For millions of people with chronic sleep problems, it would be a dream
to return to the days of sleeping like a baby. Research shows that 40
percent of Americans have difficulty sleeping a few times per week; while
1 in 3 says insomnia strikes nearly every night. Although insomnia is
the most common complaint, there are other sleep disorders that can have
adverse effects and may initially go undiagnosed.
“A sleep disorder can last for a few nights, causing minor inconvenience,
or become a pervasive illness affecting all aspects of a person’s
daytime life,” says Mangala Nadkarni, M.D., Medical Director of
The Center for Sleep Disorders at Saint Barnabas Medical Center. Dr. Nadkarni
is board-certified in Neurology, Clinical Neurophysiology and Sleep Medicine.
The Center for Sleep Disorders offers a full range of services used in
the evaluation, diagnosis and management of sleep-related disorders in
adults and children. The Center is equipped with the latest in monitoring
equipment, providing the opportunity for daytime testing and full overnight
When Insomina Becomes Serious
As we all know, transient insomnia can follow a stressful event in life,
such as a death in the family. Insomnia is actually considered to be a
physiologic response to grief. However, in some individuals, this problem
can turn into chronic insomnia. Dr. Nadkarni explains that individuals
with chronic insomnia (defined as sleeplessness that has lasted for three
months or more) develop habits that perpetuate their inability to sleep.
“The individual begins to fear going to bed and actually has ‘performance
anxiety’ associated with his or her inability to sleep,” says
Dr. Nadkarni. “The thought of nighttime turns into a nightmare itself.”
She recommends that anyone with extended insomnia should seek medical
attention before the condition becomes chronic, as chronic insomnia is
“very difficult to treat.”
Lack of sleep can have serious consequences. Research has shown that people
who are sleep deprived perform as poorly on driving tasks as those who
are operating at the legal alcohol limit.Insomniacs have sleep problems that fall into three areas:
difficulty falling asleep
problems with sleep maintenance
early rising (waking up at 3 a.m., for example)
Common Sleep Problems
Sleep Apnea (also called
Sleep Disordered Breathing) patients actually stop breathing while asleep, generally for more than
five times per hour and for longer than 10 seconds per occasion. The problem
is more common in women and in those who are overweight—especially
in men with a collar size greater than 16 inches.
While patients may not wake up during the episodes, the quality of their
sleep is poor. This can lead to symptoms such as sleepiness during the
day, lack of energy, memory problems and can manifest as a mood disorder.
Patients with severe sleep apnea are more likely to have high blood pressure
that is difficult to treat, heart attacks and strokes. They are also likely
to get involved in motor vehicle accidents.
A diagnosis of sleep apnea is made through a sleep study. The general treatment
is a specialized sleep mask that applies pressure to the airways. A weight
loss program and possible referral to an ear, nose and throat specialist
may be recommended, depending on the severity of the condition.
Women are the primary patients who suffer from a sleep disorder called
Upper Airway Resistance Syndrome. Although the individual does not stop breathing during sleep, loud snoring
affects quality of sleep. Diagnosis and treatment would be the same as
for an individual with sleep apnea.
enlarged tonsils and adenoids can cause poor sleep quality and resultant symptoms that mimic Attention
Deficit Disorder (ADD). The treatment would be removal of the tonsils
Restless Leg Syndrome or
Periodic Leg Movement Syndromeoccurs when the individual has prickly sensation or cramps in the legs
during evening hours and when the person kicks spontaneously. If the kicking
continues during sleep, it can be problematic for the bed partner. These
individuals need evaluation to determine the cause of the condition, which
can vary from iron deficiency to a condition that requires medications.
In the REM stage of sleep, the body experiences paralysis so that the dreamer
does not act out his or her dream. Those with
REM Behavior Disorder do not experience this paralysis. One of Dr. Nadkarni’s patients
dreamed that he was being chased and then suffered a severe injury after
leaping over his bed while sleeping. This condition occurs in REM sleep,
unlike those who sleepwalk during a non-REM stage. Patients may need a
sleep study to confirm the diagnosis and be treated with medications.
Narcolepsy is the most disabling sleep disorder of all. It can result in excessive
sleepiness during the day, with the person even falling asleep in mid
conversation in severe cases. Patients may even think they are hallucinating
as dreams enter their waking moments. Often patients are embarrassed to
discuss these symptoms for fear of being labeled as a psychiatric case.
Narcoleptics are generally treated with medication.
Being robbed of sleep can have a disastrous effect on a person’s
life as well. Patients who have successfully sought treatment through
The Center for Sleep Disorders feel rejuvenated by their new sleep patterns.
“They tell me that they have never felt this awake before during
the day,” says Dr. Nadkarni. “Their nighttime problems no
longer adversely affect their daily lives and the lives of their families.”
For an appointment with The Center for Sleep Disorders at Saint Barnabas,
please call (973) 322-9800.
After 20 years of practice, sleep specialist John Penek, M.D., FCCP, can
tell immediately when he walks into the examination room if the patient
has come to discuss a snoring problem. That is because the majority of
times the snorer is accompanied by a spouse.
“Most of the time they are brought in by a wife who can’t take
it anymore,” says Dr Penek. “The snorer is defensive and says
things like, ‘If my wife would stop elbowing me in the side all
night, then I’d have a good night’s sleep.’ They have
no idea of the extent of the problem or the larger health implications.”
Snoring A to Z
Snoring occurs when the airway channel relaxes during sleep and becomes
a conduit for air-induced vibration. When there is an obstruction in the
airway, structures in the throat vibrate together, producing sound. The
spectrum of snoring ranges from an undetectable sound to levels as high
as 90 to 120 decibels. The highest range is not far from the noise emitted
by a jet aircraft at takeoff, which has been measured at 140 decibels.
Although snorers tend not to awaken themselves, they may greatly disrupt
the sleep of a bedpartner. In addition, the sound may be damaging. A study
in the Journal of Otolaryngology found that bed partners of those who
snore showed significant noise-induced hearing loss in the ear most exposed
to the snoring.
Larger Health Issues
According to Dr. Penek, there is strong evidence that snoring can be dangerous
to your health.
“Snoring, especially heavy snoring that disturbs bedparter sleep,
is often associated with a condition known as sleep apnea, which may indicate
an increased risk of hypertenstion, cardiac arrythmias and sudden death
during sleep,” he relates.
As many as 30 percent of men and women in midlife with high blood pressure
also have problems with snoring and sleep apnea, which are curable causes
of elevated blood pressure.
Individuals with snoring and sleep apnea conditions are also at a significantly
higher risk for automobile and industrial accidents. According to a study
in the Medical Post, snorers are six times as likely as non-snorers to
have accidents while driving.
Some snorers suffer from a condition known as sleep apnea. Sleep apnea
results in a complete or near complete obstruction to airflow for 10 seconds
or more. A person with a typical case of sleep apnea will have apneas
of 10 to 60 seconds or longer, and will have 5 or more per hour during
sleep. Sleep apnea can occur from obstructed airflow, or from a problem
with the central nervous system.
“A drop in oxygen alerts the brain to a problem, and the brain kicks
the person out of deep sleep into a more shallow sleep,” says Dr.
Penek. “Most patients have not slept properly in decades.”
Sleep apnea can cause excessive sleepiness, which in turn can result in
automobile accidents, lack of concentration, significantly reduced energy
levels. For people suffering from heart trouble or stroke, sleep apnea
makes their condition worse because of the lack of sleep and reduced oxygen
levels and an increase in high blood pressure.
Patients who may have sleep apnea are diagnosed with a medical history
and an overnight evaluation at The Center for Sleep Disorders. Treatment
involves the use of a C-PAP (continuous positive airway pressure), a breathing
device that keeps the airway free of collapse.
Treatment for Snoring
For snorers who do not have sleep apnea, there are a variety of treatments.
These can include:
Risk factors for snoring include obesity, allergies, being male or a post-menopausal
female, a deviated septum, consumption of alcohol before bed, eating late
night meals and smoking.
Patients who no longer snore find themselves far more rested in their waking
hours, says Dr. Penek. And their partners enjoy a much needed rest as well.
“It’s hard to sleep when you’ve got a bear lying next
to you,” says Dr. Penek. “When the sound is gone, the bed
partners sleep is no longer so severely impaired.”
For information about The Center for Sleep Disorders, please call (973) 322-9800.
For the millions of Americans struggling to maintain a healthy weight,
getting more sleep may prove to be part of the answer. A recent study
presented at the 2004 North American Association for the Study of Obesity
has found a correlation between the amount of sleep a person gets each
night and their chance of becoming obese.
"Physicians have known for some time now that people who have problems
sleeping are more likely to have heart attacks, strokes, and high blood
pressure that is difficult to treat, as well as concentration and behavioral
problems,” says Mangala Nadkarni, M.D., Medical Director of The
Center for Sleep Disorders at Saint Barnabas Medical Center. “This
study provides further evidence that getting the right amount of sleep
directly affects a person’s ability to maintain a healthy weight.
According to the study, individuals who get less than four hours of sleep
per night were 73 percent more likely to be obese than those who got the
recommended seven to nine hours. Research showed that people who averaged
five hours a night were 50 percent more likely to be obese and those who
got six hours have a 23 percent greater risk.
Though people burn less calories while sleeping, evidence exists linking
sleep and the various neural pathways that regulate food intake.
For individuals who are concerned about their weight, seeing a sleep specialist
might prove to be as helpful as meeting with a nutritionist or beginning
an exercise program.
The Center for Sleep Disorders at Saint Barnabas offers a full range of
services used in the evaluation, diagnosis and management of sleep-related
disorders in adults and children. The Center is equipped with the latest
in monitoring equipment, providing the opportunity for daytime testing
and full overnight sleep studies.
Treatment is offered for various sleep-related disorders, including snoring,
insomnia, Sleep Apnea or Sleep Disordered Breathing, Upper Airway Resistance
Syndrome, and Restless Leg or Periodic Leg Movement Syndrome.
“Patients who have successfully sought treatment through the Sleep
Disorders Center feel rejuvenated by their new sleep patterns, which results
in a better quality of life,” said Dr. Nadkarni.
For more information about sleep disorders or to make an appointment with
The Center for Sleep Disorders at Saint Barnabas, please call (973) 322-9800.
Mangala Nadkarni, M.D.
Medical Director, The Center for Sleep Disorders at Saint Barnabas Medical Center
Sleep isn't just "time out" from daily life. It is an active
state that is important for renewing our mental and physical health each
day. When we sleep, our bodies rest but our brains are active. Sleep lays
the groundwork for a productive day ahead. Research has shown that a lack
of restful sleep results in daytime sleepiness, increased accidents, problems
concentrating, poor performance on the job and in school, and possibly,
Women are twice as likely as men to have difficulty falling asleep or staying
asleep and even then their sleep complaints are often not taken seriously
by health care workers. In the young adulthood of women, sleep disturbances
are usually associated with the menstrual cycle, pregnancy and motherhood.
In the menopausal years, research has shown, a woman's sleep pattern
is susceptible to hormonal changes.
The Menstrual Cycle and Sleep
Some women awake more frequently and experience other sleep disturbances
during their premenstrual state, while others report excessive daytime
sleepiness, fatigue and longer sleep hours. Usually these problems disappear
when menstruation begins, although some women may continue to have lingering problems.
Changes in women's bodies occur at different times in the menstrual
cycle and may affect sleep. A National Sleep Foundation (NSF) poll found
that 50 percent of menstruating women reported bloating that disturbed
their sleep. On average, these women reported disrupted sleep for two
to three days each menstrual cycle. Poor quality sleep is more likely
at the beginning of the menstrual cycle when bleeding starts. While a
healthy sleeper spends about 15-20 percent of his or her sleep time in
deep sleep, NSF research suggests that women with PMS experience less
deep sleep (about 5 percent of their total sleep) all month long.
Pregnancy and Sleep
Pregnancy-related sleep disturbances are well known and well accepted.
In a NSF poll, 78 percent of women reported more disturbed sleep during
pregnancy than at other times. Sleep-related problems also become more
prevalent as the pregnancy progresses.
Most women report daytime fatigue and the need for longer nighttime sleep.
Overall sleep efficiency - the proportion of time spent actually asleep
- begins to decrease by the second trimester and continues to decrease
in the third trimester. In the third trimester several things can cause
sleep disturbances: leg cramps, backache, heartburn, movement of the fetus
and increased frequency of urination. Once the baby is born; physical
stresses of pregnancy are replaced by demands of the baby's feeding
schedule and awakenings. After delivery, getting enough rest continues
to be very important as severely disturbed sleep has been linked to postpartum
depression and child abuse.
Pregnancy Sleep Tips:
Special "pregnancy" pillows may help you sleep better. Or, use
regular pillows to support your body.
Naps may help. A NSF poll found that 51 percent of pregnant women reported
at least one weekday nap; 60 percent reported at least one weekend nap.
In the third trimester, sleep on your left side to allow for the best blood
flow to the fetus and to your uterus and kidneys. Avoid lying flat on
your back for a long period.
To prevent heartburn, do not eat large amounts of spicy, acidic (such as
tomato products), or fried foods. If heartburn is a problem, sleep with
your head elevated.
Menopause and Sleep
In the perimenopausal period many women experience sleep disturbances
with changing levels of sex hormones. Overall amount of deep sleep decreases,
sleep becomes lighter and more awakening occurs during the night. Hot
flashes (unexpected feelings of heat all over the body) and night sweats
can cause repeated awakenings and feeling of anxiety. The resultant sleep
deprivation may cause daytime fatigue, irritability and depression.
Decreasing levels of estrogen cause hot flashes, which are usually accompanied
by sweating. In a NSF poll, 36 percent of menopausal and postmenopausal
women reported hot flashes during sleep. On average, they occurred three
days per week and interfered with sleep five days per month. Hot flashes
persist for an average of five years. While total sleep time may not suffer,
sleep quality does. Hot flashes may interrupt sleep; frequent awakenings
cause fatigue the next day.
Deciding what, if any, product to use to alleviate these symptoms and,
if so, for how long, are questions a woman should discuss with her physician.
The answer will depend on personal and family medical history.
Other Sleep Disorders
These sleep disorders/manifestations are more prevalent in women. They include:
Restless Leg Syndrome: Patients describe this condition in several ways including leg cramps,
tingling, numbness in legs, electric sensation or a Charlie Horse. In
young women one of the common causes of this condition is iron deficiency
anemia. Iron deficiency anemia can occur during pregnancy or due to heavy
bleeding from uterine fibroids. In older populations this may represent
a disorder by itself.
Sleep Disordered Breathing: There are two forms for this condition. Patients with Increased Upper
Airway Resistance Syndrome generally experience loud snoring and excessive
fatigue and/or daytime sleepiness. Sleep Apnea Syndrome is less common
in women during the premenopausal period unless the female is overweight
or obese. It has also been linked to polycystic ovaries. In the postmenopausal
period the prevalence of sleep apnea syndrome in women is almost equal to men.
Depression: One of the features of endogenous depression (depression due to chemical
imbalance and not necessarily to circumstances alone) is early morning
awakenings. Patients usually wake up around 3 a.m. and cannot return to sleep.
Nocturnal Eating/Drinking Syndrome: This syndrome is thought to be an illness by itself; although, some patients
report that they are attempting strict daytime dieting.
The presence of one sleep disorder does not exclude another coexisting
sleep disorder, therefore, patients benefit by having a comprehensive
evaluation and, if necessary, a sleep study. Improving sleep quality results
in improved quality of life. After all, the key to a long, happy, healthy
life is to sleep well, eat well and exercise.
For an appointment with The Center for Sleep Disorders at Saint Barnabas,
please call (973) 322-6600.
For many kids going back to school can be a time of excitement and anticipation.
But, after a summer lazy afternoons and staying up late, it might be hard
for parents to change their kids’ summer sleep habits once the school
“Helping ensure that your child gets enough sleep once school begins
will help them focus on their school work and have a healthier, safer,
and more productive school year,” says Mangala Nadkarni, M.D., Medical
Director of The Center for Sleep Disorders at Saint Barnabas Medical Center
in Livingston. “Most children require 10 to 12 hours a sleep each
night. Less sleep can cause concentration and behavioral problems.”
According to Dr. Nadkarni, it is best for parents to begin changing their
children’s sleep schedules a few weeks before school starts. She
suggests limiting nap times and moving bedtimes back a half hour every
few days until you reach the time you would like your child to go to sleep
during the school year.
To help parents plan a back to school sleep schedule, The National Sleep
Foundation and The Center for Sleep Disorders at Saint Barnabas offer
the following tips that should be maintained throughout the school year.
Begin the routine now. Parents should start their child's school sleep routine at least
one to two weeks before opening day by introducing a gradual change in
their child's sleep schedule, such as going to bed 15-30 minutes earlier
each night. This can make it easier for children to adjust their sleeping
patterns to meet the new school schedule.
Establish a regular bedtime and wake up time. Parents and children should plan a daily schedule that includes the basic
daily sleep requirements for particular age groups. This schedule should
be maintained on the weekends, though students can be permitted to sleep
in one or two hours on weekend mornings if necessary. While individual
sleep needs can vary, the amount of sleep suggested by sleep experts for
particular age groups is:
Elementary School Students 10-12 hours/night
Pre-teens (middle/junior high school) 9-11 hours/night
Teens 8.5-9.5 hours/night
Remember to add 10-20 minutes to bedtime for falling asleep.
Create a bedtime routine. Bedtime routines are important, regardless of a child's age. It should
include at least 15-30 minutes of calm, soothing activities. Prior to
bedtime, encourage quiet time with some relaxing activities. Discourage
television, exercise, computer and telephone use, and avoid caffeine (found
in beverages, chocolate and other products).
Achieve a balanced schedule. Identify and prioritize activities that allow for downtime and sufficient
sleep time. Help students avoid an overloaded schedule that can lead to
stress and difficulty coping, which contribute to poor health and sleep problems.
Be a role model. Parents and guardians can be role models for school aged children by
establishing their own regular sleep schedule and a home environment conducive
to healthy sleep habits
Become a sleep advocate. Take steps to encourage:
scheduling of events to help children keep their sleep schedules
appropriate school start times, and
a sleep curriculum in health and biology classes to help students better
understand the importance of sleep to their overall health, safety, and
quality of their lives
For more information about sleep disorders or The Center for Sleep Disorders
at Saint Barnabas Medical Center, please call 973-322-9800.