Conditions We Treat

OBSTRUCTIVE SLEEP APNEA

Obstructive Sleep Apnea is a medical condition where you stop breathing during sleep. Your upper airway becomes blocked repeatedly during sleep causing less air to reach your lungs. The narrowed airway causes snoring by making the tissue in the back of the throat vibrate as you breathe. Your brain detects that there is less oxygen and awakens you so that you can breathe. This may occur several hundred times a night. 

As a result of being awakened multiple times from your sleep you may feel tired or unrefreshed after waking up even though you have had a full night of sleep. Patients with sleep apnea may not be aware that they awaken multiple times during the night as this wake time may be for only a few seconds. During the day, however, you may feel fatigued, have difficulty concentrating or may even unintentionally fall asleep. In addition to snoring and daytime sleepiness, patients with OSA may experience choking in their sleep, multiple awakenings from their sleep to urinate, racing heart beats in their sleep, memory loss, decreased sexual desire, difficulty maintaining an erection, and irritability.  Some children with OSA have mouth breathing, bed wetting, learning difficulties, hyperactivity, cardiovascular complications and growth retardation.  OSA in pregnancy is a risk factor for hypertensive disorders, gestational diabetes, and severe maternal morbidity. 

According to the American Academy of Sleep Medicine (AASM) Obstructive sleep apnea affects nearly 30 million Americans. Approximately 17% to 28% of CMV drivers have OSA. The prevalence of OSA in pregnant patients is estimated to range from 3 to 27 percent. 

OSA can only be diagnosed definitively by a sleep study. A polysomnogram (PSG) is the gold standard for diagnosing this condition. A PSG is sleep which is done in the sleep lab under the care of a sleep technician or technologist. A Home Sleep Apnea Test (HSAT) may also be used to diagnose OSA and is done from the comfort of your home. Once OSA is confirmed, it should be treated.  Untreated OSA may result in worsening hypertension and is associated with an increased incidence of stroke, heart failure, atrial fibrillation, and coronary heart disease. 

Treatment options for OSA include positive airway pressure, positional therapy, oral appliance, nerve stimulator and newly FDA approved medication - Zepbound. 

NARCOLEPSY

Narcolepsy affects 1 in 2000 people. Patients with narcolepsy have excessive daytime sleepiness and uncontrollable bouts of sleep. Other symptoms of narcolepsy include vivid dream-like hallucinations while falling asleep or when waking up , and inability to move completely paralyzed when waking up or falling asleep (sleep paralysis).  Narcolepsy has two forms in both children and adults. Narcolepsy type 1, previously called narcolepsy with cataplexy, includes cataplexy (a sudden muscle weakness when experiencing an intense emotion such as laughter) and is associated with low cerebrospinal fluid (CSF) orexin levels. Narcolepsy type 2, or narcolepsy without cataplexy, shares all of the features of narcolepsy type 1 except cataplexy and low CSF orexin.

Narcolepsy is usually diagnosed by an overnight sleep study (polysomnography) followed by daytime sleep study called a Multiple Sleep Latency Test. Medication and lifestyle modification are the mainstay of treatment of Narcolepsy.

RESTLESS LEGS SYNDROME

RLS is seen in 7- 10 % of the population. Patients with RLS have an urge to move their legs because of uncomfortable sensations,  symptoms usually occur at rest or with inactivity; symptoms are relieved by getting up and moving; and are worse in the evening or night. Iron deficiency is associated with RLS. Mild cases of RLS can be treated symptomatically with warm or cool baths, massage, stretching, electric blankets 

INSOMNIA

Insomnia is one of the most common medical complaints. It is characterized by frequent and persistent difficulty initiating or sustaining sleep despite adequate sleep opportunities and circumstances. The diagnosis of insomnia disorder requires three main components: persistent sleep difficulty, adequate sleep opportunity, and associated daytime dysfunction. The latter may include: fatigue or malaise,  daytime sleepiness, poor attention or concentration, increased errors or accidents, social or vocational/educational dysfunction, mood disturbance or irritability, reduced motivation or energy, behavioral problems such as hyperactivity, impulsivity or aggression or ongoing worry about sleep.

Acute insomnia, also referred to as adjustment insomnia usually lasts for less than three months and occurs in response to an identifiable stressor. Symptoms usually resolve when the stressor is eliminated or resolved or when the individual adapts to the stressor. Occasionally, sleep problems persist and lead to chronic insomnia. Chronic insomnia is when the symptoms occur at least three times per week and persist for at least three months. 

Cognitive behavioral therapy (CBT) and pharmacotherapy are the main treatment options for chronic insomnia.

SHIFT WORK DISORDER

In the U.S., more than 21 million workers usually work alternate shifts that fall at least partially outside the daytime shift range. Of them, 3.1 percent work nightshift and 2.7 percent work rotating shifts. Night shift workers usually sleep 1 to 4 hours less than daytime workers according to AASM.  

Shift work disorder is defined in the International Classification of Sleep Disorders, third edition, text revision as follows:

• There is a report of insomnia or excessive sleepiness, accompanied by a reduction of total sleep time, which is associated with a recurring work schedule that overlaps with the usual time for sleep.

• The symptoms have been present and associated with the shift work schedule for at least three months.

• The symptoms cause clinically significant distress or impairment in mental, physical, social, occupational, education, or other important areas of functioning.

•  A disturbed sleep and wake pattern is demonstrated on sleep log and, whenever possible, actigraphy monitoring (preferably with concurrent measurement of light exposure) for at least 14 days (work and free days).

• The sleep and/or wake disturbance are not better explained by another current sleep disorder, medical disorder, mental disorder, medication use, inadequate sleep hygiene, or medication/substance use.

Shift work disorder takes place when sleep-wake schedules dictated by work shifts are misaligned with endogenous circadian phase. As a result, patients are sleepy during their work shift and have insomnia during the attempted sleep period. The circadian misalignment and sleep loss related to shift work increases the risk for accidents, errors, and other adverse health outcomes. 

Treatment for shift work disorder includes both nonpharmacologic and pharmacologic strategies and should be individualized and tailored to a patient's specific circumstances. 

OTHER CONDITIONS

Other sleep disorders include Parasomnias, REM Sleep Behavior Disorder, Delayed sleep-wake phase disorder, Idiopathic hypersomnia, Central sleep apnea and Periodic limb movement disorder, among others