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The science of sleep

Once a small sector of health care, sleep disorders are now receiving more attention in research and treatment.

[Times photo: Lance A. Rothstein]
Tom Warnimont of New Port Richey gets some sleep Tuesday at the sleep lab in Community Hospital of New Port Richey.

By JENNIFER GOLDBLATT, Times Staff Writer
© St. Petersburg Times
published October 13, 2002


People have been tossing and turning for centuries. In 1837, Charles Dickens penned one of the first known accounts of sleeping disorders in The Posthumous Papers of the Pickwick Club.

But the real red letter date in the field was Jan. 12, 1987 -- the day Medicare started paying to treat it.

In 1987, there were about 50 sleep centers in the United States. Now, there are about 3,100, including Sleep Associates of Florida in New Port Richey, and labs at North Bay and Community hospitals, as well as Regional Medical Center Bayonet Point and East Pasco Medical Center. Baycare is opening labs at three other hospitals in Tampa Bay.

Sleep disorder research has mushroomed. A throng of doctors -- neurologists, pulmonologists, psychologists and ear, nose and throat specialists -- have stepped up to identify and treat sleep problems.

The demand is there. At Community Hospital's sleep lab, for example, there's a monthlong waiting list to be tested.

* * *

Donna Barton, 61, has seen her diabetic husband, Bill, through a lot of medical problems. He has undergone open-heart surgery, dialysis and even a leg amputation.

Yet she said she was really frightened by his sleep disorder, which causes him to stop breathing momentarily in his sleep.

Donna Barton knew the Spring Hill couple needed help. She went to her doctor, anxious to get Bill into one of the sleep studies she'd read about. The lab at Regional Medical Center Bayonet Point was full, so she was referred to Sleep Associates of Florida, a diagnostic center that had recently opened in New Port Richey.

Bill Barton, 64, spent the night there, hooked up to a web of electrodes while doctors monitored his sleep stages, heart activity and oxygen levels. The doctors diagnosed obstructive sleep apnea and sold him a machine that forces air into his nose and keeps his breathing regular.

After 18 years of marriage, Bill "is like a different person during the day," Donna Barton now says.

"He has strength, energy -- he looks more alert."

* * *

Sales of CPAPs -- Continuous Positive Air Pressure machines like the one Barton uses -- are expected to reach $1-billion this year and are growing by about 20 percent each year.

"The old rule of thumb is, if Medicare pays for it, it gets done," said Jay Wolfson, a professor of public health at the University of South Florida. "It's been a boutique market for the last 10 years. But if I'm a hospital, if I can get paid for it and get a margin, why wouldn't I go into that business?"

Another driving force has been the exposure that sleep disorders are getting. They have become the subject of numerous articles, public awareness campaigns, college courses and even the plots of popular TV shows. That's caused a crowd of people to refer themselves to sleep labs.

"It's the overall buzz," said Dr. Michael Breus, an Atlanta psychologist and sleep center consultant. "When you turn on Mad About You and Paul Reiser has gone to a sleep clinic, at that point you have to say people are starting to recognize that it's something real and important to recognize."

About 85 sleep disorders have been identified. Most can be treated with lifestyle changes, such as getting exercise, avoiding alcohol, sleeping in a different position, losing weight, eating right and keeping a regular schedule.

One of the most talked about conditions is obstructive sleep apnea, which is what affects Bill Barton. A person with the condition stops breathing repeatedly during the night because the tissue in the back of the airway collapses and doesn't let air through. The lack of air awakens the person, at which point the person starts breathing normally again.

The condition affects about 12-million people, making it about as common as adult diabetes.

Treatment includes the use of devices that fit inside the mouth, weight loss and a surgery -- which is said to be effective only 40 percent of the time.

But the most common solution to sleep apnea is a CPAP machine. Their prices range from $700 to $2,000. It's estimated that only about 50 percent of the people who buy the CPAPs wear them correctly so that they're effective.

The effects of sleep apnea are being studied. About two years ago, researchers proved that it causes up to one-third of all cases of high blood pressure. Also, people with apnea face the known hazards of not getting enough sleep -- drowsy driving, on-the-job accidents, grouchiness and a lack of productivity.

Evolving evidence suggests an association with stroke, heart attack, and a diminished immune system.

Dr. Andrew Chesson, a neurologist who is president of the American Academy of Sleep Research, says that, like obesity, apnea exists with so many other conditions that it's hard to isolate the effects of the apnea.

Chesson adds that our 24-hour society is only making sleep disorders worse.

"Now you can go grocery shopping at 3 a.m., play on your computer or watch 100 TV channels all night. People are beginning to alter their behavior in ways that are very disruptive to sleep," he said.

"It was a lot easier when we all lived in caves."

-- Jennifer Goldblatt covers business in Pasco County. She can be reached in west Pasco at 869-6229 or toll-free at 1-800-333-7505, ext. 6229. Her e-mail address is goldblatt@sptimes.com.

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