Proven Techniques and Groundbreaking Procedures Bring Long-Awaited Cures to Patients Who Are
DYING FOR A GOOD NIGHT’S SLEEP
Most people know nutrition and physical activity are essential to good health. But few understand the importance of sleep. B. Tucker Woodson, MD, Medical College of Wisconsin otolaryngologist and certified sleep physician, says proper rest is no side issue: "Sleep — along with diet and exercise — is part of the 'critical triad' of health."
Dr.Woodson is medical director of the Froedtert & Medical College of Wisconsin Sleep Disorders Program. The program brings together specialists in several disciplines to help people overcome a range of debilitating sleep disorders.
Some disorders, like restless legs syndrome, can keep patients from achieving deep sleep. Many conditions, like narcolepsy and shift work sleep disorder, jeopardize daytime safety. All sleep disorders can negatively impact a person's overall quality of life. And one of the most common sleep problems — obstructive sleep apnea syndrome — can even lead to early death.
Beating Up the Heart"The same people who have sleep apnea also get high blood pressure, diabetes, congestive heart failure and coronary artery disease," says Rose Franco, MD, Medical College of Wisconsin pulmonologist and the Sleep Disorders Program fellowship director. Sleep apnea, she explains, is a condition in which the throat closes down during sleep, causing breathing to stop for seconds at a time. "When the throat closes, it creates negative pressure in the chest," she says. "This, in turn, puts tremendous pressure on the heart and lungs." It also causes the body to consume its store of oxygen, further straining the heart.
"When this happens 30 to 50 times a night, you are beating up the heart," says Dr. Franco. "It's like you're running a marathon — you never give the heart a chance to recover." Heart disease is not the only problem." Evidence suggests that obstructive sleep apnea may heighten a person's risk of stroke," says Humberto Battistini, MD, Medical College of Wisconsin neurologist. Dr. Battistini, the Sleep Disorders Program's expert on sleep disorders related to neurological diseases such as epilepsy, multiple sclerosis and Alzheimer's disease, says screening for sleep apnea is important. "We screen patients for risk of sleep apnea and treat them early in hopes of preventing stroke."
A deadly side effect of sleep apnea is an increased risk of causing a vehicle crash. According to Dr. Franco, people with apnea are three to seven times more likely than others to be in a crash. In fact, one of the warning signs of this disorder is having one or more near-miss incidents. Other signs include tossing and turning in bed, persistent daytime grogginess, chronic grumpiness and, most of all, snoring.
"Snoring is abnormal," says Dr.Woodson. "In the presence of other symptoms like high blood pressure, it needs medical evaluation."
Sick and Tired
Jeff Boutin, 44, had a snoring problem for 10 years. "I slept on the couch almost every night," he says. "I snored so loudly, my wife had to send me to another room. My kids could hear me on the other side of the house!"
Boutin, a project manager at a tool and die company, lives in West Bend. His wife and children were not the only ones who suffered from his snoring. "I felt tired all the time, because I never really got deep sleep," he explains. "I had a really rough time getting up in the morning, and I often felt drained at work."
Last year, after living with the problem for a decade, Boutin learned from a coworker about the Sleep Disorders Program at Froedtert & Medical College of Wisconsin. He came in for an initial evaluation with Dr. Woodson and was soon scheduled for a sleep study in the program's state-of-the-art clinical sleep laboratory. The six-bed lab is fully accredited.
"We can do any kind of sleep study here — apnea, abnormal movement, teeth grinding, seizure studies," says Ahmad Nasef, RPSGT, the lab's clinical director. The entire staff, he notes, focuses on making the patient's stay comfortable and positive.
After a patient arrives around 8 pm, a registered sleep lab technician explains the testing procedure, then fits him or her with a series of monitor leads. "In the lab, most patients fall asleep quickly," says Nasef. During the night, the technician monitors the patient's indicators from a control room. Apnea patients, who account for most of the studies, are usually wakened around 2 am and fitted with a device known as a continuous positive airway pressure mask (CPAP). This proven device uses simple air pressure to keep the patient's throat open. Beginning at a low setting, the technician gradually increases the pressure level. "We are looking for the comfort zone," says Nasef, "the point where the patient is achieving deep sleep with no breathing events or arousals."
Sleep specialists say CPAPs help up to 90% of patients with sleep apnea. The relief can be dramatic. In fact, according to Dr. Franco, using a CPAP cuts the incidence of car crashes among sleep apnea patients to below the national average. Still, while CPAPs can help many patients, they do not work for everyone.
Boutin says his sleep study showed he got only 15 minutes of deep sleep all night. The medical team decided he was a good candidate for a CPAP. Unfortunately, after three months of working with the device, he proved to be one of the people a CPAP does not help. "I always ripped the mask off in my sleep," he explains. Dr. Woodson and Boutin agreed his best option was now surgery.
Innovative TechniquesDr. Woodson is known internationally for pioneering work in surgical approaches to sleep apnea. He was the first surgeon in the United States to treat the disorder with a tongue suspension suture — a simple procedure that helps keep the tongue base from collapsing during sleep. He was also an early pioneer treating apnea using non-invasive radiofrequency energy. "The last resort treatment for patients used to be a tracheotomy," says Dr. Woodson. "Now, surgical options are more than 90% effective."
Boutin's surgery took place in late 2004. Dr. Woodson improved the patient's air flow by reconstructing hisuvula (the small lobe of flesh at the backof the mouth). He also opened up acollapsed nostril by placing a suture in the bridge of his nose and tying it to a tiny screw anchored in the facial bone.
For Boutin, recovery was quick. He says he felt the effects of the nostril procedure immediately: "When I woke, I was shocked at how well I could breathe." He left the hospital the next day and in a short time, noticed he was sleeping much better. Soon, his snoring was history.
Research Hits HomeBoutin's successful outcome is due in part to the Sleep Disorders Program's Upper Airway Imaging Study, a research project that helps surgeons plan and understand how reconstructive procedures work. "The challenge of assessing apnea patients is that their throat muscles are very active when they are awake," says Dr. Woodson. "That makes it impossible to visualize the throat anatomy." In the Upper Airway Lab, physicians create a "virtual sleep state" in the patient's throat using topical medications and a ventilator. They then use MRI technology to create a 3D image of the airway.
Dr. Franco is conducting research on the link between sleep apnea and heart health. She is investigating "inflammatory mediators," substances that are elevated in the blood of apnea patients and linked to a higher risk of coronary artery disease. The subject hits home for Boutin. His father died from heart disease at age 59.
Dr. Woodson says the program's research focus translates directly into a higher level of care: "When you are involved in cutting-edge research, you see patients with disorders all across the spectrum." Patients — whether they suffer from insomnia, neurological issues like narcolepsy, or the increasingly recognized problem of restless legs syndrome — also benefit from the program's multidisciplinary approach."
Patients can benefit from the compounded knowledge of several specialists," says Dr. Franco. "Here, a patient receives a diagnosis and gets complete treatment — therapy, counseling, curative procedures — all under one roof."
Dramatic DifferenceThese days, just months after his surgery, Jeff Boutin's life has changed dramatically. "I sleep great," he says." I wake up at 6 or 6:30 am and feel refreshed." He reports having much more energy. "I am a lot more active. I work out at a health club every day."
Boutin says taking care of his sleep disorder improved his quality of life all the way around. "It sure beats being tired all the time — I didn't realize what a difference it would make."
Source: Froedtert Today
Date: April 2005