‘I have passed a miserable night.’ —William Shakespeare, 1592
Since the very beginning of recorded history, sleep has been a continually recurring theme in human thought. Glorified in works of art and literature when it bestows its restorative powers. Vilified when it does not.
Not surprising, when you consider that sleep is every bit as essential to human existence as the air we breathe and the food we eat. Literally, we cannot live without it. And when sleep is not as complete or restful as nature intended, there can be serious consequences as well. At best, a poor night's sleep is one of life's more frustrating experiences. And at worst, potentially life threatening. Yet it happens to millions of people every night who suffer from sleeping problems.
The Sleep Medicine Program at Raleigh Neurology is dedicated to helping you determine reasons for your sleeping disorder and to provide as much information as we can to solve it for you.
‘I’m so tired, I haven’t slept a wink.’ — J. Lennon/P. McCartney, 1968
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 often 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 disorders include Insomnia, Restless Legs Syndrome (RLS), Obstructive Sleep Apnea and Narcolepsy.
Virtually very person has experienced occasional bouts of insomnia, trouble falling asleep, staying asleep or awakening too early, either due to temporary stress or a change in sleep habits. One in three adults complains of occasional insomnia; whereas chronic insomnia has a prevalence of 10-18% in the general population. Insomnia is a symptom of many conditions, most which can be detected and treated.
The neurological disorder RLS can affect any age group with symptoms more severe in middle to old age. 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 relevant in the evening hours. RLS 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.
Apnea, which means literally 'no breath,' is a pause in breathing which typically lasts from about ten seconds to as long as 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. 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, Apnea is as common as adult asthma, yet it's estimated that approximately 95% of the cases remain undiagnosed and untreated.
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 (REM) sleep and often feel an irresistible urge to sleep. No amount of nighttime or daytime sleep produces full alertness for narcoleptics.
Fortunately, there are effective treatments for all of these conditions and Raleigh Neurology is on the forefront of handling these and other sleep disorders.
The Sleep Medicine Program
‘Mr. Sandman, bring me a dream’ — The Chrodettes, 1954
Raleigh Neurology, the area's premier group neurology practice, established the Sleep Medicine Program in response to the increasing awareness of sleep-related disorders and consequent demand for expert diagnosis and treatment. Formed in 1983, Raleigh Neurology currently serves more than 130,000 patients and is the largest neurology practice in the Triangle area.
Backed by resources, expertise of the practice and our new facility, the Sleep Medicine program is a comprehensive, full-service clinical facility providing state-of-the-art capabilities. Our staff is highly qualified and specifically trained to diagnose and treat a wide range of sleep disorders.
Operating with the latest, most advanced technology for the diagnosis of sleep disorders, the 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 disorders.
Competent technologic assistance is essential to the successful pursuit of an accurate and interpretable sleep study. The Sleep Medicine Program at Raleigh Neurology has skilled technologists who use what is arguably the finest in diagnostic tools for performing sleep studies including the latest in hardware and software installations.
Diagnosis and Treatment
‘A sleep full of sweet dreams, and health and quiet breathing.’ — John Keats, 1818
If a person is experiencing symptoms similar to those described above, they can be referred to our Sleep Medicine Program for a comprehensive evaluation. Typically, either Dr. Perkins or another one of our skilled neurologists will see the patient in consultation, performing a sleep history and neurological exam. If clinically indicated, a sleep study might then be recommended. Patients arrive between 8 and 9 PM and are prepared for the study by a skilled sleep technologist.
During the night, brain wave activity, eye movement, respiration, blood oxygen level, limb movement and heart rate are all monitored in what's called a ploysomnogram, and the patient is videotaped throughout the night by the sleep technologist. The study ends around 6 AM and the patient is then free to shower and go home or to work. 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 Dr. Perkins, who can then make a diagnosis and recommend treatment options. Treatments vary as widely as the conditions themselves and can include medications, referral to ENT for surgery, referal 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 measures, new sleep hours, and avoidance of substances such as coffee, tea, tobacco and alcohol, that have the potential to disrupt normal sleep patterns.
If insomnia is diagnosed with no clear physiological causes indicated, then sleep hygiene issues may be addressed. Dr. Perkins corroborates with a psychologist who specializes in sleep disorders for these types of patients.
Getting the help you need
‘O Bed! O Bed! Delicious bed! That heaven upon earth to the weary head!’ — Thomas Hood, 1841
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 not only improves how a person feels, performs at work, and relates to others, but 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 asleep health.
If you or a family member is experiencing a sleep problem, please don't ignore it-it could be more serious than you think. Your family physician can refer you to our Sleep Medicine Program for a proper evaluation.
Sleep Resources
American Academy of Sleep Medicine
National Sleep Foundation
American Association of Polysomnographic Technologies
Southern Sleep Society
American Board of Sleep Medicine
Sleep for Kids
Restless Leg Syndrome Foundation
American Sleep Apnea Association
National Organization for Rare Disorders
Better Sleep Council
National Center on Sleep Disorders Research – NIH
CPAP Information
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