BY NAN BIALEK
Dr. Mouhammad Rihawi
When a good night’s sleep seems like an impossible dream, it may be time to see one of the area’s certified sleep specialists. Experts like Brittany J. Meyer, M.D., sleep medicine physician at the ProHealth Care Sleep Center in Delafield, and Mouhammed Rihawi, M.D., pulmonologist, sleep medicine specialist and medical director of the Ascension Sleep Disorder Center, can test for specific conditions, diagnose disorders and prescribe a course of treatment.
About one-third of adults do not get the recommended seven hours of sleep daily, according to the Centers for Disease Control (CDC). However, Rihawi notes, the prevalence of sleep disorders are likely much higher than 30 percent of adults. He believes a lack of sleep centers, not enough physicians who are sleep specialists and lack of patient knowledge about sleep disorders all contribute to a delayed diagnosis or no diagnosis at all.
The CDC notes that people who do not get enough sleep are at higher risk for chronic diseases and conditions such as diabetes, cardiopulmonary disease, stroke, obesity and depression. Lack of sleep can also contribute to motor vehicle crashes and accidents with machinery, causing injury and disability.
Some common sleep disorders, say both Meyer and Rihawi, are obstructive sleep apnea and insomnia. The most common, according to Rihawi, is insufficient sleep, but some patients simply do not consider consistent lack of sleep as a disorder. “When patients cannot sleep, they believe this is a normal thing,” Rihawi explains, “so they don’t discuss it with their physician, and the physician doesn’t ask.”
Narcolepsy, characterized by excessive daytime sleepiness, is another sleep disorder that is often misdiagnosed or undiagnosed. Although narcolepsy is associated with falling asleep during the day, sometimes even in the middle of a conversation, Meyer points out that narcoleptics also have problems sleeping at night and difficulty falling asleep. Individuals with severe narcolepsy might be abusing amphetamines (“speed”) or cocaine to keep themselves awake during the day, she adds.
“Narcolepsy is usually misdiagnosed as depression, and a lot of patients get labeled as unmotivated or lazy,” Meyer notes. “It can also be misdiagnosed as chronic fatigue syndrome.”
Meyer looks for three symptoms that may indicate narcolepsy. The first is cataplexy, meaning that the muscles go weak when the patient is experiencing strong emotions. Hallucinations or very vivid dreams while falling asleep are another symptom. “People describe this as knowing they’re awake and still dreaming,” Meyer says. A third symptom is “sleep paralysis,” or the temporary inability to move while falling asleep or waking up.
“All of these can occur twice a week or twice a month,” Meyer notes. “And sometimes they occur more when there is more stress in [patients’] lives.”
A diagnosis starts with consultation with a sleep physician who performs an overnight sleep test to make sure there are no other sleep disorders present. Doctors are looking for how fast the patient falls asleep and goes into deep sleep. Once diagnosed with narcolepsy, most people are relieved to have an explanation for their symptoms, Meyer notes.
Treatment includes prescription medications designed to consolidate nighttime deep sleep into one block so that the patient is less tired during the day and stimulant medications to help the patient stay awake during the day.
Dr. Brittany J. Meyer
There is help for those who suffer from the more common sleep disorders as well. Rihawi says patients with sleep apnea — people who stop breathing more than five times per hour — represent the bulk of referrals to the Ascension Sleep Center. Most sleep apnea patients tend to snore and gasp in their sleep, often wake up with a headache and are groggy during the day. They can be diagnosed either with a home test or with an overnight sleep study where they are monitored at the sleep center.
Sleep apnea is often treated with the use of a continuous positive airway pressure (CPAP) machine to keep an obstructed airway open. Sometimes, surgical options are used, Rihawi notes, or a special oral device might be used. For some people, sleeping on one side and weight loss help relieve apnea. Rihawi says he also sees pediatric patients with sleep apnea caused by tonsils and adenoids.
Cognitive behavioral therapy is used to treat insomnia — persistent problems in going to sleep and staying asleep. People with insomnia often have anxiety about sleep and find it difficult to “turn off” the brain at bedtime. Meyer says the therapy basically “retrains your brain and body to sleep.”
“We’re trying to avoid sleep aids if we can, because there are side effects, and new research showing long-term use can cause dementias,” Meyer notes.
Rihawi says about 11 percent of the population suffers from insomnia, and recommends that those who have it seek treatment at a medical sleep center with the resources and experience to treat all aspects of the disorder.
“We are pretty successful at treating insomnia and have made a big difference in patient outcomes and quality of life,” he says. “We are very attuned to it.”
Both doctors stress that sleep disorders can be symptoms of other diseases, or a person’s primary medical issue. In either case, a certified sleep specialist can help you rest easier. MKE
Top Sleep Tips
• Maintain a consistent sleep schedule seven days a week
• Get your morning exercise outdoors in fresh air and sunshine
• No caffeine after 3 p.m.
• No screen time an hour before bedtime
• Create a sleep-promoting environment — a dark, cool room with no distractions