In the early 1970s when Dr. Meir Kryger was a medical resident at the Royal Victoria Hospital in Montreal, he came across a patient with an ailment neither he nor anyone else understood at the time.
The patient, an obese male in his 40s, had severe fatigue and was suffering seizures as he slept. During late-night rounds at the hospital, Kryger, who currently lives in Hamden and is a professor at the Yale School of Medicine, observed that the man seemed to be having trouble breathing in his sleep. Kryger wondered if this was related to his sleepiness and seizures. With further monitoring, Kryger learned that while the patient slept, his breathing passage became repeatedly obstructed and he stopped breathing. When this happened, his heart rate dropped and, at times, his heartbeat would even stop for up to 10 seconds. This explained both the man’s sleepiness and his seizures (when the brain is deprived of blood because the heart has stopped pumping, seizures can occur).
Kryger had just come across an early documented case of sleep apnea, when a person stops breathing during sleep. Though the condition has long existed, the medical profession only became aware of it in the late ’60s and early ’70s, and the term only came into usage in the mid-1970s.
Faced with a condition he was unfamiliar with, Kryger consulted the literature that existed on sleep at the time. To his surprise, there was hardly anything published in North America about the condition and very little about sleep disorders in general. “To me, if I don’t know something, I want to study it and I want to figure it out,” he recalls. Kryger began to study sleep apnea and other sleep disorders that had received limited attention. He has since dedicated a good portion of his career to uncovering the mysteries of sleep and its role in human health. Later, responding once again to a void in the literature, he began work on an early medical textbook on sleep, Principles and Practices of Sleep Medicine. The frequently updated, seminal work is still the most widely used sleep medical textbook.
Kryger’s latest book, The Mystery of Sleep: Why a Good Night’s Rest Is Vital to a Better, Healthier Life, was released in March andis aimed at providing the general public with the knowledge they need to ask informed questions of their health care provider about their sleep health.
“Sleep problems are very, very common, and I’ve felt for a long time that there has been sort of a communications gap between patients and doctors about sleep issues,” he says during a visit to Yale New Haven Hospital’s Sleep Center in North Haven. “The main purposes of the book was to arm people with information so they can have a meaningful interaction with their health care provider if they have a sleep problem.”
Kryger adds, “Very few doctors ask about sleep issues [because] the health care provider may not know a whole lot about sleep. The reason they don’t know a lot about sleep is that most medical schools teach almost nothing about sleep during the four years of medical school, and in the post-graduate training in their residency, doctors may receive hardly anything, either. On average, if a student is lucky they’ll get one or two hours of sleep-related teaching during four years.”
Back when Kryger encountered the patient with apnea, the condition was thought to be exceedingly rare. We now know that it is quite common, and it is far from the only sleep disorder found in the population in large numbers.
“Although sleep disorders are common and there has been an upsurge of interest in them in the past few years, millions of people still suffer from the effects of undiagnosed sleep problems,” Kryger writes in The Mystery of Sleep. “The National Sleep Foundation estimates that up to 47 million American adults may be putting themselves at risk for injury, and health and behavior problems because they are not getting enough sleep. The National Institutes of Health estimates that between 50 million to 70 million Americans of all ages have sleep-related problems, including insomnia and sleep apnea.”
Since Kryger became interested in the field, he says awareness of sleep disorders has increased. “In some ways it parallels our thinking about drunk driving. Thirty years ago driving drunk was not considered bad. It had a certain macho element. You go to a bar, you get drunk, you go home and you may or may not kill someone.”
Then research demonstrated that driving drunk was a dangerous behavior and people now recognize that. Similarly, in the past, Kryger says people thought “you go to sleep, nothing can go wrong during sleep and we don’t need to think a whole lot about it. We [have since] learned that things during sleep can be medically dangerous.”
In his book Kryger notes that more needs to be done: “If you have ever been affected by severe sleepiness, you are not alone. Every year, U.S. businesses lose an estimated $18 billion in productivity and injuries because of daytime sleepiness, while sleepy drivers cause an estimated 20 percent of car accidents, as high as 1.2 million crashes, resulting in thousands of deaths and injuries and billions of dollars in property damage. Research has also shown important links between the amount of sleep an individual gets and risk of health problems: reduced sleep may lead to obesity; women who sleep much more or much less than the average are at increased risk of disease. A study of 71,000 nurses published in 2003 showed that those sleeping five hours or less had a 45 percent greater risk of developing heart disease after 10 years than those sleeping eight hours. Those sleeping nine to 11 hours increased their risk by 38 percent.”
Kryger recommends that those who may have a sleep disorder visit a sleep clinic accredited by the American Academy of Sleep Medicine (there are nearly 20 across Connecticut). Kryger sees patients at Yale’s North Haven sleep center, where patients are treated for a variety of sleep-related issues, including insomnia, restless leg syndrome, sleepwalking and much more. Some sleep conditions can be diagnosed with an appointment, others require monitoring during sleep. The center offers patients take-home sleep tests that record their pulse, heart rate and breathing. If more extensive tests are necessary for a diagnosis, the center has several overnight rooms where patients’ brain activity and other functions can be monitored as they sleep.
Many people battle with insomnia. “During the course of the year, 40 percent of the population will say, ‘I’ve had insomnia during the year.’ It may be temporary, related to stress, travel, a death in the family, an illness,” Kryger says. “Chronic insomnia is found in 10 or 15 percent of the population,” and the condition is often associated with other conditions, including depression.
Most people diagnosed with insomnia today are advised by sleep specialists to try cognitive behavioral therapy before pills. This therapy focuses on behaviors a patient can change in order to sleep better.
While each case is different, one common behavioral problem is fairly counterintuitive: going to bed too early. “The worst thing people can do if they’re having trouble sleeping is to go bed early,” Kryger says. He adds that many people who are having trouble sleeping will push their bedtime from, say, 11 p.m. to 8 or 8:30 p.m. He says this gives you more of an opportunity to go “my god, I’m not going to sleep ever again.” One common practice in cognitive behavioral therapy is to restrict the amount of time people spend in bed.
Another sleep-associated myth is that staying up late, getting up earlier or otherwise getting less sleep in order to work or study will help us be more productive. Kryger says we’re at our most productive and get the most done when we’re well rested.
The good news for patients suffering from sleep disorders is that treatment is effective. “In numbers, the problem is really great, but one of the gratifying things about treating people with sleep disorders is that we can usually make them better. So, from a doctor’s perspective and a patient’s perspective, it’s gratifying.” He adds, if you have a sleep problem, “deal with it, don’t ignore it. There’s help available.”