Deep
within Emory Hospital, past
the darkened lobby, in a zone marked “Quiet,“ lies
the Sleep
Disorders Center. Patients start showing up about 8 p.m.,
carrying small totebags with their pajamas and toothbrushes.
Among them this humid July night is Clarke Weigle, a forty-five-year-old
computer administrator in Atlanta.
“I
tend to fall asleep at the drop of a hat,“ Weigle says.
“Once I fell asleep onstage while singing with a symphony.
A month ago, I fell asleep at work while on hold on my phone
with tech support. They had to shout to wake me.“
Although
Weigle says he has never fallen asleep while driving or in other
situations where it could be dangerous, he does feel tired during
the day and would like to find a solution. His doctor recommended
that he come to Emory, where about one thousand patients a year
are observed in sleep labs.
“What
makes Emory’s sleep program unique is that we have both
clinical and research expertise–and the expertise cuts
across disciplines, from nursing to neurology to mental health
to aging,” says Associate Professor of Neurology David
Rye, medical director of the Emory Hospital sleep lab.
Tonight,
Weigle and two other men are spending the night in the lab to
be tested for sleep apnea, which causes an individual to stop
breathing repeatedly during sleep–sometimes hundreds of
times a night and often for a minute or longer. Consequently,
sleep is extremely fragmented and of poor quality.
Apnea
is one of the most common disorders seen at the center; others
include insomnia, restless leg syndrome, narcolepsy, and sleep
problems associated with illnesses like epilepsy and Parkinson’s
disease.
“My
wife says I snore and that I do seem to stop breathing at times
during the night,” Weigle says, settling into the single
bed to watch a rerun of Law and Order on the wall-mounted television
as he might at home. “I’m sure I won’t have a
problem falling asleep here. I tend to fall asleep pretty quickly.”
The
sleep lab consists of four standard hospital rooms, each with
a bed, chair, sink, television, and a computer monitoring station.
Tonight, sleep technicians Keith Pew and Teresa Bryant are on
duty. They work from 7 p.m. to 7 a.m., three nights a week.
After
hooking up Weigle to multiple electrodes, Pew closes the door
and flips on a computer that displays Weigle’s brain waves,
eye movements, chin movements (to detect teeth grinding), pulse,
heart rate, leg motion, airflow resistance in his chest and
stomach, and his blood’s oxygen level. A microphone placed
below his throat broadcasts snoring noises, and an infrared
camera sends a video image to the monitor. All data are stored
for later review and interpretation.
Night
after night, Pew and Bryant observe the idiosyncrasies and frustrations
of sleep patterns gone awry.
“I
have had patients who don’t sleep all night–one man
actually got up and wandered around the hospital. Other patients
say they won’t sleep all night, then fall asleep in one
minute,” Bryant says. “And some of them, after sleeping
for eight hours, believe they only slept for about an hour.”
“Some
of our patients,” adds Pew, “say they sleep better
here than they do at home.”
Indeed,
when patients are awakened at the lab at 6 a.m., many complain
about being roused and ask to sleep in.
“They
want to stay until 8 or 9 a.m., have breakfast and a little
coffee,” says Bryant, laughing. “But Keith and I have
been up all night and are ready to go home and sleep!”
For
centuries, sleep
has been viewed as both a human need and a human weakness. The
early Greeks believed that sleep separated mere mortals from
the more vigilant gods. In folklore, people were entranced by
sleep, put to sleep with spells, or–as in the case of Rip
Van Winkle–slept their lives away. Theories abounded as
to what caused our nocturnal slumber and its strange visions:
warm “vapors” rising from the stomach, a build-up
of toxic wastes or a cooling of the blood, the brain “shutting
down.” The sleeper was thought to be in a mystical realm
between wakefulness and death.
“Sleep
is a powerful force, one that can have an extremely positive
effect on overall health or, when reduced in quantity and quality,
can have extraordinarily detrimental effects,” says Associate
Professor of Nursing Kathy Parker (below), a fellow in the American
Academy of Sleep Medicine who conducts research through Emory’s
Sleep Disorders Center in the Department of Neurology.
The
nature of sleep is still not fully understood. But since rapid
eye movement (REM) sleep was discovered fifty years ago, much
progress has been made in discerning sleep’s architecture–its
cycles, stages, and physical characteristics. In the mid-1950s,
sleep was found to consist of two distinct states: non-REM and
REM. REM sleep is lighter,
characterized by irregular
breathing, an increased heart rate, and dreaming. Also, a type
of “paralysis” overcomes the sleeper, perhaps to prevent
any acting out of dreams.
In
the 1960s and ’70s, sleep labs thrived, but the research
was thought to be an intellectual exercise with no practical
applications. As sleep disorders were discovered, sleep medicine
evolved as a clinical and academic specialty.
Emory
has eight primary faculty in its sleep program, as well as collaborating
researchers and fellows. In addition to the sleep lab in Emory
Hospital, there is a four-bed sleep lab at Emory’s Wesley
Woods Geriatric Hospital, under the direction of Professor of
Neurology Donald L. Bliwise, and a four-bed pediatric sleep
lab at Egleston Hospital/Children’s Healthcare of Atlanta.
Sleep studies, which include human and animal subjects, attract
more than $2 million in research funds to the University annually.
“When
Dave Rye and I arrived here in 1992, there was little sleep
research and a very small clinical program,” says Bliwise.
“We’ve experienced phenomenal growth, similar to the
field of sleep medicine itself. At Wesley Woods, we’re
studying sleep apnea in Alzheimer’s disease and muscle
activity in Parkinson’s disease during sleep.”
Sleep
disorders are prevalent in America; more than one in three people
say they have suffered insomnia, which is clinically defined
as taking longer than thirty minutes to fall asleep. The causes
of sleep disorders can be physical, but they can also be cultural.
In our frenetic society, sleep is viewed as a negotiable commodity,
condensed into an all-too-brief period between late-night television
and early-morning alarm.
“Time
spent sleeping is often believed to be time wasted,” Parker
says. “But a well-rested individual is clearly more productive,
has less depression and anxiety, performs better on a wide variety
of tasks, is safer on the road, and has a better quality of
life.”
Parker
finds that college students who complain of insomnia are often
practicing poor “sleep hygiene.” By going to bed later
and sleeping later, their bodies adjust to, for example, a 3
a.m. to noon sleep cycle. When they try going to bed earlier,
they end up lying awake for hours, unable to fall sleep.
“This
can have serious consequences,” Parker says. “We’ve
had people flunk out of school because of this.”
On
the other end of the spectrum, senior citizens tend to have
more fragmented, less efficient sleep. The amount of deep sleep
decreases with age, while time spent in bed increases. “With
our elderly patients it’s often a matter of re-education,
such as limiting naps,” Parker says.
Medicines
are not recommended as permanent solutions for sleep disorders,
but there are new drugs available, such as Ambien, that target
specific neurotransmitters and have few side effects. These
can be used for up to two weeks during situations of acute stress,
jet lag, or bouts of severe insomnia.
“Prior
to the 1990s, sleep medicines had lots of side effects and problems.
Some people who took barbiturates mixed with alcohol died,”
Parker says. “The new medicines, however, can be very appropriate
as short-term sleep aids.”
Many
sleep disorders seem to have a genetic component. Studies have
shown, for example, that narcolepsy and restless leg syndrome
tend to run in families.
Narcolepsy,
a rare disorder that affects about one in two thousand, causes
overpowering feelings of sleepiness and fatigue during the day.
Restless leg syndrome (RLS), a more common condition that may
be experienced by up to 10 percent of the population, is described
as an overwhelming urge to move one’s legs when inactive,
a tingling or creeping sensation in the legs while lying down,
and involuntary jerking of the legs during sleep.
Rye,
who is board certified in sleep medicine and chair-elect of
the RLS Foundation Medical Advisory Board, is currently conducting
genetic research with the biotech company Decode on RLS in Iceland.
“We
benefit by being able to study a homogeneous population with
a wealth of genealogical and medical records. And, in turn,
we enhance the power of Decode’s gene-mining strategies
by adding information from our diverse population here in the
Southeast,” says Rye.
On
his office computer, Rye pulls up a diagram showing three generations
of an Icelandic family. The pattern is clear: clusters of individuals
reporting the symptoms of restless leg syndrome show up in sibling
groups and throughout generational lines. Volunteers are observed
overnight in a temporary sleep lab in Iceland to make sure they
fit the diagnosis of RLS.
To
observe and monitor a sleeping patient, Rye says, is to have
a “fingerprint of their brain activity. Any abnormality
can be an indicator of a serious problem.”
Yet, he adds, many sleep disorders still go undiagnosed because
doctors don’t ask about them and people don’t report
them.
And
so, much of sleep remains as mysterious as when it was considered
a gift granted by the Greek god Hypnos, who, carrying a branch
dripping with dew from the river of forgetfulness, “flew
on shady wings over the world sending all breathing nature to
its rest.”
