Sleep Services

Key signs and symptoms include:

• Loud snoring, interrupted by pauses in breathing
• Gasping or choking during sleep
• Restless sleep
• Excessive sleepiness or fatigue during the day
• Large neck size (greater than 17.5" in men; greater than 16.5" in women)
• Crowded airway
• Grogginess and morning headaches
• Sexual dysfunction
• Frequent urination at night
• Poor judgment or concentration
• Irritability
• Memory Loss
• Uncontrolled hypertension despite the use of medication to control it
• Obesity

• Obstructive Sleep Apnea (OSA): The most common type of sleep apnea caused by a narrowing of the airway, usually when the soft tissue in the back of the throat collapses during sleep. When the airway narrows, the amount of oxygen in your blood may drop. Normal breathing usually begins again with a loud snort or choking sound.
• Central Sleep Apnea: The airway does not collapse; however, the brain fails to signal the muscles to breathe.
• Mixed Apnea: Patient’s diagnosed with mixed apnea experience a combination of OSA and Central Sleep Apnea as defined above.

In all three types of sleep apnea, those who go untreated can experience repeated pauses in breathing during their sleep, sometimes hundreds of times each night. As a result, sleep is extremely fragmented and of poor quality. Disturbed sleep throughout the night can cause sleepiness during the day.

1. Excessive Tissue - When you are asleep the tongue and other muscles in the throat relax. This floppy tissue can decrease the size of your airway. As a result, your airway closes and airflow stops periodically during sleep.
2. Weight - During sleep, excessive weight around the neck and chest can create a narrowing of the airway due to the weight of muscles relaxing on the throat and chest. If you have a large neck or are clinically overweight you may suffer from sleep apnea.

Treatment for sleep apnea focuses on restoring regular breathing and relieving symptoms such as daytime sleepiness and loud snoring. Treatment Options include use of a CPAP (Continuous Positive Airway Pressure) mask while sleeping, use of an oral appliance (mouthpiece), or surgery.

Treatment of sleep apnea may also help associated medical problems, such as high blood pressure, and may reduce your risk for heart attack and stroke.

• Excessive daytime sleepiness
• Sudden loss of muscle tone especially with stress or strong emotion
• Sleep paralysis
• Changes in rapid eye movement (REM) sleep
• Hallucinations
• Waking up often, insomnia, fragmented sleep
• Automatic behaviors while asleep

Narcolepsy is a chronic sleep disorder that can cause a person to have difficulty staying awake during the daytime hours. In extreme cases, narcolepsy can cause a person to suddenly fall asleep during the day. These “sleep attacks” can occur even after getting enough sleep at night.

Doctors will base a diagnosis of narcolepsy on the patient’s symptoms, family history of narcolepsy, physical exam, and test results. Specific sleep tests may require the patient to visit a sleep disorders center for an overnight evaluation. The overnight evaluations are then followed by a daytime sleep test in which the patient will have a series of observed nap periods.

Typically, narcolepsy first occurs between the ages of 7 to 25, but can occur anytime in life. Narcolepsy affects both men and women. The symptoms can start suddenly or appear gradually. The condition is difficult to diagnose without medical tests. Often people live with mild symptoms, such as daytime sleepiness and muscle weakness, for several years before narcolepsy is diagnosed. Narcolepsy can also develop later in life or in children, but it is rare before age five.

Factors that may increase the risk of developing narcolepsy include having:

• A sibling or parent with narcolepsy
• Orexin/Hypocretin deficiency
• Having an autoimmune disorder

Individuals with narcolepsy often fall asleep without warning and, at inappropriate times. Sleep attacks don't just happen during quiet times, such as when reading or watching TV. These sleep attacks can occur during driving, eating, or other activities. These attacks can cause:

• Accidents and injuries
• Problems at work or at school
• Social problems
• Impaired memory, thinking, or ability to concentrate
• Depression

A sleep specialist may recommend special sleep tests to properly diagnose narcolepsy. During the testing, the sleep specialist will confirm a diagnosis of narcolepsy, diagnose another sleep disorder, or rule out a specific sleep disorder as the cause of your symptoms, based on:

• The results of your sleep tests
• Your symptoms
• Your sleep habits as recorded in a sleep diary

Narcolepsy is easier to diagnose if you have more symptoms than just daytime sleepiness and sleep attacks.

Narcolepsy is a lifelong condition. Although there is no cure for this condition, symptoms often improve with ongoing treatment. Most people with narcolepsy can live near-normal lives. The condition can be dangerous if sleep attacks or sudden loss of muscle tone occur while driving or using machinery. Even when these episodes occur at other times, they can cause injury or impair performance in school and on the job. To help avoid harm, try to: Avoid being alone when you are likely to have a sleep attack. Take a nap before those times during the day when an attack is likely. Safeguard your home and workspace. Seek help from family, friends, coworkers, and your doctor. If applicable, take your narcolepsy medicine as recommended.

• Stretching or bending
• Rubbing the legs
• Tossing or turning in bed
• Getting up and pacing
• Low back pain

To diagnose RLS and determine the best treatment, a sleep study may be recommended. To schedule a sleep study, contact your physician and ask for a referral to Graham Sleep Disorders Clinic.

Restless leg syndrome (RLS) can occur during periods of relaxation or inactivity and may affect one or both legs. RLS symptoms are typically worse in the evening and night as compared to morning hours. RLS is a neurological disorder characterized by unpleasant sensations in the legs and an uncontrollable urge to move when at rest in an effort to relieve these feelings. RLS sensations are often described by people as burning, creeping, tugging, or like insects crawling inside the legs. The severity of the symptoms can vary from night to night or over a long period of time. Some individuals may experience symptoms daily; though for others there may be periods when they experience no symptoms at all.

The most distinctive or unusual aspect of the condition is that lying down and trying to relax activates the symptoms. As a result, most people with RLS have difficulty falling asleep and staying asleep. Left untreated, the condition causes exhaustion and daytime fatigue. Many people with RLS report that their job, personal relations, and activities of daily living are strongly affected as a result of their exhaustion. They are often unable to concentrate, have impaired memory, or fail to accomplish daily tasks.

RLS is treatable and effective treatment can improve sleep quality, reduce daytime sleepiness, and improve the patient’s sense of well¬being.

RLS disorder is diagnosed clinically by evaluating the patient's history and symptoms. Despite a clear description of clinical features, the condition is often misdiagnosed or underdiagnosed. Unfortunately, there is no single diagnostic test for RLS.

Physicians must rely largely on patients' descriptions of symptoms and information from their medical history, including past medical problems, family history, and current medications. Patients may be asked about frequency, duration, and intensity of symptoms as well as their tendency toward daytime sleep patterns and sleepiness, disturbance of sleep, or daytime function.

In some cases, sleep studies such as polysomnography (a test that records the patient's brain waves, heartbeat, breathing and body movements, during an entire night) are undertaken to identify the presence of PLMD. Periodic Limb Movement Disorder differs from RLS, PLMD occurs only during sleep and is associated with frequent awakenings or arousals that can lead to daytime sleepiness, whereas RLS occurs when a patient is awake. These PLMD’s can be associated with medications or sleep disordered breathing although the exact cause in unknown. Treatment can include correcting any sleep disordered breathing or medications. Sometimes the kicking will go away with treatment of the obstructed airway with CPAP Once the airway is corrected the movement disorder maybe its own separate entity and will need to be treated with medication.

The Sleep Disorders Clinic at Graham Hospital offers diagnostic electroencephalograms (EEG). This pain-free test measures electrical activity of the brain with a series of electrodes and the physician interprets the brain wave patterns. Your physician may recommend EEG testing to help determine the cause of a sleep disorder, seizures, loss of consciousness, dementia or other neurological conditions.