THE VIRGINIAN-PILOT
Copyright (c) 1995, Landmark Communications, Inc.
DATE: Thursday, September 14, 1995 TAG: 9509140057
SECTION: DAILY BREAK PAGE: E1 EDITION: FINAL
SOURCE: BY MARIE JOYCE, STAFF WRITER
LENGTH: Long : 223 lines
Sleep had crept up and seized him as he drove home to Windsor after visiting a member of his congregation in the hospital. He hadn't even realized he was nodding off.
He felt tired, sure. But he's felt tired every day for almost 40 years.
The accident woke him up in more ways than one. He decided to visit the Sleep Disorders Center at Eastern Virginia Medical School and Sentara Norfolk General Hospital.
There, the staff monitors the sleep of six people a night, five nights a week. The doctors treat people for a variety of problems. And they do research in a relatively new field that still contains more mysteries than answers.
That time of the day when our minds and bodies seem to shut down is actually a very active period, physiologically speaking, said Virgil Wooten, Ballard's doctor at the sleep center. And problems then can cause problems during the day.
Ballard, pastor of Windsor Congregational Christian Church, suffers from obstructive sleep apnea, the most common problem treated at the sleep center.
Ballard simply stops breathing during the night. As he sleeps, the muscles of his throat relax more than they should, drooping so much that they cut off the passage of air. As the brain measures a drop in the blood oxygen level, it jerks him awake for just a second, just enough to tighten up the throat muscles. Then he drifts off and the cycle starts again.
This can happen hundreds of times a night, robbing the victim of a good night's sleep. The victim often doesn't even know about his problem. People usually won't remember waking up unless they stay awake for several minutes, says J. Catesby Ware, a researcher at the Sleep Disorders Center.
Ballard's snoring was legendary. Snoring can be a symptom of the disorder. His wife trained him to sleep on his side - he was a little quieter that way. On airplane trips, he'd doze off and wake up to find the other passengers looking at him and laughing. He dreads flying.
Because the condition comes on gradually, people attribute their symptoms to age. The spouse hears the snoring, the victim feels the fatigue, their doctor notices the high blood pressure. No one puts it all together.
Sufferers may be so sleepy that they are at risk for accidents like Ballard's. Beyond that, the condition can lead to high blood pressure and heart disease.
``There's probably no other disorder that's so severe and so life-threatening that people are so unaware of,'' Ware said.
Ballard has achieved a full, active life by grappling constantly with the fatigue that dogs him.
He was an Army chaplain who served a tour in Vietnam. He retired as a colonel last year. During his service, he was notorious for nodding off in staff meetings. Once, he fell asleep while his commanding officer was talking to him, laying down goals for the coming year. He laughs about it now, but at the time, the episode gave him nightmares about his career.
He realized just how bad it was when his colleagues put together a skit for someone who was leaving. Each person on the staff was one of the Seven Dwarfs. They made him Sleepy.
``It's a miracle, I guess, I made colonel in the Army. I thought I was hiding it pretty well. I guess I wasn't,'' he said.
If staff meetings were hard, counseling sessions are worse, because the stakes are higher. He has never fallen asleep, but that's because he gets up, drinks coffee and walks around.
``You didn't dare fall asleep when someone's telling their story,'' he said. ``It would be terrible.''
The problem has been a social impairment, too. When he and his wife play cards with another couple, his wife has to nudge him awake when it's his turn.
A few weeks ago, Ballard strode the darkened hallways in a quiet section of Sentara Norfolk General, with Bible and prayer book in hand and ``clergy'' badge on his tie. He carried a briefcase containing a T-shirt and shorts.
At the sleep center, five nights a week, half a dozen patients check in to get a not-so-good night's rest, while technicians stay awake, watching the sleepers.
The rooms are part economy motel and part hospital room, with a double bed, tasteful pictures and a private bath - and a camera and infrared light mounted on the wall, pointed at the bed.
Ballard sat for an hour or so while technician Sonya Blowe pasted and taped about two dozen electrodes on him - on his head to monitor brain waves and around his eyes for eye movements; on his jaw to look for bruxism, or grinding of the teeth; on his legs to record leg jitters; on his chest to monitor his heart. Two bands went around his torso to measure the movements of his breathing. There was a clip attached to his finger to measure blood oxygen levels and a little sensor, like the ring in the nose of a bull, hung under his nostrils to measure his breathing.
The equipment is used to diagnose more than sleep problems. People suffering from depression, for instance, have their first dreams earlier in the night. The dreams last longer and they have more eye movements, suggesting more active dreams.
Impotence also brings patients to the center. Most men are erect for about 100 minutes a night. By measuring the rigidity of a patient's penis while he sleeps, the staff can determine whether his impotence is due to organic or psychological causes.
``A lot goes on in sleep that we're not aware of,'' Ware said.
It's around 11:45, and Ballard is ready to go to sleep. He lies down, and Blowe plugs the equipment into an outlet at the head of the bed and turns down the lights. Outside, in the technicians' room, she adjusts some dials on a 7-foot-high console that controls the electrodes. A long sheet of paper scrolls through the machine as a dozen needles trace the peaks and valley of his vital signs - the pattern of his brain waves, breathing and so on.
By the next morning, there will be a stack as thick as several phone books lying beside the machine, documenting every second of Ballard's night.
As Ballard drifts off, the technicians can read the subtle changes in his brain wave patterns that tell them when he is asleep.
Soon, the sound of snoring fills the room, coming from several monitors. Ballard's is not the loudest.
But the needles show how serious his problem is. Every 40 seconds or so, the lines that monitor his chest movement and breathing - which were forming lazy humps while he was awake - falter and go flat. He is not breathing. A few seconds later, the line that monitors his blood oxygen level drifts downward.
Suddenly, he snorts and jerks just a little bit. The needles monitoring his body movements skip wildly, spattering ink. He settles down. His blood oxygen level drifts upward again. He never completely awakes.
Less than a minute later, the whole cycle starts again.
There is no medication for obstructive sleep apnea. Sometimes, the cure is surgery to trim the tissue at the back of the throat. Sometimes, a dental device can be used to keep the airway open, although Wooten, Ballard's doctor, says dentists sometimes sell devices without a good understanding of how they're supposed to work.
The most likely option for Ballard is a machine that pumps air through a mask he'll wear over his nose. The air has just enough pressure to keep his airway open.
Other sleep disorders can be cured through medication. ``REM behavior disorder'' attacks people while they're dreaming, the times during the night when their eyes move rapidly back and forth. Most people are paralyzed during that part of the night - at the sleep center the monitor needles tracing body movement go completely flat, while the lines watching eye movement jump up and down.
But some people, particularly men middle-aged and older, lose the paralysis and act out their dreams. It's different from sleepwalking, which occurs in a non-dreaming stage and usually affects children and young people.
One sufferer Ware knows dreamed he was a prisoner in a basement. The guard opened the door, and the man ran up the stairs toward freedom.
In real life, he jumped out of bed, stepped onto a chair beside the bed and tried to step onto the back of the chair. The chair tipped over and he careened into the wall.
Another man dreamed he was a superhero and tried to leap through a window. Fortunately, his aim was off. In more serious cases, men have dreamed of intruders and strangled their wives.
At 5 a.m., Ballard was still snoring a little. Blowe had awakened him earlier to put on the air pressure machine, but she still was experimenting with different air pressures, which she controlled by a remote switch.
Blowe had gone to get a drink and walk around a bit. The other two technicians were slumped in chairs, eyelids drooping a bit. It's ironic - they never get a full eight hours' sleep during the day. The demands of the daytime world don't stop just because you work the night shift.
A few hours later, Dr. Wooten reviewed the pages and pages of Ballard's sleep session. He decided to order a breathing machine.
Ballard's throat muscles will still droop at night, but the air pressure from the machine will keep the airway open. He will have to wear the machine's plastic mask every night, all night, for the rest of his life. It beats not breathing.
Ballard has imagined life after he gets his machine, when he'll finally know the feeling of a good night's sleep. Some people, he said with a laugh, wake up and say, ``Good morning, Lord!'' Others say, ``Good Lord. Morning.''
He loves being a country pastor. But by 5 p.m., he's exhausted. He forces himself to stay up till 10, but it's hard. What would it be like to wake up full of energy, to never have to worry about falling asleep at the wrong time?
For the past five years, he's been working on a wood carving of a goose for his wife. He can't get it finished.
``When you don't have energy, you don't do those things,'' he said. ``It gets tiresome, being tired all the time.'' ILLUSTRATION: Staff photos by Beth Bergman
The Rev. Basil Ballard, who suffers from sleep apnea, is closely
monitired while dozing at the Sleep Disorders Center at EVMS and
Sentara Norfolk General.
Ballard makes a face while getting wired by sleep clinic technician
Sonya Blowe with about two dozen electrodes he will wear for the
evening.
[side bar]
GETTING A GOOD NIGHT'S SLEEP: WHAT THE EXPERTS RECOMMEND
Doctors call it ``sleep hygiene,'' the regular behaviors everyone
should practice for a good night's rest. Here are some tips:
Go to bed and get up at about the same time every day.
If you nap, do so every afternoon at about the same time.
Exercise regularly but not right before bed. Do vigorous exercise
in the late afternoon, at least six hours before bedtime. Do light
exercise, like simple stretching or walking, at least four hours
before bed.
Cut off the caffeine at least six hours before bed.
Avoid alcohol after dinner. Although alcohol may make you feel
sleepy at first, it disturbs normal sleep patterns.
Limit your use of sleeping pills. If you take them too much, they
can aggravate sleeping problems.
Find the right room temperature and maintain it.
Try to relax before going to bed. Avoid stressful activities and
thoughts. Establish relaxing rituals, like a warm bath, light snack
or 10 minutes of reading.
Don't eat heavily right before bed.
If you can't sleep, try to maintain your regular schedules of
light and dark. Lie in the dark listening to music rather than
turning on a light to read.
Graphic
GETTING HELP
The Sleep Disorders Center at Sentara Norfolk General and Eastern
Virginia Medical School can be reached at 668-3322. The center has
been accredited by the Association of Sleep Disorders Centers.
Three other hospitals run sleep centers in South Hampton Roads.
None has been accredited by the professional association.
For information on Obici Hospital's Sleep Disorder Center, call
the physician referral line at 934-4999.
Portsmouth General Hospital runs a program through its
neurodiagnostic department at 398-4522.
Virginia Beach General's Sleep Disorders Laboratory can be
reached at 481-8168.
KEYWORDS: SLEEP DISORDER by CNB