The North Puget Sound Center for
Sleep Disorders is a regional center of
excellence for the evaluation and treatment of
sleep disorders. Our state-of-the-art facility
is located on the Everett waterfront in a
beautifully remodeled hotel with private patient
rooms, water and mountain views, private
bathrooms, and satellite television. Our
board-certified sleep disorder specialists
diagnose and treat the full range of adult and
pediatric problems, including idiopathic
hypersomnia, insomnia, narcolepsy, obstructive
sleep apnea, sleep-related eating disorders,
restless legs syndrome, snoring and snoreplasty.
You can read more about these sleep disorders
Once you’ve undergone sleep testing, your
physician may prescribe
airway pressure (CPAP) therapy to treat
sleep apnea. CPAP therapy involves the delivery
of a pressurized air supply to your upper
airway, usually through a small mask. This
continuous positive pressure helps maintain an
open airway during sleep.
Definition: Obstructive sleep apnea syndrome is a
common, potentially fatal disorder. It is often easy to recognize and treat.
Successful treatment can restore quality of life and prevent both disability
and death. The word “apnea” means lack of breathing. Sleep apnea refers to
the temporary absence of breathing during sleep.
Symptoms: Most, but not all, people with sleep apnea snore loudly and
have pauses in their breathing and/or choking episodes during sleep. Most
people with sleep apnea complain of unrefreshing sleep and daytime
sleepiness. They often awaken frequently during the night. Many people with
sleep apnea are overweight or obese. People with sleep apnea often attribute
their symptoms to either their weight or simply “getting old.” However,
getting old does not, in-and-of itself, cause sleepiness.
There are many serious consequences of sleep apnea. These include excessive
daytime sleepiness with increased incidence of motor vehicle accidents;
impaired job performance; increased incidence of high blood pressure, heart
disease and stroke; problems with memory and ability to concentrate; chronic
headaches; irritability; depression; and general aches and pains (similar to
Treatment: First line therapy for obstructive sleep apnea is
continuous positive airway pressure (CPAP). CPAP, delivered by nasal mask or
full face mask from a machine which sits by the bedside, pushes pressurized
air down the throat, which opens up the airway. This relieves the
obstruction, gets rid of the snoring and allows the patient to have
uninterrupted sleep. Unfortunately, some people are unable to use CPAP.
If CPAP fails or is not tolerated, there are other treatment options to
consider. Upper airway surgery is usually the next choice. The most common
procedure is the uvulopalatopharyngoplasty (UPPP), where the surgeon removes
the uvula and palatine tonsils and trims excess tissue in the back of the
throat. Patients with chronic nasal obstruction also often benefit from
nasal and/or sinus surgery.
Another treatment option is an oral appliance, which is fitted by a dentist.
The oral appliance is worn nightly and pulls the lower jaw and tongue
forward, which opens up the airway.
Importantly, there are things that the patient can do to improve or even
cure the obstructive sleep apnea. These include weight loss, stopping
sedative medications, decreasing alcohol consumption, quitting smoking and
avoiding sleep on the back.
Sleep Apnea External Web Resources
Restless Leg Syndrome
People with Restless Legs Syndrome (RLS) have a
difficult-to-describe sensation in their legs, often called “a creepy,
crawly sensation” that causes an uncontrollable need to move the legs.
- The discomfort is eased during movement and recurs
when movement stops.
- RLS is worst at night while lying in bed, but can
happen anytime during the day.
- It is common, and effects 5-10% of people.
- The cause is unknown.
- It often runs in families.
- RLS can lead to insomnia.
- RLS is easily treatable with medications taken at
bedtime, including anti-Parkinsonian
- drugs, benzodiazepines (the valium “family” of drugs)
- Most people never think to mention this very
treatable disorder to their healthcare provider.
- Sleep specialists are experts in diagnosing and
treating Restless Legs Syndrome.
Restless Legs Web Resources
Definition: Insomnia is defined as difficulty falling
asleep and/or difficulty staying asleep and/or unrefreshing sleep. It is
associated with next-day consequences including impaired concentration and
memory, decreased ability to accomplish daily tasks and decreased quality of
You probably have significant insomnia if:
- You have difficulty falling asleep
- You wake up during the night and have trouble getting
back to sleep
- You get less sleep than you think you need
- You often feel sleepy during the day
- You have difficulty completing your work or other
daily activities because you are too tired
Insomnia is the most common sleep disorder. According
to the Gallup Poll for the National Sleep Foundation:
- Almost half of Americans suffer from sleep
difficulties at least 1 out of 5 nights
- 74% of the sufferers have problems an average of 6
nights per month
- 26% of the sufferers have problems an average of 16
nights per month
- 70% of those frequent sufferers (the 26%) never
discussed it with a health care provider
Common causes of insomnia include:
- Anxiety and stress
- Obstructive Sleep Apnea Syndrome
- Restless Legs Syndrome
Good, healthy sleep habits are the most important first
step in treating insomnia. These include:
- Going to bed and getting up at the same time every
- Limit amount of time awake spent in bed
- No napping at all
- Avoid exercise 3 hours or more before bed
- Avoid looking at the clock (set the alarm and turn it
out of line of sight)
- Reduce or eliminate nicotine, caffeine and alcohol
(at very least, consume none of these 4-6 hours prior to bed)
There are special techniques that sleep specialists use
to treat insomnia, that do not involve medications. These include:
- Cognitive-behavioral therapy: Relaxation therapy,
sleep restriction therapy and stimulus control
Common prescription medications used to treat insomnia
- Short-acting benzodiazepines (triazolam) and the
benzodiazepine-receptor agonists (zolpidem, zaleplon and eszopiclone)
- Sedating anti-depressants, such as trazodone and
amitryptiline(these are generally not recommended unless the insomnia
sufferer is depressed)
Narcolepsy is a rare sleep disorder where the sufferer has
almost constant sleepiness and tends to fall asleep at inappropriate times.
People with narcolepsy tend to fall asleep when others would stay awake, such as
in conversation or when driving. The four most common symptoms of narcolepsy
- Excessive daytime sleepinesscataplexy, which is sudden
loss of muscle strength caused by sudden
- Emotion (such as laughing, being surprised or getting
- Sleep paralysis, which is brief loss of muscle control
just before falling asleep or upon awakening
- Hallucinations just before falling asleep or upon
Symptoms can occur all at once or can develop gradually
- Narcolepsy is not a psychiatric illness.
- Narcolepsy is diagnosed through an evaluation by a sleep
specialist followed by a sleep study at a sleep center.
- Narcolepsy is treated with medications to alleviate the
sleepiness symptoms and cataplexy (sudden loss of muscle strength).
Definition: A disorder of presumed central nervous system
cause that is associated with a normal or prolonged major sleep episode and
excessive daytime sleepiness. Cause is not known.
- Long periods of daytime drowsiness which impair
- Long, unrefreshing naps, often awakening tired or groggy
- Long, often undisturbed sleep at night
- Difficulty awakening in the morning with sleep
- Lifelong disorder--doesn’t go away
- Good sleep habits
- Stimulant medications are the hallmark of therapy:
modafinil, methylphenidate, amphetamines
- Severe warnings about driving and work impairment (for
patient and everyone else’s safety)
Snoring and Snoreplasty
Want to bring some peace back to your slumber?
Your snoring can affect everyone around you—spouse, kids or roommates, sometimes
even the neighbors. But there is a simple, non-surgical treatment that might
help make nights at your house more peaceful for everyone.
What Causes Snoring?
Forty-five percent of normal adults snore occasionally, and 25 percent snore
consistently. Often, the soft tissue in your upper palate and related structures
are the culprit. As you fall asleep and these collapsible parts of your airway
relax, the structures strike each other, causing vibration and that inevitable
For 90 percent of simple snorers—those who do not suffer from the more complex
medical condition known as obstructive sleep apnea—a non-surgical technique
called “injection snoreplasty” will eliminate or drastically reduce snoring.
Injection snoreplasty can be administered in as little as five minutes. Your
doctor will numb your upper palate with an anesthetic, then inject a small
amount of hardening agent under the skin on the roof of your mouth. Over the
next several days, the resulting blister will harden and form scar tissue,
eliminating the vibration that causes the snoring sound.
Some patients use pain medication for about two days following the injection.
Most report minimal discomfort and generally return to work the same day. For
many, the snoring is gone within two weeks. Some require a second injection, and
very rarely a third. Ultimately, the procedure eliminates disruptive snoring in
80%-90% of patients.
Sleep-Related Eating Disorder
- Uncontrollable episodes of sleep-related eating, occurring almost every night and oftentimes multiple times
- This problem is primarily
a sleep disorder, not an eating disorder
- Made worse by stress and
- The sufferer awakens and
has an uncontrollable need to eat, usually
large quantities of high-calorie foods which
are not usually consumed during the day
(entire gallon of whole milk; half a jar of
- Consume foods in a
strange manner (awaken in the morning to
find peanut butter and jelly on the
telephone receiver; find bites taken out of
raw chicken in the refrigerator)
- Weight gain is common
- Often sufferers restrict
daytime caloric intake to prevent further
- Usually the sufferer has
little or no recognition of the episodes and
is frequently sloppy or careless during the
- Unable to fall back to
sleep without eating
How this disorder affects
- Weight gain
- Disrupted, unrefreshing
sleep and daytime sleepiness
- Feeling of loss of
- Fear of choking while
eating at night
- Fear of injury---getting
cut while preparing food or starting a fire
in the kitchen
- Good sleep habits
- Avoid sleep deprivation
- Try not to keep tempting,
high calorie foods readily available
- Medications are the
cornerstone of therapy: clonazepam,
selective serotonin re-uptake inhibitors,
trazodone, other anti-depressants,
dopaminergic agents, opiates
- Psychotherapy, behavior
modification therapy and counseling don’t