A Sleep Specialist is a physician or advanced practitioner with advanced training and expertise in the management of disorders of sleep and wakefulness. Disorders managed by sleep specialists include, but are not limited to, sleep related breathing disorders, insomnia, excessive sleepiness, fatigue, circadian rhythm sleep disorders, parasomnias and sleep related movement disorders.
Our sleep physicians are dually trained and Board Certified in the subspecialties of sleep medicine AND another medical specialty.
We specialize in the clinical assessment, physiologic testing, diagnosis, management, and prevention of sleep and circadian rhythm disorders. Sleep specialists use multidisciplinary approaches, incorporating treatments from medicine, psychology, and even dentistry when needed.
Each of our physicians has their own unique specialty training offering a different perspective on common problems. At the same time, we share common skills in sleep disorders management.
During normal sleep, our airway muscles remain open permitting air flow properly. However with sleep apnea, the airway muscles can relax and become totally blocked, resulting in diminished air flow or complete obstruction. This repetitive process is described as sleep apnea.
While many people have signs of snoring, not all snoring is related to sleep apnea. On the other hand, if snoring is associated with certain symptoms, such as sleepiness or non-refreshing sleep, this may be an indication of sleep apnea which requires further evaluation. Recall that while sleep partners are often the ones to complain about snoring, treating one's snoring can improve the sleep quality of the bed partner affected as well.
Common symptoms associated with sleep apnea include restless sleep, awaking with a choking, gasping, smothering, or snorting sensation, morning headaches, dry mouth, frequent need to urinate during the night, sweating during sleep, waking up unrefreshed, daytime sleepiness, and memory impairment.
Risk factors for sleep apnea include increasing age, male sex, obesity, certain sedating medications, alcohol use, or abnormal upper airway anatomy.
Neck Size? Men with neck sizes of 17 inches or greater and women with neck sizes of 16 inches or greater have a higher risk of sleep apnea.
Patients with poorly treated high blood pressure requiring at least two or three medications are at higher risk for sleep apnea.
Patients with cardiac rhythm problems, such as atrial fibrillation in particular, are at increased risk of having sleep apnea.
If a bed partner specifically identifies pauses in breathing, this is a very sensitive indicator of having this disease.
The complications of sleep apnea include increased risk of accidents because of daytime sleepiness and inattentiveness. The effects of sleep disorders can be significantly more than driving while under the influence of alcohol. There have been studies showing that people with severe sleep apnea are two times as likely to be involved in a motor vehicle accident as opposed to people without this condition.
In addition, there is now ample medical evidence showing that untreated sleep apnea can increase the risk of cardiovascular problems such as high blood pressure, heart attacks, abnormal heart rhythms, or stroke. It has also been associated with poorly controlled diabetes mellitus.
In pregnant women, there is increasing evidence that untreated sleep apnea can be associated with complications toward the end of pregnancy and smaller weight babies.
The best way to identify this particular disease is by performing an overnight sleep test called a polysomnogram. The test is performed in a comfortable hotel-like atmosphere with highly trained technicians that monitor breathing, brain, leg movements, and heart parameters throughout the night. It is a painless test and can provide invaluable information on how to proceed with further treatment. In some cases, a home sleep study can be arranged as well. It is advisable to have a board certified sleep physician review these results for the most accurate interpretation.
If one is diagnosed with obstructive sleep apnea, the severity of the disease can dictate the potential treatment options.
Most people are familiar with CPAP, a device that produces air pressure using a soft and pliable nasal mask placed over the nose which provides mild pressure support to prevent the throat from collapsing throughout the night. While it may take several weeks or months to get used to this particular treatment, it can be particularly rewarding as it can improve sleep and reduce multiple risk factors discussed above.
Your sleep physician may also discuss alternative treatments.
Dental Treatments – With mild or moderate sleep apnea, an oral appliance, which is a modified dental guard, may be suggested. This is usually a custom-designed dental guard that helps maintain an open airway throughout the night and is generally well accepted. It does require at least ten native teeth.
Nasal Valves – Newer alternative treatments for sleep apnea continue to develop including a novel nasal device called "Provent". Board certified sleep physicians are well versed on this newer form of therapy.
Tongue retaining device - This treatment may be a reasonable alternative for snoring or mild sleep apnea and is available through our office.
Surgery – On occasion, surgical treatment may be an alternative form of therapy or as additional therapy to help remove excess tissue in either the nasal area or the throat area, which may improve airway movement. The success rate with surgery is roughly about 50% and sometimes is used in combination with other forms of treatment.
Weight loss – Other forms of treatment for sleep apnea include weight loss. Weight loss can reduce the severity of sleep apnea and in some cases of mild sleep apnea can actually eliminate the disease. But one cannot assume that weight loss alone will cure the problem without retesting after weight loss has been achieved. Avoidance of alcohol and sedating medication can also decrease the severity of sleep apnea. Sometimes avoidance of sleeping on your back can reduce the severity of sleep apnea. Unfortunately this is difficult to achieve throughout the entire night on a consistent basis.
A board certified sleep physician is the best resource to determine which optimal treatment you should pursue. It is important to find an acceptable form of therapy.
Consider sleep apnea as a chronic illness that requires control.
No real cure currently exists. Just as in conditions such as high blood pressure or diabetes mellitus. It requires regular follow-up and treatment to help reduce complications and improve symptoms.
Chronic insomnia is a complex problem with many potential causes. Sleep specialists perform comprehensive evaluations and individualize therapy based on sleep behaviors and sleep rhythms. Sleep diaries and even smartphone apps are helpful tools utilized to help direct treatment plans.
This relatively common problem can contribute to insomnia and non-restorative sleep. Sleep specialists perform comprehensive evaluations including blood work for potential mineral deficiencies that contribute to this disorder. A thorough medication evaluation (both prescriptions and over the counter) is essential to the evaluation.
- Do you experience any of these problems? (a) Unintentionally falling asleep during the day, (b) General daytime sleepiness, (c) Unrefreshing sleep, (d) Fatigue, (d) Insomnia
- Do you ever wake from sleep with a choking sound or gasping for breath?
- Has your bed partner noticed that you snore loudly or stop breathing while you sleep?
Other questions you can ask yourself to determine if you are at higher risk for sleep apnea include:
- Have you ever nodded off or fallen asleep while driving?
- Do you often wake up with a headache?
- Do you have a neck size of 17 inches or more?
- Do you have a body mass index (BMI) of 25 or higher?
- Do you have high blood pressure?
- Do you have a family member who has sleep apnea?
Obstructive sleep apnea is a common and serious sleep disorder that causes you to stop breathing during sleep. The airway repeatedly becomes blocked, limiting the amount of air that reaches your lungs. When this happens, you may snore loudly or making choking noises as you try to breathe. Your brain and body becomes oxygen deprived and you may wake up. This may happen a few times a night, or in more severe cases, several hundred times a night. The lack of oxygen your body receives can have negative long-term consequences for your health. This includes:
- High blood pressure
- Heart disease
- Pre-diabetes and diabetes
A board certified sleep physician can help you select a treatment plan that is right for you. Depending on the treatment, he or she may work in collaboration with other members of the sleep team, including dentists, psychologists, physician assistants, nurses, and technologists. Treatment options include:
- Oral Appliance Therapy
- Weight Management
- Positional Therapy
- Lifestyle Changes