Straight from the sleep lab doctor

Here's an edited transcript of an Idaho Health interview with Dr. Janat O'Donnell, a lung specialist who interprets sleep studies at Saint Alphonsus and St. Luke's hospitals in Ada County.

About sleep apnea

Sleep apnea is not the most common sleep disorder that we see in society, but it is the most common sleep disorder that we see in the sleep center. Other illnesses can cause apnea, too. If you can identify patients with congestive heart failure who have sleep apnea, you can sometimes improve heart function by treating them. Some people advocate that anyone with congestive heart failure should have a sleep study. There are people who say that anybody who has hypertension, which is up to 50 percent to 60 percent of the population, will have sleep apnea as a cause of their hypertension.

I would say that anybody who has hypertension and has associated snoring, apneas witnessed (by bed partners); or sleepiness in the day should have a sleep study. I think that if you have two of those three parameters, you should have a sleep study. CPAP (continuous positive airway pressure machines) are one of the treatments for sleep apnea.

Do surgical treatments work?

It depends on the surgery. If you are talking about children and tonsillectomy, the success rate is higher. Recent studies question whether it is 70 to 80 percent. It may not be that high.

What's next when sleep studies fail to find a problem?

We do the initial evaluation for insomnia, and there are many things we can do in the clinical setting that would be a benefit. I think there are times when you see somebody for insomnia and you do uncover an underlying sleep disorder other than insomnia. They will complain of insomnia with frequent awakenings, but in actuality, it will be their sleep apnea that is waking them up. So they may come in with a complaint of insomnia, but it's actually leg movements or breathing issues. So we do the initial evaluations, and there are a lot of things that we can do in the office setting to improve sleep. There also are people who do cognitive behavioral therapy.

How many sleep studies does Saint Al's do in a year?

1,600 last year, sleep studies at Saint Al's.

Do we understand the connections between genetics and sleep disorders?

I don't know if we understand them completely. Some of it is anatomical.

Do kids suffer from sleep disorders?

I think the important thing about that is I know of children who need to be on CPAP who struggle with it (partly because they find it uncomfortable), but it could be seen in a sort of positive light. I think that's one segment of the population where there's still so much education that needs to be done. I saw a mother yesterday, and she brought her little 9-year-old-boy, and he was taking her path in terms of body build and weight gain, and I just asked her if he was snoring. And she said, yes he snores. He raises the house. That's never normal.

Is there a link between attention deficit hyperactivity disorder and sleep problems?

It's fascinating that up to 30 percent of kids with attention deficit hyperactivity disorder probably have some kind of sleep disorder. There's so much that needs to be done in this community and everywhere in terms of public awareness about sleep disorders and kids.

I think that oppositional defiant disorder, anxiety, depression, all of the mood disorders can be greatly affected by sleep. Children are different because they often don't appear sleepy. They just sometimes get hyperactive or get defiant or have behavioral issues. But it's not uncommon where I will talk to a parent whose child is falling asleep in class, and actually it is the teacher who is bringing this to their (parents') attention. They (the kids) are sort of in constant motion because they are trying to keep awake.

Is there any link being explored between sleep disorders and disorders on the autism spectrum?

I am not aware of a direct connection. I'm just not sure it's been researched or studied.

Are sleep disorders on the radar screen of Treasure Valley pediatricians?

I think it depends on the pediatricians. I know that the ones that I (send patients to) are very much aware about this. But I don't know that across the board, people are looking for sleep disorders, sleep disturbances. I think if they were educated, that the flood gates would open. We are a very sleep deprived society.

Is the number of patients going up?

We've seen an increase, which I think reflects a recognition of sleep disorders in the medical community, which I think is good.

Do you think we sleep less and less?

I do. I think there's a number of reasons, and I think it started with the invention of the light bulb. I think we are a society now that operates on a 24-hour basis. There's shift workers, there's a big push for production, and I think also TV and computers and games. It's just that we're in such an electronic world. I think that's had very negative effects on sleep. We're also a society that exercises less, especially our children. When we were kids, we'd be outside and playing, and now our kids are sitting in front of screens and playing handheld video games.

If kids have to go on CPAP, will they have to be on it for the rest of their lives?

It's not known. The hope is there will be more options as time go on. There's a medication right now being tested for sleep apnea.

Some people see going without sleep as a badge of honor. Is it?

In early rat studies in sleep deprivation, the rats were dead in 17 days. And even in partial sleep deprivation studies, there are cognitive effects, mood effects, tension, focus, memory, mainly short term memory, enormous effects on your mood. It increases irritability. It can heighten anxiety. I have had people who were treated for depression for years and in actuality when they were treated for sleep disorders, they discovered they didn't have depression.