Sleep problems get new attention but health threat still underrated


Sometimes he would fall asleep at a stoplight. Sometimes when he was sitting in a chair at home.

"I would doze off anywhere I would park my carcass," said Scott McCollister, 49, a mechanic and maintenance technician at Sinai Hospital.

Norman James, now 14, developed trouble paying attention at William H. Lemmel Middle School last year. His grades dropped but his mother, Joann McGowen, was just as alarmed by Norman's snoring - so intense that it penetrated from one floor to another of their Walbrook Avenue home.

"It was so loud you'd hear it no matter what," she said.

Both Norman and McCollister were eventually diagnosed with sleep apnea - which means they stopped breathing in their sleep.

Apnea is one of several common sleep disorders that affect millions of people and cost billions in lost work and medical bills. As more Americans realize they're suffering from it, sleep clinics in Maryland and other states are expanding to keep up with the demand for treatment.

Even so, according to a nationwide group of experts who reported yesterday, sleep problems are too often ignored and underrated as serious health threats.

As a result, the Institute of Medicine called for more research, better training for doctors and a campaign to educate the public about the importance of a good night's sleep.

"We think there's a problem with diagnosing these disorders, and there's an under-appreciation of them," said Dr. Harvey Colten, a professor of pediatrics at Columbia University Hospital and chairman of the IOM panel.

Between 50 million and 70 million Americans don't get the sleep they need to stay healthy, increasing their risk of cardiovascular disease, heart attack, diabetes, obesity and stroke, the report declared.

Sleep apnea alone affects up to 18 million people. But unlike McCollister and James, 75 percent of those who suffer from it never get a diagnosis, the report said.

The stakes are high. Estimates in the 1990s put the cost of treating sleep apnea, insomnia and less common disorders such as restless leg syndrome and narcolepsy at $15.9 billion. The IOM report says that's probably conservative.

Sleepy drivers cause about 100,000 car accidents a year, and fatigue costs business billions in lost productivity, according to the National Sleep Foundation.

Colten said three factors are fueling an increasing concern about sleep disorders: better diagnostic tools, an aging population that finds it hard to get a good night's sleep and a society increasingly focused on a 24-hour, caffeinated lifestyle.

"I was surprised by the magnitude of the problem," Colten said.

Those who treat and study the sleep-impaired praised the report's recommendations.

"Look at all-night cable TV, look at the Internet. Look at all-night Wal-Marts. I don't think there's any question people are getting much less sleep," said Dr. David Neubauer, associate director of the Johns Hopkins Sleep Disorders Center.

Researchers also agreed that there is much to learn about sleep and the effects of deprivation.

"The treatments we have work fairly well, but they don't work for everyone. There's so much yet to be done," said David Dinges, a clinical psychologist who studies sleep deprivation at the University of Pennsylvania.

Still unresolved: how sleep affects the immune system, why women are more prone to insomnia than men, and why men are more prone to apnea than women. There are also many questions about what happens to the brain when we sleep, Dinges said.

Trying to find answers, Dinges has kept test subjects awake for up to 88 hours to determine the effect of sleep deprivation on memory and brain function. He also has tested the latest medications designed for sleep-deprived Air Force pilots.

What makes deprivation dangerous, he said, is that some people think they're better equipped to go without sleep than others - driving all night or trying to work without shut-eye.

Dinges' research shows that everyone eventually shows the effects of sleep deprivation, with slower reaction times and a loss of concentration.

"People lose the ability to introspect the condition," he said. "It's like someone who suffers from depression or in pain. They lose their objectivity."

Some skeptics argue that drug company advertising is overheating public concern about sleep deprivation, prompting overuse of pills and creating a whole new crop of sleep-related problems.

Sales of prescription sleep aids jumped from $1.1 billion in 2001 to $2.7 billion last year, according to IMS Health, a consulting firm that tracks pharmaceutical sales. The number of prescriptions written jumped from 29 million in 2001 to 43 million during the same period.

"The drug companies are spending hundreds of millions of dollars a year trying to frighten people about how much sleep they need," said Dr. Daniel Kripke, a psychiatrist and sleep researcher at the University of California at San Diego. His own research shows that people need 6 1/2 to 7 1/2 hours of sleep a night.

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