Ravenna – Whether it’s difficulty falling asleep or problems staying asleep, a poor night’s sleep is a bad way to start the day.
I enjoy helping people who find themselves tossing and turning when they should be snoozing. Typical problems I treat run the gamut from insomnia to narcolepsy and include everything in between, such as sleep apnea, sleepiness, sleepwalking and leg movements.
The good news is that with the proper diagnosis and treatment, most sleep problems can be treated successfully.
My first move is to identify whether the patient can’t fall asleep, can’t stay asleep, or can’t wake up. To do this, I have the patient describe his or her bedtime routine, and we talk about how long it takes them to fall asleep, whether they snore or kick their legs and if they yell or do something else they shouldn’t be doing in their sleep.
I also gather information such as whether the person wakes up during the night and cannot fall back asleep, what time he or she starts their day, whether they nap during the day and their emotional state during the day.
Serious Sleep Interruption – Obstructive sleep apnea is the most common sleep problem that I treat. Snoring and daytime sleepiness are symptoms often related to sleep apnea. Most people with sleep apnea snore, but not everyone who snores has sleep apnea.
People with sleep apnea experience interrupted sleep. In severe cases this happens from tens to sometimes a hundred times a night. For patients with sleep apnea, sleep usually is not refreshing.
Daytime sleepiness is usually one of the obvious results of sleep apnea, but more importantly, sleep apnea is potentially life threatening. Untreated sleep apnea increases the person’s risk for high blood pressure, poor blood sugar control, stroke, abnormal heartbeats and heart attack. Fortunately, treatment to control sleep apnea can reduce these risks.
The starting point for patients with suspected sleep apnea is a sleep study. The UH sleep lab in this area is at the UH Streetsboro Health Center. If you come in for a sleep test, you would be connected to sensors that monitor brain activity, blood oxygen levels, leg motion, snoring and breathing. A computer would record the signals, and you would be video-recorded while sleeping for possible later review, with a sleep technician in another room.
After the test, I review all the data to make a definitive diagnosis. If the sleep test confirms a diagnosis of sleep apnea, many times the first line-treatment is a CPAP (continuous positive air pressure) machine that keeps the upper airway open while the person is sleeping.
I always educate my patients about sleep apnea and CPAP before starting treatment. When patients understand their problem and why CPAP is necessary, I find treatment is more successful. In 95 percent of cases, if you tolerate CPAP and use it as prescribed, it controls the problem.
Help for the Sleepless – Insomnia – the inability to fall asleep or stay asleep – usually doesn’t have a physical cause, which can make treating it challenging.
For most patients, insomnia has behavioral causes, related to what we call “poor sleep hygiene.” This means any habits or environment that interfere with sleep, like a bedroom that is not adequately darkened, screentime during bedtime, or drinking caffeine or exercising too close to bedtime.
I help patients identify their pre-bedtime behaviors that may interfere with their sleep and then work with them to develop a strategy to improve their sleep hygiene.
A sleeping pill is usually not the answer. Pills are intended for short-term use, such as temporary reasons for insomnia. Insomnia usually is a chronic problem, and there is no good pill to treat it.
Insomnia can be treated effectively, if you’re willing to commit to making behavioral changes and have realistic expectations. Some patients also have other medical or psychiatric issues that contribute to or cause insomnia. I tell my patients at the outset that successful treatment is a process and not an immediate fix.
Sleep issues are not the only possible reason for daytime sleepiness or tiredness. When the evaluation shows these symptoms are related to another underlying health or medical problem, I conduct further testing and evaluation if I suspect a neurologic issue, or refer the individual to a primary care provider or another specialist for other types of problems.
Dr. Sih is a neurologist in the University Hospitals Neurological Institute at UH Portage Medical Center, 6847 N. Chestnut St., Ravenna. Call 330-297-2401 to make an appointment.
