SLEEP MEDICINE AT CHESTNUT HILL HOSPITAL
S. David Scott, Ph.D., M.D., A.B.S.M., F.A.C.P.
Sleep is a fascinating and mysterious part of our lives. Those who enjoy healthy sleep have fewer physical and emotional problems. Good sleep is a sign of contentment.
Poor sleep plays a role in many health problems. Chief among these is hypertension. It is harder to control diabetes in those who are sleep deprived. Poor sleep leads to poor work performance, impatience, intolerance and more accidents. Unfortunately, we live in a culture that does not encourage or reward good sleep habits.
The most common sleep problem is insomnia, which can be treated by education and behavioral modification, but it is often covered up with medication. Due to the masking of insomnia, the most frequently treated sleep disorder in our offices is sleep apnea.
Sleep apnea is a breathing disorder caused by partial collapse of the throat during sleep that obstructs breathing repeatedly. Symptoms of sleep apnea include snoring and excessive daytime sleepiness. When airflow becomes too slow, or stops, the body sounds an alarm and disrupts sleep until normal breathing is restored. The result is non-refreshing, inefficient sleep.
The condition is diagnosed by a sleep study that can be done at Chestnut Hill Hospital. The experience is similar to an overnight stay in a hotel. Lightweight wires are attached to the body. They measure 13 variables in the sleeping patient such as snoring, oxygen in the blood, EKG, airflow and muscle activity. The result is 6-8 hours of sleep data captured on a computer. This data is scored and analyzed. It reveals not only sleep apnea, but also a variety of less common sleep problems.
If sleep apnea is diagnosed, a second study is scheduled to apply the therapy. We use a device called CPAP or Continuous Positive Airway Pressure to treat sleep apnea. A mask attached to a small air compressor covers the nose and assists breathing during sleep so that airflow does not stop. While it is true that getting used to this device takes time and patience, the benefits of healthy restful sleep far outweigh the inconvenience.
All sorts of things can be learned from a sleep study. We can diagnose depression based on its effects on sleep. Unusual sleep problems such as narcolepsy and leg twitching can be demonstrated. The sleep study can reveal interruptions in sleep caused by pain and stiffness in muscles and show the effect of medications on sleep. A sleep study shows REM, or dream sleep, and if it is normal in amount and timing. Since the EKG is recorded all night, heart rhythm disturbances can be found and documented, and we can see if blood oxygen stays in the normal range during sleep. In short, having a sleep study can reveal important information that can be helpful in the diagnosis of many common health problems.
Our program includes pediatric sleep studies and encourages them in children with poor school performance or behavioral problems that may have their origin in poor sleep. Large tonsils in children can cause sleep apnea and tonsillectomy is usually curative. Sleep studies before and after tonsillectomy will prove that. Many children cannot perform early in the morning when school starts. These are the ‘owls’ who prefer getting to bed late. ‘Larks’ on the other hand, like to get started early and go to bed early. These preferences are usually life-long and can be managed and accommodated if diagnosed.
The Sleep Medicine program at Chestnut Hill Hospital celebrates its 8th anniversary on May 21st. In that time we have seen more than 1500 patients and performed more than 3000 sleep studies. Most Sleep Medicine specialists today are Internists with specialty training in Pulmonary (breathing) Diseases. Sleep Medicine can be considered a sub-specialty of Pulmonary Disease since it involves breathing, but other sleep specialists may be Neurologists, Otolaryngologists or Psychiatrists. The field is young compared to other specialties. It was organized in its present form in the early 1990s. It is highly desirable for Sleep Medicine specialists to be Board-certified and for sleep laboratories to be accredited by the American Academy of Sleep Medicine. Scott Rosenberg, M.D., and I are Board-certified Sleep Medicine specialists at Chestnut Hill Hospital. We cooperate closely to maintain excellence in our program, but we have separate private practices in the community.
If you think you have a sleep problem, discuss it with your doctor or contact Dr. Scott (215 233-9494) or Dr. Rosenberg (215 247-8070) to answer your questions or schedule a consultation.