If you’ve seen one sleep clinic, you’ve seen them all: a few consulting rooms, a spartan bed or two, computers, wires. Some clinics, of course, are more handsome than others, and the Stanford University Sleep Disorders Center is one of these. Created in 1970 in answer to requests for treatment, SUSDC consists of a yellow corridor of offices on the third floor of the Stanford Medical Center and a “sleep laboratory"—five bedrooms, a computer room, and an isolation chamber modeled on one at the Montefiore Hospital in the Bronx— in another building.
Desperate about your sleep, you phone Stanford for an appointment. You will be expected first to have your doctor send your medical records and his or her description of what the trouble seems to be. You will be only an outpatient at SUSDC. (Logically enough, you may spend the night, but not the day, at a sleep clinic.) The Stanford doctors’ job is to find out what causes your sleep problem. They then send you back to your own physician for any long-term care.
Once you are checked into the Medical Center, a doctor will examine you and get your own version of your difficulty. You will then fill out what may seem like endless questionnaires about how you live and how you sleep, or how you think you do. Often, your own opinion of your sleep can be wide of the mark. Therefore, if you complain of insomnia, the Stanford staff will insist that you come back some night for an impartial sleep record, called a polysomnogram. At the sleep laboratory, you will change into your nightclothes and sit on a chair while a technician attaches some electrodes with surgical tape (they do not hurt, and you will not get a shock). You will have at least two electrodes on your scalp, one on the outside of each eye, and three on your chin. If you have complained of night twitches that wake you up, another electrode may be fastened to your left leg. If your breathing seems to be part of the problem, an electrode may be fastened to your nose, or to a mercury-filled tube across your chest, to record its expansions and contractions.
Trailing a ponytail of wires, you walk into one of the bedrooms and lie down. The technician will attach your wires to the headboard (they are long enough to give you full freedom of movement) and, with the assurance that he is available at any time at the other end of the intercom, he will leave you, with some magazines, to go to sleep—or to try to. The technician will monitor the eight-channel polygraph which will mark down lines for your brain waves, your eye movements, your muscle tone, and whatever other rhythms seem indicated in your case. By the end of the night, the polygraph will have a complete record of when you fell asleep, how long you slept, how much of it was dreaming sleep, and when you woke up. If you are an involuntary kicker, the electrode on your leg will also record those unmistakable blips at regular intervals.
You may have to have more than one polysomnogram before Stanford can pin down the source of your difficulty. If you have been overdosing on liquor or pills, you may need to spend some time in the hospital for detoxification. A “reactive insomnia,”which can happen when one first stops taking medication, discourages some people. When they do stop taking the pills, they often find to their surprise that they are sleeping a lot better.
So little is still known about the causes of and solutions for many sleep disorders that Stanford asks those patients who are willing to become research subjects also. Diagnosis is still much too time-consuming. If, for example, you have an unusual circadian rhythm, which makes you sleepy when other people are likely to be awake, the usual way to discover it has been to monitor your temperature for a week with a deep rectal thermometer attached to a thirty-foot wire. Dr. Laughton Miles, a New Zealand M.D. with a Ph.D. from Cambridge University, who runs the diagnostic services of SUSDC, has now invented two devices that attach to your belt. One of them measures pulse rate and the other measures temperature and body movement. Stanford hopes such inventions will cut down the somewhat staggering cost of sleep-disorders diagnosis (between $125 and $730 per patient at Stanford).
Some problems require special medication; others, the help of psychotherapy. But if you are lying awake because you are preoccupied about something or have not had enough exercise, you should be able to work out your own solution. And if you are just getting older and hence sleeping less, the answer may be to welcome the extra time awake and make some use of it. The sleep specialists are fairly sure of at least one thing: We sleep in order to be awake, not vice versa. —R.M.G.