Saturday, April 19, 2014
Sleep Medicine

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The Sleep Medicine Program

Raleigh Neurology Associates established our Sleep Medicine Program in response to the increasing awareness of sleep-related disorders and consequent demand for expert diagnosis and treatment. Backed by resources, expertise of the practice, and our state-of-the-art facility, the Sleep Medicine Program is a comprehensive, full-service clinical facility providing unsurpassed capabilities. Our staff is highly qualified and specially trained to diagnose and treat a wide range of sleep disorders. We offer two fully capable sleep labs for our patients’ convenience, one in Raleigh and one in Durham.

Operating with the latest and most advanced technology for the diagnosis of sleep disorders, our Sleep Medicine Program can provide patients with the best possible care in a relaxed environment. Unlike the majority of other sleep clinics, our Sleep Medicine Program isn't located within a hospital complex, making the location more accessible and convenient for patients. The rooms are furnished with patient comfort in mind, featuring regular beds instead of hospital beds and a pleasant atmosphere that looks and feels as much like home as possible. This setting provides a more favorable environment for conducting a sleep study, the most common procedure for evaluating and classifying sleep disorders.

Common Sleep Disorders

There are over eighty different conditions that fall within the category of Sleep Disorders; too little sleep, too much sleep or disturbed sleep are all signs of a sleep disorder. Excessive snoring should not be ignored, as that too can be indicative of a more serious problem. The most common sleep disorders include Insomnia, Restless Legs Syndrome (RLS), Obstructive Sleep Apnea and Narcolepsy.

Insomnia
Virtually every person has experienced occasional bouts of insomnia, trouble falling asleep, staying asleep or awakening too early, due to temporary stress or a change in sleep habits. One in three adults complain of occasional insomnia, whereas chronic insomnia has a prevalence of 10-18% in the general population. Insomnia is a symptom of many conditions, most of which can be successfully detected and treated.

Restless Leg Syndrome (RLS)
RLS can affect any age group but is more severe among the middle-aged and elderly. Patients with RLS have an unpleasant sensation deep in their legs, accompanied by a strong urge to move their legs. These symptoms are worse at rest and are relieved temporarily by movement. The disorder is most prevalent in the evening hours and manifests itself in sleep as periodic limb movements that disrupt a person's sleep without their knowledge. Spouses are more often aware of the problem than the sufferers themselves.

Sleep Apnea
Apnea, literally meaning 'no breath,' is a pause in the breathing pattern, which can last from ten seconds up to one minute. A person afflicted with Sleep Apnea may experience hundreds of breathing interruptions each night, resulting in brief awakenings. These arousals are caused by the increased effort to breath during an apnea. Due to these repeated awakenings, sufferers often complain of excessive daytime sleepiness. If left untreated, Sleep Apnea increases the risk of hypertension, heart attack and stroke. The condition occurs most often among middle aged, overweight men and post-menopausal women. Far from being a rare disorder, Sleep Apnea is as common as adult asthma, yet it is estimated that approximately 95% of cases remain undiagnosed and untreated.

Narcolepsy
Narcolepsy is a chronic disorder characterized by excessive daytime sleepiness, cataplexy (sudden loss of muscle tone often brought on by strong emotions), hypnogogic hallucinations (extremely vivid dreams at sleep onset), and sleep paralysis. Narcolepsy sufferers transition quickly from wakefulness to dream sleep (REM), and often feel an irresistible urge to sleep. No amount of nighttime or daytime sleep produces full alertness for narcoleptics.


Diagnosis and Treatment

If a person is experiencing symptoms similar to those described above, they can be referred to our Sleep Medicine Program for a comprehensive evaluation. One of our specialized neurologists will see the patient in consultation, performing a neurological exam and analyzing sleep history. If clinically indicated, a sleep study will be recommended, in which patients arrive between 8 and 9 PM and are prepared for the study by a skilled sleep technologist.

During the night the patient is videotaped while brain wave activity, eye movement, respiration, blood oxygen levels, limb movement and heart rate are all monitored in what is called a polysomnogram. The study ends around 6 AM and the patient is then free to shower and/or leave. A multiple sleep latency test (MSLT), which measures how sleepy a patient is by observing how long it takes them to fall asleep, may also be ordered. This type of study is usually performed the day after a polysomnogram and further evaluates the person's daytime sleepiness.

The results of each patient's sleep study are reviewed by one of our sleep neurologists, who then make a diagnosis and recommend treatment options. Treatments vary and can include medications, referral to ENT for surgery, referral to a dentist for a mandibular advancement splint, or implementation of a Nasal CPAP (a nighttime breathing apparatus that blows air into the nose and throat, usually though a mask). This is the most effective and common form of therapy for obstructive Sleep Apnea and is sometimes administered during the initial sleep study.

Surgical procedures like Uvulopalatopharyngoplasty (UPPP), a type of surgery on the back of the mouth and top of the throat to treat severe snoring and Sleep Apnea, can be done on an outpatient basis by an ENT surgeon. Major changes in lifestyle may also be prescribed including weight loss, new sleep hours, and avoidance of substances that have the potential to disrupt normal sleep patterns such as coffee, tea, tobacco and alcohol.

If insomnia is diagnosed with no clear physiological causes, then sleep hygiene issues may be addressed. Our doctors corroborate with a psychologist who specializes in sleep disorders for these types of patients.


Getting the help you need

Suffering the symptoms of a sleep disorder can be one of the most disruptive forces in a person's life. In many cases, a spouse or other family members are also affected by the individual's condition. It could be their excessive snoring that keeps others awake, or the fact that he or she awakens fatigued in the morning, unable to properly function in normal daytime activities at home, on the job, or even behind the wheel of a car.

Sleep deprivation, whether from fragmented nighttime sleep, insomnia or even insufficient sleep has been shown to promote decrease immune function, decreased cognitive function ('brain fog'), decreased growth hormone levels, decreased insulin receptors, sensitivity and increased body weight.  Enhancing the quality of sleep improves how a person feels, performs at work, relates to others, and also may prevent the development of life-threatening medical conditions. Accurate diagnosis and treatment by the Sleep Medicine Program is the first critical step toward improving sleep health.

If you or a family member is experiencing a sleep problem, please don't ignore it, as it could be more serious than you think. Your family physician can refer you to our Sleep Medicine Program for a proper evaluation.

Our Sleep Specialists

  A. Thomas Perkins, MD, PhD specializes in Sleep Medicine and Adult Neurology at Raleigh Neurology’s main location. He is the developer and director of the Sleep Medicine Program and is actively involved in the clinical research of sleep disorders and epilepsy. Dr. Perkins received his MD from the Northeastern Ohio University College of Medicine, and his PhD in Neurobiology from Kent State University. He is doubly board certified in Sleep Medicine by the American Board of Sleep Medicine and the American Board of Psychiatry and Neurology. Dr. Perkins has been with Raleigh Neurology since 1997 and continues to seek opportunities to further improve the Sleep Medicine Program and to raise awareness of the potential severity of sleep-related disorders.  
  S. Thomas Kirk, MD specializes in Sleep Medicine and Adult Neurology at Raleigh Neurology’s Durham office. Dr. Kirk received his MD from the University of Texas Medical Branch in 2005, completed his Neurology Residency at Baylor College of Medicine in 2009, and subsequently his Sleep Medicine Fellowship training at the Duke University Medical Center in 2010. He is a member of the American Academy of Neurology and American Academy of Sleep Medicine.
  Leslie H. Boyce, MD specializes in Child Neurology and Pediatric Sleep Medicine at Raleigh Neurology's main location. Dr. Boyce graduated from Rutgers University with a BS degree in neurobiology and behavior, and received her MD from the University of Medicine and Dentistry of New Jersey. Dr. Boyce completed her pediatrics and neurology training at Columbia Presbyterian Medical Center in New York City, and subsequently spent a year there involved in basic science research on cortical development. She has been an Assistant Professor of Neurology, Division of Child Neurology at UNC Chapel Hill since 1997. In addition to board certification in pediatrics and neurology with special competence in child neurology, Dr. Boyce became board certified in sleep medicine in 2007.

 

Please contact us at:

(Main Location)             
1540 Sunday Drive
Raleigh, NC 27607
Tel: 919-788-9071
Fax: 919-420-6088

(Durham Location)
4111 Ben Franklin Blvd.
Durham, NC 27704
Tel: 919-719-8834
Fax: 919-582-0528


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