Time for Bed

Joel Friedman says he always had a snoring problem--of the "rafter-rattling, window-breaking" kind. Friends refused to share a hotel room with him on vacation. His nocturnal breathing often kept his wife awake. But he never thought it was a problem until the night his wife noticed a lull in his snoring--and realized he'd stopped breathing too. "She was worried I was going to die in the middle of the night," recalls Friedman. "She told me I had to call the doctor."

The diagnosis: sleep apnea.

That was three years ago. Looking back now, the 53-year-old copywriter figures he probably suffered from the sleep disorder for decades before he was diagnosed. "I would always be tired during the day, I was always falling asleep," says Friedman, who lives outside Chicago. "But I slept eight hours so I never knew why I was tired. I always thought it was because of my diabetes--I assumed my blood-sugar level was off."

Diabetics are indeed at higher risk for developing sleep apnea, a condition that causes people to stop breathing frequently during the night, often for periods of 10 seconds or longer. But Friedman never thought he had a sleep disorder. While sleep apnea is relatively common, affecting as many as 5 percent of all men and half as many women, sufferers are often unaware they have it. They don't usually wake up when they stop breathing; they just feel tired during the day. But that could describe a growing number of Americans these days. And it's one reason why, in an increasingly sleep-deprived society, disorders are often misdiagnosed--or not diagnosed at all.

As many as 50 to 60 million Americans suffer from frequent or chronic insomnia annually--a figure that is expected to nearly double by 2050, according to an analysis by researchers at the University of Toronto). In addition, 28 million have restless legs syndrome, a neurological condition that disrupts sleep; 12 to 15 million have sleep apnea, and more than 140,000 have narcolepsy, a chronic neurological disorder causing unexpected urges to sleep throughout the day. Others suffer from parasomnia disorders, which include sleepwalking, night terrors, sleep-eating syndrome, and (less frequently) sleep violence. But many don't realize it.

"There's a major problem with the underdiagnosis of sleep disorders," says Carl Hunt, the director of the National Center on Sleep Disorders Research, part of the National Institutes of Health, who estimates that as many as 60 to 70 percent of those with these disorders aren't being diagnosed correctly. Part of the problem, he says, is that "as a society, we just don't value sleep." Sleep specialists blame a lack of awareness in the medical community, as well. "Physicians are becoming more aware of sleep disorders, but there's still a ways to go," says Dr. Clete Kushida, an associate professor and director of the Stanford University Center for Human Sleep Research. "Many of these conditions have always been there but they've been misdiagnosed."