Posted on 01/31/2003 3:42:55 PM PST by petuniasevan
Here’s everything you wanted to know about sleep disorders but were too tired to ask
By Cheryl Sherry
Post-Crescent staff writer
Wayne Winistorfer never had a problem falling asleep. Staying awake was another story.
The 47-year-old Oshkosh man had a long history of snoring, headaches upon awakening and extreme sleepiness despite what he thought was a decent night’s rest.
It runs in his family, he said.
“The women that married into my family always joked about the family that could fall asleep at the table. It’s just the way several of us are. It’s the family pattern,” Winistorfer said.
He is far from alone. According to the National Sleep Foundation, Winistorfer is one of least 40 million Americans who suffer from chronic, long-term sleep disorders each year.
Another 20 million Americans suffer from occasional bouts of sleeplessness or simply don’t get enough sleep because of hectic lifestyles.
It is those with the chronic disorders who have the attention of doctors staffing medical sleep clinics.
The Fox Cities has two such clinics: The St. Elizabeth Hospital Sleep Laboratory, founded in 1993, and the ThedaCare Sleep Disorders Center, which originally opened at Appleton Medical Center in 1986 and moved to its current location at Theda Clark Medical Center in Neenah in March. Both continue to do brisk business.
“We have been so busy since we opened the lab,” said Lisa Wallace, St. E’s sleep technician and registered nurse. “I know people are becoming more aware of what’s going on. There are a lot of people who have never heard of (sleep disorders) and have had the problem for years.”
St. Elizabeth’s clinic treated 423 sleep-deprived patients in 2002. The ThedaCare center treats nearly 1,000 patients per year. It can handle four sleep studies per night and is considering expanding its facility to handle six per night.
While doctors have identified more than 70 sleep disorders, most of which can be managed effectively once they are correctly diagnosed, the most prevalent problems include insomnia, two different forms of sleep apnea, restless leg syndrome and narcolepsy.
Winistorfer has not one but three chronic sleep disorders.
The Affinity Health Systems’ director of rehabilitation services out of Appleton was among the first to check into St. E’s sleep lab in the early ’90s. His diagnosis and ultimate treatment literally changed his life.
“Being able to sleep and wake up refreshed without headaches, it’s great,” Winistorfer said.
Sleep disorders not only fail to give the body its much-needed rest, they also can indicate more serious health concerns, said Michael Maguire, medical director of the ThedaCare Sleep Disorders Center, which is accredited by the American Academy of Sleep Medicine.
“For example, heart failure patients. There’s a subset of heart failure patients who can benefit, who do have unrecognized sleep breathing disorders and other sleep disorders,” Maguire said. “A large number of children with ADHD have untreated obstructive sleep apnea. You treat that and they are miraculously off the Ritalin.
“A number of psychiatric patients, too, have a number of chronic sleep disorders, including insomnia, that can be treated effectively, and their disorders tend to regress or improve. Pretty much across the board, for all spectrums of chronic diseases, this is a new angle to see if it can modify the treatment and improve and sometimes eradicate the problem.”
Winistorfer always knew he had a problem with sleepiness but didn’t think it was a diagnosable condition or that it amounted to anything other than lost zzz’s.
“Did I have a problem with alertness, staying awake and falling asleep inappropriately? Since high school. People I went to high school will tell stories about how I would fall asleep in class. … Driving home at night … I had an incredibly difficult time staying awake. I hit the ditch a couple of times.
“I went to college and took up coffee drinking and drank copious amounts of coffee. But in college I would find that several hours had passed with my head laying on the books. It was very difficult to watch a full movie if I went to a theater. And, literally, if I sat down at a party and it was late, I could fall asleep. Sometimes it didn’t matter what time of the day it was.”
While working for an Oshkosh pulmonologist who specialized in sleep medicine, Winistorfer’s wife, Carol, came home with a diagnosis of her own. Sleep apnea. Winistorfer’s response? “Oh, come on. It’s just me. I’m a tired person.”
According to Bradley Lauderdale, pulmonary and critical care medicine physician with Affinity Health System and head of St. E’s Sleep Laboratory, sleep apnea is marked by large periods of shallow breathing and large gasping recovery breaths. Upward of 20 to 30 involuntary breathing pauses, or apneic events, an hour occur during a night’s sleep. They can be accompanied by loud snoring (although not everyone who snores has sleep apnea), choking sensations, morning headaches and daytime sleepiness.
“It affects sleep directly because of the arousals,” Lauderdale said. “And because of the effort the body goes through to get the breathing started up again. It causes the sleep to be repeatedly broken up.”
Through a bit of prodding, Carol talked Winistorfer into a sleep lab evaluation. Sleep partners often are the impetus behind such testing, Maguire said.
“The majority of sleep disorders are picked up by the sleeping partner and not the patient themselves,” he said. “The two hallmarks of sleep apnea are loud snoring with witnessed apnea, where you actually stop breathing, and fatigue and sleepiness during the day. Not everyone’s going to have both of these, but the majority have both. You really have to believe what your sleeping partner says of you because it really can affect you a lot.”
Winistorfer had another, more personal reason for wanting to go based on something else he read.
“Untreated sleep apnea can lead to cardiac arrhythmias,” he said. “My dad died at age 53 of cardiac arrhythmia. He had two heart attacks that weren’t related to high blood pressure, were not related to cholesterol. They didn’t know. He had had (a heart attack) at 50 or 51 and had a second at age 53. He was in the hospital a couple days and had a little bit of high blood pressure. They put him on a little bit of medication, sent him home and he died in his sleep that night.
“He was the guy who could fall asleep at the dinner table. And snored. I am sure that’s what killed him.”
Lauderdale agreed. “With obstructive sleep apnea, we see connections with hypertension and high blood pressure. There are also associations with heart disease and stroke. Cardiac and stroke conditions occur more frequently in patients with sleep apnea that is not under treatment.”
Winistorfer’s nocturnal polysomnography at St. E’s sleep lab uncovered obstructed sleep apnea, where the muscles in his throat relax and occlude his breathing, as well as central nervous system sleep apnea, where the brain turns off the breathing.
He was prescribed a CPAP, or continuous positive airway pressure mask. Pressure from an air blower forces air through the nasal passages. It is the most widely used and effective treatment for sleep apnea.
“It took some getting used to, but at the same time, once I got used to it enough that it made a difference, now I won’t sleep without it,” Winistorfer said.
The CPAP didn’t entirely take care of Winistorfer’s problems. “The physician I was working with said we needed to do a daytime study, a Multiple Sleep Latency Test,” he said. “I slept in the lab and in the morning they woke me up and asked me to stay awake for periods. Then I had to take a series of naps throughout the day. What they do is keep you hooked up, but test how long it takes to fall asleep after a reasonably good night’s sleep. If you can fall asleep in less than five minutes for each of the naps, it’s a problem. I fell asleep immediately.”
Winistorfer also was diagnosed with narcolepsy, which is now controlled with Ritalin. “I am no longer afraid to drive distances. I can watch an entire movie. I can go to parties and stay awake. I can go to meetings at work, which was a problem. I can hear a whole sermon. I do think it has changed my life.”
Said Maguire of sleep studies: “You don’t have to take time off work. You don’t have to have someone drive you. There are no aesthetics. You just come and spend the night in the lab. Consider it a hotel stay over and don’t be intimidated by the wires.
“Most people sleep pretty well through it. It’s not perfect. It’s not your own bed, but most people tolerate it remarkably well.”
Cheryl Sherry can be reached at 920-993-1000, ext. 249, or by e-mail at csherry@ postcrescent.com
Tell anyone you know who has a child being treated for ADHD. Maybe their doctor doesn't know about this!
Poorman has all the symptoms of sleep apnea.
I'm going to put this article under his nose and encourage (read, nag) him to go to St E's for this clinic.
I never knew about these connections. Seems like a pretty important thing to investigate if one has a family history of stroke, etc.
[ZZZZ, ZZZZZ, ZZZ]
:-)
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