers has pushed the limits. They want to find out how to tackle not just one trait of troubled sleep, but how to treat the problem at the broadest level.

Insomnia comes in many forms, most of which are related to behavior or chemicals, such as medication, stress or jet lag. The best way to determine an effective treatment is to figure out what triggered the disruption.

When someone is asleep, they are in one of two stages—REM sleep (rapid eye movement) or non-REM sleep. The two states are as different as awake and asleep, says Dr. Lisa Shives of the American Academy of Sleep Medicine.

“REM sleep has features that are more similar to awake than non-REM, like active dreams and increased heart and breathing rates,” she says. “People are always intrigued by REM, and there has been a great deal of research in the past year as far as REM and memory, specifically the slippage between awake and REM sleep. People typically move from one to the other on a regular basis as they lie in bed, but rarely remember the transition when they wake.”

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One explanation for the memory loss lies in basic human evolution, Shives says. In those few moments we are awake, we see that it is dark, so our brain tells us to go back to sleep. Unfortunately, this basic biological trait can backfire, especially when it plays a role in increasing insomnia.

“Recent research has helped us understand how important light is to your signal as to whether you should be awake or sleep,” Shives says. “I recommend that people shouldn’t use their computers before bed or sleep with their TVs on because the light signals a part of your brain that basically tells you it’s time to rise and plow the field

“Insomniacs perpetuate the problem. It’s midnight and they can’t sleep, so they watch TV, play a video game or work on the computer, and it increases the problem because it is telling the brain not to go to sleep, but to wake up and start working.”

There are a few people, however, who just cannot sleep, even after most of the known triggers of insomnia are eliminated.

“It is an issue of people not getting all of the prime elements of sleep,” Townsend says. “Genetic studies have showed that there are traits passed down that can influence the likelihood of having insomnia, and in those patients, there appears to be a loss of neurons in a particular region of the brain. There is no precise cure for insomnia now, but stem cells might fill the missing pieces.”

Even more baffling than the triggers of insomnia is narcolepsy, which impacts an estimated 200,000 Americans. The disorder occurs when the REM stage superimposes itself on the wake stage, a change that is almost automatic for the people who suffer from the attacks. In the most severe cases, high levels of stress or joy can trigger narcoleptic symptoms, so the person will remain conscious, but his body will suffer from sleep paralysis.

Not much is known about the triggers of narcoleptic attacks, aside from incorrect levels of the hormone hypocretin, Townsend says. Recent mapping of the human genome has allowed researchers to accelerate research on hormonal regulation. But treatment of narcolepsy is far from perfect, says Shives, especially since even the best drug is a bit of a monster.

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“When it comes to narcolepsy, we are really recommending use of sodium oxybate, as it condenses sleep and cuts down the chances of sudden attacks. But it also is known as a date rape drug,” she says. “Because of all the bad press because of its other use, they put this huge sodium load in the solution, so you need to make sure you don’t give it to people with kidney or heart problems, and it is so short acting that you have to take a dose in the middle of the night, so you need to have a dose ready for you on your bedside table.”

Insomnia and narcolepsy are two of the more discussed sleeping disorders, but neither plays as large a role in American life as sleep apnea, the interruption of a person’s normal breathing pattern while asleep. Apnea is the fastest growing sleep disorder in the country by far. Snoring is annoying, but it is nothing compared to the actual dangers of apnea.

The best way to find out if one suffers from apnea is through a sleep study, in which the patient is connected to machines that monitor their conditions while they sleep, says Dr. Clifton Hunt, a sleep apnea specialist with the Delaware Sleep Disorders Center.

If the patient suffers from apnea, several treatment options are available. The most widely used is the continuous positive airway pressure machine, or CPAP. Via a mask over the patient’s mouth and nose, the machine forces air into the lungs so people can breathe regularly throughout the night, without worrying about a sudden stoppage.

“The CPAP machine is the most effective known therapy, and a significant number of people wear the mask and don’t mind,” says Hunt, who has used the machine and found it helpful. “But with that said, about a third of the people don’t like the mask, and some are even scared to come in for a sleep study because they feel they will be tied to the machine the rest of their life.”

The field is constantly improving through a multi-faceted approach. Hunt says there have been some significant breakthroughs in the past few years.

“We have been working with a wide variety of specialized doctors to try to treat this,” Hunt says. “Ear, nose and throat doctors are helping with improving circulation, dentists can help with a mouth guard to force the airway open, and nutritionists are helping people into better shape, which impacts airways, blood pressure and stress.”
 


Sleep Like a Baby

“The best way to get to sleep is to have a pattern that is consistent,” Dr. John Townsend says. So:

  •  Set a regular schedule for sleep.
     
  • Don’t exercise within two hours of going to bed.
     
  • Don’t use caffeine after 6 p.m.
     
  • If you can’t sleep, don’t watch television, work on the computer or play video games.

 

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