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Sleep Disorders


Overview

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 below.

Once you’ve undergone sleep testing, your physician may prescribe continuous positive 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.

Obstructive Sleep Apnea

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 fibromyalgia).

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) and narcotics.
  • 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

Insomnia

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 life.

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
  • Depression
  • 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 day
  • 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
  • Psychotherapy

Common prescription medications used to treat insomnia include:

  • 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

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 are:
  • Excessive daytime sleepinesscataplexy, which is sudden loss of muscle strength caused by sudden
  • Emotion (such as laughing, being surprised or getting angry)
  • Sleep paralysis, which is brief loss of muscle control just before falling asleep or upon awakening
  • Hallucinations just before falling asleep or upon awakening

Symptoms can occur all at once or can develop gradually over years.

  • 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).

Idiopathic Hypersomnia

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.

Symptoms Include:
  • Long periods of daytime drowsiness which impair performance
  • Long, unrefreshing naps, often awakening tired or groggy
  • Long, often undisturbed sleep at night
  • Difficulty awakening in the morning with sleep “drunkenness”
  • Lifelong disorder--doesn’t go away

Treatment:

  • 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 snoring noise.

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.

Finding Relief


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

Symptoms:
  • Uncontrollable episodes of sleep-related eating, occurring almost every night and oftentimes multiple times per night
  • This problem is primarily a sleep disorder, not an eating disorder
  • Made worse by stress and sleep deprivation
  • 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 peanut butter)
  • 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 weight gain
  • Usually the sufferer has little or no recognition of the episodes and is frequently sloppy or careless during the binges
  • Unable to fall back to sleep without eating

How this disorder affects the sufferer:

  • Weight gain
  • Disrupted, unrefreshing sleep and daytime sleepiness
  • Feeling of loss of control
  • Fear of choking while eating at night
  • Fear of injury---getting cut while preparing food or starting a fire in the kitchen

Treatment

  • 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 work
 
 
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