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Daytime Dozing: Something to Wake Up About

By Lisa E. Stafford
American Forces Press Service

WASHINGTON, April 15, 1998 – Do you feel drowsy at mid-morning? In the afternoon? At work after a heavy lunch? Or all the time, even when you think you've had a full night's rest? Your problem may be a sleeping disorder.

Excessive daytime sleepiness, or EDS, is the prime symptom of a number of disorders, including narcolepsy and apnea. Victims can't stay awake in the day even after getting "enough" sleep at night. They may fall asleep uncontrollably at inappropriate times and places.

"Due to greater public awareness of sleep disorders, the Navy has seen an increase in the number of referrals for service members and their families with sleep disorders," said Navy Dr. (Capt.) D. R. Kang, specialty leader for Otolarynology and residency program director at Naval Medical Center San Diego. "The shift work schedules of many Navy personnel can affect the quality of their sleep and possibly lead to insomnia and excessive daytime sleepiness."

The Navy addresses sleep disorders via sleep laboratories and various medical specialists with backgrounds in neurology, pulmonology or otolarynology. The Navy has two sleep labs that specifically treat active duty service members with sleep disorders. One is at Naval Medical Center San Diego and the other at National Naval Medical Center Bethesda. Other naval hospitals send patients out to civilian sleep labs for evaluation.

The Naval Medical Center San Diego sleep lab has plans to do a pilot study of sleep patterns in service members with closed head injury. The lab is also interested in looking at sleep patterns and the effect of low ambient light exposure on some Navy ships and submarines.

"I think it is good that there is finally more attention on sleep disorders," Kang said. "It would certainly help more people to get a better night's sleep."

This issue is especially important in military settings, where service members must be alert at all times, particularly during military operations.

"EDS interferes with a person's ability to concentrate and perform daily tasks and routines. People often report feelings of low esteem, frustration and anger about being misunderstood," said Dr. Michael J. Thorpy, director of the Sleep-Wake Disorders Center at Montefiore Medical Center in New York. People with some sleeping disorders also tend to have problems with their social, work and family relationships, he said.

According to a new National Sleep Foundation Gallup survey, about one-third of American adults -- 63 million -- operate at levels of sleepiness considered hazardous by a scientifically validated sleep measurement by the American Board of Sleep Medicine.

"Car accidents caused [by drivers] falling asleep at the wheel tend to be deadlier than other crashes and account for at least 100,000 police-reported crashes and 1,500 deaths a year in the United States," Thorpy said. "Moreover, sleepiness contributes to inattention, which accounts for one-sixth of all accidents."

Being tired all the time is not something to dismiss, foundation experts said, yet 36 percent of those surveyed believe afternoon sleepiness is normal. Feeling tired or sleepy can negatively affect productivity, but most of those surveyed who experienced daytime sleepiness didn't consider it serious enough to consult a doctor, the survey said.

In the survey, 82 percent of adults reported taking measures to stay awake; 70 percent said they drank coffee or other caffeinated beverages. Naps were surprisingly popular, with nearly one in five reporting at least one a day.

"EDS can be a symptom of a medical condition such as insomnia and is also characteristic of several sleep disorders," said Christine Englehardt, executive director of the American Sleep Apnea Association. "Nearly 95 percent of individuals who suffer from sleep disorders go undiagnosed and untreated," Thorpy said. The condition is rarely caused by psychological or psychiatric disorders such as depression, he said. However, several sleep disorders associated with EDS include:

  • Narcolepsy, a disorder affecting a part of the brain that regulates sleep and wakefulness. It affects an estimated 200,000 adult Americans. Narcolepsy usually begins in the second decade of life and, once it appears, is a life-long condition.
  • Sleep apnea, a disorder that causes a person to repeatedly stop breathing for short periods during sleep. Victims are often unaware they've stopped breathing and won't awaken whether they resume breathing quietly or in explosive gasps and snores. These disruptions prevent deep, refreshing sleep. An obstructed airway is the most common cause of apnea. Approximately 12 million Americans, mostly men, have sleep apnea.
  • Restless Legs Syndrome consists of involuntary movements of the legs, feet and or toes during sleep. Victims are often not aware of these movements and often complain of several other symptoms such as insomnia and EDS.
  • Circadian Rhythm Disorder affects about 70 percent of the 25 million Americans who work night shifts or other nontraditional schedules. While a day has 24 hours, most people's bodies unconsciously operate on a sleep-wake rhythm of 27 to 28 hours, and while they adapt to a night schedule, their bodies still "prefer" to be awake in daylight. The disorder interrupts a person's "body clock" rhythm. It can take different forms and, for instance, can be as simple as delayed sleep phase syndrome, in which a person gets totally off kilter by progressively going to sleep later and awakening later.

You can consult one of the following for sleep disorders:

American Sleep Disorders Association

1610 14th St., NW, Suite 300

Rochester, MN 55901

E-mail: ASDA@asda.org

Web site: http://www.asda.org

American Sleep Apnea Association

2025 Pennsylvania Ave., NW, Suite 905

Washington, DC 20006

Phone: (202) 293-3650

Fax: (202) 293-3656

Web site: http://www.sleepapena.org

Narcolepsy Network

P.O. Box 42460

Cincinnati, OH 45242

Phone: (513) 891-3522

Fax: (513) 891-9936

Web site: http://www.websciences.org/narnet

National Sleep Foundation

729 15th St., NW, 4th Floor

Washington, DC 20005

E-mail: natsleep@erols.com

Web site: http://www.sleepfoundation.org

Restless Legs Syndrome Foundation, Inc.

PO Box 7050, Department CP

Rochester, MN 55903-7050

Web site: http://www.rls.org

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