It’s almost 8 p.m. and 8-year-old Emma Brasier’s getting ready for bed. Her green-and-blue owl pajamas belong to her, but almost nothing else in the room does, from the pink bedspread and sheets to the oversized teddy bear slumped on a chair, to the video camera mounted near the ceiling.
Emma is preparing for an overnight sleep study at the Sears Sleep Center in Bangor, one of just a few sleep labs in the state that evaluate kids with sleep problems. Children as young as 18 months old visit the center, with problems ranging from sleep apnea to night terrors.
By the age of 2, most children have spent more of their lives asleep than awake, according to the National Sleep Foundation.
Emma sits gamely while technologist Vanessa Brown attaches a maze of wires to her head and body, with electrodes that will monitor the girl’s brain waves, heart rate, airflow, and eye and leg movements throughout the night. An elastic belt around her chest will track her breath, while a finger sensor detects the amount of oxygen in her blood.
Brown and another technologist will spend the ensuing hours monitoring the readouts from a nearby room, looking for signs that Emma’s oversized tonsils are interfering with her breathing while she sleeps, as her doctor and parents suspect. If they are, she’ll have her tonsils removed.
Brown collects the wires into a bundle behind Emma’s head.
“I’m going to make a special ponytail with them and then I’m going to keep an eye on you tonight,” Brown says. “Remember I showed you where I sit to make sure you’re OK?”
Emma, of Cambridge, nods her head, turning as her father, Wendell, enters the room. He’s also undergoing a sleep study, or polysomnogram, on this Tuesday night, hoping to get a better handle on his sleep apnea. Emma’s stepmother, Shannon, will sleep in the room with her on another bed.
“Hi Daddy,” blond-haired Emma says over her shoulder.
“Hi sweetheart,” Wendell answers as Brown finishes attaching the last few wires to Emma’s head.
“This is what’s happening to you!” Emma exclaims to her dad.
Brown affixes an electrode to the girl’s chin.
“Daddy I have a beard!” she says.
“You know what? Me, too,” Wendell replies with a smile.
While the Sears Sleep Center also evaluates adults, the facility maintains a special focus on children with sleep problems. Established in 1982, the center performed the state’s first sleep study and provides tests and treatment for a range of conditions, including sleep apnea, insomnia, narcolepsy, restless leg syndrome and night seizures, according to founder Dr. James Sears.
While sleep disorders in adults typically lead to daytime drowsiness, sleep apnea and other sleep conditions in children often lead to attention and focus problems, symptoms sometimes misdiagnosed as attention deficit hyperactivity disorder, he said.
“You may see a significant improvement in ADHD symptoms with appropriate treatment of sleep apnea,” Sears said.
An estimated 1 to 4 percent of children suffer from sleep apnea, many between 2 and 8 years old, according to the American Sleep Apnea Association.
About half an hour after her sleep study began, Emma finally nodded off. Brown spotted the precise moment, pointing on her computer screen to where the spikes and dips of Emma’s EEG readout subtly smoothed, a change barely perceptible to the untrained eye.
A small black-and-white TV screen showed Emma laying on her back, arms relaxed at her sides. A microphone picked up the sound of her breathing from her mouth, heavily and just shy of a snore.
Wendell, still waiting for his sleep study to start, popped his head around the corner.
“Oh, it gets a lot louder than that,” he said. “A lot louder.”
Wendell’s readouts will appear on another screen later in the evening. A self-employed contractor, he has been keeping his wife up at night with his tossing and turning. He has used a breathing apparatus called a continuous positive airway pressure machine at night for about two years, but suspects it needs adjustments.
Nationally, insufficient sleep has gained attention as a public health risk, linked to car crashes, industrial disasters, and medical and other on-the-job errors, according to the U.S. Centers for Disease Control and Prevention. People short on sleep also are more likely to suffer from chronic diseases such as high blood pressure, diabetes, depression and obesity, as well as cancer.
An estimated 50 million to 70 million American adults suffer from sleep disorders, according to the CDC.
While the medical community has grown more aware of the risks, with sleep apnea in particular, critics worry that expensive sleep studies for the condition may be overprescribed. Over the past decade, the number of accredited sleep labs testing for sleep apnea has quadrupled, according to an NPR report. Meanwhile, Medicare payments for sleep testing jumped nearly 40 percent from 2005 to 2011, from $407 million to $565 million, according to the Office of the Inspector General, which found the field vulnerable to fraud by providers.
Most of us fall short in judging our quality of sleep, underestimating how many times we wake up and how long we dozed, said Sears, who is board-certified in neurology, sleep medicine and neurodiagnostics. We’re also lousy at assessing when we’re getting drowsy, he said.
“The research suggests that if you’re driving, which is of course one of the most dangerous times, if you feel drowsy, you’ve probably been drowsy for 10 to 15 minutes before you become aware of it,” Sears said.
While many patients are skeptical they’ll be able to sleep in the lab, most manage to nod off, he said. Those with sleep problems often actually get more shut-eye in the lab than at home, an unexplained phenomenon known as “reverse first night effect,” Sears said.
“Out of hundreds of studies a year, it’s probably one to three per year that can’t sleep in the lab,” he said. “It’s a very low number.”
Sears Sleep Center also offers home sleep studies, which insurers favor for their lower cost and work well as a basic screening tool but provide less detailed data than an in-lab study, determining sleep by a patient’s lack of movement rather than brain waves, he said.
Patients are most commonly referred to his lab for sleep apnea, a condition in which breathing briefly and repeatedly stops during sleep, either because the muscles in the back of the throat fail to keep the airway open or the brain fails to properly control breathing.
Sears has seen some wild behavior during his decades at the center, from spouses who unintentionally injure their partners in bed — he acknowledges helping to improve “at least a few marriages” — to sleepwalkers who outwit drastic measures to keep them confined at night.
“If you put a deadbolt on the door, usually the sleepwalker will learn how to open it,” Sears said. “They do quite involved maneuvers.”
Some can even outfox motion detectors, like those installed in store doorways that ping when a person walks past, he said.
“They learn to step over the light beam or even turn the switch off,” Sears said.
Sleepwalkers typically exhibit the same behavior every time, he said. Some cook and prepare food, realizing it only upon discovering a mess in the kitchen the next morning, Sears said.
Sleepwalking is much more common among children than adults. Kids also are more likely to experience night terrors, crying vigorously during deep sleep but appearing awake and resisting attempts by their parents to comfort them. While the child is usually fine in the morning, the same can’t be said for Mom and Dad, Sears said.
The majority of sleep disorders are at least partially treatable, with breathing devices such as Wendell Brasier’s CPAP machine, surgery, or maintaining a rigid routine, Sears said. Medications such as Ambien typically are reserved for insomnia, prescribed most often as the result of a clinical evaluation rather than a sleep study, he said.
Sears, who describes himself as a “fairly good sleeper,” said some patients are amazed at how much better they feel after treatment for a sleep disorder.
“If you’ve had this disorder for a period of years, you tend to forget what it’s like to feel well rested,” he said.
As for Emma, tonsil surgery will be scheduled if her sleep study turns up breathing problems. While the Brasier family awaits her results, she’ll try to get some sleep back in her own bedroom.