Steven O’Brien, Psy.D
Sleep, why do people sleep at all? Why can’t we just stay awake? Some
biologist suggest that sleep provides the opportunity to conduct self-repair and
purge the body of it’s waste that has built up during the day’s activity.
Nevertheless, the body is capable of repairing itself and disposing of wastes
during waking hours, so sleep in a way really isn’t necessary for routine
maintenance (e.g., urinating, etc.). Dr. Quentin Regestein, lead sleep and sleep
disorders researcher at Harvard Medical School also believed that sleep kept our
distant ancestors out of harms way during the night when they could not see as
well as their night roaming predators.
Sleep is regulated by a connected series of structures in the deep midline
areas, and along other way stations that extend through the central axis of the
brain, these structures relay information about things that affect sleep. In Dr.
Regestein notes, he spoke of experiments that were performed by researchers.
The researchers he spoke of would destroy specific brain structures of a lab
animal and then note how the animal slept.For instances, in one lab animal
the researcher cut through the axis of the brain at one level, which would
prevented the animal from awakening; showing that brain structures below the
level of the cut were responsible for awakening the lab animal.
The American Sleep Disorders Association (ASDA), Association for the
Psychophysiological Study of Sleep (APSS), Association of Sleep Disorder Centers
(ASDC), and the American Psychiatric Association (APA) has studied sleep and
sleep disorders since the early 1970’s. Out of all the sleep disorders
currently being studied, sleep apnea has gain world wide attention, affecting
over 15 million people. Apnea, derived from the Greek word “want to breath.”
Sleep Apnea (cessation of air flow at the mouth for greater than 10 seconds) can
reflect 1) loss of central nervous system drive to maintain ventilation, 2)
mechanical upper airway obstruction, or combinations of both. The second
edition of Anesthesia and Co-Existing Disease states “Conversely, obstructive
forms of sleep apnea are due to an abnormal relaxation of the posterior
pharyngeal muscles” – there is persistence of respiratory movements, but airflow
is absent due to upper airway obstruction. Study shows awakening occurs when the
arterial partial pressure of carbon dioxide rise or oxygen falls. Severe apnea,
which affects about 1 percent of the general adult population, often results in
400-500 awakenings a night. Moreover, depending on the severity and the number
of episodes of sleep apnea, the patient’s daily life and survival can be greatly
endangered. According to the Wisconsin Sleep Cohort Study, over an eight-year
period, a 37 percent death rate has been reported among persons with apnea (20
episodes or more per hour). The Wisconsin Sleep Cohort Study also reported sleep
apnea is more likely to occur in men then women, for the male hormone,
testosterone is believed to be related to sleep apnea. Admittedly, researchers
believe a female hormone, progesterone stimulates respiration and therefore may
help prevent breathing problems. In the Wisconsin Sleep Cohort Study, the
researchers noted a strong link between smoking and sleep apnea. Smokers that
smoked 40 or more cigarettes a day had the greatest risk of developing sleep
apnea then patients who had never smoked. The medical community has yet to fully
understand the intra play of factors producing the sleep apnea syndrome.
Sleep affects psychological well-being. Because sleep apnea deprives
patients of sleep, numerous of studies have consistently shown that sleep loss
affects daytime performance, sleepiness and mood. One of the first capacities
that Dr. Arthur J. Speilman of the Department of Psychology in New York spoke of,
is the ability to produce creative solutions to problems., and how being deprive
of sleep can impair a patients functional capacity. Dr. Paul Glovinsky, Dr.
Spielman’s research colleague noted “the focus of psychology is behavior, which
at first glance might be thought to cease during sleep”. Dr. Glovinsky also
noted “neither the mind nor the body truly cease activity during sleep. Far
from turning off, the brain in sleep generates a variety of states , accompanied
by predictable physiological changes and typical forms of mentation.” By
studying Drs. Speilman and Glovinsky works one can conclude, the sleeplessness
of sleep apnea or the prolonged wakefulness of creative output, the timing of
physiological rhythms can be affected by psychological states.
In 1988 a congressional commission determined that sleep related
problems cost American Society 50 billion dollars a year and that 95% of
individuals with sleep disorders were going undiagnosed. According to the
American Academy of Family Physician (AAFP), The standard method for diagnosing
sleep apnea is nocturnal polysomnography. In order for the this test to be
preformed often requires the patient to stay overnight in a sleep laboratory,
which can be quite costly. There are also less costly methods of diagnosing
sleep apnea. Dr. Tivinnereim of the AAFP developed the use of a five portable
pressure transducer catheters connected to a data logger that can be clipped to
the patients garment. The transducers are used to measure the intrathoracic
pressure fluctuations. Case study: Ten patients with obstructive sleep apnea
were recruited from a sleep clinic to undergo simultaneous evaluation with the
portable transducer catheter. Pressure signals were synchronized with the
polysomnographic tracings to compare the classification of 200 events of apnea.
The portable transducer catheter detected all 200 events recorded during the
nocturnal polysomnography procedure.
Because of in-depth research of sleep apnea and sleep disorders, the
ASDA can now safely treat sleep apnea. One method that is widely used is C-PAP
(Continuous – Positive Airway. C-PAP is a mask that covers the patients face
that provides a slightly increased air pressure for easier breathing. As a
result from using the C-PAP machine, muscles lining the airway and structures
such as the soft palate are no longer sucked into the airstream. Another method
of treating sleep apnea (a fairly new surgical procedure) called
uvulopalatopharyngoplasty. This procedure involves revision of the uvula (the
tissue that hangs from the midline of the throat) and tightening up the throat’s
lining. Study has shown surgery to be the best route for sleep apnea patients.
Case study: A 38-year-old production supervisor was interviewed four months
postoperative and reported that the surgery had changed his life. He was no
longer weary, and he had astonished his employers by coming up with some new
business innovations. He also added that he felt so energetic that he had taken
on a second job. Some patients that were seen postoperative reported comparable
improvements. The biochemistry of sleep is only partially understood; yet the
knowledge of sleep apnea and how it occurs intra plays a great role in treatment.
In short, being deprived up sleep because of a sleep disorder like sleep apnea
can eventually lead to interruption of daily task and human survival is greatly
reduced. Many people choose to prognosis themselves as to why they are having
trouble sleeping. Researchers urge patients with a unbalanced sleep pattern to
seek professional help.
“Five billion people go through the cycle of sleep and wakefulness every day,
and relatively few of them know the joy of being fully rested and fully alert
all day long.”
– William Dement (1988)
Arthur J. Speilman, Phd.D., and Paul B. Glovinsky, Ph.D.
– Department of Psychology. The City College of New York
Pinellas Public Library Cooperative, Inc. – InfoTrac System
– Largo, Florida
Drs. Robert K. Stoelting, Stephen F. Dierdorf , and Richard L. McCammon.
-Second Edition / Anesthesia and Co-Existing Disease
John P. Dworetzky
– Psychology / Fifth Edition
Dr. Quentin Regestein – lead sleep researcher, Harvard Medical School
– Sleep problems and solutions
Dr. Scott Mantel – Anesthesiologist
– Morton Plant Hospital, Department of Anesthesiology
Dr. Paul Borelli – Anesthesiologist
– Morton Plant Hospital, Department of Anesthesiology