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Ask the Expert

Are You Getting a Good Night's Sleep? The Importance of Diagnosing and Treating Sleep Disorders

Dr. Carolyn Wang

Are you getting a good night’s sleep? It may be more important than you think. In fact, research has shown a link between sleep disorders and a growing list of chronic and potentially life-threatening medical conditions. A sleep disorder can also affect your mood, memory and ability to learn, as well as your body’s ability to fight off infection and lose weight. 

 

Since 1982, the Suburban Hospital Sleep Disorders Center has been dedicated to improving the quality of life for people with sleep/wake disorders. In this column, the Sleep Disorders Center’s new medical director, Dr. Carolyn Wang, discusses the importance of diagnosing and treating sleep disorders. 

 

What are sleep disorders and how prevalent are they? 

 

The term “sleep disorder” covers a range of conditions, including insomnia, sleep apnea, periodic limb movements, narcolepsy, and snoring. Up to one out of five people in the United States has a sleep disorder and suffers from the consequences of excessive daytime sleepiness that regularly interferes with daily activities, from safely operating motor vehicles to maintaining adequate job performance.  

 

Common sleep disorders include insomnia and a form of sleep apnea known as obstructive sleep apnea. Obstructive sleep apnea is especially dangerous because it is characterized by frequent disruptions in breathing due to the collapse of the airway, as well as low oxygen levels.   

 

What are the most common symptoms of a sleep disorder? 

 

Symptoms of a sleep disorder include loud and/or irregular snoring, interruptions in breathing during sleep, feeling unrefreshed upon awakening in the morning, morning headaches, excessive daytime sleepiness, depressed or anxious mood, attention and memory problems, and/or complaints of inability to fall asleep or stay sleep. 

 

Who is at risk for a sleep disorder? 

 

Anyone can suffer from a sleep disorder, although there are some groups of individuals that are at greater risk. If you are overweight there is a greater likelihood that you suffer from a sleep disorder. Researchers have also linked sleep disorders, specifically obstructive sleep apnea, with cardiovascular disease, stroke, diabetes, and obesity. It has been found that 20  to 30 percent of individuals with neurological diseases experience some type of sleep disorder. In addition, as many as one-third of individuals with poorly controlled epilepsy suffer from sleep disorders.  

 

My bed partner says that I snore. Does this mean that I have a sleep disorder? 

 

It is often the bed partner who prompts the patient to discuss the possibility of a sleep disorder with his/her doctor. That said, snoring — even loud snoring — in and of itself does not always indicate the presence of a sleep disorder. If, however, you are experiencing any of the other symptoms of a sleep disorder, then your loud snoring may be a sign of the sleep disorder known as obstructive sleep apnea.   

 

What can happen if a sleep disorder is not diagnosed and treated? 

 

Chronic sleep deprivation from a sleep disorder can affect an individual’s mood, cognitive functioning, and overall health. There are higher morbidity and mortality rates seen in adults who get less than seven hours of sleep per night. Sleep disorders are an underlying cause for several other disease states and conditions. For example, research has shown that untreated sleep apnea is associated with an increased risk of high blood pressure, heart disease, heart failure, and stroke. Additional studies have demonstrated a connection between sleep-related breathing disorders and type 2 diabetes. Untreated sleep apnea can make it more difficult to manage the symptoms associated with all of these conditions. 

 

In addition, with sleep deprivation, pro-inflammatory factors increase and natural killer (NK) cells decrease, weakening your immune system and making it harder to fight bacterial and viral infections. For all of these reasons, it’s important to diagnose and treat a sleep disorder. 

 

How can I determine if I have a sleep disorder? 

 

You should talk with your doctor about being evaluated for sleep apnea if you’ve been diagnosed with high blood pressure, cardiovascular disease or diabetes; if you’ve suffered a cardiac event or a stroke; if you are overweight or obese; if you suffer from a neurological disease; or if you are experiencing any of the common sleep-disorder symptoms described above.  

 

A careful review of your systems with your doctor should help reveal any underlying sleep issues. If your physician suspects that you may be suffering from a sleep disorder, he or she can then refer you for a sleep study or for a consult with a sleep specialist. 

 

Who can order a sleep study? 

 

Any physician can order a sleep study, but more commonly your primary care physician, cardiologist, neurologist, and pulmonologist will. These physicians can also refer you to a sleep specialist for consultation. The sleep specialist can further evaluate your sleep disturbance and order and interpret a sleep study. 

 

What's involved in a sleep evaluation at the Suburban Hospital Sleep Disorders Center? 

 

The Suburban Hospital Sleep Disorders Center is a hospital-based facility that is a fully equipped diagnostic and treatment center. Patients who are referred for a sleep study, known as an overnight polysomnogram, spend the night at the Sleep Disorders Center, where they are closely monitored while they sleep. Depending on your condition, a daytime nap study called a Multiple Sleep Latency Test (MSLT) may also be ordered.

 

What technology is used during a sleep study and what can I expect will happen?  

 

During an overnight sleep study, electrodes are placed on your scalp to measure your brain waves and eye muscles. These sensors will show how you progress through the various stages of sleep during the night. Monitors are also placed on your extremities to detect twitching or jerking movements and on your chin to detect jaw movement. Additional monitors will measure heart rate, snoring, air flow and oxygen levels throughout the night, as well as movement of your chest and abdomen. A video camera in the room allows the sleep specialist to determine if you are experiencing movement disorders, seizures, or another condition that affects your sleep. All of the monitors used in the sleep study are designed to be as unobtrusive as possible and allow for a full range of movement. The room is dark and quiet, helping to ensure that you are able to best fall asleep and stay asleep. 

 

If a daytime nap study or MSLT is required, you will again be monitored with scalp electrodes to evaluate the stages of sleep you enter during a nap period. You will be given the opportunity to take four to five 20-minute nap periods, which are separated by two hours. 

 

After the sleep study has concluded, the sleep specialist will interpret all of the data to determine if you are suffering from a sleep disorder. This information will then be relayed to your referring physician. 

 

How are sleep disorders treated? 

 

Management of a sleep disorder can take a variety of forms. Treatment may include lifestyle changes, behavioral modification, cognitive therapy, and even sleep restriction. These may be used in conjunction with medications that include hypnotics and stimulants. In the case of obstructive sleep apnea, the use of a breathing machine such as a continuous positive airway pressure (CPAP) device, a dental appliance, or surgery may be recommended. For those patients who require a CPAP mask, newer technology has made these devices much more comfortable to wear. 

 

How much sleep should I get on an average night and how can I help ensure that I get a good night’s sleep? 

 

Adults should strive for between seven hours and eight hours of uninterrupted sleep per night. One way to help ensure that you get a good night’s sleep is to practice good sleep hygiene. This includes limiting the use of alcohol before bedtime; finishing your exercise routine at least three hours before your bedtime; and avoiding caffeine, particularly in the afternoon hours, as well as heavy meals prior to bed. Exercising in the early morning hours; practicing relaxation techniques prior to sleeping; and keeping a cool, dark, and quiet sleeping environment also helps.  Most importantly, keep a consistent bedtime and morning rise time, even on the weekends. 

 

 

About Dr. Wang 

Dr. Carolyn Wang graduated from Brown University with honors with a Bachelor of Science degree in neuroscience. She is a graduate of New York College of Osteopathic Medicine. She performed an internship in internal medicine at Johns Hopkins University/Sinai Hospital followed by a residency in neurology at George Washington University Hospital, where she served as chief resident in the department of neurology and then as a neurology sleep fellow. Dr. Wang is board certified in psychiatry and neurology. 

 

For more information about scheduling a sleep study at the Suburban Hospital Sleep Disorders Center, call 301-896-3939.  Your physician will need  to complete and sign a referral form before you can be scheduled for a sleep study.  To obtain a copy of the form to bring to your physician, go to suburbanhospital.org and search for “sleep disorders center.”

 



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