The Vital Sign of Sleep

Sleep deprivation and its effects on health can be attributed to lifestyle factors, work schedules or sleep disorders. At least 25% of the population suffers from sleep disorders such as insomnia, sleep apnea and restless legs. The effects of sleep deprivation can include mood disturbance, increased risk for major depression, increased risk of obesity and diabetes, impaired glucose tolerance and decreased sensitivity to insulin, suppression of the immune response, heart problems and impaired daytime neurobehavioral performance. Sleep apnea itself is associated with increased risk for heart disease, atrial fibrillation, blood pressure elevation, inflammation and depression.

Despite the fact that sleep problems such as insomnia are common, few physicians ask their patients about sleep problems and even fewer provide treatment recommendations- in large part because physicians have little, if any, training in the area of sleep problems. Furthermore, patients may be reluctant to inform their physicians about sleep problems since they may fear that the physician will prescribe sleep medications or conceptualize sleep disorders such as insomnia as a “psychiatric” problem.

As a result, physicians should routinely assess sleep as a key “vital sign” in all office visits. Physicians should ask basic questions such as whether the patient has difficultly falling or staying asleep, how many hours they are sleeping and whether they snore and feel sleep-deprived. Physicians and patients also need to know that over-the-counter sleep aids and anti-depressant medications are not effective treatments for insomnia. They should also keep in mind that newer-generation sleeping pills such as Ambien, Sonata and Lunesta are the best choices for sleeping pills for short-term insomnia (with several new sleeping pills expected to be approved soon), and that cognitive-behavioral therapy (CBT) is more effective than sleeping pills for chronic insomnia without the side effects of medication.

The number of sleep clinics that can diagnose and treat patients with sleep problems such as insomnia has increased to 2200 centers in 2005 and there are now an equal number of board certified sleep medicine specialists in the United States (there were less than 100 20 years ago.) Unfortunately, only a small number of these sleep specialists have expertise in CBT and there are only several hundred psychologists worldwide with expertise in CBT. Sleep clinics can perform all-night sleep studies to diagnose and treat sleep problems such as sleep apnea and periodic limb movements, although such studies are usually not indicted for the treatment of insomnia. Treatment of sleep apnea usually entails use of continuous positive airway pressure (CPAP).

Sleep is becoming increasingly recognized as an important vital sign. As a result, more treatments for sleep disorders are becoming available, as are the number of professionals available to diagnose and treat sleep disorders. Campaigns to raise public awareness of sleep problems are under way.