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The search for sleep
Seattle Times Eastside bureau
Victoria Laise Jonas bought the 1,000-thread-count Egyptian cotton sheets. She spent $2,000 on a pillow-top mattress and misted her room with sleep-enhancer aromatherapy. But her snoring never ceased.
It was so loud, so obstructive, it often awakened her. Her sons teased her. Her husband deserted their bedroom. Jonas dreaded staying in hotels or — God forbid — an intimate bed-and-breakfast.
Every evening, she battled fatigue on the bus from her job in Seattle to her home in Maple Valley. What if people heard? A woman making these sounds?
"I'm tired of being tired," Jonas says.
So it has come to this. Dressed in pink pajamas, Jonas sits inside a room at Swedish Medical Center's sleep institute in Issaquah on a recent Tuesday night.
Technician Robert Kimani attaches electrode wires to her legs. Her arms. Her scalp. He wraps more wires around her waist and inserts a tube in her nose.
Common sleep disorders and treatments
Restless legs syndrome: A neurological disorder characterized by an overwhelming urge to move the legs when they are at rest. Can be accompanied by unpleasant sensations, such as tingling, itching or aching. Symptoms may also include involuntary jerking that intensifies at night. Treatment includes prescription drugs to reduce pain and allow sleep. Walking, stretching or massaging the legs have been known to help.
Narcolepsy: A neurological disorder caused by the brain's inability to regulate sleep-wake cycles. People with narcolepsy experience recurrent sleep episodes throughout the day. Other symptoms include dreamlike hallucinations and sudden loss of muscle tone that results in slurred speech, buckling of the knees or weakness in the arms. Treatment includes drug and behavioral therapy.
Insomnia: The inability to fall asleep or remain asleep. Insomnia is the most common sleep complaint among Americans and is linked to poor overall health. When insomnia persists for longer than a month, it is considered chronic. Treatment includes exercise, medication, relaxation techniques and behavioral and cognitive therapies.
Sleepwalking: Starts during deep sleep and results in walking or performing other complex behaviors while asleep. More common in children than adults, it's more likely to occur if a person is sleep-deprived. There's no specific treatment. Children usually outgrow it. Adults should talk to a doctor about possible triggers. Hypnosis has been known to help.
At 9:57 p.m., he tucks Jonas into a queen-size bed, turns off the lights and, in a sweet voice, asks her to do one last thing.
Increasingly, Americans are failing to carry out this basic human function. The National Institutes of Health says more than 70 million people suffer each year from chronic to sporadic sleep problems — a number that's expected to swell in tandem with our burgeoning waistlines, advancing age, erratic work schedules and 24-hour lifestyles.
The rise in diagnosed disorders has spawned a proliferation of sleep institutes across the country, where patients pay $3,000 and up for trained technicians to monitor their sleep patterns overnight. Since 1995, accredited sleep clinics in the United States have more than tripled, from 297 to 963. Many more are unaccredited.
Pharmaceutical companies are also fueling America's sleep commerce, raking in billions from sales of popular prescription drugs like Lunesta and Ambien. More than 38.3 million sleeping-pill prescriptions were dispensed last year, according to Verispan, a Pennsylvania research firm that tracks health-care data.
Sleep deprivation erodes memory and concentration, doctors say. It disturbs neurological function, inhibits tissue and muscle restoration and slackens reflexes.
"Sleep is something your body needs to recharge your batteries, and it affects nearly every aspect of your life," said Marci Cleary, spokeswoman for the National Sleep Foundation. "It's food for the brain."
Washington has 26 sleep centers accredited by the American Academy of Sleep Medicine, with 10 in the Puget Sound region. Doctors diagnose disorders ranging from insomnia to sleep apnea, restless legs syndrome and narcolepsy.
They say patients generally wait an average 10 years before seeking treatment. And when they do, doctors discover the disorder has taken another toll — on relationships at home.
Jonas, 54, doesn't want to be here, inside this hospital room designed to resemble a midrange hotel, with the anonymous landscape painting on the wall. Her eyes scan the room. She spots an infrared camera bolted to the ceiling and an opening in the wall.
"Is that hole supposed to measure how loud I'm snoring?" she asks Kimani.
"No," he says. "It's a nightlight."
She laughs, trying to ease her anxiety. There's no hiding here. For eight hours, Kimani, a registered polysomnographer, will chart Jonas' brain activity, breathing and heart rate on a computer. He will watch her movements via a video monitor. And he will listen to her snore, rating the level on a scale of one to three, three being the most severe.
Kimani is gathering data that will, if his hunch is correct, reveal telltale signs of apnea, a condition in which soft tissue at the back of the throat collapses during sleep and blocks off air. Contributing factors include excessive weight, snoring and loss of muscle mass from aging, which leaves the airway narrow and soft.
About 20 million Americans suffer from it.
Jonas never assumed she had a sleeping disorder. She figured snoring, like any other personal quirk, was just part of who she was.
Her lack of energy seemed symptomatic of a busy life. She works full time in human resources for the Seattle Police Department, sits on the Maple Valley City Council and is president of the Maple Valley Food Bank.
"You just juggle every day," she said. "I never slowed down to really think about my sleeping habits."
Nor did she consider that snoring could be depriving her body of precious oxygen during the night.
At work, Jonas dozed off in front of her computer. Gulping energy drinks by the caseload did nothing. She ate to stave off exhaustion but ended up gaining weight. Studies show the sleep-deprived brain releases leptin, a hormone that increases appetite.
Jonas' snoring was a long-standing joke at home. Her sons used to record her at night for kicks, she said. Her husband tried earplugs and headphones for awhile. But for the past 15 years — more than half her marriage — Jonas has slept alone.
Last year, at Issaquah's Salmon Days Festival, Jonas saw a brochure on the Swedish sleep institute. Months later, she made the appointment.
Not all sleep centers are created equal. Nearly 1,900 operate today nationally, and about half are unaccredited.
To be certified, a center must pass a detailed inspection from the American Academy of Sleep Medicine, which requires a board-certified sleep specialist on staff, trained technicians and on-site emergency services.
The evaluation can take four to six months.
Accreditation is voluntary, and not all insurance companies require it. But more and more, this "gold standard" is considered an edge in a field where consumers can pick from a growing number of choices, said Kathleen McCann, spokeswoman for the academy.
"With the growth of sleep centers, a lot are fly-by-night," McCann said. "They're not equipped to provide a proper evaluation or diagnosis."
There are exceptions. Evergreen Hospital Medical Center in Kirkland, for instance, has a sleep-disorder clinic that is in the process of getting accreditation. The same is true for Overlake Sleep Disorders Center in Bellevue.
McCann and others, like Dr. Gerald B. Rich, who has treated sleep disorders for nearly 30 years, advise patients to adopt a "buyer beware" attitude.
"There have been a proliferation of commercially driven centers where the quality can be rather uneven or poor," said Rich, director of the Pacific Sleep Center in Portland.
Patients diagnosed with sleep apnea can opt for surgery that removes tissue from the mouth and throat. Another, more-invasive procedure involves moving the jaw, facial bones and tongue several millimeters forward to widen the airway. Recovery is arduous, and end results often yield little improvement, say some doctors.
"Surgery isn't a cure for most people," said Dr. Sarah Stolz, associate medical director of the Swedish Sleep Medicine Institute.
The most common — and effective — treatment is a continuous positive airway pressure, or CPAP, machine. About the size of a shoebox, it consists of a plastic pressurized mask attached to a small pump that continually forces air through the airway to keep it from collapsing.
The mask may not be the sexiest thing to wear to bed, Stolz said, "but for some people, this machine can turn their lives around."
One week later
One week has passed since Jonas went for her sleep test.
The results show she suffers from "very severe" obstructive sleep apnea, said Stolz, Jonas' doctor. During the night, she stopped breathing an average of 79 times an hour. Her oxygen levels plummeted. "This is really hard on your heart," Stolz said. "It can accelerate heart disease, high blood pressure or even cause a stroke."
Now, a CPAP machine will reside by Jonas' bed for the rest of her life.
"It's embarrassing to admit that you snore like a bear," she says. "But you know what? I have a medical problem. Your health is your health."
Her husband was pleasantly surprised by the CPAP machine, she says. It wasn't as loud or strange as he imagined.
"He thought it would look like something out of 'Star Wars.' He said, 'Maybe we can even start sleeping together.' "
Jonas admits the mask will take some getting used to but she's optimistic.
"I'm retiring in 10 months. I have more energy for more activities. I'll be sleeping with my husband in the same bed again.
"Life is good."
Sonia Krishnan: 206-515-5546 or firstname.lastname@example.org
Copyright © 2006 The Seattle Times Company