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Sleep Disorders

If you are exhausted and do not get sound sleep or if getting more sleep is always on your mind, it is time to seek help from a sleep specialist. Lack of restorative sleep may not just be a hassle, but may actually have adverse implications on your health.

CNSM offers a complete approach to the diagnosis and treatment of sleep disorders. With over 20 years experience and specialty training in sleep medicine, our providers are dedicated to helping patients overcome sleep problems. With the appropriate treatments, most patients are able to regain restorative sleep and report an improved quality of life.


Understanding Sleep Disorders

You are not alone; sleep disorders affect some 40 million Americans a year. While some sleep problems are fleeting, chronic sleep deficiency may affect your health and warrants medical attention.

Common sleep disorders include insomnia, obstructive sleep apnea, restless leg syndrome and narcolepsy. Other disorders that interrupt sleep include snoring, repetitive dreams, sleepwalking, and sleep eating disorders. While these problems may seem benign, if they continue for long periods of time, they can begin to take a significant toll on your health.

Sleep, an essential time of rest and rejuvenation, benefits our minds and bodies in many, often unseen, ways. When you continuously do not get the amount of sleep needed, you may begin to experience the results of the deficiency as daytime drowsiness, trouble concentrating, irritability increased risk of accidents, lower productivity, depression, and anxiety.

Over the last decade, groundbreaking research has been published detailing the detrimental effects of sleeplessness on the body. Not only does a lack of sleep make you tired and less energetic, but sleep deprivation, or non-restorative sleep, can be dangerous to your health. New studies show that chronic sleep deprivation has an effect on the hormone, endocrine, and nervous systems, and may cause long-term changes in the body which increase the risk of obesity, diabetes, stroke, high blood pressure and heart disease.


Symptoms of Sleep Deprivation

How do you know if you are sleep deprived or just tired? If you fall asleep as soon as your head hits the pillow, regularly need an alarm clock to wake up, or feel the need for frequent naps during the day, it is very likely you are experiencing a sleep disorder.

If your sleep partner complains of your nightly snoring and you continually feel you are not getting a good night’s rest, you could be suffering from sleep apnea, the most commonly diagnosed sleep disorder. If untreated, sleep apnea can increase your risk of heart attack, stroke, hypertension, diabetes, cardiac arrhythmia and may also cause weight gain.

Other signs that you may be suffering from a sleep disorder include:

  • Difficulty waking in the morning
  • Poor performance in school, on the job, or in sports
  • Increased clumsiness
  • Difficulty making decisions
  • Falling asleep during work or class
  • Feeling especially moody or irritable

It is important to seek treatment for a sleeping problem because it not only poses a personal health risk but risks to others as well. A sleep deprived person, lacking concentration and experiencing diminished motor skills, can become a danger to others, such as when driving a car or operating machinery. Famous examples of serious large scale accidents which have been linked to sleep deprivation are the Challenger disaster, Chernobyl nuclear reactor meltdown, and the Exxon Valdez oil spill.


Diagnosing Sleep Disorders

The first step to diagnosing a sleep disorder and starting treatment is to meet with one of the providers at Comprehensive Neurology and Sleep Medicine. During the initial consultation, we will review your medical and health history and sleep patterns to better understand the underlying cause of the problem. Sometimes the history review is all that is necessary to begin a treatment plan, but often a sleep study will be recommended. Sleep studies are performed overnight in a specially equipped sleep center.

Some of the more common diagnostic sleep tests include:
Polysomnogram (PSG) – Conducted at a sleep center, a polysomnogram is a diagnostic sleep study that measures the quality of a person’s sleep by measuring the body’s involuntary functions during sleep, such as breathing and heart rate. This study typically lasts one night. A typical polysomnogram records the following data:

  • Brain waves (electrodes placed on the scalp)
  • Eye movement (electrodes placed on the face, by the eyes)
  • Chin muscle tone (electrodes placed on or under the chin)
  • Heart rate and rhythm (electrodes placed on the chest)
  • Leg movements (electrodes placed on the legs)
  • Breathing (breathing sensor placed near the nose and mouth)
  • Breathing effort (two small belts placed loosely around the chest and abdomen)
  • Oxygen level (small sensor attached to the finger)
  • Audio and video taping

CPAP Titration Study – Conducted at a sleep center, a CPAP titration study is a sleep study used to determine the appropriate pressure to be used with a CPAP machine. During the night of a CPAP titration study, data will be recorded as during a PSG; however, a CPAP mask will be added at the beginning of the night. Through the night, the pressure released from the CPAP machine will be progressively increased, or titrated, until it is shown that the patient reaches restful sleep without interruption due to abnormal breathing patterns. This study typically lasts one night.

Split Night Study – Conducted at a sleep center, a split night study is a combination of a PSG and a CPAP titration study. A PSG is completed for the first 2 hours of the study. If significant sleep apnea is noted, then a CPAP titration study will be initiated.

Multiple Sleep Latency Test (MSLT) – Conducted at a sleep center, an MSLT assesses daytime sleepiness and is used to diagnose narcolepsy. This test may be performed after a PSG. The MSLT consists of a series of 20-minute naps, during which the patient tries to fall asleep. The test is given every two hours throughout the day, with each nap lasting about 20 minutes. During each nap, sensors and electrodes record data on body functions (heartbeat, breathing, eye movement, etc).

Blood Work – Blood tests may be ordered to identify an iron deficiency, thyroid abnormality or other abnormalities which can be linked to poor sleep.


Sleep Disorder Treatment

Sleep study results are available approximately five days after the tests have been performed. Once complete, you will again meet with your provider at CNSM to develop an individualized treatment plan. Treatment options vary depending on diagnosis, but may include:

Sleep Apnea – There are five treatment options for sleep apnea: CPAP, a dental appliance, weight loss, or two surgical procedures (UPPP) and Inspire.

The preferred treatment option for obstructive sleep apnea (OSA) by the American Academy of Sleep Medicine is CPAP. CPAP is a medical device that delivers pressurized air via a facial/nasal mask to keep the airway open. Another option is for a dental appliance to be formed by your dentist to advance the jaw and open the airway during sleep. Weight loss is another method, as a significant drop in body weight (10-15%) can decrease the severity of sleep apnea by 50%. Inspire, an implant is newly approved by the FDA. It works through the stimulation of the hypoglossal nerve resulting in an open, unobstructed airway. Lastly, an ear, nose, and throat specialist may complete a surgery called an uvulopharyngopalatoplasty, or UPPP, to enlarge the airway and decrease the severity of sleep apnea.

Narcolepsy is typically treated with pharmaceuticals such as Provigil, Nuvigil or other stimulants.

Insomnia is treated with traditional medication, Cognitive Behavioral Therapy (CBT), adjustments to sleep patterns, or a combination of the therapies. CBT for insomnia is a non-medication approach to the treatment of insomnia. CBT includes the modification of behaviors and beliefs about sleep. This is a tailored treatment plan designed to meet each patient’s specific needs regarding sleep behaviors.

Restless Leg Syndrome (RLS) can be overcome simply through medications such as Mirapex and Requip. When indicated, iron supplements may also be prescribed.

Whatever your diagnosis, the providers at CNSM can offer treatment options to help you restore healthy sleeping patterns. Listlessness and lack of energy do not have to be a way of life. Take the first step to a good night’s rest by calling 301.694.0900.