Insomnia, Snoring, Sleep Apnea

The world and life of a sleep tech

Archive for January, 2009

The Case of Extreme Insomnia

Posted by amykr on January 28, 2009

If you watch the morning shows you saw a family suffering from a son’s extreme case of sleep deprivation.  This young man was diagnosed with multiple health issues including Autism, learning disabilities, behavior disorders and health issues.  What was finally determined was that he was only getting about 2 hours of sleep.  His parents were wonderful and supportive but they could not help him and they were unable to figure out why he was having so many issues. 

After he was treated the change was remarkable.  He went from functioning on the level of an 18 month old to almost age level which is 3 years old.  He was able to play.  He was finally able to interact with others, both his parents and his friends. 

So what does this have to do with the average person.  Well if you do have a sleep disorder then you are walking around in a constant sleep deprived state.  This can show up as fatigue, depression, lack of motivation. It can also lead to hostility, sadness and hopelessness.  You may not be able to concentrate so you might give up reading, or trying to learn something new.  These are the more looked over symptoms of sleep disorders.  So if you or someone you love snore and have ADD, depression, fatigue, or other learning or behavior problems you might want to talk to your doctor about having a sleep study.

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Staring at the ceiling

Posted by amykr on January 27, 2009

You have been lying there counting the little holes in your ceiling tiles for days or should I say nights now.  Your tired, irritable and just wish you could sleep.  Insomnia is one of the biggest issues people seek help for.  This is especially true of women.  But few bring this issue to their physician because they do not want medications or they are taking over the counter medications.    

 

I think that its time we looked at all the choices you have when dealing with insomnia.  I like many of you are a fellow sufferer.  I have spent many a night completing a novel or watching that really bad movie at 1am.

 

So I thought it might help to discuss options to help deal with the issue.     Of course I am not a physician and my first recommendation is to go visit your primary care to discuss the problem.

 

The first thing I always try is to look at my sleep hygiene.  Do I have a calm relaxing sleep environment? Is the room dark, the television off, all the pet off the bed and is the room organized?  All these make for a relaxing place to sleep.

 

Next I look at my sleep routine.  Do I go to bed at the same time? Do I have a specific routine that tells my body its time to get ready to sleep?  This is important as the brain needs these cues to get ready for sleep. 

 

So you have done all these things and you are still having problem sleeping what choices do you have?  Over the counter medications contain antihistamines that have the side effect of causing sleepiness.  These are good for an occasional problem. 

 

 The natural products vary greatly.  There is some very interesting research going on with Melatonin as a sleep aide.  It is a hormone your body produces that helps you to sleep.  There is also research going on with Valerian Root but it has not been as successful.  The problem with natural remedies is that they are not regulated and they can interact poorly with other medications you are taking.  You also need to let your doctor know you are taking them before a medical procedure as they can have an effect on your blood and its ability to clot. 

 

Finally there are prescription medications.  I will save that for another blog.

 

If you have any questions please do not hesitate to write me. 

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Lack of zzzzzz can cause achoooo

Posted by amykr on January 23, 2009

In today’ society we thing that the more we do the more successful we are.  Many times this idea pertains to everything but our health.  We run around perpetually sleep deprived and it is taking a toll.  Our bodies are not working optimally and we increase our susceptibility to many virus and germ.  The common cold is the biggest culprit of the wait and attack the week method of germ patrol.

 

When we are sleep deprived we release hormones that increase inflammation throughout out body.  We also decrease the production of antibodies to fight disease.  So what does this mean?  You wake up at 6am after going to bed at midnight for the third straight day.  Your head is a little foggy, and your joints hurt just a bit more then usual.  You go about your day the way you normally do but you feel yourself dragging just that little bit.  Just enough that when you get home all you want to do is veg out in front of the tv and do nothing.  Unfortunately, during the day someone on your office who did not have enough vacation time came in sneezing and sniffing and coughing.  You did your best to steer clear of them but you needed a file from their desk.  Well you were just exposed to the rhinovirus and that little guy just love us overworked people because that means he has a new place to call home.  Our bodies do not have the strong defenses needed to fight him off.  So for the next eight to ten days you feel terrible.  But you compound that problem because you still do not give your body the rest it needs to fight our friend the rhinovirus so he hangs on for an extra day or two. 

 

We have to remember that we need to take care of ourselves first.  That includes forgoing the evening news or Jay Leno sometimes if we know we have not gotten the rest we need.  This is especially true during this cold weather when everyone is inside and all the windows are closed.  This just makes it that much easier to share our germs.  So I challenge you during this cold weather to try and get at least 1 hour extra sleep every other day.  You will feel better and your body will thank you.  

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Revisiting the Decision

Posted by amykr on January 20, 2009

I am currently remote scoring for a lab in Ohio. It has been having a great deal of internet issues and so I called the office to see if someone was there that could help. The young lady who answered took the opportunity to ask me some questions about the exam and what to expect.

The first thing she asked, though, was how long ago I took the test. The problem being, that if I took it awhile ago then I probably would not know what to expect. The thing is that although some of the rules have changed, for the most part the test structure really has not changed.

Well, that brought me back to when I first learned sleep.

I was working as a respiratory therapist in an inner city hospital. I truly enjoyed my patients but I knew I was burned out. I was working the ED night shift one night, and in came a guy who had been gored by a bull. When you think about it: what more could I see? It really is the last thing you expect at 02:00am.

So, after talking to my manager, I decided I would try sleep.

I had four days of orientation. To say the guy who trained me did not want me there was an understatement. He liked his solitude. He said “put the leads here, put these filters on and monitor the patient.” That was it. He gave me a diagram for lead placement I used for the first three months while I was working. I thought this is easy…

…Until I took a registry review class. I did not know how much I did not know until then.

While I was there someone took pity on me and gave me an R and K manual. Other people drew me pictures of the 10/20 system.

I spent the next month rewriting our policies for correct lead placement and filter settings and I taught myself to score using the R and K manual. I would literally hold it up to the screen and figure out what stage the patient was in. Fortunately the EKG and respiratory events were pretty easy for me to figure out.

Titration became a whole different matter.

I learned to sit on my hands. As a respiratory therapist I want to fix a desaturation with all my being. I am not one to sit and watch a person desat to 80% or lower and not intervene.

I learned. I became the go to guy or gal for my reading doctor. I learned how interesting sleep was.

I would never trade my first year for anything. I will, however, do what I can to make sure no one has to go through their first year the same way I did.

I love to mentor new technicians and I hope to always be there to answer their questions when they need it.

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Questions that need answers.

Posted by amykr on January 17, 2009

There are many concerns my patients have when they come into my lab. Concerns about sleeping here, concerns about treatment of sleep disorders, and concerns about their health.  Some of these concerns just make me giggle once in a while so I thought I would share some insights that might relieve you if you are thinking of having a sleep study.

“Why am I being taped and what will you do with it?”  We video tape sleep studies so that we have a record of your sleep, your snores and if you have any unusual behavior such as sleep walking, sleep talking or acting out your dreasm (also known as REM behavior disorder0 we have a record for the doctor to see.  It is never seen by anyone outside the technicians who run and read the study and the physician.

“Do you see what I am dreaming?”  Now we do know when you are dreaming because we can see your eye movements but we do not know what you are dreaming about.  In many cases people do not even remember that they did dream during the study.

“What happens if I do not sleep during the study?”   I have had very few patients who have not fallen asleep during the night of the study.  Many times patients are in a very light sleep known as stage 1 sleep and are not even aware of it.  If for some reason you feel you could not sleep you can always ask your doctor for a sleep aide to bring with you.  Just remember if you are going to take a sleep aide please arrange for someone to drop you off and pick you up from the study.

“Why can’t I have the television on during the night?”  Television advertisers are in the market to sell you products and they can not if you are asleep.  They have designed their late night commercials to not only increase the volume of the show but to flash light at you to wake you up.  We want to have a true good night’s sleep so we ask that there be no distractions such as television during the study.

I hope this will help anyone considering coming in for a study to relax and feel more comfortable.  If you have any questions please do not hesitate to ask them.  That is the best way for you to feel comfortable and get the sleep you need to be your best self.

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So whats all this talk about restless legs

Posted by amykr on January 13, 2009

We see ads on television for medications for restless legs mostly sponsored by drug companies and so we wonder could I possible have this condition?  What is this condition? Do I really need another medication?

Television gives use a chance to be educated about ideas and condtions that are current.  But if you happen to be my mother then every time you see one of these comercials you wonder if this is what is wrong with you?  I am sure she is not the only one.  I am sure many people wonder the very same thing. 

I have had two patients that I believe describe it best.  One said she felt like little jolts of electricity run up and down her legs.  The other said she felt compelled to walk in circles for half the night. 

What causes it?  Well there are some ideas but mostly it is associated with certain conditions: Obesity, anemia, hypothyroid, preganacy. viamin defecincies and a hot of other health issues.  There is proof that some forms of restless leg syndrome runs in families.

So if you have it what can you do about it?  First as always talk to your primary care doctor.  He might want to do some tests.  Make sure you have a healthy diet, and reduce your use of unhealthy subastances like nicoteine, caffeine and alcohol. Get better sleep and exercise as these can help to reduce the feeling of restless legs. If these do not help then your physician may find that there are medications that could help.

Resources:

http://www.medicinenet.com/restless_leg_syndrome/article.htm

http://www.rls.org/

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What our eyes tell us

Posted by amykr on January 10, 2009

As we get older we notice many changes to our bodies. The need for reading glasses being one of them. The other one being that we just do not sleep as well as we used to. Well these two issues may very well be connected. In a study done at University of Kansas by Dr. Patricia Turner M. D., “as the eye ages the pupil gets small and the lens absorbs more light. These two issues work together to decrease circadian photoreception” A fancy way of saying the eye is not as able to absorb different spectrums of light then it used to be. So the part of the eye that helps regulate our bodies just does not work as well.

This inability to judge absorb adequate light can lead to problems such as insomnia depression, or other issues.

So would I bring up this problem if I did not have an answer for you to help you. It appears according to this article that indoor lighting might be a contributor to the problem because it is not as bright and it is heavier on the blue spectrum of light. One thing that might help if you are having issues of insomnia or depression is to go outside. The light outside is brighter it has all the light spectrum so it will allow you to absorb more of the light you need. A second thing you can do is make sure your eyes are as healthy as can be. Go see an optometrist once a year. Lastly if your vision is poor and you seem to be having issues you might want to talk to your doctor about Melatonin supplements.

It is always interesting how research seems to prove the ideas our mothers used to tell us. Like go outside and play, you will feel better and sleep better.

Turner, P, Mainster, M. Circadian Photoreception: Ageing and the Eye’s Important Role in Systemic Health. British Journal of Ophthalmology. Posted on Medscape 12/26/2008. http://www.medscape.com/viewarticle/582906_print

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You expect me to sleep with all that!

Posted by amykr on January 9, 2009

People who come to the sleep lab always seem to expect the worst. It does not help that their friends have told them all sorts of horror stories and that the internet is full of misinformation. So when most people come in they are usually either totally clueless as to what will happen or they are terrified that we are going to tie them to the bed and attach all sorts of things to them. Really a sleep study is not bad at all.

The first thing you should know is that at my sleep lab we our rooms look like your bedroom or a hotel room. There is a queen size bed and a flat screen tv in each room. People do not need to share rooms. However you also can not share your room with your spouse. I know you wives out there are excited to have a snore free night to yourselves.

The next thing you should know is that we do attach some wires to you with tape and paste. These wires are so we can monitor the electrical activity in your brain and in certain muscles. The wires are very thing with a cup or a snap at the end. They are tied together in a bundle so that you will not get tangled in them. I have never ever lost a patient do to self hanging during a sleep study. I also use sticky pads like when you have an EKG done.

The third thing you should know is that the tests are recorded for sound and video. This is so the physician can see and hear anything unusual. There are people who act out their dreams and who sleep walk that we need to have on video. This way the doctor can see what was going on and will be able to get the proper diagnosis.

The fourth thing you should know is what we are looking at while we, the technician and the physician, are sitting at the computer. We have 6 channels that look at brainwaves from different portions of your brains. We monitor your eye movements so we can tell when you are dreaming (do not worry we never see what you are dreaming.) We have three wires on your chin to monitor for teeth grinding. We monitor your heart and your oxygen levels. We monitor your leg movements to see if you have leg movement or leg cramps during the early part of the night. We monitor your snoring to see how loud it is. And finally we monitor your breathing with two belts, one around your chest and one around your belly. We also put on a thermister and pressure transducer to monitor your breathing in and out of your nose and mouth.

Finally you should know about the CPAP but I will leave that to another blog entry because there is so much to talk about just with that. I will also talk about what conditions we are testing for. I think people should know we are not just looking for sleep apnea.

I hope this makes you feel a little more comfortable about what will happen when you arrive at our lab. You are always welcome to visit any time you are in Apopka.

One of the rooms at Emery Sleep Solutions

One of the rooms at Emery Sleep Solutions

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Extra Side Effect of One New Years Resolution

Posted by amykr on January 2, 2009

Many people suffer from insomnia. We work hard, relax little and suffer from input overload. As woman we also suffer from hormonal changes that can increase insomnia. What can you do about this if we do not wish to take medications?

One New Years resolutions that might be able to help is exercising. There are some rules thought. It works best in the morning according to Dr. Youngstedt’s research at University of California at San Diego. He found that it can help regulate the body’s internal clock also know as circadian rhythm based on when you do your exercise. That outdoor exercise has the added effect of light exposure which helps to regulate this rhythm as well. He also recommends that people with insomnia try exercising different times of the day as some people it does help to exercise in the evening.

Since many of us commit to exercise as part of the New Year it might help to try exercising in outdoor light, do small intervals throughout the day or to experiment with the time you exercise as a way for you to improve you sleep.

I hope you are having a great and productive New Year.

http://www.acsm.org/Content/ContentFolders/NewsReleases/2003/TROUBLE_SLEEPING__A_LITTLE_EXERCISE_MIGHT_HELP.htm

http://www.physsportsmed.com/issues/1997/10oct/young.htm

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