- The Washington Times - Tuesday, April 22, 2003

Who hasn't lost sleep over the past few weeks watching wall-to-wall coverage of the war with Iraq, what some back in 1991 called the "CNN syndrome?"
Insomnia, a prolonged lack of sleep that can affect mental sharpness and overall physical health, may be the result of too many ominous headlines. While yawning through a big meeting might be an embarrassing side effect of insomnia, more worrisome repercussions could include missing key time from work or even nodding off behind the wheel.
Insomnia refers to difficulty falling asleep, waking up repeatedly during the sleep cycle and feeling exhausted come morning. Conditions such as back pain, depression and arthritis can trigger insomnia.
Less extreme cases may be conquered by listening to soothing music or drinking a glass of warm milk, which contains the sleep-inducing amino acid tryptophan, before calling it a night. More serious bouts of insomnia can be treated with brief rounds of sedatives to restore order to the sleep cycle. Or, if breathing during sleep is interrupted, a condition called sleep apnea, a continuous positive airway pressure (CPAP) machine, which prevents such interruptions, can be used by the patient to get a sound night's sleep.
A survey conducted by the District-based National Sleep Foundation reported April 8 that concerns over war, terrorism and a rickety economy have caused a steep increase in stress and sleeplessness. The group suggests turning off the news an hour before going to bed to have a better chance for a restful sleep. It also recommends avoiding eating or drinking before bedtime and making the bedroom quiet, dark and comfortable.
Insomnia isn't limited to our tumultuous times, however. Experts say up to 30 million people, on average, suffer from a significant lack of sleep. That means getting much less sleep than needed over an extended period, which leaves someone physically drained during waking hours.
Primary insomnia, according to the National Institutes for Health, refers to at least one month's worth of sleep complications not stemming from any specific physical or mental cause, but rather because of stress or poor sleep habits.
Anne E. O'Donnell, interim chief of Georgetown University Medical Center's Division of Pulmonary Critical Care and Sleep Medicine, says we shouldn't be surprised if the war in Iraq caused sleepless nights nationwide.
"I don't know anyone who is tracking this, though it is assumed that when people find themselves in stressful situations, war or otherwise, they have difficulty sleeping," Dr. O'Donnell says.
Stress is a common cause of insomnia, but so, too, are chronic pain, addiction and stimulants such as coffee or drugs. Neurological conditions such as Parkinson's disease also can bring about restlessness. This cocktail of causes makes insomnia tricky to treat.
The first step is to analyze what doctors call the patient's "sleep hygiene," or overall approach to the sleep process.
"A lot of the times it's a behavior," Dr. O'Donnell says of insomnia. "People fall into bad patterns. Insomnia patients should not eat, drink or work out close to bedtime. And they should keep their 'wind down' time fairly consistent from night to night to help them sleep. Drinking beverages with caffeine also can complicate sleep patterns."
Dr. Marc Schlosberg, co-director of the Washington Hospital Center's sleep center, says our anxious times likely affect how well we sleep.
"I would think there would almost have to be [an effect], from my own experience. I've seen a lot of it after September 11," says Dr. Schlosberg, who treated a Pentagon employee who battled insomnia for more than a year in the wake of those attacks.
The first thing Dr. Schlosberg does when evaluating a patient complaining of insomnia-type symptoms is to look for psychological or physical conditions that might be behind the restlessness.
"Just about all psychological conditions can cause insomnia," he says. Depression can lead to insomnia in some, and antidepressants such as Prozac can leave others jittery.
Physical conditions that can lead to lost sleep include sleep apnea and periodic limb movements.
Among the more difficult forms of insomnia to treat is sleeplessness involving a traumatic event in the past that has repercussions on current-day sleep habits, such as a rape or a physical attack.
Should the emotional turmoil stem from a current situation, such as a divorce, stress-reduction techniques may not be enough to help, says Charles McPhee, host of nationally syndicated "Dream Doctor" radio show out of Atlanta.
"Until the divorce is settled, until the finances are solved … there's not a lot sleep physicians can do for their patients," he says.
Mr. McPhee, citing a National Sleep Foundation survey, says more than two-thirds of Americans reported at least one symptom of insomnia in the weeks after the September 11 attacks. Before the attacks, that figure came in around 58 percent. Insomnia symptoms include frequent waking during the night, difficulty falling asleep and a feeling of being tired and unrefreshed during the day.
The war with Iraq shouldn't significantly alter our collective sleep patterns, unless we have friends or loved ones directly involved in the conflict, argues Mr. McPhee, who coordinated the sleep research laboratory at the National Institute of Mental Health in Bethesda during the 1980s.
Sleep disorders, overall, didn't receive much attention until about the mid-1970s. "In a global sense, the world of sleep disorders is very young," Mr. McPhee says.
One reason is the nature of the condition itself.
"It isn't immediately life-threatening; it's more a quality-of-life concern," he says. "It hasn't been given a lot of priority."
In recent years, sleep laboratories have begun cropping up in hospitals to address those long-ignored concerns, he says.
Richard Jeffrey, medical psychologist with the National Rehabilitation Hospital in the District, says doctors in the past decade have begun tying sleep laboratory work with behavioral modifications to fight insomnia. Patients can be "very subjective" when describing their sleep maladies, Mr. Jeffrey says, so sleep labs give doctors tangible evidence of just how serious the problem may be.
The labs use different biofeedback devices, such as electroencephalogram (EEG) and electromyogram (EMG) machines to measure brain waves and electric activity in muscles, respectively.
"You can see if the person tends to have problems getting into a deeper level of sleep," Mr. Jeffrey says.
The equipment can point out problems such as muscle groups that stay tense throughout the sleep cycle
"Sometimes, when people get overtired or tense, they have a hard time releasing muscle tensions and slowing down their physical processes. We use biofeedback to make them more aware of signs of physical tension," Mr. Jeffrey says.
Armed with that information, doctors work backward to find the root causes.
"You start with the simple things, like sleep hygiene," Mr. Jeffrey says. "Then, you do more exploratory psychotherapy to identify underlying conflicts."
Doctors also may use medications on a short-term basis to help "break a person out of a pattern."
Andrew Woessner of Great Falls has spent the past two years battling insomnia caused, most likely, by sleep apnea. Doctors have told the 39-year-old the condition strikes him as many as 100 times on his worst nights. Now he is turning to Georgetown University Medical Center's Sleep Disorders Center to further study his condition and plot possible treatments, including surgery.
The chronic lack of sleep has forced a subtle shift in his lifestyle.
"It's the kind of thing you personally tend not to notice. You just tend to be tired," Mr. Woessner says. "Some days I feel better than others."
So far, he hasn't had any drowsy moments behind the wheel, but, he says, "It's not fun to go through life always tired.
"There are certain times in the afternoon when I'll hit incredible lows," he says. "I gotta hit the coffee machine hard to keep going after work."
Those fighting insomnia caused by less specific causes can take some simple steps to get more sleep, Mr. McPhee says.
If your mind races over all the items on tomorrow's "to do" list, he suggests jotting them down and then acknowledging that nothing can be done about them until the next day.
Another strategy involves maintaining a fixed wake-up time each morning, he says. If someone doesn't fall asleep until, say, 3 a.m. and normally should rise at 7 a.m., he or she should still get up at 7. Sleeping through the alarm may mean extra sleep, but it could perpetuate the disrupted sleep cycle and hurt the chances for a return to a regular sleep pattern.
"The body likes a schedule," he says.



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