For health monitor ///////// winter 2000

Sleep Disorders Clinic

By Andrew Gorosko

In the Sleep Disorders Center at Danbury Hospital, Arthur Kotch, MD, and Arthur J. Spielman, PhD, look intently at a long piece of graph paper bearing a chronological record of a patient’s physical activity.

The graph provides the doctors with empirical evidence of the man’s activity, as they seek to diagnose his sleep-related problem and how it can be resolved.

Dr Kotch, a specialist in pulmonary medicine, is the director of the Sleep Disorders Center. The doctor also is an associate clinical professor of medicine at the Yale University School of Medicine.

Dr Spielman, a clinical psychologist, is the director of research and education at the Sleep Disorders Center.

“Uninterrupted and restful sleep is essential for a healthy life. Yet many people suffer from chronic, treatable sleep problems that cause them fatigue, irritability, medical problems, morning headaches, lost time from work, and an inability to concentrate,” according to the sleep center.

The Sleep Disorders Center at the hospital, which is accredited by the American Sleep Disorders Association, offers people help with various sleep problems including sleep apnea, insomnia, narcolepsy, parasomnias, sleep cycle disturbances, and restless legs syndrome.

Simply put, sleep apnea involves very loud snoring, pauses in breathing during sleep, and excessive daytime sleepiness.

Insomnia concerns difficulty with falling asleep or staying asleep, or insufficient, disturbed, or non-restorative sleep.

Narcolepsy is excessive daytime sleepiness.

Parasomnias include sleep walking, sleep talking, and sleep eating, as well as bed-wetting and sleep terrors.

Sleep cycle disturbances involve sleep cycles that are advanced or delayed from normal sleep cycles, as well as problems adjusting to shift work.

 Restless legs syndrome concerns involuntary leg movements that disturb sleep, or prevent the onset of sleep or continued sleep.

  The sleep center has gown from a part-time sleep laboratory to a busy center, said Dr Spielman, who is a diplomate of the American Board of Sleep Medicine and a full professor of psychology at City College of New York.

The sleep center conducts sleep studies to determine if a person has a primary sleep disorder. During such sleep studies, staff members perform “polysomnography,” continuously non-invasively electronically monitoring patients as they sleep in testing rooms, which have bedroom furnishings similar to those found in a hotel room.

The testing rooms are equipped to detect sounds made by patients during sleep, Dr Spielman said. The patient is wired with electronic sensors to record brain activity, breathing, blood-oxygen levels, heart rhythms, limb movements, eye movements, and snoring.

“There’s a lot of monitoring,” Dr Spielman said.

In the testing, patients go to sleep in the three testing rooms at their typical bedtimes. The center also conducts daytime sleep studies for patients who must sleep in the daytime due to their jobs.

Before conducting sleep studies, patient histories are taken by staff members to show doctors where to look in diagnosing sleep problems.

Sleep center staff members, including physicians, psychologists, and sleep technologists, review the sleep studies, interpreting the information derived from test equipment. The staff then discusses the findings with patients.

The patient’s primary care physician receives a report, including a diagnosis and recommended treatments to resolve the problem.

Sleep Apnea

A common sleep disorder treated at the sleep center is sleep apnea. “Apnea” is a Greek word that means “want of breath.”

Loud, habitual snoring may indicate a potentially life-threatening disorder called “obstructive sleep apnea,” according to the American Sleep Disorders Association.

Such loud snoring may indicate that the person’s airway is not fully open during sleep, with the loud sound caused by efforts to force air through the narrowed air passageway.

In overweight, middle-aged men, very loud habitual snoring may be the first indication of the potentially life-threatening disorder. In sleep apnea, sufferers don’t get enough oxygen during sleep. The condition may cause excessive daytime sleepiness, and may result in high blood pressure, heart failure, heart attack, and stroke, according to the association.

 The hospital’s sleep center treats sleep apnea in various ways. Weight loss can have a positive effect on the problem. Surgery, in some cases, may be indicated.

Use of a respiratory device which assists nighttime breathing usually has immediate beneficial effects and can have dramatic positive effects, according to Dr Spielman. The breathing mask device, which is affixed to a patient’s head with elastic straps, fits over his or her nose. Known as a C-PAP mask, for “continuous positive airway pressure,” the device pushes air through the patient’s respiratory system, enhancing nighttime breathing. The breathing mask often is the best approach in helping people with sleep apnea, Dr Spielman said. The vast majority of patients see improvements in their conditions, he said.

An estimated 4 percent of males and 2 percent of females have sleep apnea, said Dr Kotch. By comparison, an estimated 10 percent of the population experiences insomnia.

For people who travel, portable C-PAP devices are available to provide them with breathing help at night.

For people who are not able to tolerate wearing a mask while sleeping, a dental appliance, which repositions the jaw to open up the airway, may be employed. 

Restful sleep has definite benefits, according to the sleep center. Well-rested people wake up refreshed and alert, ready to enjoy daily activities in a good mood. People work more effectively, drive more safely, and spend their leisure time awake and rested. People have more energy and motivation, and have better concentration.

Also, a good night’s sleep allows a patient’s spouse or partner to get a quiet night’s sleep in the same room.