WHAT IS A GOOD NIGHT'S SLEEP

A “good night’s sleep” is what we require to feel energized in the morning and prepared to take on the physical and mental challenges of the day. Although we spend 1/3 of our lives asleep, the study of normal and disordered sleep is in its infancy.

Sleep is an active process involving an organized sequence of events. There are five stages of sleep, each physiologically different and fulfilling specific needs. In order to awaken in the morning feeling well-rested, a person must cycle through the five stages of sleep in an orderly sequence with a minimal number of interruptions and for an adequate duration of time (typically 7-9 hours for adults).

Restful nighttime sleep is critical to the maintenance of physical and psychological well-being. Each year more than 50 million Americans report difficulty sleeping or are dissatisfied with the quality of their daytime alertness. Ten million annually seek the help of a physician, and approximately half of these patients are prescribed medications for sleep. Unfortunately, many others do not seek professional help at all.

IMPACT OF SLEEP DISORDERS

A good night's sleep has a positive impact on life and activities of daily living. Many disorders of sleep and wakefulness result in daytime tiredness or sleepiness which may not be well understood by others. Frequently, patients with sleep-wake disorders are thought of as lazy and unmotivated by colleagues, family members, and friends. This creates an additional burden for the patient. Sleep disorders may masquerade as depression, chronic fatigue syndrome, attention deficit disorder, and sexual dysfunction. Sleep disorders can result in a significant negative impact on work performance and social relationships. Certain sleep disorders may increase the risk of heart disease, stroke, reflux and glaucoma.
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WHAT IS A SLEEP EVALUATION

Sleep disorders may have a negative impact on life and activities of daily living.  Many disorders of sleep and wakefullness result in daytime tiredness or sleepiness which may not be well understood by others.  Frequently, patients with sleep-wake disorders are thought of as lazy and unmotivated by colleagues, family members and friends.  This creates an additional burden for the patient.  Sleep disorders may masquerade as depression, chronic fatigue syndrome, attention deficit disorder, and sexual dysfunction.  Sleep disorders can result in a significant negative impact on work performance and social relationships.  Certain sleep disorders may increase the risk of heart disease, stroke, reflux and glaucoma.  A sleep evaluation begins with a detailed sleep and wakefulness history and a neurological exam.  A patient may then be asked to monitor his or her sleep and nap schedules by keeping a diary.  This may be followed, in some cases by an overnight sleep study (polysomnogram) to observe, evaluate, and record nighttime sleep.  daytime wakefulness may be evaluated with a Multiple Sleep Latency Test (MSLT), a reproducible measure of sleepiness.  The ability to stay awake may be evaluated with a Maintenance of Wakefulness test (MWT).  With this information, a definitive diagnosis may be reached and an appropriate treatment plan developed.  Out treatment philosophy integrates a mult-modal approach to the management of sleep disorders employing:.

• Patient education
• Behavioral modification
• Judicious use of pharmotherapy
• Specific interventions such as CPAP, BiPAP or a dental device for sleep apnea
• Light therapy for circadian rhythm disorders
• Pulmonary, otolaryngological (ENT), psychiatric and psychological consultation when indicated

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COMMON SLEEP DISORDERS

Obstructive Sleep Apnea (OSA):
Loud disruptive snoring, episodes of observed stoppage of airflow and gasping for breath during sleep, snorts and arousals, daytime sleepiness.

Idiopathic Daytime Hypersomnia:
Excessive daytime sleepiness.

Narcolepsy:
Excessive sleepiness, sleep paralysis (awakening in the morning or from a nap and being briefly physically unable to move), hypnogogic hallucinations (episodes of being in a dream-like state but still awake), cataplexy (sudden loss of muscle strength triggered by emotion, especially laughter), fragmentation of sleep at night.

Insomnia:
Sleep onset difficulties, multiple nighttime awakenings, or awakening too early in the morning and not being able to fall back to sleep.

Delayed Sleep Phase Syndrome (DSPS):
Unconventional timing of sleep/wake schedule, for example falling asleep at 2:00 am and sleeping until 10:00 am.

Restless Leg Syndrome (RLS):
Uncomfortable leg sensations accompanied by the irresistible urge to move and adjust legs or arms to relieve discomfort. Symptoms usually occur when resting quietly, attempting to fall asleep or during passive restricted activities (on an airplane, at the theater or opera).

Periodic Limb Movements of Sleep (PLMS):
Semi-rhythmic contractions of the limb musculature during sleep, often accompanied by limb jerks, most often involving the feet.

REM Sleep Behavioral Disorder (RSBD):
Dream enactment behaviors occurring at night which may be violent and potentially dangerous to the patient or bed partner, characterized by yelling, cursing, punching, running and other actions triggered by the content of the patients’ dream.

Parasomnias:
Abnormal behaviors associated with sleep such as night terrors, sleep walking, sleep talking.

Nocturnal Eating:
Uncontrolled episodes of eating during the night of which the patient may or may not be aware.
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SLEEP HYGIENE SUGGESTIONS

• Establish a regular wake-up time each morning, even if the previous night’s sleep was inadequate. This schedule should be adhered to even on weekends. This will reinforce your internal sleep clock and improve sleep.
• Set aside time in the evening for relaxation and thinking. Try to avoid taking the troubles of the day to bed. If you have a lot of things on your mind make a written list of them and what you plan to do. Diary keeping and list making are excellent stress reducing strategies and promote sleep.
• Just prior to bedtime try to do something enjoyable and relaxing.
• Get in bed only when you are ready to go to sleep and get out of bed in the morning when you wake up. Use the bed only for sleep and sex. Decreasing the amount of awake time in bed will reinforce the sleep schedule and getting into bed, at the appropriate time, will help trigger “sleepiness”.
• Napping fulfills nighttime sleep requirements during the day, reducing the amount of sleep required at night and potentially disrupting the sleep/wake schedule. Get to know your own response to napping and nap only if it helps. If napping is necessary, try to limit the nap to 45 minutes at a regular time, preferably between 2 and 5 PM.
• A healthy body sleeps better than an unfit one, although it may take several weeks to feel the positive effects of exercise. Exercise in the late afternoon, if possible. Exercise should be avoided just before bedtime.
• Hunger disturbs sleep. A healthy evening snack is suggested. Avoid eating dinner too late (after 8 PM) as the digestive process may disrupt sleep.
• Do not drink any caffeine containing beverages (tea, coffee, hot chocolate, caffeinated sodas) after lunch. Caffeine is a stimulant and takes at least 8 hours to be fully metabolized. Avoid chocolate in the evening.
• Sleep is disturbed in smokers due to the effects of nicotine. Make every attempt to quit smoking, or at least cut back. Avoid cigarettes within 2 hours of bedtime.
• Alcohol is deceptive: its initial disinhibiting and sedating effect may help you fall asleep, BUT alcohol disrupts sleep in the second half of the night. It increases arousals, suppresses slow wave and REM sleep with a net result of non-restorative sleep. Alcohol should not be used to induce sleep.
• Occasional loud noises disturb sleep, even in those who claim to have adapted to them. You may sound screen the room with a distracting fan or “sound” machine.
  The bedroom temperature should be comfortable, excessively hot or cold rooms disturb sleep.

These suggestions help to make sleep a more natural, refreshing experience.
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CPAP CARE AND INFORMATION

Reasons to Use Your CPAP

Some Helpful Hints on How to Adapt to Your CPAP Successfully

Care of the device and accessories

Care of CPAP equipment is simple and requires a minimal amount of time to maintain properly. It may help to think of the care as on a ‘once a day, once a week, once a month and as needed’ schedule. This information will also be discussed with you when the equipment is delivered.

• Wash the CPAP mask daily in warm water and a mild soap. Pat dry with a clean towel.
• Wash the tubing once weekly by taking it in the shower with you and letting a good amount of water run through it. Hang it to drip dry.
• There is a filter in the CPAP machine. This filter will either be disposable or washable, depending on the machine delivered to you. You should check the condition of the filter once monthly and either replace, or wash it, if it is dirty. You should be supplied with replacement filters if your machine has the disposable filter type.
• The headgear may be washed in mild soap and warm water on an as needed basis.
• We do not recommend soaking the mask or tubing, as this can result in swelling of the plastic and distortion of shape.
• Wash your mask and tubing daily if you have a cold.

Adapting to the CPAP device
 

We recognize that getting used to wearing a mask on your face while sleeping is not an easy task for many people. There is a great degree of variability in the ease with which people adapt to CPAP. Try not to put an undue amount of pressure on yourself to immediately bond with the device. We expect that this will be a process, not an immediate result! If you are only able to wear it a brief period of time at first, that’s a start. You will become increasingly more used to it with time. Some suggestions:

We understand that the psychological battle of adapting to sleeping with a mask and CPAP device is often greater than any difficulties encountered physically adjusting. Remember: Your bed partner is interested in your health and wants you to use this device. Your bed partner will be grateful for a quiet’s night sleep. No one cares what you look like while you are sleeping (except you)!

It is best to have the equipment lower than the bed level so that secretions or humidity that may condense in the tube can run downhill away from you. Many people like the machine positioned at the head of the bed. This can allow for more easily turning side to side. You can, however, have it at the side of the bed—whatever works for you.

Air leaks from the mask reduce the treatment pressure and may lead to inadequate treatment of the sleep apnea. Repositioning of the mask on the face and adjustment of headgear is the first step in dealing with this. If this doesn’t fix the problem, you may need an alternative mask or a different size. Approximately 20% of the patients require a change from the mask that they were originally studied with. You may call the office to arrange a mask re-fitting session with our daytime technologist or call the homecare company that provided your equipment. Remember that the mask should feel snug, but not tight. Over tightening the mask may aggravate leakage. If there is a white plug on the mask, it should be closed unless you are instructed otherwise. (It is a port for oxygen delivery, which is not needed in most patients.)

If you have any persistent pink/red marks on your face from the mask, please let us know as soon as possible. If you continue to wear your mask with this degree of irritation, you may end up with an ulcer/scab/scar on your face that could have been prevented with a mask adjustment or refitting. Our daytime sleep technician, Joel, is very skilled at mask adjusting and is quite available to address this issue, should it arise.

While we try to get you comfortable with a given mask the night of your titration study, changes in mask type are sometimes made, depending on your comfort and experience at home.

If you feel you are not making progress within the first 2 weeks towards being able to use the CPAP device for the entire night, please call and arrange a CPAP mask re-fitting/ desensitization session with our daytime techs so that the problems can be addressed BEFORE you throw the equipment out the window. Early intervention is critical if you are not adapting.
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Sleep-Related Organizations

Light Therapy Sources

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