Sleep Medicine is a relatively new field of medicine. It is recognized by the American Board of Medical Specialties. Our doctors both practice Sleep Medicine. Dr. Tehmina Badar is Board Certified in Sleep Medicine and has been practicing Sleep Medicine for over a decade. Both Dr. Tuazon and Dr. Badar treat various sleep disorders from insomnia to sleep disordered breathing such as Obstructive Sleep Apnea and Central Sleep Apnea. Other disorders include restless leg syndrome and periodic limb movement disorder and even narcolepsy.
Diagnosis begins with a detailed history and physical exam. This includes an extensive sleep evaluation and the doctors typically will ask detailed questions about the patients’ sleep habits and patterns, eating habits, environmental conditions, caffeine and tobacco intake. After this extensive evaluation, the doctor may order a sleep study. This is usually an overnight study during which the patient spends the night at a sleep laboratory. This is a monitored study. No needles are involved but expect to literally be wired. The sleep study encompasses EEG or brain wave leads to evaluate the specific sleep onset and the different sleep stages (in fact there are 3 non-REM sleep stages; and REM sleep occurring in a cyclical pattern throughout the night). There are also snore sensors, airflow sensors, bands on the chest, abdomen and also leads on the legs. There are also oxygen sensors and an ECG lead (to determine heart rate and check for abnormal heart rhythms). Yes, the patient is wired. But most patients do just fine. One or two nights away from home can actually change their lives.
As has been extensively researched, good quality and quantity sleep is absolutely imperative to each individual’s health. In fact sleep-disordered breathing such as Obstructive sleep apnea is a common sleep disorder: millions of Americans, both male and female suffer from this “public health burden”. What is Obstructive Sleep Apnea? It is a repeated cessation of airflow (for at least 10 seconds at a time), commonly linked with a drop in blood oxygen levels. This has been linked with hypertension (high blood pressure), diabetes, heart attacks, strokes, abnormal heart rhythms, problems with concentration, memory and mood abnormalities such as depression. It is more common as we age and is also linked with being overweight.
Treatment options include positive pressure therapy which works 90% of the time. The positive pressure therapy involves wearing a mask which is attached to a small compressor device which blows pressurized room air (not extra oxygen unless needed) in to the nose or nose and mouth. This maintains a patent airway so that the patient can have a good quantity and quality of sleep. Other options include surgery. The most common surgery at this time is performed by an ENT surgeon and is called a uvulopalatopharyngoplasty or UP3 for short. The surgeon removes the tonsils/adenoids, part of the soft palate and the uvula (the soft tissue that hangs at the back of the throat). This is not nearly as effective as positive pressure therapy but in selective patients it can work quite well. There are also dental devices that allow for a more patent airway but are commonly used for milder forms of obstructive sleep apnea. Advantages of the oral appliance over positive pressure therapy include ease of use, comfort, portable, and less noise. Of course, weight loss is an important long term treatment goal because even if 10% of the total body weight is lost, this can translate to a significant improvement and at times resolution of the disorder.
Insomnia is probably the most common sleep disorder and the great majority of individuals will have at some point in their lives an inability to fall asleep or stay asleep. Thankfully, the majority of patients will be able to recover from this temporary insomnia. However, some will continue to suffer on a regular basis. Diagnosis, as mentioned above starts with a detailed sleep history. Common causes include pain, medications, situational insomnia (e.g. stress related to the loss of a loved one). However, there are many causes of insomnia and may even be related to another primary sleep disorder such as Restless Leg Syndrome or even Obstructive Sleep Apnea. Treatment begins with improved sleep habits, behavioral therapy and at times sleep aides (medication). Of course, if the patient has another primary sleep disorder this will also need to be treated.
Restless Leg Syndrome refers to a sense of discomfort in the limbs, usually the legs, but can occur in the arms as well. It is fairly common, occurs more commonly in women, approximately two times more, and increases in prevalence as we age. The sensations occur at rest and are relieved by movement. Different terms have been used to describe the discomfort. Terms that patients use to describe the symptoms include crawling, creeping, pulling, itching, drawing. One that seems quite appropriate is a sense of “coca-cola in my legs”.
Restless leg syndrome can be idiopathic (meaning not due to other medical illnesses) or
can be secondary to other disorders such as iron deficiency, kidney failure (dialysis patients), diabetes with or without associated neuropathy, multiple sclerosis, pregnancy, Parkinson’s Disease and others.
Treatment options are broad and depend on the frequency and severity of symptoms and range from exercises, iron supplementation, avoidance of caffeine, nicotine and alcohol. Finally, a broad array of drug treatments are available as well.
These are just a few of the sleep disorders that Dr.s Badar and Tuazon manage. Sleep is an essential part of healthy living and deserves the kind of detailed approach that our doctors provide.