Sleep Difficult, but Treatable After Katrina's Onslaught

Images of her mother's floating corpse invade one Katrina survivor's sleep. Two weeks after hurricane Katrina ravaged the Gulf Coast, many people who spent days awaiting rescue with no food or water in flooded attics or on rooftops or overpasses, or huddling in stifling, fetid, crowded, rowdy shelters, report struggling to sleep, distressing dreams, and frequent awakenings.

While tattered sleep is only one of a long list of symptoms of acute stress disorder, it's one that often responds quickly to hypnotic medications and supportive counseling.

Normalization of sleep also can help people in crisis cope better with the challenges of their waking lives, suggested Howard Roffwarg, M.D., a professor of psychiatry and director of the Division of Sleep Medicine at the University of Mississippi Medical Center in Jackson.

“Early treatment of acute stress disorder often prevents progression to posttraumatic stress disorder,” Roffwarg noted.

The city of Jackson, where 80-mph winds downed trees and disrupted power but did not cause flooding, provided shelter in its coliseum for about 1,300 evacuees from the 90-mile stretch of Gulf Coast that took the brunt of the storm. The University of Mississippi Medical Center set up ad hoc multispecialty clinics in the trade mart adjacent to the coliseum.

Most of the people Roffwarg and colleagues saw in the first two weeks after the hurricane had evacuated ahead of Katrina's landfall on August 29. They did not face imminent danger from the flooding or witness injuries or deaths. Still, Roffwarg said, most reported feeling stunned and anxious. Some didn't know where relatives were or how friends had fared in the storm. Some knew they had no home, possessions, or job to return to. As they narrated what had happened to them, he said, they expressed great apprehension about having to start their lives anew.

“I saw chins quivering and tears welling up,” he reported. Most of these people reported having much more trouble sleeping than usual.

Telling their story and receiving reassurance that their reactions were normal brought some relief, Roffwarg said. He gave some people a prescription for a two- to four-week course of a low-dose benzodiazepine with both sedative and antianxiety effects, such as alprazolam, lorazepam, or clonazepam.

Most of these individuals had no history of psychiatric disorders or abuse of alcohol or drugs. None reported feeling suicidal. Development of tolerance to and dependence on the prescribed short-term medications is unlikely in this population, Roffwarg said. Nevertheless, he advised those who received prescriptions to return for follow-up to the medical center's regular psychiatry clinic or see another physician if they relocated elsewhere, he said.

“Their life circumstances are not going to improve immediately,” Roffwarg said.

Many responders to the crisis—physicians and other medical personnel, police and other community workers, telephone and power company employees, relief organization staff and volunteers, and ordinary citizens—worked nearly nonstop to provide help. They typically grabbed a little sleep at odd hours, in buildings such as schools or churches, if they could, but often on the open ground, in cars, or other dicey spots.

Physicians from New Orleans' Charity Hospital slept in red, infectious-waste bags on the roof of the adjacent Tulane University Hospital parking garage, using stacks of diapers for pillows, while security guards and a Marine sniper watched out for marauders below, according to a report in the New York Times.

Marcus Franklin, a staff writer for the St. Petersburg Times in Florida, was shot and wounded in an attempted robbery while covering Katrina's aftermath in Baton Rouge, La. Franklin blamed four days of sleep deprivation for his lowered vigilance to his surroundings.

Assuring that rescue and relief workers get enough sleep to maintain their alertness and decision-making skills is crucial to successful management of catastrophic events, said Jerome Barrett, executive director of the American Academy of Sleep Medicine (AASM), based in Westchester, Ill. The AASM issued public service announcements urging responders to schedule periodic naps to avoid extreme fatigue.

About 40 sleep disorder centers are located in the Louisiana-Mississippi-Alabama southern-rim areas worst hit by Katrina. Spotty phone and power service two weeks after the storm left assessment of damage to these centers incomplete.

The AASM created a hurricane disaster relief fund to help repair damaged sleep centers and sleep specialty practices, and plans to disperse all of the contributions received as grants starting in October, Barrett reported. It also is coordinating donations of therapeutic equipment from manufacturers and other sleep centers, including continuous positive airway pressure devices needed by patients with sleep apnea.

More information on the AASM's huricane disaster relief fund is posted at<www.aasmnet.org/HurricaneRelief.aspx>. The National Sleep Foundation has posted tips to foster sleep in times of crisis at<www.sleepfoundation.org>.▪