The Relief Of Sleep For Disordered Lives Getting Some Rest Is A Only A Dream For Some. But The Weary Are Breathing Easier, Thanks To Doctors.

Posted: June 13, 1991

Carrying a toothbrush and change of clothes, Charles Woodard of Stratford was ready for one of the most important evenings of his life.

Before his wife read a magazine article on sleep laboratories, he never expected that there would be a medical explanation for his problem.

According to Woodard, his family has complained for the last five years that his snoring is so loud that it keeps them awake at night and that during the day, he simply cannot keep his eyes open.

"I've stopped driving because I fall asleep at the wheel," he told Eva Morozsan, respiratory care director at Kennedy Memorial Hospitals/Stratford Division, which opened in 1981 as the first sleep laboratory in South Jersey. ''When my boss caught me sleeping on the job, I knew something had to be done."

In anxious anticipation of the event, Woodard, 41, a postal worker, took the day off because he didn't want to be awakened by an alarm in the morning preceding his overnight stay at the sleep lab.

A good night's rest is important to Woodard, one of a growing population of people diagnosed with sleep apnea, a respiratory disorder that causes a person to experience complete breath cessations for up to 40 seconds while appearing to sleep.

From the rapid growth in the last decade in the knowledge of symptoms and treatment of common apnea and other sleep disorders, more diagnoses have been made and medical sleep laboratories have been opened in the pulmonary and neurological divisions of hospitals across the country. And South Jersey is no exception.

Conditions once treated with a bit of sympathy and a bottle of tranquilizers have been given scientific names and specific forms of treatment.

There are about a half-dozen sleep disorder clinics in South Jersey, where referred patients spend the night being monitored while they doze. Because of limited space, most centers have waiting lists of about four months. Most patients agree, however, that the results are worth the wait.

Labs in Camden, Gloucester and Burlington County hospitals offer tests for dozens of sleep dysfunctions, including insomnia, the inability to go to sleep; narcolepsy, the inability to stay awake; nocturnal myoclonus, periodic leg spasms experienced throughout the night; sleep walking, and many more. Most laboratories are geared primarily toward sleep apnea, a disorder that in its advanced stages could be life-threatening.

Sleep apnea manifests as a blockage in the victim's breathing that puts a strain on the brain and heart and lowers the level of oxygen in the blood. Doctors say that if left untreated, apnea could lead to fatal cardiovascular conditions, such as a heart attack or stroke. They say a certain type of snore is a dead giveaway for a diagnosis of sleep apnea.

"You have two types of snores," explains Alan G. Backman, technical director for the sleep lab at Deborah Heart and Lung Center in Browns Mills. ''There is the social snore, where a person only snores on occasion, and the pathological snore, a deep, loud snore that takes place every night. Snoring always has been known as a male thing, which contributes to the fact that most apnea victims are overweight males."

Backman said overweight males, such as Woodard, who snored every night had a 30 percent chance of developing sleep apnea in their lifetime.

"What happens is that as a person gains weight, fat tissue will accumulate on the inside back of the throat, blocking the airway. It continues to get worse because all these people want to do is sleep and eat. Their body metabolism slows down, they continue to gain weight and there is a rapid progression of the disease."

If the sleep apnea victim loses weight, he or she will rid themselves of the disorder, doctors said. "But for most of the patients who are extremely overweight," said Silvio J. Zapasodi, a pulmonologist who heads Kennedy's sleep clinic in Stratford, losing weight "is not easy for them to do."

Because Deborah, which opened in 1986, has limited space and has no room yet dedicated to sleep study, its lab is equipped to deal with six sleep disorders. It deals primarily with sleep apnea cases because they are most severe.

"We are swamped because the sleep business is booming," Backman said. ''It would not be advisable for us to take an insomnia victim when I get life-threatening sleep apnea patients."

According to Backman, 20 million to 40 million people in the United States each year are affected by a sleep disorder; 8 million to 10 million are affected with sleep apnea, typically the most serious of the disorders.

People who are diagnosed with disorders such as narcolepsy and nocturnal myoclonus are referred to a neurologist and often treated with oral medication. In some cases - insomnia, for example - patients could be referred to a psychiatrist.

Poor eating habits, psychological problems, alcoholism and other forms of substance abuse are some of the factors that contribute to sleep disorders, doctors said.

Backman said many of his patients were truck drivers, and he is studying the relationship between sleep apnea and traffic accidents.

"Certainly, a high rate of accidents could involve someone affected with sleep apnea," he said. "I'm hoping to get insurance companies involved and, perhaps, make it mandatory that a truck driver take a sleep apnea test."

Apnea is picked up almost immediately after a person falls asleep in the lab, but getting to sleep is sometimes the hard part.

Upon Woodard's arrival at Kennedy/Stratford, he watched television for about an hour to hasten his drowsiness while Morozsan readied the lab.

At 8 p.m., Woodard entered an inviting bedroom, decorated with artificial plants and wall hangings. An adjoining laboratory and its elaborate monitoring equipment were not visible from the room.

Electrodes attached to Woodard were connected to a polysomnogram, a glorified electrocardiogram that produces test results in the form of lines squiggled onto a chart that documents breathing, leg movement, eye movement and heartbeat.

Woodard's forefinger was attached to the probe of a pulsoximeter, a device that shows the level of oxygen saturation in the blood. If that level falls below 95 percent saturation, the person most likely has sleep apnea.

Throughout Woodard's stay, monitors picked up extensive periods of breath cessation and an abnormally low level of oxygen saturation, which were documented before a diagnosis was made, Zapasodi said.

Once diagnosed, the patient is given some options for treatment. The most popular and most effective is the CPAP mask, a triangular mask that fits over the patient's nose. Through the device, oxygen is forced through the blockage in the airway, enabling the person to breathe easily and sleep.

Zapasodi said that usually the patient's spouse detected the problem before the patient, who is often unaware of his poor sleeping.

"It is essential for the partner to appear at the initial consultation

because oftentimes, he or she knows more about the symptoms than the one who is victimized," Zapasodi said.

The patient purchases the mask, takes it home and wears it every night to control the symptoms. The average cost for a complete stay with a sleep lab ranges from $900 to $1,500 and includes treatment such as the mask.

Sleep apnea experts say the mask is effective for 80 percent of the people who suffer from the condition. The remaining 20 percent find the mask too uncomfortable to tolerate.

Other treatment options used before development of the mask include removing the blockage surgically or undergoing a tracheotomy, which doctors recommend only in limited cases.

But the mask is not simply handed over when a diagnosis is reached. The patient must again sleep in the lab - with the mask, during daytime - so technicians can determine the level of air pressure needed to effectively offset the apnea.

"The mask controls sleep apnea, it doesn't cure it," said Roy Levenson, a pulmonologist for the sleep clinic at Rancocas Hospital in Willingboro. ''It's like a diabetic taking insulin."

At Rancocas, a single hospital room with inviting beach scenes hanging on the walls is separated from the sleep laboratory chambers by a window with blinds. In the follow-up study, the masked patient is again hooked to a polysomnogram, and even though studies are done during the day, most patients have no problem falling asleep.

"If they don't fall asleep, then they probably don't have sleep apnea," Levenson said. "The key to monitoring is to watch the patient's level of oxygen saturation."

In one study, which lasted about an hour, the graph reading for the patient, a salesman in his 40s, often showed complete cessation of breath. The patient's initial study, with no mask, showed the level of oxygen in the blood at a low 70 percent.

In such cases, Levenson will pump up the level of air pressure emitted through the mask until breathing flows smoothly at a healthy 95 percent.

"This looks like it is working pretty well," Levenson told a lab technician. The patient was sent home with his mask and instructions.

Cooper Hospital-University Medical Center in Camden, which houses one of the larger sleep laboratories in South Jersey, opened a year ago last month. Officials there said the lab must be in practice a few years before applying for accreditation.

Jim Dubois, administrator of pulmonary services at Cooper, said there was not much of a wait at Cooper because there were two beds and plenty of staff on hand. "We have seven physicians and we are able to see two patients simultaneously, so the wait is only about three weeks to a month," he said.

Backman said that as the study of sleep disorders continued to make its way into the medical world, more and more medical schools had opened sleep labs.

"It has changed many of my patients' lives. I had one newly married woman who came in after her spouse was treated and asked, 'What did you do to my husband? I never knew this man. He's wonderful!' " Backman said.

The American Sleep Disorders Association, headquartered in Rochester, Minn., provides accreditation to the labs.

John Bordon, accreditation manager for the ASDA, said there were 141 accredited labs in the country. Beth Israel Medical Center in Newark, N.J., is the only accredited sleep center in the state, he said.

As for Woodard, he wasn't able to use the bulky CPAP mask, and was given instead a new device called a BiPAP. In this state-of-the-art device, oxygen is emitted through nose pillows, which resemble nose plugs.

"So far, so good," Woodard said last week, adding that a good night's sleep gave him much more energy for daytime activities. "But I'll let you know for sure in a few weeks."

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