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CPGH offers help for those who can't sleep

Posted: Monday, April 15, 2002

The benefits of a good night's sleep can go a long way.

Be it productivity on the job from being well-rested or a clear memory thanks to brain cells that have had time to properly regenerate, sufficient slumber carries a wide array of benefits. It can even save a life.

What could happen to those who don't get the sleep they need?

Nearly 20 million Americans live with the answer to this question each year, losing precious seconds, minutes and even hours each night. And David Smith of Kenai knows the answer all too well.

"I'm just constantly falling asleep," he said before going to visit Central Peninsula General Hospital's sleep clinic last week.

"I snore so bad, I wake myself up. Just sitting still, I'll doze off."

Smith suffers from sleep apnea, the near or complete cessation of breathing for more than 10 seconds at a time. His body, in an attempt to correct the loss of natural oxygen and carbon dioxide exchange, briefly interrupts his sleep, but not enough for him to remember the arousal.

Having sought help before moving from Arlington, Wash., four months ago, Smith has turned to CPGH's sleep center to help him. Like Davis, the hospital's sleep therapy program is new to the Kenai Peninsula.

 

Dave Smith watches a movie while he tries to sleep during an exam last week at Central Peninsula General Hospital's Sleep Center. Wires attached to his body relay information to a computer monitor outside his room as an infrared camera records his movements. He is wearing a mask that is attached to a machine to help him breathe better at night.

Photo by M. SCOTT MOON

"It's been kind of a growing problem," said Kevin Aft, the respiratory therapist who oversees the sleep program from the Sleep Technology Institute in Houston.

Initially, Aft said CPGH received periodic visits from a sleep program at an Anchorage hospital, but necessity dictated that a program be established on the peninsula. In January, the program began full operation, keeping in contact with Aft via satellite links.

"There was a higher demand, so there needed to be a facility on site," he said. "We provided the technology and the staffing. The way we've got it set up, it allows physicians in Alaska who are looking at patients to connect with physicians in Texas."

Rebecca Davis is the director of the CPGH sleep program and said obstructive sleep apnea -- the kind Smith suffers from -- is the the most common.

"It accounts for most sleep apnea cases," she said. "And 90 percent of the people who have it go untreated."

When sleeping, the throat muscles relax, tongue, tonsils and uvula -- the fleshy tissue hanging at the back of the throat -- all relax. If one or more of these parts is loose or overgrown, or if someone has a particularly small airway, airflow can be blocked while sleeping.

The other types are central apnea, in which the brain periodically fails to instruct the diaphragm to breath, and mixed, which is a combination of the two.

As often as 90 times in an hour, apnea, a Greek word meaning "want to breathe," sufferers can nearly asphyxiate. The results can be listlessness, a tendency to doze off, loss of memory, depression and sometimes headaches as less oxygen gets into the bloodstream.

 

Data recorded during Smith's overnight exam displays on a computer screen outside his room. A doctor will examine the information later.

Photo by M. SCOTT MOON

Beyond simple quality of life issues, research has shown that untreated cases have increased risk of heart problems or stroke. Worse still, is the chance of someone falling asleep behind the wheel of a car.

Kathleen Grimm of Nikiski recently received treatment for sleep apnea. She said before she was diagnosed with obstructive sleep apnea, she had run out of options.

"I never felt like I was getting a good night's sleep," she said. "Even though I may have slept for 14 hours, I'd wake up and feel like I wanted to crawl back into bed. (Doctors) said it was depression."

The first step was to learn that she actually had sleep apnea.

Grimm stayed overnight at the sleep center to get tested in February. There, she slept, connected to monitoring instruments that recorded her apneas (arousals) and hypopneas (near arousals) along with her heart rate, brain activity and blood-oxygen level.

Several weeks later, Grimm returned to be tested with a machine that uses compressed air to clear a person's airways. Called a CPAP (continuous positive air pressure), the machine is the size of a small toaster connected to a face mask. The total package can fit on a nightstand. The mask fits over the nose, with rubber hoses plugging the nostrils, over the mouth, or both.

The CPAP has adjustable pressure settings and makes minimal noise. It can even come with a humidifier, to keep airways moist, particularly for such a dry climate as Alaska. And it's impact is instantaneous.

"We can literally change lives overnight," Davis said.

Grimm admitted she had her doubts, but she said the difference is very noticeable. And she's recommended it for family members.

 

Polysomno technologists Jayson Estby and Debbie Bundick monitor the sensors attached to Smith's body on a computer screen outside his room.

Photo by M. SCOTT MOON

"When doctors suggested the sleep study, I was skeptical," Grimm said. "My mom is the one who made me turn the corner. She had a sleep study done two years ago, and she was having 121 arousals per hour.

"Now I have a lot more energy. I'm sleeping through the night without getting up anymore. People at work have noticed that I don't have the dark eyes."

And her family has noticed. One of the curious side effects of sleep apnea is that it affects spouses and bed partners. Grimm said she is trying to convince her husband, Chuck, to have the study done, but he said he likes the changes he is seeing in his wife.

"I don't think we'll know how much, but it's definitely made a difference," he said. "I want to give it time, before I say 'yea' or 'nay.' We figured 60 to 90 days."

Kenai Fire Marshal James Baisden said he was a severe snorer and had never given much thought to his wife's assertion that he would stop breathing at night. But one night while on duty at the fire station, he got confirmation of his wife's claims.

"I was here one night napping on the couch," he said. "The guys at the fire house said it looked like I was struggling to breath. They said if I had continued, they would have tried to use a tube to clear my air passages."

 

Polysomno technologists Jayson Estby and Debbie Bundick monitor the sensors attached to Smith's body on a computer screen outside his room.

Photo by M. SCOTT MOON

His physician, Dr. James Zirul, suggested Baisden go to the sleep center. There, he was diagnosed with sleep apnea and prescribed the breathing aid. His wife, Rhonda, said she appreciates the difference.

"Once they got him on the machine, he slept better," she said. "I tell Dr. Zirul he saved our marriage."

Sleep technician Jason Estby said treatment only works, however, if the patients wear the CPAPs. He said some complain that the masks aren't comfortable, and therefore won't wear it through their sleep, or at all.

"Compliance will define the success of the program," he said. "That's why local care is important. There are some (patients) who come back if they are having discomfort and want to adjust or change their mask."

The treatment is not inexpensive. For those who use it, it pays to follow through. Davis said the test to diagnose for sleep apnea can cost between $1,400 and $2,000. And the CPAP runs anywhere from $600 to $1,200.

"Typically, insurances pay for about 80 percent of the cost," she said.

According to a February article in Men's Health, there are other methods of treatment for apnea, from sleeping on one's side or stomach, using a specially designed mouth guard, having tonsils, the uvula or part of the soft palate surgically removed, or even having a tracheostomy (cutting a hole in a patient's throat).

As compared to the CPAP, most remedies are only half effective at the most, and the tracheostomy is reserved for the most severe cases.

Smith said he was not pleased with the results of treatment he had received before he moved to Alaska.

 

Technologist Jayson Estby fits Smith with a mask similar to the one he has been wearing at home to help him breathe better while he sleeps.

Photo by M. SCOTT MOON

"I've already been through these overnight type of things," he said. "All they do is hook you up to some machine that doesn't work."

This past Thursday, he checked in to the sleep center to check out a new CPAP and find a solution to his sleeping trouble. After having some discomfort and burning in his throat and switching face masks several times, he finally settled on combination mouth and nose mask.

And what was the verdict the next morning?

"I fell asleep in like 20 minutes," he said. "I'm used to waking up every half hour. I slept all night. They had to wake me up."



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