Don’t take sleep issues lightly
In the basement of Falmouth Hospital sits a block of four rooms where patients sleep while technicians in an adjoining space oversee a host of inputs monitoring their sleep patterns. This is Cape Cod Healthcare’s Sleep Lab, and growing awareness of the seriousness of sleep apnea and its involvement in cardiac and other ills is driving more doctors to send their patients to the facility for diagnosis.
“We are booked up three to four weeks ahead,” said the lab’s medical director, Mir F. Shuttari, MD, a pulmonologist with a board certification in sleep medicine.
Unlike privately operated sleep labs, the Falmouth facility is the only one in the region connected to a hospital. If any medical issues arise, a patient could easily be transported to the emergency department within the hospital to receive immediate care, Dr. Shuttari said.
Unlike sleep apnea studies performed by patients in their homes with a portable monitor mailed to them with a set of instructions, a sleep study in the lab collects more sources of data that are immediately interpreted by trained sleep medicine technicians. Furthermore, if breathing issues are identified midway through the night, those technicians can treat the problem during the second half of the night with a CPAP (continuous positive airway pressure) mask, he said. This device assists breathing by keeping the patient’s airway open.
Sleep apnea – the repeated cessation of breathing for short periods during sleep – has been linked to potentially fatal illnesses, such as irregular heartbeats, congestive heart failure, heart attack and stroke, as well as contributing to high blood pressure, depression and obesity. Symptoms include snoring, a shirt neck size 17 or larger, gasping during sleep, and sleepiness during waking hours, according to the National Heart, Blood and Lung Institute.
Fifty percent of patients with congestive heart failure also have sleep apnea, Dr. Shuttari said. Congestive heart failure occurs when the heart becomes less effective at pumping blood, and the kidneys respond by making the body retain more salt and water, so fluid builds up in the lungs and extremities. Experts disagree whether sleep apnea causes congestive heart failure or congestive heart failure causes sleep apnea, but the two conditions are closely associated, he said.
“It’s kind of a chicken or egg situation,” Dr. Shuttari said.
In addition to sleep apnea, the sleep lab can diagnose, study and treat
- Narcolepsy, which causes a person to fall asleep involuntarily
- Restless leg syndrome, which may manifest in an irresistible urge to move the legs and broken sleep from leg movements
- Sleepwalking, when a person gets up and moves about while sleeping
- Insomnia, or difficulty getting or staying asleep.
Once a patient arrives at the Sleep Lab, they are taken to one of the four rooms, which somewhat resemble hotel rooms, though without windows. There, patients change into pajamas and a technician hooks them up to a variety of leads and devices. A thick, paste-like substance is used to attach some of the electrodes to the scalp and face. It can be scrubbed off with soap and water the following morning. A harness of wires is hung around the neck.