Going DEEP into SLEEP
Chronically-fatigued folks undergo studies at Tuality Forest Grove Hospital
Getting a decent nights sleep wasnt just a challenge for Carol Currie. Putting her head down on her pillow and drifting off used to be downright dangerous.
I didnt have a lot of trouble falling asleep, said Currie, 66, a retired nurse who suffers from sleep apnea. But my airway would obstruct and I would jerk awake.
Id stop breathing for a couple seconds 19 or 20 times an hour.
Currie, a Beaverton resident, is one of thousands of Americans dealing with a variety of sleep issues as the New Year gets under way. For her, counting sheep wasnt doing the trick so she headed to Tuality Healthcares Sleep Lab for an evaluation.
Located at Tualitys Forest Grove Hospital, the lab has been open since 2009. It offers most of the indulgences of a fine hotel private bathrooms, cable TV, comfy recliners and top-quality queen-size beds to help guests relax and rest.
In the lab, specialists and technicians perform overnight sleep studies on patients with sleep and fatigue-related issues from occasional insomnia to restless leg syndrome to debilitating cases of obstructive sleep apnea (OSA). They also deal with nocturnal seizures and neuromuscular disease-related breathing problems during sleep.
No problem is too small, said Dr. Peter Hahn, a specialist in sleep medicine and pulmonary medicine who has directed the lab for more than three years. Any degree of sleep trouble is worth an evaluation.
Living with OSA is nothing new for Currie, who participated in her first sleep study 15 years ago in Oklahoma. But as she has aged, her apnea has worsened and complaints from her husband, Alan, finally sent her to Tualitys lab.
A lot of people snore when theyre sleeping flat on their backs, said Currie, but I would snore even when I was on my side. It kept my husband up.
Last August, Currie checked into the lab at 8 p.m. and technicians hooked her up to a number of monitors. Then, they watched her while she slept. Theyre testing all kinds of things how youre breathing, your oxygen saturation and your heart rate, Currie said. Theyre looking for anything that interrupts your sleep.
In Curries case, the prescription was a device called a CPAP, ordered by Dr. Srinivas Mummadi, a pulmonary disease specialist at Tuality. Wearing the appliance has helped her avoid airway collapse while sleeping, giving her a shot at a full eight hours of rest.
Im on a better machine now, with headgear that fits me, reported Currie. Its basically a nasal application that directs warm air in through my nose.
The trick for me was getting the proper oxygen saturation level. A person should be at 98 percent, but with my sleep apnea, mine was dropping into the 70s.
Patients from 'all over'
For many sleep-deprived people, discoveries made during a 10-hour analysis can be life-changing. Tualitys lab can handle two overnight sleep-study patients at a time, usually by referral from a primary care physician. Various data including brain activity and breathing patterns are recorded by lab staff.
The next morning, Hahn or another doctor reads the study and schedules a follow-up appointment with the subject to discuss various approaches to solving his or her problem.
We run studies every night of the week, and our patients come from all over the Portland metro area, noted Hahn.
Another option is to self-refer by calling the lab at 503-681-4139 and make an appointment for a consultation. "We prefer to see the patient first and only order a study if needed," noted Hahn.
Sasheen Pack, who has managed the sleep lab for the past two years, said she's particularly gratified by feedback from patients who spend the night at the facility.
"When they arrive at the lab, sometimes they're very fearful at first," said Pack, a respiratory therapist who has worked at Tuality for 11 years. "They're not sure what's going to happen. But after they talk to our technicians and hear about the equipment and what will be happening overnight, they start to relax."
Some patients prefer a portable study, which takes place in the comfort of their own home. Were big believers in portable studies. The patient picks up the [monitoring] device, takes it home and sleeps with it, said Hahn.
The home studies are less detailed, but are especially helpful to people with an already-diagnosed problem such as sleep apnea. Symptoms include loud snoring, gasping for air and restless sleep.
The prevalence of sleep apnea has been skyrocketing since the 1980s, said Hahn, who pointed out that obesity is often a factor.
Even more serious in terms of its long-term negative health implications is OSA, the collapse of a persons airway as often as once every 60 seconds while asleep. This type of apnea can lead to high blood pressure, strokes and heart disease.
Some studies show that up to 25 percent of the population has this condition, said Hahn.
Currie was among that unlucky minority.
If you have untreated sleep apnea, you will eventually also have hypertension and heart failure, said Currie, who acknowledged that weight-loss is one of her medically-indicated goals this year. When youre deprived of the right amount of oxygen, its like your heart is running a marathon all night long.
Insomnia a big issue
The Forest Grove lab isnt the Ritz Carlton, but Pack noted that she often hears rave reviews from study subjects. "Many times these patients comment how much better a night's sleep they got in the lab than they do at home," she said.
Insomnia trouble falling asleep or staying asleep through the night is a big issue these days, Hahn said. The most common causes are underlying depression or anxiety. With life in the 21st century proceeding at warp speed, almost anyone can fall victim to occasional sleeplessness.
Still, its nothing to yawn about. Chronic insomnia at night can lead to daytime symptoms of sleepiness, fatigue, irritability, short-term memory loss, sexual performance issues and loss of concentration.
Sleep deprivation can also put drivers at an increased risk for accidents and push already-weary and fatigued folks into a real funk.
Eight hours is sort of what were supposed to get each night, but a lot of people have fragmented, poor-quality sleep, Hahn said. The less sleep you have on consecutive nights, the more likely you are to develop secondary ills, like depression.
Over-the-counter medications to put oneself to sleep Benadryl, Tylenol PM and Nyquil are among them arent necessarily bad, said Hahn. But there are some drawbacks.
The problem with self-medicating is that it will work for only a short period of time, he said. Patients might be better off taking advantage of the Sleep Labs cognitive behavioral therapy program, which teaches them better ways to fall and stay asleep.
Hahn, who joined Tualitys medical staff in 2010, came from the Mayo Cinic in Rochester, Minn., where he was a consultant in pulmonary, critical care and sleep medicine. He specializes in sleep-disordered breathing, periodic limb movement disorders, parasomnias and narcolepsy.
One of only a handful of fellowship-trained sleep medicine doctors in Oregon, Hahn said its a relatively new, exciting field that lends itself to measurable results. We can actually see the change in our patients from day to day, he said.
Those with health insurance are typically covered for up to 80 percent of the charges related to a sleep study, Hahn added.
For Currie, the benefits of nailing down her problem and addressing it successfully far outweighed any inconvenience or cost.
I didnt realize how much harm I was doing to my health by not dealing with my apnea, she said. And I didnt know how much better Id feel after I started to get a good nights sleep.
Now I dont feel the need to take a nap in the afternoon.
Brian Wilbur, Forest Grove, insurance company president
I sleep like a log for six to seven hours each night. When Im tired, Im able to take 10-minute catnaps and wake up fully energized.
Karen Thias, Forest Grove, teacher
I'm not a good sleeper. Even as a child I would wake up often during the night. Sometimes I have trouble falling asleep, and most nights I wake during the night. Several years ago I spoke to my doctor about it. She prescribed something to help with sleep which worked well the first few nights, but then stopped working, so I quit using it. Usually stress/worry keeps me from sleeping. Now, I read when I can't sleep. I keep a night-light and a pile of books by my bed. I read when I go to bed, and if I wake in the night and can't fall quickly back to sleep I read. I call it my thought replacement therapy. Sometimes it works quickly, sometimes it takes hours.
Debby DeCarlo, Forest Grove, writer
I go to sleep pretty easily, but if I wake up in the night, I focus on my breath. I count 10 breaths and start over pretty much my meditaiton routine. The interesting part is that when I am meditating during the day, I can sit for 40 minutes, but if I do it when in bed, in the night, I fall asleep within a few minutes. Watching a Kindle movie at bedtime usually puts me to sleep in minutes. If I'm fretting about something, I write it down, put it in a box and tell God to take care of it. It works pretty well. I haven't had to do that for a long time, but I used to regularly. Now that I'm getting older, being forgetful is helpful. I can't remember what I was fretting about.
Debra Bratland, Forest Grove, public transportation driver
I feel so blessed that I usually sleep soundly through the night. I was sleep-deprived for almost 16 years while caring for my disabled son, who sometimes required assistance a dozen times a night. Perhaps my sound sleep now is to make up for all of the sleep I didn't get then.
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