Dissenter sandman 

Unfortunately, for many Oklahomans, it happens all the time. Oklahoma ranks No. 2  nationally in sleep disturbances and disorders, just beating out West Virginia, according to a recent study by the Perelman School of Medicine at the University of Pennsylvania and published in the online edition of the Journal of Clinical Sleep Medicine.

This is no surprise to Dr. Kellie Jones, M.D., associate professor at the University of Oklahoma, Pulmonary, Critical Care and Sleep Medicine, who has seen a rise in patients with sleep disorders such as sleep apnea, restless leg syndrome and insomnia.

“One of the main players is the obesity rate,” Jones said.

“What happens is when patients gain weight, they have fat deposition in their upper airway, so that makes the upper airway smaller, and that makes it more likely to collapse.”

Oklahoma has the 7th highest obesity rate in America. Jones added it is not just obesity that can cause sleep disorders but the way the fat is carried. People with central obesity, where more of the weight is carried in the middle, are at a higher risk for obstructive sleep apnea. Basically, the fat distribution makes it harder to breathe, among other things.

“It’s pretty devastating,” Jones said.

“They’re more likely to die, have a stroke, heart attack, heart disease, diabetes and poorly controlled hypertension. Not over the course of six months — it’s not immediately — but when you study these patients over years, they’re more likely to die than patients who don’t have obstructive sleep apnea.”

Bedtime story
Even scarier news is that many professionals in the sleep medicine field report instances of apnea-related sleep disorders among children and teens. Dr. G. Paul Digoy, M.D. and fellow of the American Academy of Pediatrics, specializes in pediatric ear, nose and throat medicine at the OU College of Medicine and said that while high obesity factors into childhood sleep disorders, too, it might not always be the answer.

Most often, big tonsils are the most common cause of snoring and obstruction, he said.

“Seventy percent of my practice is dealing with upper airway obstruction in children,” Digoy said. But, “definitely, as the child gets a little older, and by older I mean 3 on up, obesity is going to play a pretty big role.”

Digoy advises that if a child is dealing with apnea, a “tonsillectomy is the first line therapy for children who have obstruction.” However, if the child is overweight, tonsil surgery will only temporarily correct the problem.
“We’re finding that children who have ... snoring and restless sleep, waking up frequently and sometimes bedwetting, will have greater challenges in the classroom,” Digoy said.

“Let’s say you have a child that has sleep apnea. These children are more likely to be hyperactive during the day, as well as face cognitive challenges. Children who don’t sleep well are probably less likely to excel in school.”

Sweet dreams

Both Jones and Digoy agreed that taking steps now to lose weight, stop smoking and stop drinking caffeine after noon are great preventative measures to help get restful — and sometimes life-saving — sleep.

Jones also offered additional tips to help improve sleep hygiene. First, turn off the TV and lay aside the books.
“We train ourselves not to go to sleep,” Jones said. “Pick the same bedtime and waketime every day, and sleep in a dark room that is as cool as can be, because that is a definite sleep trigger.”

Also, avoid naps and sleeping in because that throws off natural sleep cycles. It sounds like a no-brainer, but it happens more than people would like to admit, Jones said.

But if the damage is already done, Jones suggests seeing a doctor who specializes in sleep disorders to discuss options to help return to nocturnal normalcy. Treatments may include continuous positive airway pressure (CPAP) machines that blow pressure into the patient’s throat to open airways, dental appliances or, in severe cases, upper airway surgery.

“One thing is not for everyone,” Jones said.

“I had a patient, and it probably took us almost two years to get him on the right mask, the right machine and get everything fixed and his sinuses addressed. ... You can’t just give up. Sometimes it can be frustrating, but there are few things in life that are as satisfying as a good night’s sleep, and it’s important to put effort into achieving that.”

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