8 minute read
SWEET DREAMS
By Gale Smith
For more than 30 years, Daniel Meneses dreamed only of one thing — getting a good night’s sleep. Since he was 13, he woke up in the morning more exhausted and physically achy than when he went to bed the night before.
“Almost every day, I would walk into a room and ask myself, ‘Why am I here?’ It got to the point where I was always depressed; I thought I just wasn’t smart because I couldn’t remember anything.”
Growing up in his native Colombia, Meneses had little access to resources, so he learned to live with the problem. As he got older, he became more impatient and irritable, to the point where his behavior affected relationships with friends and family.
At the age of 48, Meneses knew he needed help when he had to make to-do lists so he wouldn’t forget anything. Just as important, he couldn’t play board games with his wife anymore. “She loves board games, but I couldn’t concentrate,” he said. “I couldn’t even remember my last move during a simple checkers game.”
His wife fi nally convinced him to seek medical help. Through an Internet search, they found Dr. Aparajitha Verma, a neurophysiologist at The Methodist Hospital. After talking with Meneses about his history and symptoms, Verma recom mended a sleep study.
Verma, who is medical director of the hospital’s Sleep Disorders Center, says whenever people can’t fall asleep within 30 minutes of lying down, have excessive daytime sleepiness or sleep for seven or more hours and wake up tired, it’s usually a sign they have a more serious sleep problem.
The Sleepover
As with all overnight sleep studies conducted at Methodist, Meneses spent the night in a room modeled after an in-home bedroom, decorated with soothing colors, TV, easy chair and an adjacent bathroom.
Sleep center technologists attach wires to electrodes, placed on the patient’s head and upper torso to measure brain waves, eye and chin movement, the different stages of sleep, heart rate and rhythm. None of the devices is painful, and there are no needles involved.
Additional monitors measure leg movement, breathing, and oxygen and carbon dioxide levels in the blood. Monitoring is done in a nearby control room, and a video record is made of the entire stay.
The study begins with “lights out.” At that time, patients are not permitted to read, watch TV, eat, talk on the phone or perform any other activity that may interfere with sleep. They are monitored for approximately eight hours. After being awakened in the morning by the technologist, patients are given an hour to shower and prepare for the day ahead.
Now, more than three decades after his problems began, Meneses knows the reason for his years of sluggishness
and fatigue. He is one of the 18 million Americans who suffers from obstructive sleep apnea or OSA.
Obstructive sleep apnea is the most common form of apnea, which is the Greek word for “without breath.” It is caused by a blockage of the airway, usually when the soft tissue in the rear of the throat collapses and closes during sleep. When the airway is closed, the person stops breathing repeatedly during sleep. When this happens regularly, sleep is extremely fragmented and of poor quality.
“I always thought people with sleep apnea woke up gasping for air, and I never had that problem. I knew I snored a lot and was excessively sleepy during the day,” Meneses said. “After talking with Dr. Verma and doing the study, I now understand that OSA is more prevalent in men than women, and I had the most common symptoms.”
After analyzing the sleep study, Verma developed a treatment plan specifi c to
Meneses’ needs. She recommended a second sleep study using a nasal continuous positive airway pressure mask, which is the most common treatment for sleep apnea.
The CPAP titration study is standard for people diagnosed with apnea. During this test, the machine pushes air at a pressure high enough to keep the airway open during sleep. This study, however, proved ineffective for Meneses.
Because of his severe asthma, the test showed he would need such a high pressure level that he would not be able to use the mask effectively. Verma then consulted with her colleagues within Methodist’s Comprehensive Sleep Disorders Program to see if Meneses would be a candidate for surgery. Bedrooms in the Sleep Disorders Center are modeled after an in-home bedroo patient before the study begins (right).
A Dream Realized
After reviewing Meneses’ case, center surgeons performed oral surgery on him in January to enlarge his airway. “Before my surgery, I had poor circulation in my legs and feet. I was extremely tired, not able to think clearly in the mornings, and I didn’t feel productive. Now I’m getting six to eight hours of uninterrupted sleep each night. It’s amazing,” he said.
Sleep is such an essential part of the human existence that we spend about a third of our lives doing it. Sleep disorders affl ict 50 to 70 million people in the United States. In addition to being a major cause of disease and injury, sleep disorders put people at risk for heart attack, stroke, hypertension, obesity, depression and accidents. Methodist’s Sleep Disorders Program is multidisciplinary and comprised of physicians with expertise in the management of patients with various kinds of sleep issues. Patients can be seen by neurologists; ear, nose and throat physicians; oral and maxillofacial surgeons; psychiatrists; and pulmonologists. The program also serves as the focal point of educational efforts and research protocols in sleep medicine. A core component of the sleep program is Methodist’s Sleep Disorders Center, a 10-bed outpatient facility that is accredited by the American Academy of Sleep Medicine, the national leader in setting standards and promoting excellence in sleep medicine. According to Methodist pulmonologist Dr. Mario Gonzalez, good sleep is important to a person’s cognitive function. Patients who have extreme asthma, emphysema or chronic obstructive pulmonary disease are often referred to him when symptoms of wheezing, shortness of breath or chest tightness do not improve.
bedroom (left). Sleep technologist Kelsey Lawrence attaches electrodes to a
Epworth Sleepiness Scale
The Epworth Sleepiness Scale quantifi es the level of daytime sleepiness. Rate how likely you are to fall asleep in certain situations. How likely are you to doze off or fall asleep in the situations described below, in contrast to feeling just tired?* This refers to your usual way of life in recent times. Even if you haven’t participated in some of these activities recently, try to determine how they would have affected you and circle one number. Use the following scale to choose the most appropriate number for each situation.
Chance of Dozing Off
“Many of these patients are depressed and have a lack of concentration, all because of lack of sleep,” Gonzalez said. He often sees these signs in patients with neuromuscular disorders, such as amyotrophic lateral sclerosis. Patients with ALS, commonly known as Lou Gehrig’s disease, have weaker diaphragms, so sleep issues are more prevalent. ALS patients feel weak, experience more headaches, and overall, are not well rested.
0 = no chance of dozing 1 = slight chance of dozing 2 = moderate chance of dozing 3 = high chance of dozing
How likely are you to doze off in the following situations?
“Oftentimes, these patients and their caregivers won’t know what kind of help to ask for unless their physician is aware of how diseases affect sleep. We have the ability to provide our patients the comprehensive care they need to treat the entire person, not just one aspect of the problem,” he said. As for Meneses, the oral surgery greatly improved his condition, but a repeat sleep study in April showed that his OSA, while not as serious, is still somewhat present. He will likely wear an oral appliance, such as a custommade mouth guard, to help move the jaw forward so he can breathe better at night. “Even though I still write to-do lists every day, my memory is so much better. I can function again, and I don’t feel dumb. And no one is calling me ‘Forgetful Jones’ anymore,” he said. For more information about Methodist’s Comprehensive Sleep Disorders Program, visit methodisthealth.com or call 713-790-3333. !
1. Sitting and reading: 0) Never 1) Rarely 2) Sometimes 3) Often 2. Watching TV: 0) Never 1) Rarely 2) Sometimes 3) Often 3. Sitting, inactive in a public place (theater, meeting): 0) Never 1) Rarely 2) Sometimes 3) Often 4. As a passenger in a car for an hour without a break: 0) Never 1) Rarely 2) Sometimes 3) Often 5. Lying down to rest in the afternoon when circumstances permit: 0) Never 1) Rarely 2) Sometimes 3) Often 6. Sitting and talking to someone: 0) Never 1) Rarely 2) Sometimes 3) Often 7. Sitting quietly after lunch without alcohol: 0) Never 1) Rarely 2) Sometimes 3) Often 8. In a car while stopped in traffi c: 0) Never 1) Rarely 2) Sometimes 3) Often
* If you are already on CPAP or BIPAP, please answer these questions indicating the way you feel when you are using CPAP or BIPAP.
What does your score mean?
If you score 8 or lower, keep doing what you are doing. You are in good sleep health. If you score a 9 or higher, you may benefi t from a consultation by a sleep specialist and/or a sleep study. !
