- Associated Press - Saturday, February 4, 2017

DUBUQUE, Iowa (AP) - It’s 10 p.m. on the Wednesday after Christmas, and two of the four beds at Mercy Medical Center-Dubuque’s sleep lab are full.

A sign at the end of the hallway warns: “Quiet, please. Sleep study in progress.”

Sleep technician Tina Walsh puts EEG leads on Jon Obe, of Dubuque, in preparation for such a study.

“I look like a Martian,” said Obe, 65, who was affixed with more than a dozen electrodes, patches and sensors on his head, chest, cheeks and legs to monitor that record his breathing, heart rate, brain waves, and eye and leg movements.

The former neurodiagnostic services technician at Mercy suffers from sleep apnea.



He uses a continuous positive airway pressure (CPAP) machine, which includes a mask he wears at night that fits over the nose and mouth that gently blows air into his airway to help keep it open during sleep.

Lately, however, Obe has been waking up with headaches.

“I wonder if the level of the CPAP is not controlling the apnea as well as when I started,” Obe said.

Over the past 15 years, sleep has become widely recognized as a critical aspect of good health, and new research has shed more light on its importance in cardiovascular, metabolic and immune health, the Telegraph Herald (https://bit.ly/2kX6Fhh ) reported.

The Tri-state area now boasts at least eight sleep labs that monitor, diagnose and help treat a range of disorders, from apnea to restless leg syndrome to insomnia and narcolepsy.

Sleep studies also are performed at UnityPoint Health-Finley Hospital in Dubuque, Iowa; Southwest Health in Platteville, Wisconsin; Midwest Medical Center in Galena, Illinois.; Jackson County Regional Health Center in Maquoketa, Iowa; Regional Medical Center in Manchester, Iowa; Crossing Rivers Health in Prairie du Chien, Wisconsin; and Midwest Sleep Services in Dubuque, Iowa.

“There was no specialty of sleep medicine in 1993 when I did my fellowship,” said pulmonary physician Dr. Mark Janes, of Medical Associates in Dubuque.

Janes is board certified in sleep medicine. He diagnoses and treats sleep disorders, including sleep apnea.

“Sleep medicine was in its infancy,” Janes said. “It wasn’t until the late ‘90s when it started to gain in popularity, as cardiologists began to recognize the link between obstructive sleep apnea and cardiovascular disease.”

By the early 2000s, sleep fellowships were in vogue, he said.

Today, with four beds, Mercy Medical Center can perform at least 16 sleep studies per week. Southwest Health and Finley Hospital each average more than 100 sleep studies per year.

“Chronic sleep loss can add up to some negative health impacts,” Janes said, leading to a long list of both mental and physical health issues.

Among them are anxiety, depression, diabetes, high blood pressure, heart disease and obesity, as well as sharp increases in the rates of accidental injury and even death. Sleep loss even has been linked to an increased risk for liver disease.

And even one bad night’s rest will affect a person’s mood, energy, mental clarity and judgment, Janes said.

Unfortunately, the value of sleep is vastly underrated in today’s modern, work-centric society, according to numerous studies and local health professionals.

About 35 percent of people get fewer than the needed seven hours of sleep per night, and 12 percent say they sleep for five hours or less, according to U.S. Centers for Disease Control and Prevention.

“Americans in general are sleep deprived because we do not fully understand the benefits of sleep or the effects of being sleep deprived,” said Walsh, of Mercy.

Too many of people view sleep as a flexible item in their schedules that can be moved around easily to accommodate hectic work schedules and family life, she said.

Sleep should be thought of as a fixed point in our day, and everything else should be adjusted as needed, Walsh said.

“Always make sleep a priority. It affects everything,” she said.

An estimated 80 million Americans suffer from some type of sleep disorder, and the largest category is insomnia, according to Chris Johnson, who oversees the sleep center at Finley Hospital.

The next largest is obstructive sleep apnea, which affects about 20 million Americans - 80 percent of whom might not realize they have it, Johnson said.

Obstructive sleep apnea occurs when a person stops breathing repeatedly during sleep. Extra tissue in the throat or a decrease in muscle tone can cause the tongue to fall back and the airway to narrow or close during sleep, preventing air from getting into the lungs. Sleep patterns are disrupted, resulting in excessive daytime sleepiness or fatigue, Johnson said.

“Each snore is a gasp for breath, as your body is being deprived of oxygen,” she said. “The airway narrows and your brain may sense not getting enough oxygen and wakes you up to take that breath and briefly arouses you to open that airway. It may be so brief that you do not realize it.”

On the average, a sufferer can experience 30 to 40 apneas per hour and never realize it, said Ann Bonner, sleep center supervisor at Southwest Health.

The cessations of breathing can last anywhere from 10 seconds to more than one minute. Some people awaken every 30 seconds, she said.

“As far as they’re concerned, they sleep just fine. In their head, they went to bed at 10 o’clock and got up at 7 to take on the day,” Bonner said. “But they wake up and feel fatigued and they’re tired during the day … because they may have slept four to five hours a night when you take into account the number of times they awaken.”

About 38,000 cardiac deaths annually are linked to sleep apnea, according to the National Commission on Sleep Disorders Research.

“Sleep is the time when the body restores itself or recharges its batteries,” Bonner said. “But if you’re struggling to breathe, your oxygen level is reduced and your heart is working harder to compensate for what’s happening, which is stressing your heart when you’re supposed to be relaxing.”

About 70 percent of people with high blood pressure have sleep apnea. Diabetes patients, too, should be screened for sleep apnea as there is a close correlation between the two, Johnson said.

“Do you feel like you’re in the Matrix yet?” asked Amanda Sternquist, marketing assistant at Southwest Health, of Tim Gratz, of Fennimore, Wisconsin, as he was prepped for his sleep study Dec. 27.

Like Obe, Gratz was affixed with electrodes, patches and sensors on his head, chest, cheeks and legs. Infrared cameras monitored his movement in the night, along with a “snore mic.”

The 35-year-old Readstown, Wisconsin, police chief has struggled with poor sleep for years. He said he averages about four to five hours per night, tossing, turning and waking up periodically throughout the evening.

“I’m told I snore really loud and stop breathing in the middle of the night for short periods of time,” he said. “It’s just always been that way, ever since the military, not being able to get enough sleep. I’m sure (stress) has something to do with it.”

Gratz served just shy of four years with the U.S. Army’s 82nd Airborne, with deployments to Iraq and Afghanistan.

“Sound machines, different mattresses, different sheets and pillows - I’ve tried just about everything,” he said. “I’ve stayed away from sleep aids and stuff like that. Given my profession, I have to be able to wake up in the night and be readily available.”

With some coaxing from his wife - who is well aware of his snoring - and a referral from his doctor, Gratz underwent the sleep study hoping to get answers.

“We sell ourselves short with sleep … and I think my overall health would be greatly affected if I were able to get more sleep,” he said. “And maybe even just a better quality of sleep.”

Dressed in sweats and a t-shirt and with a braid of wires protruding from his head, Gratz reclined in bed and watched TV just before 9 p.m. He turned the TV off at 10:30 p.m. and eventually dozed off about 45 minutes later.

“It was rough with all the wires connected to me. I had a hard time getting to sleep,” he would tell the sleep tech the next morning.

His sleep was very light, according to Randy Burkholder, who monitored Gratz throughout the night.

In a separate room across the hallway, Burkholder studied spikes, spindles and other changes on monitors tracking Gratz’s brain wave patterns, oxygen levels, breathing and eye movements.

Gratz reached the deep REM sleep once during the night, but it lasted only for about a minute, according to a follow-up email from hospital staff. He also rolled several times during the night, pulling one of the wires loose.

The study showed Gratz has mild obstructive sleep apnea, which causes him to have shallow breathing. The apnea, however, is not severe enough to warrant treatment in the form of a CPAP machine, Burkholder determined.

“This is because he is not losing enough oxygen with these episodes to qualify for further treatment,” Sternquist wrote in an email based on Burkholder’s observations. “The main issue as to why he’s not getting a restful night sleep, however, seems to be because he’s not falling into a deep sleep.”

Gratz’s doctor most likely will end up ordering him some sleep aids that help him sleep better and that do not interfere with his job, she wrote.

Sleep deprivation poses not only numerous health concerns but a public safety issue as well, according to local and national health experts.

“Your brain doesn’t function as well. Your reflexes aren’t as good, so it’s a risk of increased accidents,” said Janes, of Medical Associates.

It is similar to the impairment posed by driving under the influence of alcohol.

Findings from an AAA Foundation for Traffic Safety report released last month show drivers who have had too little sleep are no different than those who have had three or four alcoholic drinks and are too drunk to drive.

The report analyzed data from the National Motor Vehicle Crash Causation Survey to delve into how much driving ability decreases based on varying lack of sleep.

The report suggests drivers who sleep only five or six hours in a 24-hour period are twice as likely to crash as drivers who get seven hours of sleep or more.

And, not surprisingly, the less sleep a person behind the wheel gets, the higher the crash rate. For instance, drivers in the study who got only four or five hours of shut-eye had four times the crash rate - close to what is seen among drunken drivers.

Mounting research, too, has revealed working a job that disrupts one’s natural sleep patterns can pose a major risk to health and well-being.

A study by a team from Baylor College of Medicine in Texas, and recently published in the journal Cancer Cell, found persistent sleep deprivation in mice causes liver disease and eventually leads to liver cancer.

To model the effect of chronic sleep disruption - or “social jet lag” - mice fed a healthy diet were exposed to disrupted light and dark cycles for nearly two years, by changing the times the lights went on and off during the night each week.

As a result, the mice developed a range of conditions not seen in control mice, which had regular light and dark cycles, according to the study.

Researchers found that the mice gained weight and developed fatty liver disease, which progressed to chronic inflammation and eventually liver cancer in some cases.

Researchers said the finding supports previous studies that persistent disruption of circadian rhythm - the physical, mental and behavioral changes that follow a roughly 24-hour cycle - in night-shift workers is a common risk factor for obesity, heart disease, diabetes and depression.

“If prolonged, your body is in a constant state of increased stress overnight when it should be restorative, and that causes inflammation that’s linked to diabetes, liver problems, cardiovascular disease, decreased immune response, etc.,” said Finley’s Johnson.

“Good, quality sleep every night is important … because your health depends on it.”

___

Information from: Telegraph Herald, https://www.thonline.com

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