FEATURE STORY — March/April 2008

The Science of Sleep

At the UIC Sleep Science Center, a team of specialists is putting patients, and their sleep problems, to rest

By Rachel Farrell
Photography By Lloyd Degrane

Tonight, Robert Fletcher ’03 UIUC will become a lab rat. Not in the literal sense, of course, but in the sense that he’ll be confined to a laboratory, hooked up to sensors and monitored by a team of technicians.

You see, lately Fletcher has been feeling groggy all the time. He is forgetful, feels depressed, has trouble concentrating when talking to someone and isn’t producing like he used to as an architect at Aumiller Youngquist. And for a 26-year-old who’s healthy, active and sleeps at least eight hours a night, that’s not normal.

To determine the source of his problem, Fletcher visited the UIC Sleep Science Center earlier today and saw Dr. James Herdegen ’82 UIUC, the Center’s medical director and associate professor of pulmonary, critical care and sleep medicine. Herdegen recommended that Fletcher undergo a sleep study—a painless, 10-hour procedure in which a patient’s heart rate, brain wave activity, eye movements, muscle activity and body position are monitored during sleep. This data will ascertain whether Fletcher has a sleep disorder.

Now dressed in a white undershirt, white socks and plaid pajama pants, Fletcher is sheepishly waiting in one of the Center’s laboratory rooms for his study to begin. The room, however, looks more like a hotel suite than a medical lab. Its walls are painted an eggshell hue and its floors are covered with plush, knit carpeting. On one wall hangs a framed painting of a beach, on another is a plasma TV. In the center of the room is a queen-sized bed covered with a mustard-colored blanket. What throws off the Holiday Inn vibe is the camera hanging from one wall and some unidentified medical equipment on a desk.

With a copy of the book “Six Degrees” in hand, Fletcher lays down on the bed and props his head upon two starchy pillows. The mattress sinks under his weight as he opens the book, turns to where he last left off and comfortably crosses his ankles.

A petite woman enters the room dressed in chocolate-brown scrubs. She introduces herself as a sleep technician and, in one hand, carries a pile of rainbow-colored wires the size of vermicelli noodles.

“OK, Robert, I’m going to get you set up for your study,” she says cheerfully. She pats a swivel chair to coax Fletcher out of bed. He moves quietly to the chair and sits down, folding his hands in his lap. For the next 45 minutes, the technician engages in what looks like some cruel practical joke—attaching 22 wire-connected sensors to points on Fletcher’s forehead, cheeks, scalp and legs. Afterwards, she wraps a seatbelt-like strap around his chest and stomach, tapes a small microphone to his throat and covers his index finger with a plastic clamp.

By 9:55 p.m., the process is complete and Fletcher says he’s ready for bed. He crawls under the covers while the technician connects the sensors to a computer tower. As soon as the lights go out, the study begins.

Weeks later, Fletcher learns that he has sleep apnea and periodic leg movement. The former, because it’s mild, can be treated with an oral appliance; the latter responds well to medication. Fletcher’s future looks optimistic, but what about the other 50 million to 70 million Americans who chronically suffer from sleep problems?

An unmet public health problem

According to Herdegen, 80 to 90 percent of people with sleep problems don’t get diagnosed or treated. Several factors are to blame for this. For one, sleep studies—the “gold standard” procedure for diagnosis—are expensive and time-consuming, and most U.S. communities don’t have the resources to provide them.i In the United States, for example, approximately 2,310 sleep studies per 100,000 people are needed annually to satisfy the demand for diagnosis and treatment of sleep apnea; on average, only 427 studies per 100,000 people are performed.ii In an April 2006 report, the Institute of Medicine declared sleep disorders and sleep deprivation “an unmet public health problem.”

To make matters worse, demand for treatment is increasing in the United States as the prevalence of sleep deprivation and sleep disorders continues to rise. The obesity epidemic, in particular, is contributing to the growth. “We think that obesity is driving the prevalence of sleep disorders [such as] sleep apnea,” explains Herdegen, a tall, lean man with wire-rimmed glasses. “And until we make some public inroads on obesity, sleep apnea is not going to go away. It will probably get worse before it gets better.”

Changes in the work force are another contributor. More than 20 million Americans perform shift work, which can cause sleep deprivation and circadian rhythm disorders (a syndrome in which the “internal body clock” is disrupted). In addition, technological advancements are reducing our sleep. “In 1910, for example, people functioned through light and dark cycles,” says Herdegen. “The incandescent bulb wasn’t widely available and we didn’t have TV, so people were getting about two more hours of sleep than they are now. Today, we’re pretty much a sleep-deprived society.”

The consequences are greater than you might think. In the long term, sleep disorders and sleep deprivation are associated with an increased risk of hypertension, diabetes, obesity, depression, heart attack, stroke and even premature death. According to the Institute of Medicine, 20 percent of all serious motor vehicle crash injuries are associated with driver sleepiness, independent of alcohol effects. And Americans spend hundreds of billions of dollars each year on doctor visits, medical services, prescriptions and over-the-counter medications to treat their sleep problems.

The UIC Sleep Science Center is trying to help address this public health problem. It annually treats more than 1,500 patients, ranging from ages 6 to 90, for a range of sleep disorders such as obstructive sleep apnea, restless legs syndrome, insomnia and narcolepsy. In May 2007, the Center moved its facility from the over-crowded outpatient clinic at the University of Illinois Medical Center to the Tech 2000 building at the corner of Harrison and Leavitt streets in Chicago. At this new, larger location, the Center can see more than 150 patients per month, instruct medical students in clinics five times a week, offer as many as 10 sleep studies per night (compared to four at the hospital) and provide one-on-one treatment consultations for sleep apnea patients.

The man behind the mask

Imagine standing before a shelf lined with mannequin heads. On each one is a different plastic mask—some white, some turquoise, some with tubes sticking out like tentacles. You envision that these masks might be worn during scuba diving or used in the emergency room. Then you’re told that you have to wear one of these to bed. And sleep with it. For the rest of your life.

For patients diagnosed with obstructive sleep apnea, this is the harsh reality. Sleep apnea sufferers stop breathing during sleep because their airways collapse; to keep them open, they need to wear a nasal mask attached by tube to a Continuous Positive Airway Pressure device, which generates a positive-pressure air flow. (Other treatment options, which include surgery and oral appliances, are typically less effective than CPAP.)

Mark Eley, the Center’s “durable medical equipment coordinator,” is responsible for getting patients accustomed to CPAP therapy. A slight man with a thick moustache and polite manner-of-speech, he takes a gentle, therapist-like approach when meeting with patients during their one-hour consultations. He lets patients touch the masks before putting one on; he encourages them to feel the air flow before breathing it through the mask. But some patients vehemently refuse to use the therapy.

“So I put on my salesman hat,” says Eley with a little smile.  “I say, ‘At a minimum, would you at least be willing to give it a try?’ Almost always, they’re going to agree to at least try. We take baby steps.”

By taking such an approach, Eley hopes that more patients will stick to CPAP. “Studies have shown that one of the key components of patient compliance is the interaction that he or she has with the technician,” he explains. “If you have a technician who is very compassionate and patient and knowledgeable, you’re going to persevere. If you have a technician who says, ‘Here’s your mask, good luck, see ya,’ that’s not going to work. There’s no success with that.”

After the consultation, Eley provides “an aggressive follow-up,” calling the patient a few days later, one week later and a month later to make sure that he or she is using the device. “It’s for their well-being, whether they realize it or not,” says Eley.

By working so intensely with patients, Eley may be saving lives. In a 2005 study, individuals with untreated sleep apnea were far more likely to die from cardiovascular disease than individuals who received CPAP therapy for at least five years (14.8 percent versus 1.9 percent).  

Air effects

In her high-rise apartment on Chicago’s South Side, Veronica Coleman, 58, has decorated her home for the holidays. There’s a Christmas tree covered with homemade decorations, a table topped with red candles and a cluster of stockings ready to be stuffed. Yet Coleman isn’t feeling so festive.

Diagnosed with chiari malformation (structural defects in the brain), intracranial hypotension (spinal fluid leak), central sleep apnea and insomnia, Coleman suffers from chronic headaches, dizziness, fatigue and balance problems. She falls asleep as early as 7 p.m., wakes up several times during the night, and gets up around 3:30 a.m. feeling just plain “crappy,” she says. In 2004, her health problems became so severe that she had to go on disability, leaving her 30-year job as an auditor for United Healthcare.

Since last summer, the Center has been working with Coleman to treat her sleep apnea and insomnia. Herdegen put her on a sleeping pill, Sonata, and fitted her for a nasal mask; he’s now monitoring her daily use of CPAP through a micro-chip that’s planted in the device. Getting used to the nasal mask hasn’t been easy for Coleman.

“It makes so much doggone noise with the air blowing,” she says, groaning. “It keeps me up. And how am I supposed to get a boyfriend with this thing on my face? I’m going to scare him away!”

But Coleman doesn’t have much of a choice in the matter: Without CPAP, she stops breathing during sleep 28 times an hour. With CPAP, “I can tell the difference—I feel better in the morning,” she admits.

For this, Coleman is grateful. “I mean, what did my parents and grandparents do?” she says. “They didn’t have any sleep clinics. Grandpa snored; he probably had sleep apnea. But back then, nobody knew what sleep apnea was. They probably had pulmonary problems when they died. I hate to say it...” Her voice trails off, but her point is made: If sleep centers, such as UIC’s, had existed back then, would her relatives have lived longer, healthier lives?