The Nightmare Of Sleep Disorders

June 30, 1991|By A.M. CHAPLIN

While most people who feel sleepy during the day have nothing wrong with them besides a schedule -- or an attitude -- that doesn't allow enough hours in the sack, others have a different problem: sleeping disorders. These quirks of biology (and occasionally psyche) prevent their victims from sleeping restfully despite long hours in bed -- or in other cases force them to sleep at times when they should be awake.

Many of those with sleep disorders are insomniacs, but others are victims of more exotic disorders such as sleep apnea, narcolepsy and periodic limb movement disorder. These relatively unusual disorders have probably been with us since the dawn of human history, but it's only in the last two decades that it's become possible to understand the physical mechanisms that underlie them and thus to treat them effectively.

This advance in knowledge of sleep disorders is due to the advent and spread of sleep laboratories. The labs' application of technology to the study of sleep has saved many sufferers from the frustration, depression, isolation and despair that can result when their disorders aren't recognized for what they are.


Walter Blucher was always difficult to wake up -- very difficult to wake up. And, even when his parents or his wife finally succeeded in getting him out of the sack, he'd still feel tired, no matter how much sleep he'd had -- even 12 hours a night. Still, working as a maintenance mechanic, he managed to get by -- until he began working the 11 to 7 shift.

"I was unable to adjust," he says. "I began falling asleep all the time."

In addition, he explains, he would have periods when he would appear to be in an unhearing trance, with his jaw slack and his attention elsewhere, or nowhere. Yet if his wife would so much as suggest that anything was wrong, he'd get angry: He was quite unaware of these lapses from ordinary consciousness and he couldn't believe there was anything wrong with him, since he was only 30 and in very good health.

But then he was fired from his job. That initiated a period of personal crisis -- and a willingness to consider that he might have a medical problem. His wife, a nurse, encouraged him to get help, and eventually he found himself at the Maryland Sleep Diagnostic Center in Ruxton.

There he was diagnosed as having narcolepsy, a sleep disorder characterized by excessive daytime sleepiness during which the sufferer may be unable to keep from falling asleep. These attacks can come on not just while resting, but even while walking, talking or driving. Believed to be caused by a defect in the central nervous system, narcolepsy is also sometimes characterized by sudden weakness of the muscles and hallucinations.

The American Narcoleptic Association believes one out of every 100 Americans suffers from this disorder, yet most of them are neither diagnosed nor treated. Mr. Blucher is one of the lucky ones. He was treated with a drug that heightens his awareness and prevents him falling asleep, and thus he was able to get

another job.

"My life is back to normal with the medication," he says. "I'm back to being myself."

NOT SO LONG AGO MR. BLUcher would have been dismissed as just one more guy who couldn't hold a job because he was lazy or stupid or weird. The change comes thanks to the advent of sleep research laboratories.

The first big step toward modern sleep research was taken in 1953, when physiologists Nathaniel Kleitman and Eugene Aserinsky discovered that some sleep was characterized by flickering eye movements -- now known as REM, or rapid eye movements. By that discovery they put an end of the view of sleep as a passive state, and initiated the present understanding of it as both active and inactive.

"It just took off from there," says Dr. Philip L. Smith, the slim, intense director of the Johns Hopkins Sleep Disorders Center at Francis Scott Key Medical Center. He explains that the continuing revolution has been driven by technology: by hooking up sleepers to machines that can measure their biologic functioning. Before researchers came up with the idea of using technology on sleepers, he adds with a laugh, all you could do was watch people lying there with their eyes shut.

The Hopkins sleep lab, as it's called, is a model of how far that technology has come: It can analyze several sleepers simultaneously, with banks of machinery recording many different variables such as brain waves, eye movement, muscle tension, heart action and oral-nasal air flow. Sleep disorders like Mr. Blucher's narcolepsy show up as distinctive arrangements of squiggles on the reams of graph paper covered during each night of sleep.

Not only the machinery has multiplied. So, too, has the number of researchers and centers. The American Sleep Disorders Association, founded in 1975, had 339 individual members at the end of 1984, and has 1,650 now. And the number of centers belonging to the association has expanded from 57 in 1983 to 151 now.

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