A good night's sleep "” those seven to nine restorative hours that leave you bright-eyed and bushy-tailed. Is anyone logging in enough shut-eye in a world where people run on a 24/7 clock and load up on caffeine and carbs to keep their motors running "” then tuck smartphones into their pillows?

"There's a lot going on at night, no doubt about it," says Martin Scharf Ph.D, director of the Tri-State Sleep Disorders Center. "And if someone in the family has a sleep disorder, everyone in the family has a sleep disorder because sleep affects physical and emotional health."

He uses the example of a nap-deprived, cranky toddler. "Adults are more civilized, but that's how they feel when they don't get restorative sleep. This is such a critical area that crosses every area of medicine. It relates to overall health, both physical and mental."

Sleepiness abounds, according to Junaid Malik, MD, medical director of the Bethesda Sleep Center. "And people don't realize how a sleepy person is at risk for weight gain because they eat to stay awake and for depression because sleep deprivation builds up over time. And there's a question of sleep's relation to pain "” if you get a good night's sleep you do feel better."


There are more than 80 different diagnostic categories of sleep disorders including circadian rhythm disorders, snoring, night terrors, insomnia, restless leg syndrome, narcolepsy, sleep walking, jet lag issues, and pain-related sleep loss. There's even sleep paralysis and sleep sex.

But obstructive sleep apnea (in which one stops breathing while asleep because of an obstruction in the breathing passage or a collapse of muscles in the throat) gets the most press "because it's very dramatic," says Scharf.

"We spend a lot of time with people who have non-restorative sleep. And about one-third have apnea. Two-thirds of the remaining people have other problems," he says. "Now we find sleep apnea is a major player in hypertension, diabetes, obesity. These are disorders that are causing the country billions of dollars so getting a handle on it is really critical."


Sleep apnea affects up to 18 million Americans, according to American Association for Respiratory Care.

"The latest stats I have seen indicate that one out of every five adults has some form of sleep disorder," says Deborah Kovacs-Sturdevant, manager of The Sleep Center at Mercy Anderson. "What people need to understand is that sleep disordered breathing is a disease and must be managed by the patient and healthcare team like any other disease."

The good news is that "more physicians are aware of the health risks associated with sleep apnea and are watching for signs that a patient may have the disorder," says Mohammad Sheatt, MD, sleep specialist and medical director at The Sleep Center at Mercy Anderson and specialist at Bethesda Sleep Center.


America's weight gain is a major culprit in obstructive sleep apnea, with one-third of us packing on too much poundage and considered overweight or obese. Since about 80 percent of obstructive sleep apnea cases are obese and overweight people, that's a lot of people walking around irritated and oft-times depressed, or roughly 15-20 percent of the U.S. population, Sheatt says.

"There is a link between obesity and sleep apnea, and our society as a whole is getting more obese," Kovacs-Sturdevant says.

"Part of the 24/7 lifestyle includes eating more processed and fast foods, which in turn can lead to more obesity, which can lead to sleep apnea. Sleep apnea affects every aspect of our lives, and the lack of quality sleep has negative health consequences."

Neck size is the biggest predictor of sleep apnea, according to Scharf. "As neck circumference gets bigger the airway gets smaller."

Allergies compound the problem by blocking the nose in many people when they lay down, forcing mouth breathing in which the jaw slides back, narrowing the throat where the tongue is attached. You breathe harder to get air in. You keep struggling and blood pressure goes up. "That's why two to three times as many snorers develop high blood pressure," Scharf says.


"Sleep apnea can increase your risk of high blood pressure, heart disease or heart attack," says Sheatt. GERD (acid reflux) is also fairly common in people with sleep apnea."

At what point should you become concerned about your uneven slumber?

"If you are still sleepy no matter how much sleep you get, seven or eight hours," Malik says. "If you snore loudly, you have heart problems, diabetes. If you are on three to four drugs to control high blood pressure, then there's a 50-80 percent in that group may have sleep apnea. If congestive heart failure is a diagnosis, it's 50 percent. Those with high blood pressure or diabetes should consider the possibility.

"All things get worse with sleep apnea. It's like throwing gasoline on a fire. But it is treatable and treatment may help prevent other problems down the road."


To diagnose sleep apnea, an overnight sleep study at a sleep center is usually required after a physical exam and medical history, although at-home tests are sometimes used. In a sleep lab, electrodes are placed at various points on the body to record and measure electrical activity of the brain, eye movements, muscle activity, heart rate, breathing patterns, air flow and blood oxygen levels.

In many cases, pushing away from the table is the solution. Losing weight takes care of the problem "in well above 50 percent" of obstructive apnea cases, Malik says.

Sheatt agrees, "Virtually every one of our sleep apnea patients can be helped by losing weight "¢ it is especially helpful to those with obstructive apneas which are, by far, the highest percentage."

Conservative treatment of obstructive apnea may include sleeping on your side, avoiding alcohol, use of nasal sprays or breathing strips for sinus problems. But the use of the CPAP machine (continuous positive airway pressure) is often prescribed for obstructive sleep apnea. Patients wear a mask over the nose and/or mouth while sleeping and a blower gently forces air into the back of the throat to keep the area open. The pressure is individually adjusted to prevent the upper airway tissues from collapsing during sleep.


"Results are usually immediate and dramatic. Literally overnight people feel different," Scharf says. "Most people, we get it right the first time. Others might have to come back to try out different masks or some other change. Thirty percent of the time . . . you can put them on a CPAP that first night under supervision . . . and it works."

Malik says there are about five different types of machines now and better options for masks. "Usually the problem in the past is that we've just picked a mask for a patient instead of letting the patient pick the mask and trying different ones out."

"Proper fit with the CPAP is the most critical thing," Scharf says. "Just because you've found the right pressure doesn't mean you've found the right mask for the patient. If you really work with them from the get-go, new data says you have high compliance rate close to 85 percent."

That's well above the 50 percent or less success rate for a variety of surgical solutions that can include raising the soft palate where vibrations occur, reducing the size of the tongue at the back, putting in pillars or small pegs on the throat's sides to stiffen the soft palate and reduce the flutter that can cause obstructive apnea, even stitching the tongue to pull it forward. It all depends on the patient's anatomy.

Dentists are also studying the problem of sleep apnea and working to solve it through the use of appliances, like mouth guards, to push the lower jaw forward.


Cincinnati dentist Dr. Timothy Kitzmiller, a member of the American Academy of Dental Sleep Medicine, explains on his website that extensive adjustable appliances like TAP® and SomnoMed snap over the teeth, moving the lower jaw forward to prevent the tongue and throat tissues from collapsing into the airway.


The newest options for obstructive apnea treatment include a valve on the nostril that lets you breathe in, but prevents you from fully exhaling and produces a back pressure to keep the throat open.

Also in the works is a pacemaker-like device implanted under the skin that stimulates a tongue muscle at the right moment to keep the throat from collapsing when a patient tries to breathe in. "UC Health has a research trial . . . called the STAR trial (for the implant)," says Virgil D. Wooten, MD of UC Health's University Hospital Sleep Medicine Center. "We need as many treatments as we can get because people are so different, and we need more options for treatment."

Bethesda Sleep Center, (513) 865-1690; Good Samaritan Sleep Center,
(513) 862-5722; The Sleep Center at Mercy Hospital Anderson, (513) 624-1201;
Tri-State Sleep Disorders Center,
(513) 671-3101; UC Health Sleep Medicine Center, West Chester, (513) 475-7500;
Dr. Timothy Kitzmiller, (513) 334-0217.