Sleep Disorders and Disability

Before he was treated for obstructive sleep apnea (OSA), Rick Cardenas would deny that he had a problem.  He denied, for example, that he snored.  Other things, he couldn’t deny.  “One of the things that really pushed it over the edge,” said Cardenas, “was that I would be talking with the woman I was going out with at the time, and I would fall asleep in the middle of the conversation.  That’s not good for a relationship!”

Cardenas says that he had heard of OSA and was encouraged by his girlfriend, a nurse, to get an evaluation at a sleep clinic.  As he recalls, “The first night I went in, I had just gone to sleep when the staff came running in and said, ‘You’ve got it!’”  Translation:  He had an easily diagnosable case of OSA.

OSA is one variety of a common set of problems known collectively as sleep disorders—or physiological, biological or psychological conditions that chronically disturb sleep.  Everyone’s sleep pattern is unique, and many suffer from occasional and temporary sleep problems.  Only when a problem is “ongoing and bothersome” is a person said to have a sleep disorder that merits diagnosis and treatment, explains Dr. Mark Mahowald, director of the Minnesota Regional Sleep Disorder Center at the Hennepin County Medical Center (contact info below).

Mahowald says that many who experience sleep disturbances attempt to self-diagnose their problem, while some are not even aware of it.  This results in a high degree of uncertainty about the actual incidence of sleep disorders among Americans.  Estimates range from 17 to 30 percent of the population, or between 50 and 90 million people, with perhaps as many as 95 percent never receiving an official diagnosis.

Sleep disorders take many forms, including narcolepsy, REM (rapid eye movement) behavior disorder (acting out of dreams), sleep‑related seizures, gastroesophageal reflux, periodic limb movement syndrome and many others.

One of the most common sleep disorders is insomnia, an inability to fall asleep naturally or an inability to stay asleep or to resume sleep after waking in the middle of the sleep cycle.  At least 10 percent of Americans, perhaps many more, suffer from insomnia.  Many believe that it is somehow attached to psychological problems, to which Dr. Mahowald responds:  “That’s absolutely not true.”

OSA is also common, with as many as 4 percent of Americans—12 million people—suffering from it.  People with OSA literally stop breathing—repeatedly—during their sleep, often for a minute or longer, and as many as hundreds of times during one night.  Sleep apnea, if untreated, has been associated with increased risk of heart failure, high blood pressure, pulmonary hypertension and potentially lethal abnormal heart rhythms.  OSA is also associated with a 23‑fold increase in the risk of a heart attack, up to nine times the risk of motor vehicle accidents, and has also been documented in over 70 percent of men with stroke.  It can cause convulsions in sleep and disabling lethargy, memory problems, impaired concentration and increased risk of job‑related errors, injuries and termination.

Disability and Sleep

In addition to the possibly disabling problems above, an untreated sleep disorder can be disabling in and of itself.  Those suffering from sleep disorders may suffer in their relationships and are at greater risk for accidents.  People with certain disabilities also are known to suffer from sleep disorders at a higher rate than the general population.

According to Dr. Mahowald, 50 percent of people with neuromuscular disorders suffer from “significant breathing problems during sleep.”

There is a strong correlation between Parkinson’s disease and sleep disorders.  According to Mahowald, approximately 70 percent of clinic patients with REM sleep disorder will go on to be diagnosed with Parkinson’s.  Patients with Parkinson’s also frequently suffer from insomnia.

People with Down syndrome have a 40-50 percent chance of suffering from OSA.  This is largely due to physiological factors associated with DS, such as the shape of the head and tongue, enlarged adenoids and/or tonsils, and so forth.

Speaking to a convention of the American Council of the Blind in 2002, Dr. Steven Lockley from the Harvard School of Medicine noted the relationship between blindness and sleep disorders:  “Blind people have more sleep disorders than sighted people… People with no light perception have a higher incidence and a greater severity of sleep disorders than blind people with some degree of light perception.  In the majority of totally blind people, these sleep disorders are due to a body clock disorder because of a lack of light perception reaching the brain.”

Other than those mentioned above, there may or may not be a higher incidence of sleep disorders among people with disabilities.  Dr. Mahowald points out that there is no reason to believe that the incidence of sleep disorders among PWD is any lower than for the general population, and there are a couple of reasons to believe that PWD may fail to report symptoms associated with sleep disorders.  People who have recently acquired a disability, for example, may just assume that their sleep problem is “part of the territory.”  Others may rank it as a low priority in relation to other medical needs associated with their disability.

Help for Sufferers

According to Dr. Mahowald, the good news about these disorders is that, in most cases, they are: “Identifiable.  Diagnosable.  Treatable.”

Research has made many sleep disorders readily identifiable to the medical profession.  For many people, diagnosis will involve taking a test called a polysomnogram, which is used to analyze sleep patterns.  When the patient comes into the sleep center, they will be asked to lie on a bed and simply sleep.  (The test may be carried out during the night so that normal sleep patterns can be reproduced.)  In preparation for the test, electrodes will be placed on the scalp, the outer edge of the eyelids, and the skin on the chin.  Characteristic patterns from the electrodes will be recorded during wakefulness with the eyes closed, and during sleep.  The time taken to fall asleep will be measured, as well as the time to enter REM sleep.  Sometimes a person’s sleep movements will be recorded on video.

Treatment for a sleep disorder will be developed between the patient, his or her family and medical professionals, and may include lifestyle changes, medication, medical devices or corrective surgery.  In addition, training in stress reduction techniques may be considered.  The costs of assessment and treatment are typically covered by both Medicare and Medicaid, as well as by private insurance.  Check with your sleep center.

In Cardenas’s case, the use of a Bi-PAP or bi‑level positive airway pressure machine allowed him to get a good night’s sleep for “the first time in years.”  As an added benefit of his treatment, Cardenas was soon rid of a bad case of dry mouth and bleeding gums.

A final message from Dr. Mahowald:  “There is no reason to have insomnia, excessive daytime sleepiness, or unusual behaviors during sleep.”

See information below if you think you might have a sleep disorder.

To contact the MN Regional Sleep Disorder Center at the HCMC, call 612-347-6288 or 1-800-343-6774, or visit  http://www.hcmc.org/a_z/mrsdc/mrsdc.htm.

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Do You Have a Sleep Disorder?

Some symptoms:

Loud snoring, waking up with headaches, a reduced sense of well‑being, forgetfulness, a lack of energy and motivation, leg cramps or a continuous and uncontrollable urge to move one’s legs, anxiety, depression, difficulty learning or concentrating, obesity, high blood pressure, awakening with a choking feeling or gasping for air, racing heartbeat during the night, pauses in breathing during the night, restlessness while sleeping, nighttime sweating and frequent awakenings.

Symptoms are often reported not by the patient, but by his or her bed partner.  A true diagnosis of a sleep disorder has to come from a professional.

Where to Go for Help

To receive a list of accredited sleep centers near you, call the Excessive Daytime Sleepiness (EDS) Hotline toll free at 888-412-9253.

For more info, here are some Web sites to visit:

The American Academy of Sleep Medicine at http://www.aasmnet.org
“Talk About Sleep” at http://www.talkaboutsleep.com/
The Sleep Channel at http://www.sleepchannel.net/
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