In pursuit of catching a good night's sleep

In pursuit of catching a good night's sleep
May 22, 2005
Wendi Winters
The Capital
As a professor, Katherine Tunney's problem wasn't students dozing off in her classes. The problem was her own quality of sleep and its effect on her mood, concentration and driving.
For years the Annapolis woman suffered from obstructive sleep apnea syndrome, a disorder that wreaks havoc on the ears - and sleep - of those around the sufferer. Five out of 100 people are suspected of having this disorder, which was first described in medical literature in 1965.
A person with sleep apnea often has loud, boisterous snoring that drives spouses from the bedroom and has even been known to annoy the neighbors.
The sufferer's breathing stops and restarts throughout the night in an irregular pattern of snoring, pauses and gasps for breath. The soft tissue at the back of the throat relaxes during deep sleep, blocking the airway. The brain, sensing rising carbon dioxide levels in the body, "wakes" the body up to a lighter level of sleep, forcing it to breathe again.
For some, the blockage cycle only happens a handful of times a night. For others, it may be dozens of times an hour, which prevents their body from reaching - or maintaining - the deep, healthy Rapid Eye Movement sleep everyone needs for several hours each night to awaken refreshed.
"Any more than 20 times an hour, a person is at risk for heart attack, heart arrhythmia or sudden death," cautions Dr. Michael Pardo an ear, nose and throat doctor who specializes in treating patients with sleep problems.
During the day, the sleep apnea victim might suddenly doze off at work, while sitting still or, worse, while driving. And sleep apnea isn't confined to adults. According to Dr. Pardo, it's is the leading reason for taking out tonsils in a child. The cure rate for surgery in children is 90 percent. The success rates for surgical procedures on adults can be as low as 40 percent.
Sleep apnea isn't the only impediment to a good night's sleep. There are at least 80 additional documented disorders, including bruxism (teeth gnashing), restless legs syndrome, insomnia, sleepwalking, narcolepsy (suddenly falling asleep) and sleep deprivation.
The National Highway Traffic Safety Administration conservatively estimates that 100,000 police-reported crashes are the direct result of driver fatigue each year. Falling asleep at the wheel results in an estimated 1,550 deaths, 71,000 injuries and $12.5 billion in monetary losses.
"I wish I were an alcoholic some mornings, it would be easier," says Ms. Tunney. "People who suffer from sleep apnea frequently wake up with a horrendous headache and feel like they have a horrendous hangover."
Sleep apnea
Dr. Pardo suspects sleep apnea caused the death of former Green Bay Packer star Reggie White.
"You have all these big guys with huge necks running around on the field," he says. "While they're pro-athletes, they're fairly fit. But five to 10 years later, all that muscle has gone to fat."
He feels one major cause of sleep apnea is obesity.
"As the population becomes more obese, we're likely to get more cases of sleep apnea," he says.
Before diagnosing the problem, Dr. Pardo, whose practice is located in the Sajak Pavilion, conducts a battery of tests to determine what causes a patient's snoring.
"Most of our patients are sent in by their spouses," he says, smiling. "The first thing is to determine if there's a breathing problem or if it's just obnoxious snoring."
He quizzes patients on alcohol, caffeine, sedative and drug use and on their sleep habits and sleeping position.
Sleep study
One tool he uses is a sleep study, which may be done at home, in a hospital or in free-standing sleep centers.
In mid-March, Ms. Tunney chose to undergo a new, in-office surgical procedure.
The Pillar Procedure, developed by Restore Medical of St. Paul, Minn., is designed to stiffen the soft palate in the back of the roof of the mouth.
Dr. Robert Meek, who runs the Annapolis Snoring Clinic, debuted the technique here.
"It was just approved by the FDA a year ago for use in humans," says Dr. Meek. "It's indicated for mild sleep apnea."
He performed the procedure, which use a disposable, gun-like mechanism to implant three three-quarter-inch polyester cords into Ms. Tunney's soft palate. It took less than 10 minutes.
At $2,500, he says, "it's more expensive than a pair of poly pants, but it stays in style much longer."
If all goes well, within a couple months firm tissue will grow around the implants, making the soft palate resistant to collapsing during sleep.
"I have seen a definite improvement in the quality of sleep I get," says Ms. Tunney. "In July I will be retested by a sleep lab. It takes up to three months for the scarring to occur. At that time the three implants mesh together to further stiffen the soft palate."
Dr. Meek tailors treatments based on "the severity and co-morbidities of a situation. The elderly are more likely to be treated with medicine or CPAP."
'The Mask'
Continuous Positive Airway Pressure, also known as "the mask," is a machine that gently forces air into the nasal passages when its user is asleep. The airflow causes enough pressure to keep the airway open. The machine and mask that fits over the nose are connected by a long, flexible tube. The mask and its nozzle are held in place over the face by straps.
For younger patients, Dr. Meek prefers to utilize surgical treatments ranging from the Pillar Procedure to laser surgery to the radical, and rarely performed, permanent tracheostomy.
He also probes to determine if a patient has reflux as that condition may cause choking during sleep.
"Sometimes apnea can be reduced if the reflux is medically treated. It's a circular phenomenon," he says.
Not all sleeping disorders need to be corrected with surgery. For some sleep-deprived patients, a lifestyle change, such as losing weight, changing a sleeping position, reducing stress or eliminating or reducing alcohol, changing caffeine and cigarette smoking, is all that needed. Still others benefit from a dental appliance designed to pull the jaw or tongue forward, providing a less obstructed airway during sleep.
"Every patient has to be judged separately," says Dr. Pardo.
The Sleep Center
In the basement of North Arundel Hospital is a suite containing two cozy bedrooms, several offices and a room filled with computers and monitors. In this area, lights and voices are lowered. People walk around quietly. It's not a nap center for the employees. It's part of the hospital complex's Sleep Center. An additional two testing bedrooms are upstairs.
Despite the center's quiet aura, it's a busy place. In March, over 110 patients spent the night. A stay in one of the rooms costs $1,400, an expense that may be covered by insurance.
According to manager Sandy Thomas, the center's four beds are often booked six to eight weeks in advance. In the new tower building planned for the hospital, a six-bed unit is being built.
"As people become more and more aware of sleep disorders, sleep centers are filling up," Ms. Thomas said. "Demand exceeds space."
Marlene Boniconti of Glen Burnie spent a night in The Sleep Center in early April. At 310 pounds, Ms. Boniconti suffers from diabetes, rheumatoid arthritis and emphysemia.
"I had sleep problems for a while and never mentioned it to the doctor because I thought he'd think I was crazy," she says. "I'm usually up all night. I'm bored to tears with TV and even tried green tea."
Getting answers
When she went to the sleep center, a technician helped her get acclimated to her room and its soft, sleep-inducing furnishings and began to hook up the 24 pieces of equipment used in the study. A gloopy paste is used to attach tiny color-coded sensors to her body.
Eight types of activity are monitored by the sensors, including brain waves, heart rate and rhythm, eye movements, muscle activity, leg movements, airflow during breathing, breathing movement and oxygen level.
The room is monitored by infrared cameras.
Even slathered with sensors, the patients pop off to dreamland pretty quickly.
"They're here because they can't stay awake!" says Ms. Thomas. "Sometimes we can't push the 'start' button fast enough."
If the idea of going to the sleep center isn't your thing, or you can't wait the up to two months to get in, there are sleep tests that may be done in the home.
"I can test the patient for two, three or four nights at a lower cost," says Dr. Meek, who prefers home sleep tests. He added, that with equipment attached to the body, "there's the 'first night' effect. People don't sleep well in a strange environment."
"The home study doesn't tell you about Rapid Eye Movement levels or serious arythmia, but provides a basic evaluation," he says. "It's more accurate."
Whatever method is used, correcting a patient's sleep problems is good not only for them, but their spouse as well.
"We've gotten husbands back in the bedroom and saved a lot of marriages," says Dr. Meek, laughing. "They're some of my happiest patients."