Insomnia, Snoring, Sleep Apnea

The world and life of a sleep tech

Archive for May, 2009

Insomnia and Fibromyalgia; Combination Therapy Helps

Posted by amykr on May 27, 2009

Fibromyalgia patients have to learn to deal with chronic pain. The problem is that pain and insomnia cause a vicious cycle of increased pain and decreased sleep. Insomnia has been shown in many studies to decrease a patient’s pain threshold.

Treating insomnia can be quite difficult. Medications are usually the first line of treatment. They work well in the beginning but patients build up a tolerance over a period of time. This is particularly true of Fibromyalgia patients because it must overcome the pain the patient feels. When you mix the short term effects of medication such as Ambien or Lunesta with cognitive behavioral therapy, also known as CBT, patients have much more success.

Cognitive behavioral therapy is a psychological treatment where a therapist helps a person changes their thinking about an issue so they can change the behavior. This therapy has shown a 30%-40% success rate in the treatment of insomnia. When it is combines with short term sleep medications the efficacy increases to 65%-70%.

Many patients may be reluctant to go this route because doctors in the past may have told them their Fibromyalgia was in their head. The medical profession has changed their understanding of this condition and is looking to alternative therapies to help to deal with this condition. Cognitive behavioral therapy is one tool to not only help with insomnia but to help with the chronic pain as well.

As with any therapy you should always discuss your options with your doctor because he/she knows your full case history. For those who are looking for the best way to handle the sleepless nights these therapies are a great new option.

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Passion for Sleep; Dr. William Dement

Posted by amykr on May 27, 2009

If ones life is measured by ones passion then Dr. William Dement is one of the most successful people alive. His passion for increasing knowledge goes hand in hand with his desire to educate everyone about the need for adequate sleep.

Dr Dement has been teaching and researching for 57 years and has been with Stanford’s department of psychiatry since 1963. During this time he was the first person to document REM sleep, the stage of sleep where dreams occurred. He has also learned and brought to the public Narcolepsy, a condition that causes sudden loss of control of muscle tone and periods of spontaneous sleep. He continues to research and is currently publishing articles on sleep debt and vigilance. His discoveries and role in the study of sleep has created the standards of testing and care for patients with sleep apnea, daytime sleepiness, restless leg syndrome and many other sleep related disorders.

Father of sleep research and treatment

Father of sleep research and treatment

I have the luxury of meeting Dr. Dement and hearing him speak at the Focus Conference on Critical Care Medicine in Orlando last week. His desire to change how Americans look at sleep, especially our young people, and to increase the time we sleep is inspiring. He spoke on his current research, the fact that in order to learn optimally, function at peak performance and have a great memory we need to reduce our sleep debt on a regular basis. He does feel that we do not create strong enough routines for ourselves or our children.

His biggest crusade is his desire to end drowsy driving. According to the NSF it is difficult to track drowsy driving due to limited reporting. What is known is that 78% of all drowsy driving accidents end with a fatality. It is also known that there are very few laws to protect people from drowsy drivers. He feels that this is unacceptable and is encouraging people to be aware and treat your drowsy friends and coworkers like a person who is intoxicated and give them a ride.

Dr Dement closed his talks by informing his audience that he will continue to learn and teach until he simply can not anymore. His passion for the field he created and the joy he takes in teaching others is truly and inspiration to all.

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Oral Devices for Sleep Disorders

Posted by amykr on May 7, 2009

Oral devices are one of the least talked about ways to help people with sleep disordered breathing. Because of this lack of discussion there is a great deal of misinformation as to who they work for and what they do.
Sleep apnea and primary snoring can have a profound effect on not only the person who has it but also their bed partner. Loud snoring disturbs sleep and if sleep apnea is present then the pauses and gasps can wake their partner from a sound sleep. When the sleep apnea is mild the option of treating it with an oral device can be quite beneficial.
These small devices come in two varieties. The first one, and the most popular is the mandibular advancement device, it moves the lower jaw forward so that the tongue is advanced and develops more muscle tone and opens the airway. Although there are many manufacturers of these devices the person who should choose which you use and fit you is a dentist who is experienced in sleep disorder dentistry.
The other type of device is best for patients who wear dentures or who have issues that would not allow the jaw to be moved into the proper position. It is called a tongue retention device. It uses suction to pull the tongue forward. This moves it out of the back of the throat and also ads muscle tone to it to help to open the airway.
These devices have several advantages over other treatments. It does not require any surgical procedures. It is small and lightweight making it easy to travel with. It is easier to get used to then some of the other treatment options available.
The drawbacks are that they do not work as well for moderate to severe apnea or where the problem is somewhere other then the back of the throat.
If you have primary snoring, or snoring without any other disorder or you have mild sleep apnea and loosing weight or positional therapy, training yourself not to sleep on your back this might be a solutions. It also might be a good solution for those who do not want to have surgery to fix their snoring problem.
If you want more information on this subject http://www.aadsm.org can provide you with links to doctors in your area accredited to perform medical sleep dentistry.

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Why is He Here?

Posted by amykr on May 6, 2009

I love my patients, but I have to admit there are some patients that make this job more challenging. They are not the patients with severe apnea or the patients who do not believe they have apnea; They are the patients who do not have anything.

You know the ones I am referring to: you put them to bed, you read their questionnaire, and you expect to see an AHI of at least 15 events per hour. Then it is 1 a.m. and you hear nothing. Not a snore, not a gasp, nothing. You look at the study and they have had plenty of stage 3 and REM already. You look to see if maybe they had not done any sleeping on their back. Nope, they have been asleep on their back the whole time.

When you talk to them the next morning you get one of two responses. My favorite is “This is the best night sleep I have had in years.” The other type of patient is convinced he did not sleep.

We had the former patient in our lab last week. He teaches college. He scores papers on his laptop in his bed until 1 in the morning, most nights. His wife complains that he snores but he says she snores as well. The best part was when I handed him the sleep hygiene tips sheet. He said I left one item off the sheet. He informed me that he slept with his two children in bed with him. Now I was standing there trying to figure out how he did not tell his doc this before the doc sent him to the sleep lab.

I do not know about you, but if I stayed up until 1 a.m. every morning, had two squirming children in bed with me every night, and taught college all day, I would be exhausted.

So what do we learn from this patient? That every once in a while it is nice to have an easy patient.

Oh yeah, and if he even remotely looks young enough to have kids, ask if they have their own room.
Reprinted for http://www.advanceforsleep.com

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