Monday Medical: Sleep disorders can be harmful

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Years ago, I asked our then 4-year-old son whether his little sister's loud crying the previous night had awoken him. "Not me, Mom," he replied. "I was wide asleep."

What a perfect description for the sleep disorders that afflict as much as one-third of our population. Too many of us spend too many nights in the unhealthy gap between "wide awake" and "sound asleep."

David Kukafka, M.D., would like to reduce those numbers here in the Yampa Valley. Board-certified in sleep medicine, internal medicine, pulmonary medicine and critical care medicine, Kukafka now sees patients in Steamboat Springs on a monthly basis.

"Sleep problems range from not getting enough sleep to potentially life-threatening conditions," Kukafka said. "Quality sleep is a largely unrecognized way to stay healthy - it is as important as eating right, exercising and handling stress.

"We should be getting eight hours of sleep a night, but most Americans average six hours. This has medical as well as social effects," he said. "It's also not just the length of time we sleep, but the quality of our sleep that has an impact on our health."

Insomnia, restless leg syndrome, snoring and sleep apnea - when breathing stops and restarts numerous times during the night - all can interfere with quality of sleep. The consequences run the gamut from inability to focus to serious health challenges.

"Untreated moderate to severe sleep apnea has been proven to have a relationship to increased risk of cardiovascular disease," Kukafka said. "Insomnia can be caused by stress or anxiety, but sleep apnea is often the cause of sleep problems for many people who have insomnia."

Sleep disorders can be diagnosed in a sleep laboratory such as Yampa Valley Medical Center's Sleep Study Center. Kukafka has been medical director of YVMC's sleep lab since 2005. He also interprets lung function tests for the outpatient pulmonary diagnostic lab.

A sleep lab test involves overnight monitoring of 18 or more parameters, including brain waves, oxygen levels, breathing patterns, arm and leg movements and heart rate. A registered polysomnographer administers the test, which gathers massive amounts of data for six to eight hours.

"A diagnostic sleep test gives us a very comprehensive picture of a person's sleep quality and quantity," Kukafka said.

YVMC's Sleep Study Center recently added a second bed and now can accept more patients. Respiratory Care Services Director Bill Moore said demand for sleep tests previously caused a two-month wait for some patients.

The Sleep Study Center diagnoses adults and children age 4 and older. Yes, even children suffer from poor-quality sleep. Pediatric sleep apnea now is linked to attention deficit disorders.

"If your child is snoring loudly and has attention deficits, a sleep study may not be needed, but you should definitely take your child to an ear, nose and throat specialist," Kukafka said.

Maryann Wall, M.D., a Steamboat Springs ear, nose and throat surgeon, agrees with Kukafka.

"All children who snore need to be evaluated for the possibility of sleep-disordered breathing or apnea," she said. "Both of these sleep disorders have been associated with hyperactivity, attention deficits, poor school performance and even brain development," she said.

"However, up to 10 percent of children who have these sleep disorders do not snore. So whether or not snoring is present, any child with attention deficit disorder should be evaluated."

Wall and Kukafka agree that removal of the tonsils and adenoids can eliminate or reduce childhood sleep disorders and associated attention deficit problems.

Snoring frequently is the most obvious symptom of sleep apnea for adults, as well as children. And it often is the reason patients go to their family physician or a sleep specialist, Kukafka said.

"A lot of men are in denial about their sleep problems, and their wives drag them in because they snore," he said.

Although sleep apnea frequently strikes men in their 40s and 50s, women also have sleep disorders. Primary risk factors for sleep apnea in adults are: being overweight, having high blood pressure, snoring, feeling tired and excessive daytime sleepiness, Kukafka said.

"Many people who are sleepy and not energized during the day have simply accepted this as the norm," he said. "But we have an opportunity to help them live better lives by diagnosing sleep problems or other contributing factors, such as depression or medications. We want to help people feel better and be healthier."

Christine McKelvie is public relations director at Yampa Valley Medical Center.

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