One-third of all
adult Americans--about 50 million people--complain about their
sleep. Some sleep too little, some fitfully, and some too much.
Although one-third of our lives is spent asleep, most of us don't
know much about sleep, not even our own. We don't even know exactly
why we sleep, other than--like an overnight battery recharge--sleep
promotes daytime alertness. Sleep problems profoundly disturb both
sleeping and waking life. What is the significance of these problems
and what can be done about them? Recent scientific research is
beginning to provide some of the answers.
Sleep
was, for Shakespeare, the "balm of hurt minds, great nature's second
course, chief nourisher in life's feast." For centuries, science
knew little more: sleep was a magical phenomenon. Not until the
1930s was it shown to possess a secret life. Only then did investigators,
using the electroencephalogram (EEG), measure the brain's electrical
activity in sleeping subjects. On rivers of graph paper, they could
watch the rhythm of activity in the brain during sleep. They discovered
that these biological rhythms naturally Fall into different states,
stages, and cycles. Instead of being a quiet and peaceful period
of rest and recuperation, as most of us think of it, sleep is a
very complex, dynamic activity. Your body may be the picture of
tranquillity while you sleep. But, in fact, numerous biochemical,
physiological, and psychological events are constantly taking place.
How
Long To Sleep
Most adults sleep between 7 and
8 hours. But no one really knows how much sleep we need. Sleep
duration varies widely. A natural "short sleeper"
may sleep for only 3 or 4 hours, and actually function worse with
more sleep. A "long sleeper," on the other hand, may need more than
10 hours. "Variable sleepers" seem to need more sleep at times of
stress and less during peaceful times. Changes with age also contribute
to changes in the ability to sleep continuously and soundly. A newborn
infant may sleep 16 hours a day, an adolescent may sleep very deeply
for 9 or 10 hours straight, while an elderly person may take daytime
naps and then sleep only 5 hours a night. With advancing age, some
people switch to shorter days and some to longer ones. Such a switch
may be simply a normal condition of aging. Or, it may result From
shifts in daily patterns, retirement, or changes in the person's
physical or mental health.
In general, sleep is helped by
two factors--being tired at bedtime and being in tune with your
own internal clock. Sleep may be difficult or less satisfying if
it occurs at a time when the biological clock says,
"It's time to be awake."
To find out how much sleep you
need, try to determine your own sleep pattern. You should feel
sleepy about the same time every evening. If you frequently have
trouble staying awake in the daytime, you may not be sleeping long
enough. Or perhaps you are not sleeping well enough. Both the quantity
and quality of sleep and wakefulness are important. You are sleeping
as much as you need if, during your waking hours, you are alert
and have a sense of well-being.
Insomnia
Insomnia, the most common sleep
complaint, is the feeling that you have not slept well or long
enough. It occurs in many different forms. Most often it is characterized
by difficulty falling asleep (taking more than 30 to 45 minutes),
awakening frequently during the night, or waking up early and being
unable to get back to sleep.
With rare exceptions, insomnia
is a symptom of a problem, and not the problem itself. Good sleep
is a sign of health. Poor sleep is often a sign of some malfunctioning
and may signal either minor or serious medical or psychiatric disorders.
Insomnia can begin at any age. And, it can last for a few days
(transient insomnia), a few weeks (short-term insomnia), or indefinitely
(long-term insomnia).
Causes
Of Insomnia
Transient insomnia may be triggered
by stress--say, a hospitalization for surgery, a final exam, a
cold, headache, toothache, bruised muscles, backache, indigestion,
or itchy rash. It can also be caused by jet travel that involves
rapid time-zone change.
Short-term insomnia, lasting
up to 3 weeks, may result from anxiety, nervousness, and physical
and mental tension. Typical are worries about money, the death
of a loved one, marital problems, divorce, looking for or losing
a job, weight loss, excessive concern about health, or plain boredom,
social isolation, or physical confinement.
Long-lasting distress over lack
of sleep is sometimes caused by the environment, such as living
near an airport or on a noisy street. Working a night shift can
also cause problems: sleeping during the day may be difficult on
weekdays, especially when the person sleeps at night on weekends.
But more often, long-term insomnia stems from such medical conditions
as heart disease, arthritis, diabetes, asthma, chronic sinusitis,
epilepsy, or ulcers. Long-term impaired sleep can also be brought
on by chronic drug or alcohol use, as well as by excessive use
of beverages containing caffeine and abuse of sleeping pills.
Sometimes (as we shall see),
long-term sleep difficulty can result from a number of other directly
sleep related medical ailments that are more directly related to
sleep. Some examples are sleep apnea, nocturnal myoclonus, or "restless
legs" syndrome.
Many patients with long-term
insomnia may be suffering from an underlying psychiatric condition,
such as depression or schizophrenia. Depression, in particular,
is often accompanied by sleep problems (which usually disappear
when the depression is treated). People with phobias, anxiety,
obsessions, or compulsions are often awakened by their fears and
worries, sometimes by nightmares and feelings of sadness, conflict,
and guilt.
Easing
the symptoms of Insomnia
Insomnia is a complex problem,
not given to simple solutions. Most experts agree that treatment
should start with assessing and correcting sleep hygiene and habits.
Exercise
Regular exercise tends to benefit
sleep, but not right at bedtime. Vigorous exercise, especially
just before sleep, can cause arousal and delay sleep. You cannot
force sleep on a given night by exercising excessively during the
day. Exercise in the morning also has little beneficial effect
on sleep. The best time to exercise is in the afternoon or early
evening. But, even then, it probably won't help you sleep unless
you exercise on a regular schedule.
Trying
Too Hard
Trouble falling asleep, the most
common form of sleep disturbance, may be brought on simply by going
to bed too early. Sleep cannot be forced. You should not go to
sleep until you are sleepy. If you turn in too early--even if you
do fall asleep--you could experience a disturbed night's rest or
could wake early without feeling refreshed. If you go to bed when
you feel sleepy but find that you can't fall asleep, don't stay
in bed brooding about being awake. It is best to get out of bed.
Leave the bedroom. Read, sew, watch TV, take a warm bath, or find
some other way to relax before slipping between the sheets once
more.
Naps
Laboratory tests have shown that
daytime naps disrupt normal nighttime sleep. Although many people
feel like napping between 2 and 4 p.m. (siesta time), most sleep
better if they don't nap during the day. Naps should not be used
as a substitute for poor sleep at night. However, there are exceptions
to this general rule. Many older people, in particular, do sleep
better at night when they take daytime naps. But if you are a napper
who sleeps poorly at night, your nighttime sleep might improve
if you skip the naps.
Bedtime
Snacks
If hunger keeps you awake, a
light snack might help you sleep, unless it causes problems with
digestion. Avoid heavy meals, alcohol, and caffeine-containing
coffee, tea, and cola. For those who can tolerate milk, that old,
time-tested remedy may work best.
Smoking
At Bedtime
Nicotine stimulates the nervous
system and can interfere with sleep. In one sleep laboratory study,
smokers experienced greater difficulty than nonsmokers. Sleep patterns
also improved significantly among chronic smokers when they abstained
from smoking.
Alcohol
The effect of alcohol is deceiving.
It may induce sleep, but chances are it will be a fragmented sleep.
The sleeper will probably wake up in the middle of the night when
the alcohol's relaxing effect wears off.
Regular
Bedtime
The best way to sleep better
is to keep a regular schedule for sleeping. Go to bed at about
the same time every night, but only when you are tired. Set your
alarm clock to awaken you about the same time every morning--including
weekends and regardless of the amount of sleep you have had. If
you have a poor night's sleep, don't linger in bed or oversleep
the next day. If you awaken before it is time to rise, get out
of bed and start your day. Most insomniacs stay in bed too long
and get up too late in the morning. By establishing a regular wakeup
time, you help solidify the biological rhythms that establish your
periods of peak efficiency during the 24-hour day.
Sleeping
Pills: A Temporary Solution
According to the latest evidence,
the medical profession is becoming increasingly conservative in
prescribing sleep-promoting medications. Over the past decade,
prescriptions filled in drugstores have dropped from 42 to 21 million.
Only about 10 percent of people with insomnia receive prescribed
sleeping pills. Another 5 percent buy over-the-counter sleep compounds
that don't require a prescription. Still others use drugs intended
for other purposes--for example, daytime sedatives, antihistamines,
anticholinergic drugs, and tranquilizers. None of these drugs should
be used without consulting a physician first. Their misuse or outright
abuse poses a danger. All sleeping medications should be used sparingly,
for the shortest possible time, and in the smallest effective dose.
Prescribed
Sleeping Pills
All brands of prescribed sleeping
pills are hypnotics--that is, drugs that depress the central nervous
system and put users to sleep. A variety of hypnotics are now on
the market, including barbiturates, benzodiazepines, and several
classes of drugs generally referred to as the nonbarbiturates/nonbenzodiazepines.
The barbiturates usually lose
their effectiveness within 2 or 3 weeks of daily use. Doctors today
tend not to prescribe the barbiturates. Most prefer to treat their
patients with one of the benzodiazepines or a variant class of
drug, which are considered less addictive and safer in overdose
than barbiturates. The benzodiazepines are still very toxic, however,
when taken in combination with alcohol, overdoses are taken or
when respiratory disorders. Benzodiazepine drugs sometimes can
aid sleep for up to 30 days. The benzodiazepines are not all alike,
though. Some work faster than others, some produce effects that
last longer, and some are eliminated from the body sooner.
Which type of sleeping pill is
prescribed depends on a person's particular problem and needs.
One pill might be right for problems falling asleep and another
for problems in maintaining sleep or insomnia associated with anxiety.
Do
Sleeping Pills Help?
When taken For a brief period
and under a doctor's guidance, prescription sleeping pills may
help you sleep better. But insomnia cannot be corrected with pills.
At best, sleeping pills have only limited usefulness. They provide
a temporary solution to insomnia. Thus, only when a person's health,
safety, and well-being are threatened should drugs be sleep-promoting
considered and then only after the doctor takes a medical history
and does a physical examination. He or she might identify conditions
that should not be treated with sleeping pills and weigh other
risks drug treatment.
Hazards
Although temporarily helpful,
sleep promoting medications can eventually cause disturbed sleep,
side effects, a sleep "hangover" during the day, and dependence
on the drug. Further more, once the drugs are stopped, sleep problems
return, at least temporarily, and may be even more severe than
they were before the medication was First taken. Clearly, the regular,
long-term use of sleeping pills should usually be avoided.
Sleeping pills can be fatal when
taken in combination with alcohol or other drugs. Even when not
fatal, combining drugs and alcohol can be perilous to driving and
the use of other machinery. Long-acting sleeping pills, by themselves,
may also impair driving performance the day after they are taken.
People who are taking sleeping pills should never drink for a couple
of days afterward.
Sleeping
Pills For The Elderly
Many people over 60 are dissatisfied
with their sleep. While they make up about 14 percent of the population,
they consume about 20 to 45 percent of all sleep medications.
Toxic (poisonous) drug reactions
occur more frequently in the elderly than in the young. In addition
to their frequent use of sleeping pills, many older people also
take other medications prescribed by their doctors. Combining sleeping
pills and other drugs poses an increased hazard for the elderly
because of changes in bodily functioning that accompany aging.
The elderly tend to absorb and excrete all medications more slowly
than younger people and usually require smaller doses. Their nervous
systems may also be more sensitive, which, in turn, may increase
the effects of combining drugs.
Sleeping pills may cause older
people to stumble or fall, feel groggy or hung-over, or appear
forgetful and senile. Before turning to sleep medications, older
people (like people of any age) should consult their doctor and
first seek help to the underlying cause of the sleep problem.
Sleeping
Pills And Pregnant Women
Pregnant women should be aware
that sleeping pills may be harmful to their infants. If a woman
is pregnant or intends to become pregnant, she should ask her physician
whether it is safe or advisable to use any drug.
She also should learn about the
effects of every drug, including cigarettes and alcohol, on her
and her unborn baby.
A
National Health Problem
Sleep disturbances place an uncalculated,
but enormous, burden on the American public. Many industrial and
automobile accidents are related to undiagnosed and untreated disorders
of sleep. School and job performance, and even everyday social
relationships, are also affected. Most sleep disorders, whether
caused by physical or mental factors, can be treated or managed
effectively once they are properly diagnosed.
Anxiety &
Depression
In a recent national survey,
47 percent of those reporting severe insomnia reported a high level
of emotional distress. Psychological factors, such as fears, phobias,
and compulsions, can so occupy the mind that sleep is delayed,
disturbed, or shortened. Chronically tense people are frequently
so restless, hyperactive, and apprehensive that they expect not
to sleep when they go to bed.
In depressed people, an overwhelming
feeling of sadness, hopelessness, worthlessness, or guilt can be
associated with abnormal sleep patterns. Often, the depressed person
awakens early and cannot return to sleep. Yet, sometimes, just
the opposite is true. Some depressed people find relief in sleeping,
denying or escaping from the problems of living by sleeping. The
loss of a sense of purpose in life may be associated with an overwhelming
urge to sleep, a constant feeling of tiredness, or nighttime sleep
marked by an irregular sleep/wake pattern.
Many depressed people complain
of insomnia without recognizing they are depressed. If you have
lost interest in activities you used to enjoy, or if you have feelings
of hopelessness or suicidal thoughts, you may be one of them. You
should discuss the problem with your physician, who may recommend
psychiatric consultation. While the complaint may be insomnia,
the underlying depression, not the insomnia, must be treated. Antidepressant
medications and/or psychotherapy can produce remarkable improvement,
both in mood and sleep patterns.
Snoring
Snoring is a sign of impaired
breathing during sleep. The older you get, the more apt you are
to snore. Almost 60 percent of males in their 60s and 45 percent
of females are habitual snorers--in all, one in eight Americans.
Light snoring may be no more than a nuisance. But, snoring that
is loud, disruptive, and accompanied by extreme daytime sleepiness
or sleep attacks should be taken very seriously. Such snoring may
be a sign that a person is suffering from the life-threatening
condition called sleep apnea--a blockage of breathing during sleep.
Sleep
Apnea
Discovered only recently, sleep
apnea is believed to affect at least 1out of every 200 Americans,
70 to 90 percent of them men, mostly middle-aged, and usually overweight.
But the condition can afflict both men or women at any age.
People with this disorder actually
may stop breathing while asleep-even hundreds of times--without
being aware of the problem. During an apnea attack, the snorer
may seem to gasp for breath, and the oxygen level in the blood
may become abnormally low. In severe cases, a sleep apnea victim
may actually spend more time not breathing than breathing and may
be at risk for death.
In the most common form of the
condition, obstructive apnea (also called upper airway apnea),
air stops flowing through the nose and mouth, but throat and abdominal
breathing efforts are uninterrupted. The snoring that results is
produced when the upper rear of the mouth (the soft palate and
the cone-shaped tissue--the uvula--that descends from it) relaxes
and vibrates as air passes in and out. This sets up an air current
between the palate and the base of the tongue, resulting in snoring.
Typically, the individual will wake up, emit a vigorous snort or
grunt while gasping for air, then immediately fall back to sleep,
only to repeat the cycle.
In another form of the disorder,
central apnea, both oral breathing and throat and abdominal breathing
efforts are simultaneously interrupted. In a third type of apnea,
mixed apnea, a brief period of central apnea is followed by a longer
period of obstructive apnea.
Sleep apnea can be recognized
by a number of symptoms. As mentioned, loud and intermittent snoring
is one warning signal. The person who has sleep apnea may experience
a choking sensation, early-morning headaches, or extreme daytime
sleepiness, as well. His bed partner or roommate might comment
on his excessive body movements or his snorting or gasping for
breath during sleep. If the condition is suspected, it should be
reported to a physician, who may recommend evaluation by a specialist
in sleep disorders. Since sleeping pills may be harmful for people
with sleep apnea, they should not be taken if the condition is
suspected.
Many people with such conditions
as obesity, deviated nasal septum, polyps, enlarged tonsils, large
adenoids, or a host of other problems may be particularly likely
to develop sleep apnea. Doctors can reliably diagnose the disorder
only by monitoring oxygen intake, breathing, and other physical
functions while the patient is sleeping.
In mild cases, sleep apnea often
responds to medication. Or, in the case of overweight middle-aged
males, losing weight may lessen the problem. Another procedure,
known as continuous positive air pressure, involves the use of
a machine that blows air into the nose during the night, opening
the air passages in the throat. Patients with severe sleep apnea
may require surgery. One procedure widens the throat. In another,
a tracheostomy, which is used in very severe cases, a small hole
is made at the base of the neck, below and in front of the Adam's
apple. At night, a valve on a hollow tube in the hole is opened
so that air can flow directly to the lungs, bypassing the sleep
induced upper airway blockage. During the day, the valve is closed,
allowing the patient to breathe and speak normally.
Narcolepsy
A sleepy feeling during the day
could be caused by insufficient, inadequate, or fragmented sleep,
by insomnia, or by boredom, social isolation, physical confinement,
or depression. But, if you continually experience excessive daily
daytime sleepiness--sometimes expressed as tiredness, lack of energy,
and/or irresistible sleepiness--you could be suffering from another
little-known, chronic sleep disorder called narcolepsy. According
to the American Narcolepsy Association, 1 out of every 100 Americans
is afflicted with this disorder. Yet, between 50 and 80 percent
of them remain undiagnosed. People with narcolepsy suffer from
sleep apnea more often than the general population, although apnea
is not a core feature of the disorder.
During a narcoleptic attack,
the person may find it physically impossible to stay awake and
sleeps for periods ranging from a few seconds to a half hour. An
attack can occur while watching TV, reading, or listening to a
lecture. More surprising, these sudden attacks of sleep can also
strike while walking, eating, riding a bike, or carrying on a conversation.
Despite modern medical knowledge
about narcolepsy, people who have such attacks typically do not
seek medical attention for years--an average of 5 to 7 years. Usually,
narcolepsy starts in the early teen years, but it can strike anyone
at any age. At first, the symptoms are rather mild. Gradually,
over a period of years, they increase in severity.
Narcolepsy
With Cataplexy
Besides the presence of excessive
sleepiness, which usually is the first symptom noted, the person
suffering from narcolepsy may experience a sudden weakness of the
muscles called cataplexy. A cataplectic attack is usually triggered
by such emotions as laughter, anger, elation, or surprise. It may
be experienced as partial muscle weakness lasting a few seconds
or as almost complete loss of muscle control lasting for 1 to 2
minutes. During this period, the victim may be in a state of nearly
total physical collapse, unable to move or speak, but still conscious
and at least/ partially aware of activity in the immediate environment.
Sometimes, narcolepsy is misdiagnosed
as epilepsy. But while epilepsy is often accompanied by loss of
bladder and bowel control and tongue biting, narcolepsy is not.
More often, the symptoms of narcolepsy are attributed to laziness,
malingering, or psychiatric disorder. Job and home life usually
suffer when narcolepsy goes untreated.
Narcolepsy, believed to be caused
by a defect in the central nervous system, has no known cure. However,
after proper diagnosis, the disorder can be effectively managed
with drugs.
The
Danger of Narcolepsy
People who have narcolepsy but
don't know it represent a serious safety hazard to themselves and
others when they drive. They may doze off while waiting for a traffic
signal to change, or they may drive to destination and be completely
unable to recall how they got there. At least one in every 500
drivers is estimated to be suffering from narcolepsy.
Tragically, many of the drivers
may not survive to be diagnosed or counted among the sufferers.
Yet, narcolepsy is a major traffic safety problem with a low-cost
and easy solution: proper diagnosis and medical care. Diagnosed
patients who understand their symptoms appear to be very safe drivers,
and their driving can be coordinated with the use of medication.
Unusual
Movement During Sleep -
Nocturnal Myoclonus
Just before some people fall
asleep, they experience an uncomfortable, but not always painful,
sensation deep in the thigh, calf, or feet. They usually find that
vigorous movement eases the discomfort enough to fall asleep, but
they complain of sleepiness and fatigue during the day. These people
are generally not aware that such episodes of repetitive leg muscle
jerks or muscle twitches--nocturnal myoclonus--are followed throughout
the night by hundreds of related awakenings. People with nocturnal
myoclonus may have involuntary movement in their legs, in addition
to twitches, while trying to relax. This condition, known as
"restless leg syndrome," usually occurs in people who also have nocturnal myoclonus.
Like many other sleep disorders,
nocturnal myoclonus often goes unrecognized by the person who has
it. It is most common in middle-aged and older people. And, it
may be inherited. Often a bed partner or roommate must call attention
to the characteristic twitches--repeated muscle jerks in which
the big toe extends, while the ankle, knee, and, occasionally,
the hip flex. Upon awakening, some people with nocturnal myoclonus
complain of an itching-crawling sensation in their legs, like "current
going through them."
In some cases, these disorders
have been associated with too little vitamin E, iron, or calcium,
and vitamin and mineral supplements have been used as treatment.
In other cases, drugs have been found effective, and, in still
other, less-severe cases, relief has come from leg exercises.
Children
Most childhood sleep disturbances
occur only at certain ages, are temporary, and disappear as the
child grows older. While annoying or frightening, they usually
are not serious. In some cases, however, abnormal sleeping habits
can be a sign of more serious problems requiring medical consultation.
Sleepwalking
Sleepwalking (somnambulism) is
fairly common, especially among children. An estimated 15 percent
of all children between the ages of 5 and 12 have walked in their
sleep at least once, and most outgrow the disorder. Typically,
the child (or adult) sleepwalker sits up, gets out of bed, and
moves about in an uncoordinated manner. Less frequently, the sleepwalker
may dress, open doors, eat, or go to the bathroom without incident
and usually will avoid obstacles. But sleepwalkers don't always
make their rounds in safety. They sometimes hurt themselves, stumbling
against furniture and losing their balance, going through windows,
or falling down stairs.
In children, sleepwalking is
not believed to be influenced by psychological factors. In adults,
it could indicate a personality disturbance.
Usually, it is enough for parents
of sleepwalkers to provide their children with emotional support.
They should also lock windows and doors and make sure the child
does not sleep near stairways and potentially dangerous objects.
For severe cases, a doctor may prescribe drugs.
Night
Terrors Versus Nightmares
Night terrors (known as pavor
nocturnus in children) are relatively short nocturnal episodes
during which the child sits up in bed, emits a piercing scream
or cry, looks frightened, and sweats and breathes profusely. Episodes
usually occur between the ages of 4 and 12, are more common in
boys than girls, and can be expected to disappear as the child
grows older. Typically, they occur during the first third of the
night. The disorder may progress to sleep walking, but generally
that only happens when the child is made to stand up. Later the
child will forget the entire episode. Parents should comfort and
provide warmth and support to children who experience night terrors.
The condition does not indicate any personality disorder.
Nightmares, unlike night terrors,
can be recalled afterward and are accompanied by much less anxiety
and movement. These frightening dream experiences, which tend to
occur at times of insecurity, emotional turmoil, depression, or
guilt, can occur in all age groups. They are rarely accompanied
by the anguished, terrified scream of the night-terror arousal.
A person experiencing a nightmare will usually recount in de tail
a threat which ultimately led to the awakening. Some people rarely
have nightmares, while others seem predisposed to them.
Bedwetting
Bedwetting (enuresis) is a common
childhood sleep disorder which, contrary to popular belief,. is
almost never emotionally or psychologically caused; less than 1
percent of bedwetting has an emotional source. About 5 to 17 percent
of children aged 3 to 5 wet their beds; usually the condition will
stop by the age of 4 or 5. However, a bedwetting child may feel
guilty or ashamed. Waking the child up in the middle of the night
or handing out punishments and rewards may only serve to increase
the problem.
In most cases, the cause is unknown,
but a congenitally small bladder, a bladder infection, or some
other physical problem may be responsible. Bedwetting that continues
into adolescence or adulthood may be attributed: to emotional problems,
but neurological disease or diabetes also can be the cause. If
the disorder persists, a physician should be consulted. For some
children, drugs or time away from home may be prescribed for short
periods, such as a week at camp or a weekend with friends or relatives.
Help
for Sleep Disorders
If your sleep is continually
disrupted and you lack initiative and energy during the day, you
should seek professional help. In most cases of sleep disorder,
it's best to see your own physician first, in order to sort out
the general nature and severity of a sleep problem. The physician
may conduct a thorough physical examination, ask you questions
about your sleep habits and emotional state, and can often determine
whether the sleep difficulty is related to treatable causes. However,
if necessary, a referral to a mental health specialist or facility,
a sleep clinic, or a sleep disorders center may be made.
The same basic service is provided
by both sleep clinics and sleep disorders centers. Generally, sleep
clinics are set up as part of hospitals. Sleep disorders centers
may be associated with hospitals, medical centers, universities,
or psychiatric or neurological institutes. Most clinics or centers
primarily treat patients on referral from general practitioners
and internists. However, it is possible to obtain information on
specific sleep problems directly from a clinic or center or to
make an appointment for a consultation.
Specialized sleep facilities
usually have on their staffs experts called somnologists with training
in a variety of medical and scientific fields. A sleep disorders
team will often include a physician, a psychologist, a psychiatrist,
and a surgeon.
Patients are typically seen as
outpatients. They are interviewed thoroughly, if indicated, have
their sleep patterns recorded in the laboratory for one night (sometimes
two or three consecutive nights) to determine the cause of the
sleep disturbance.
Fees vary, depending on the clinic
or center. An entire analysis can range from a few hundred to about
a thousand dollars. Insurance companies or Medicare, may cover
some of the cost. (This can be determined by consulting the center
or your insurance company.)
Special sleep facilities are
scattered throughout the country. Your physician or nearest hospital
should be able to help you locate the nearest sleep clinic or center.
Or, for a complete roster of accredited and provisional sleep disorders
centers and clinics, write to:
Association of Professional Sleep
Societies
604 2nd St., SW Rochester, MN 55902
