Tuesday, February 28, 2006

Somnus Sleep Clinic in the News

An article in the Clarion-Ledger newspaper features Somnus Sleep Clinic:
The lesson: Listen to your spouse.
For 23 years, John Kirk snored and Linda Kirk endured.
It got so bad about 10 years ago, John hardly slept - and often, neither did Linda.
John was tired all the time, went to bed early, skipped outings, stopped exercising and made sure to do important tasks in the morning, because he was so wiped out later in the day.
He'd often stop breathing for long periods while sleeping, awake gasping for air, and remember none of it in the morning.
But still, his wife's suggestions notwithstanding, he did not seek medical advice.
He wishes he had.
Like most other sleep disorders, sleep apnea isn't all that hard to deal with once you know you have it.
"My sense is there are an awful lot of people out there doing like I did for one reason or another, your ego, whatever," said Kirk, 55, an IT manager from Brandon.
That's almost certainly true, said Dr. Michael Rack, a specialist in sleep disorders.
"Sleep disorders are very common," said Rack, who left the sleep disorder clinic at the University of Mississippi Medical Center last year to help open Somnus Sleep Clinic in Flowood.
Rack said an estimated 2 to 4 percent of the population suffers from sleep apnea, as many as 10 percent from what's called restless leg syndrome, and an untold number from various forms of insomnia.
But apnea - when you stop breathing for extended periods during sleep - is "the bread and butter of sleep medicine," he said.
That's because it's so serious. Sleep apnea deprives your brain of oxygen. There's some evidence it also can lead to high blood pressure, weight gain, heart trouble and loss of brain power.
Which is why Kirk thinks he used to forget things, like what restaurant he and Linda were going to for dinner.
What pushed him over the edge was when Linda told him a while back that she counted how long he'd stopped breathing while he was asleep. It was 30 seconds.
Unbeknownst to either of them, he was doing that all the time.
The National Institutes of Health points out sleep apnea can lead to heart disease, heart failure or stroke.
Linda looked for help and found Somnus, a sleep clinic with a homey atmosphere. John was reluctant to go to a sleep clinic because he was intimidated by what he figured would be a clinical, hospital-like atmosphere.
Clinic technicians hooked John up to a dozen electrodes and watched him sleep for about four hours in what's called a sleep study.
What they found was amazing: He wasn't breathing for 10 to 20 seconds every couple of minutes. That's considered a moderate case of sleep apnea.
After four hours of sleep, they woke him, hooked him up to a machine that helps people with sleep apnea breathe, and he slept like a baby for the rest of the night.
"For the first time in 20 years, he slept for five hours straight," said Linda.
The machine is called a CPAP, which stands for continuous positive airway pressure. It's basically a mask that gently blows air into your mouth.
(in most cases, it's the nose)
That usually fixes the problem, Rack said.
A dentist can provide a device that's placed in the mouth and keeps the airway open.
In more severe cases, surgery to open an obstructive airway is sometimes necessary.
But the CPAP fixed Kirk's problem, he said.
It was a little weird, at first, sleeping with a mask on, he said, but it changed his life so much he'd go to bed wearing a Darth Vader mask and hugging an oxygen tank if he had to.
Since undergoing the sleep study three weeks ago, he said, he's been sleeping all night, every night. He's dreaming again, something he hadn't done in a long time because he wasn't sleeping deeply enough.
He's no longer snoring, isn't tired at work, and has some of his old personality coming back, Linda said.
In short, he's learned to listen to his wife.
"I can't overemphasize enough the importance of listening to your spouse," he said. "They're the people who suffer when you're snoring. They're the people who monitor you and worry.
"Without her," he said, "I would never have come in."

Saturday, February 18, 2006

Sleeping Pill Wars

An editorial in the New York Times talks about the high use of sleeping pills in American society:
Americans are popping sleeping pills at a rapid rate, thanks to heavy marketing by the drug companies and a belief that a new generation of sleeping pills is safer than its predecessors. The upsurge is raising justifiable concerns that the pills will be overused by people who don't really need them or that doctors may reflexively prescribe pills while ignoring underlying conditions that may be responsible for sleeplessness.
As Stephanie Saul reported in The Times recently, some 42 million sleeping pill prescriptions were filled last year, up nearly 60 percent from 2000. More and more people are turning to a new generation of sleep aids called "Z" drugs. The best seller is currently Ambien, but over the past year it has been vigorously challenged by a newcomer, Lunesta, prompting a huge advertising and marketing battle.
Decades ago barbiturates were the drugs of choice for insomnia, but they are addictive and carry a high risk of death by overdose. In the 1970's they were largely displaced by benzodiazepines, drugs that include Dalmane and Halcion, which are less prone to overdose but have their own unpleasant side effects, including next-day drowsiness, dependence and withdrawal symptoms. The Z pills were developed to overcome such side effects.
But any implication that they are a huge breakthrough must be viewed skeptically. Roughly speaking, the recommended starting doses of two brand-name Z pills seem to cut only 15 minutes or so from the time needed to fall asleep after taking a placebo, while extending the duration of sleep by a half-hour or less. Most are classified as controlled substances because they can be abused and can cause dependence. Recent evaluations have reported finding no evidence that Z drugs are much different from their predecessors in terms of effectiveness and short-term adverse events.
Most experts believe that people should try a range of tricks, like minimizing the habits that interfere with sleep, before turning to pills. Some experts say psychotherapy, where available, has more lasting effects than sleeping pills. Insomniacs need to weigh whether sleeplessness is worse than the pills designed to ameliorate it.

I haven't heard the term "Z pill" used before. The Z pills include Lunesta, Ambien (and now Ambien CR), and Sonata. The Z pills bind to a subtype of the benzodiazepine receptor, and are more selective than the benzos such as valium and xanax. The Z pills have fewer side effects than the benzos: they are less addictive, and cause fewer memory problems.
The article mentions psychotherapy for insomnia. This is not commonly available. Here is a list of the less than 100 doctors and psychologists in the country who are certified in behavioral sleep medicine.

Friday, February 17, 2006

I'd love to do a sleep study on this guy

The Drudge Report links to this story about a Vietnamese man who hasn't slept since 1973:
You’d think going without sleep for that long may have its drawbacks, but not for the man in central Quang Nam province who has never been ill after decades of insomnia.
His inability to sleep has not only made him famous, but also represents a “miraculous” phenomenon worthy of scientific study.
Sixty-four-year-old Thai Ngoc, known as Hai Ngoc, said he could not sleep at night after getting a fever in 1973, and has counted infinite numbers of sheep during more than 11,700 consecutive sleepless nights.
“I don’t know whether the insomnia has impacted my health or not. But I’m still healthy and can farm normally like others,” Ngoc said.

Insomnia frequently occurs after brain injury (usually by trauma, but fever and infectious disease can also cause brain injury). However, I am not aware of any medically-documented cases of total insomnia. I do not believe this story, he must drift off into sleep at some point during the 24-hour day.
A recent movie dealt with this topic.

Thursday, February 16, 2006

Sleep Education

The American Academy of Sleep Medicine now has a Sleep Education site aimed at patients with sleep disorders.

Saturday, February 11, 2006

Oral Appliances for Sleep Apnea

The National Sleep Foundation reports on the new American Academy of Sleep Medicine Practice Parameter for the use of oral appliances for the treatment of obstructive sleep apnea:
An oral appliance for sleep disordered breathing is a device that a dentist fits on the teeth or mouth to reduce snoring and to treat sleep apnea. Given how creative dentists are hundreds of such devices have been developed. Now the American Academy of Sleep Medicine (AASM) has updated its practice parameter recommendations for use of such devices. AASM’s experts find that the devices can be effective to treat snoring and mild to moderate sleep apnea, but they also caution that there is much more evidence – and better evidence – that continuous positive air pressure (CPAP) should be the first form of therapy for obstructive sleep apnea. They also caution that patients fitted with oral devices should be thoroughly evaluated before and after a device is fitted to determine whether it is not only reducing snoring and improving sleep as perceived by the patient, but also maintaining blood oxygen at the appropriate levels. But according to one practitioner of dental sleep medicine, it is very important to find a specialist who is familiar with the many available types of devices. He said that too many dentists fitting patients with oral appliances are familiar with only one type and this is an area where "one type does not fit all."
The major changes compared to the old 1995 practice parameters are:
1) a follow-up sleep study to ensure resolution of OSA is now recommended even for mild cases of OSA
2) the new parameters specify that dentists should be fitting these devices. There are some oral appliances out there that can be fitted by physicians without dental training. I was planning on using one of these in my sleep practice, but will now reconsider this.