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August 14, 2002
Los Gatos, California Since 1881 |
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Photograph by Kristopher Gainey
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Registered polysomnographic technologist Andi Gagnon monitors a client's heart, brain, eye, muscle and respiratory function.
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Bay Sleep Clinic brings rest to the weary
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Scott Steinberg
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Vince Set'tle studies jagged lines for a
living. What could appear to the layperson as
a seismological reading of the San Andreas
fault is, in the case of Set'tle, actually an
electronic narrative of sleep. He's an
expert, and to many, a godsend.
After years of research spearheaded by Dr.
William Dement of Stanford University,
analysts have an accurate data portrait for a
normal sleeper. Set'tle measures the norm
against the not-so-norm.
And there's quite a bit of that.
More than 100 million Americans regularly
fail to get adequate sleep, according to the
American Academy of Sleep Medicine (AASM).
And 47 million of those 100 million have some
sort of chronic sleep disorder. This includes
insomnia, narcolepsy, periodic leg movements,
obstructive sleep apnea, oversleeping,
sleepwalking—sleep researchers have
identified 84 disorders involving the bizarre
and the mundane.
Take, for example, a female smoker known for
eating cigarette butts in her sleep. Or the
man who stabbed his wife, concealed the
evidence and then woke up. Or the state
swimming champion who also happened to be a
narcoleptic. He fell asleep midlap and was
found dead on the swimming pool floor.
What is meant to be one of the most
recuperative times of our day can be anything
from a frustrating experience to the bane of
our existence.
Bay Sleep Clinic in Los Gatos is an eager
part of the nascent field of sleep medicine.
Fifty years ago the field was treated as a
puny cousin to more serious medical
endeavors. But now doctors, scientists,
insurance companies and frustrated sleepers
and bedfellows alike are taking note of
Dement's not-so-demented theories.
They are also taking note of some very
effective treatments that can improve health
and even save lives.
Tara Nader opened the Sleep Bay Clinic two
months ago in Saratoga. At her new Los Gatos
location she hopes she is even better
equipped to help sleepers diagnose their
disorders and set them on the path to
treatment.
"I used to think we 'died' when we went to
sleep," the Iranian-born Nader said. "It is
quite the opposite. Sleep is one of our most
active states. People need to prioritize it
as that."
But first and foremost she wants to educate
sleepers, especially teens. She said 85
percent of teenagers report not getting
enough sleep. This is why she hopes to talk
at local high schools about good sleep
practices.
The average understanding of such a vital
process as sleep is elementary and
misconceived, Nader said.
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Photograph by Kristopher Gainey
It doesn't look like the most comfortable way
to sleep, but this sleep clinic patient tries
to catch a few winks while technicians hook
him up to electrodes.
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Take, for example, a sleeping baby. She is
napping in her crib. Her mother is reading a
magazine, satisfied by the heavy breathing of
her adorable child. The baby begins to snore.
The mother thinks, "How wonderful! My child
is sleeping so soundly."
However, children are not meant to snore.
Snoring is the telltale sign of an upper
respiratory obstruction, more commonly known
in the field as sleep apnea.
"Some researchers believe Sudden Infant Death
Syndrome (SIDS) may be caused by apnea,"
Nader said.
A person has apnea if breathing stops for 10
seconds or more during sleep. It can happen
as frequently as 100 times an hour. This sets
off alarms in the body: Wake up or risk
suffocation.
This causes very fragmented sleep, which
results in dreadful daytime performance.
Twelve million Americans, mostly overweight,
middle-aged men, have some form of sleep
apnea, according to the AASM. But treatment
is varied and readily available.
First, a primary care physician will refer a
patient to a sleep clinic. The patient then
spends a night sleeping at the clinic. A
sleep technologist such as Set'tle attaches
40 probes and electrodes to the sleeper to
measure sleep vital signs: brain waves;
cardiovascular waves; and jaw, eye, leg,
chest and hand movements.
But how, one wonders, could anyone possibly
sleep under these conditions?
It is easier than it seems, technicians say.
"We try to make this clinic different, try to
give them a personal touch," Nader "We go out
of our way to facilitate an easy transition
into treatment."
The Los Gatos office has two beds, and Nader
hopes to expand that to four. In two months,
the clinic has helped diagnose 20 problem
sleepers.
Once sleepers receive a positive apnea
diagnosis, many opt to wear a continuous
positive airway pressure (CPAP) machine
during the night.
The CPAP resembles a fighter pilot mask. It
has a box that generates airflow. The box
feeds into a nasal piece that plugs the
nostrils. Although the sleeper appears to be
going to bed in preparation for a mustard gas
attack, the device saves lives and marriages,
Nader said. "So many of our patients come to
the clinic at the prodding of their spouse."
There are surgical procedures that can
correct nocturnal airflow. It may be as
simple as a tonsillectomy, as involved as
trimming the uvula, or as radical as breaking
the jaw and setting it further from the
trachea.
There are also behavioral treatments for
apnea.
"It is important for sleepers to lose
weight," said Mohsen Marefat, engineer and
the Bay Sleep Clinic business manager.
"Double chins fold back into the throat and
constrict nighttime breathing," he said. "But
it is a vicious cycle. If you're not getting
enough sleep, you are likely to be eating
poorly to compensate for energy loss. Then
you're gaining weight and aggravating sleep
problems."
Unlike apnea, the causes for insomnia are not
always so physiological. Strapping a CPAP to
an insomniac is akin to wrapping a knee for a
broken arm.
Insomniacs must implement better sleep
practices, said Set'tle, who is also a sleep
researcher at Stanford University.
"Don't read in bed. Don't watch television in
bed if you are an insomniac," he said. "A
sleeper should not convince their body they
can be awake in bed. The bed is for sleeping.
If you want to read, go into another room.
Then return to the bed and try once again to
fall asleep."
Sleeping pills over time often prove
ineffective, too, according to the AASM.
Drinking alcohol before bedtime jeopardizes
sleep. The alcohol turns to sugar as it
metabolizes and energizes you. Exercising
later than five to six hours before sleep
also dooms the sleeper because exercise heats
the body. The body sleeps better if cooler,
Set'tle said.
It can be as simple as knowing what's right,
and practicing that.
But Set'tle admits that sleep patterns are
not fixed across the population. There are
people who are "short sleepers," he
said—those who happen to need less sleep
than others.
Whether you are Rip Van Winkle or Thomas
Edison (who reportedly took six to seven
45-minute naps throughout a 24-hour period),
all sleepers must cycle through the periods
of sleep.
These periods are called 1, 2, 3, 4 and REM,
or rapid eye movement. Sleepers dream in REM,
and it is commonly known as the deepest point
of sleep.
Period three, however, which is also known as
"delta," is considered the most recuperative
time of night. During that period, the brain
secretes a hormone essential to childhood
growth and cerebral patching for adults.
"It should take a person 10 minutes to fall
asleep," Set'tle said. "If your head hits the
pillow and you are immediately in REM, you
have a sleep disorder. Your body is missing
essential sleep cycles."
The mind normally paralyzes the body during
REM while it performs a series of mental
gymnastics, sorting through names, faces,
tastes, world geography, movie trivia and
whatever other detritus of an overcrowded
mind.
But some sleepers are not paralyzed during
REM. They physically act out their dreams,
Set'tle said. This is called REM behavior
disorder, and it normally occurs in elderly
patients. Their reactions are often violent,
involving kicking, strangling and beating.
And while sleep disorders more often disrupt
the quality of life rather than life itself,
Nader, the owner of Bay Sleep Clinic, readily
points to road statistics as a means to
understand the urgency of the problem.
There are 76,000 road injuries, and 15,000
fatalities, per year associated with
sleepiness, according to the AASM.
"Insurance companies are more than willing to
pay for sleep analysis," Mahenfat said.
"There are actuarial studies that show it
saves them payments in the long run."
In fact, Set'tle adds, insurance claims to
the tune of $15.9 billion annually are the
result of or are induced by sleep disorders.
This may include auto accidents, strokes,
high blood pressure, heart attacks and
erectile dysfunction.
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