A wake-up call for a dozy society

By Dr Ken Whyte

In the middle of the afternoon a car drifts out of its lane and mysteriously drives off the road. If there is a vehicle coming the other way then the head-on accident and the resulting carnage inevitably hits the headlines.

Falling asleep at the wheel is simply one of the more horrific curses of modern living - in a society where sleep deprivation is the "norm."

Transport authorities have no clear idea of the contribution of sleepiness to the horrors on our roads, especially during summer. Heat, the stress of rushing to get ready for a holiday, and longdistance driving, all increase the risk of falling asleep at the wheel.

Shift work is one of the villains. The ability to ignore the natural rhythm of light and dark (by using artificial light), is another. These twin "evils" have led to a host of problems with our sleeping systems.
Some individuals are so profoundly affected, the problem genuinely deserves the label of a disease.

Sleep-deprived workers have been responsible for a host of major accidents ranging from the Three Mile Island nuclear accident to the Exxon Valdez oil spill.

These increasing problems with sleep, coupled with technological advances in studying sleep, have in the last 25 years led to the development of sleep medicine.

Day-time sleepiness is often life-style inflicted - people simply go to bed too late or work long hours or shifts. Nevertheless, we now recognise a wide variety of sleep disorders, ranging from an inability to initiate sleep to profound day-time sleepiness because of breathing problems which disturb sleep.

Obstructive sleep apnoea is a disease which renders sufferers profoundly sleepy and a danger to themselves and all and sundry.

When we go to sleep our hearts slow down, our breathing becomes shallow and irregular and our muscles relax and become floppy. In the throat this causes the airway to narrow.

In a third of people the narrowing is merely sufficient to cause snoring, but in one out of 20 individuals the throat is effectively strangled. Breathing stops, then the sufferer wakens momentarily and breathing restarts.

These apnoeas (pauses in breathing) are too short to be remembered next day and may occur hundreds of times a night. The individual wakens feeling as if they had never been to sleep. They fall asleep whenever they are not stimulated, behind the wheel for example.

Because they are irritable from loss of sleep, these individuals are hell to live with. The impact on their quality of life can be profound, ranging from wakening at night choking, to poor memory and impotence. There is a strong suspicion that disturbed sleep can lead to heart and circulatory diseases.

Diagnosis is complex and requires the patient to sleep in a sleep laboratory, where their breathing and sleep is intensively monitored.

Most apnoea sufferers can be effectively treated with the nightly use of a nasal mask. Air is pumped under pressure through the mask and this opens the throat. The improved quality of life is almost instant. Sleep studies are expensive, though treatment with the mask and pump is relatively cheap.

Meanwhile, society continues to ignore the hidden costs of sleep deprivation and neither the public health system nor the private health insurance industry has been willing to confront the problem.

In the Auckland public health system patients will only get to the top of the waiting list if they report falling asleep driving or while they are engaged in conversation. Yet these profoundly sleepy and most dangerous patients still have to wait eight to nine months to be seen.

Less sleepy but still potentially very dangerous individuals on the roads or at work, suffer severe loss of quality of life while they sit on a stagnant waiting list.

* Dr Ken Whyte trained in sleep medicine in the pioneering Scottish National Sleep Laboratory in Edinburgh, and is clinical director of the sleep centre at Greenlane Hospital. He also consults at the Mercy Hospital sleep laboratory.