A Nation of Sleepy People 

By Andrew E. Filderman, MD
Medical Director, Pen Bay Center for Sleep Medicine
Diplomate, American Board of Sleep Medicine

Americans today are sleepy. Before Thomas Edison’s invention of the light bulb, people slept an average of 10 hours per night. Today Americans average 6.9 hours of sleep on weeknights and 7.5 hours per night on weekends. Approximately 70 million people in the United States at one time or another have been affected by a sleep problem. About 40 million suffer from a chronic sleep disorder, while an additional 30 million are affected by intermittent sleep-related problems. Approximately 1/3 of Americans report they feel sleepy during the day. The National Highway Traffic Safety Administration conservatively estimates that 100,000 police-reported car crashes are caused by drowsy drivers.  

There may be many causes of excessive daytime sleepiness. In addition to sleep abnormalities, other potential causes of daytime sleepiness include medical conditions (such as thyroid disease, anemia, or diabetes mellitus), medication side-effects, chronic pain, fibromyalgia, chronic fatigue syndrome and depression. 

The most common sleep disorder affecting Americans is insomnia. Insomnia is defined by either the inability to fall asleep or maintain sleep. Up to 40 per cent of adults report at least occasional difficulty sleeping. Chronic or severe insomnia affects 10-15 percent of adults. Direct and indirect costs of insomnia care and work loss are estimated to be 42 billion dollars. 

Obstructive sleep apnea is a condition in which the upper airway collapses during sleep, resulting in a partial or complete cessation of airflow or breathing. Airway obstruction may occur repeatedly during the night. Sufferers of sleep apnea may have symptoms including excessive daytime sleepiness, irritability, personality change and difficulty concentrating. New studies are now reporting links between sleep apnea and such cardiac diseases as hypertension, atrial fibrillation, stroke and coronary artery disease. There may also be a correlation between sleep apnea and diabetes mellitus. 

The primary risk factor for obstructive sleep apnea is obesity. Men with neck sizes greater than 17 inches and women greater than 16 inches have a greater frequency of sleep apnea. Other risk factors include enlarged tonsils/adenoids and such craniofacial abnormalities as a recessed jaw. The prevalence of obstructive sleep apnea in the general population is relatively high. A recent study at the University of Wisconsin estimated that

24 percent of men and 9 percent of women have abnormal sleep studies consistent with obstructive sleep apnea, with at least 4 percent of men and 2 percent of women having clinically significant obstructive sleep apnea.  

Children may also be at risk for obstructive sleep apnea. Importantly, most children with this problem are not obese. Rather, they usually have enlarged tonsils/adenoids contributing to crowding of the airway. Of note, many children with this problem do not complain of being sleepy. The typical child with sleep apnea may present with neurocognitive deficits such as hyperactivity, behavioral problems and learning disabilities. It is critical that children not be misdiagnosed since sleep apnea is a treatable condition. 

Less common sleep disorders which may contribute to daytime sleepiness include narcolepsy (a neurologic disease causing sleep attacks), restless leg syndrome/periodic leg movements, bruxism (grinding of teeth) and circadian rhythm disturbances in which an altered biologic clock causes abnormalities in sleep/wake times. 

The majority of sleep disorders are treatable. Many disorders such as insomnia may be evaluated with a simple history taken by the patient’s primary care provider. More complex issues may require evaluation by a sleep medicine physician and may include an overnight sleep study. Penobscot Bay Medical Center has a two bed sleep laboratory performing overnight sleep studies several days a week. The key to getting help for a sleep problem is to first discuss this with your primary care provider. Your provider may be able to treat the disorder or feel that referral to a sleep medicine physician is appropriate.

Updated: 01/21/10