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Published March 17, 2013, 11:40 PM

Sleep therapy helps residents battle apnea

GRAND FORKS - About six months ago, Kevin Dean noticed a problem. By mid-afternoon, he was getting so tired he could close his eyes and fall asleep. “I was just not feeling rested,” he said. “I really felt fatigued,” and he usually slept seven or eight hours a night.

By: Pamela Knudson, Forum News Service, INFORUM

GRAND FORKS - About six months ago, Kevin Dean noticed a problem.

By mid-afternoon, he was getting so tired he could close his eyes and fall asleep. “I was just not feeling rested,” he said. “I really felt fatigued,” and he usually slept seven or eight hours a night.

This symptom was perplexing because he hadn’t had sleep problems in the past. He did snore, though, his wife told him.

Dean is one of millions who suffer from a sleep disorder, but their symptoms often go undiagnosed because they don’t realize sleep is the issue – they are not getting enough of the kind of restorative sleep the body requires.

“They think, ‘Oh well, I snore’ and they just live with it,” he said. “It doesn’t mean you’re just getting older. It could be very treatable, like sleep apnea.”

Sleep disorders

The National Institutes of Health estimates that 70 million Americans suffer from sleep disorders, which can range in severity from snoring and restlessness, to reflux (food returning to the throat from the stomach), to sleep apnea, an abnormal pause in breathing.

The inability to get a good night’s sleep can inhibit a person’s mental and physical performance. It lowers the body’s ability to resist and fight illness, and insufficient quality sleep can cause ailments such as anxiety, depression, memory loss and dementia, high blood pressure, heart disease and stroke.

For several weeks when afternoon fatigue struck, Dean tried drinking coffee or eating a snack – anything that might help boost his energy to carry out his duties as public information officer for the City of Grand Forks. When things didn’t improve, he decided to talk to his primary care physician.

His doctor suspected sleep apnea and encouraged him to get tested for it. Dean was open to the idea because “there were solutions to the problem,” he said. “I wasn’t afraid to learn I might have this condition. I was relieved because I knew there was something they could do to help me.”

Sleep study

At the Altru Sleep Center, six bedrooms are decorated to create a soothing, home-like setting to help patients relax. A sleep study involves pasting electrodes to the body to monitor brain waves, rapid eye movements, breathing patterns, respiratory efforts, oxygen levels, snoring, muscle tone, leg movements, electrocardiogram and heart rate. In a nearby room, technicians monitor data streaming across computer screens and record information such as when the patient turns over and to which side. The next morning, the technician reports those findings to a physician who specializes in sleep disorders.

Sheila Thompson, a registered polysomnographic technician, and her colleagues determine if the patient qualifies for CPAP, “controlled positive airway pressure,” and, if so, put the CPAP mask on and adjust the amount of pressure to fit the patient’s needs. CPAP forces the airways to open, increasing breathing capacity.

They also check for partial airway obstruction which causes hypopnea, overly shallow breathing. In addition to CPAP, treatment options for sleep apnea include an oral appliance or surgery, she said.

Both Essentia Health and Sanford Health in Fargo have similar sleep centers. There are also at least two independently owned sleep centers in Fargo, the North Dakota Center for Sleep and the Sleep Wellness Center.

Apnea reduces sleep quality

When Dean was sleep-tested in August, before bedtime, he was told that if he had 30 episodes of sleep apnea during the night “that would put me in the category of needing a CPAP machine,” he said.

He went to bed at 11 p.m. and, despite being hooked up to an array of electrodes, had no trouble getting to sleep, he said. Later, he remembers technicians woke him and fitted him with a CPAP mask.

“I said, ‘I thought I had to have 30 episodes of sleep apnea before that was needed.’ They told me I’d already met the criteria … It was midnight.” Once he was fitted with the CPAP mask, the apnea episodes “calmed down,” he said.

The sleep study revealed that, in certain 30-second intervals, he was not breathing for 24 seconds.

He learned that while he slept, he would stop breathing – without knowing it – then suddenly snore “which would sort of kick-start my body into breathing again,” he said.

The study showed that sleep apnea was preventing him from getting the quality and amount of REM, or “rapid eye movement,” sleep that’s necessary for good health. Sleep apnea permitted only a “shallow” sleep that led to his afternoon exhaustion.

With sleep apnea, the airways are relaxing too much, which causes snoring, said Thompson. “That causes the person to stop breathing and (blood) oxygen levels to drop.”

On the night of his sleep study, Dean’s blood oxygen level had dropped to 80 percent, he said. “It should be at 95 to 97 percent. That impacts your heart, your brain, your muscles, your whole body. That can’t be good for you.”

The CPAP mask he now uses nightly took some getting used to, Dean said. At first, it gave him kind of a claustrophobic feeling. It took about six weeks to get comfortable sleeping with it, he said.

The device “has made a huge change” in the quality of his sleep, he said. “I could not be more delighted with the results.”

The tubing that connects the mask to the machine on his bedside nightstand pivots and is long enough to allow for movement, he said. “Anywhere you have access to electricity, you can use the CPAP.”

Often unrecognized

Sleep disorders often go unrecognized in individuals, said Dr. Arvind Bansal, sleep medicine specialist at Altru, yet “26 percent of adults in the U.S. are at risk for sleep apnea.”

“Recognition is most important in my mind,” he said. “If you don’t recognize it’s a problem, treatment won’t do any good.”

He said he is struck by the fact that patients – who could have been helped by sleep therapy – “10 to 15 years down the road, now they’re dealing with health care issues” such as diabetes, high blood pressure and other chronic medical conditions. “And there’s no recourse, there’s no going back.”

He said it’s common for people to think of snoring as “a funny thing.” But the sleep disorders that snoring can signify affect one’s quality of life – “your productivity at work, high blood pressure, diabetes, depression, dementia. …. You can hurt yourself and others too,” he said, noting safety threats that arise from lack of adequate sleep.

Sleep apnea is also prevalent – and even more unrecognized – in children, Bansal said. Kids who have been diagnosed with attention deficit hyperactivity disorder (ADHD) or aren’t doing well in school may actually have sleep apnea.

The condition may be due to tonsils or adenoids that are “overgrowing,” he said. Once removed, the apnea ends.

Advances in technology will make

in-home sleep-testing available to a wide range of patients, he said. Altru is planning to offer this service.

Growing field

The field of sleep medicine continues to grow, Thompson said. Americans’ obesity problem is contributing factor, she said. Fat tissue puts extra pressure on airways and makes sleep apnea worse. Dramatic weight loss and bariatric surgery may eliminate the need for CPAP.

“Surgery to correct sleep apnea is not a guarantee,” she said. Three months after surgery, more than half of patients who get evaluated at the Sleep Center still need CPAP.

“I’ve found that if obese patients can lose 20 percent of their starting weight, they can improve (their sleep apnea) by one class,” Bansal said. “They can go from severe to moderate or from moderate to mild.

“They can even eliminate sleep apnea, he said.

“There may be some people who just can’t wear (the CPAP mask),” Dean said. “I could not be more pleased with the results. It’s incredible.

“My wife thinks it’s the best thing,” he said. “She says it’s the smartest thing I ever did because she gets better rest.

“Anytime you can do something that makes your spouse happy, it’s a good thing.”

Call Knudson at (701) 780-1107; (800) 477-6572, ext. 1107; or send e-mail to pknudson@gfherald.com.

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