The Sleep Doctor is in the House
Q&A with Neil Freedman, M.D., Medical Director of the Sleep Laboratory at Lake Forest Hospital
Dr. Neil Freedman is board certified in Sleep Medicine, as well as Internal Medicine, Pulmonary and Critical Care Medicine and is a former faculty member at the University of Pennsylvania School of Medicine and Penn Center for Sleep Disorders.
He currently lectures nationally on various sleep topics and is the Chairman of the National Sleep Medicine Course and Co-Chairman of the National Sleep Board Review Course for the American College of Chest Physicians.
Q: Dr. Freedman, what are the most common sleep complaints/problems in American society today?
A: There is a wide spectrum of sleep problems ranging from disorders that make us tired during the day to problems that make it difficult to sleep at night. The Institute of Medicine estimates that between 50 and 70 million Americans suffer from one of several sleep disorders.
The most common sleep-related problems include symptoms of daytime sleepiness, insomnia, and obstructive sleep apnea, a potentially serious disorder that interrupts breathing during sleep. Obstructive sleep apnea is as common as asthma in adults (5% of middle aged adults), and it is unfortunately becoming more prevalent in children due to an increase in childhood obesity.
Q: Why should most individuals care about not getting enough sleep?
A: Chronic sleep loss has been associated with adverse outcomes including difficulties with memory, a wide range of medical problems, poor performance in school and work and an increased risk for motor vehicle accidents. Almost 20% of all serious car crash injuries in the general population are associated with driver sleepiness, which is more common than accidents caused by alcohol.
Several studies have also associated long term chronic sleep loss (less than 6 hours per night on a regular basis) with an increased risk for obesity, hypertension, diabetes and death. The reasons why longterm short sleep times may cause these medical problems are unknown.
Q: Why do most sleep disorders remain underdiagnosed?
A: One of the major reasons is that while we are beginning to turn the corner, most practicing physicians and other health care providers still do not receive adequate education on sleep problems during their training.
Also, many patients who have suffered with chronic sleep problems don’t tell their physicians about these complaints because they believe that it is normal to feel tired or sleep poorly. It should be clear, that chronic daytime sleepiness or poor sleep is not the norm, and most of these problems can be treated if not cured.
Q: Who is at risk for obstructive sleep apnea and why should I care about it?
A: Risk factors in adults include being overweight, male gender, women who are postmenopausal, and older age (over 65 years old). Typical sleep apnea complaints include snoring, gasping, choking, frequent awakenings, restless sleep, increased trips to the bathroom in the middle of the night and symptoms of daytime sleepiness.
Importantly, many patients, especially those who sleep alone, may be unaware of these symptoms and not all patients with sleep apnea are tired during the day. Therefore, it is imperative to realize that the absence of any or all of these typical symptoms does not rule out the diagnosis.
Undiagnosed obstructive sleep apnea can have grave consequences. In addition to daytime sleepiness due to disrupted sleep, more severe sleep apnea has been associated with poorer quality of life, depression and several dangerous cardiovascular problems including hypertension, heart attacks, atrial fibrillation, stroke and death.
The good news is that several effective treatment options are available that have been shown to improve the symptoms and reduce the risks of bad outcomes associated with untreated sleep apnea. Typical treatment options include weight loss, oral appliances (mouth piece), surgery and/or CPAP devices. Your physician and or sleep specialist should be able to determine which treatment option is best for you.
Q: What does the Sleep Laboratory at Lake Forest Hospital’s main campus offer patients with sleep problems?
A: We offer the full spectrum of sleep diagnostics and treatment from sleep studies to comprehensive sleep care. The sleep laboratory itself was recently upgraded with the most advanced technology currently available. My partner, Scott Field, M.D., and I are both board certified in sleep medicine and are well qualified to diagnose and manage the full continuum of sleep disorders. We also offer those patients with more complex sleep-related breathing problems, which may be due to various medical conditions, access to cutting edge breathing technology such as assisted servo ventilation (ASV) bilevel therapy and Auto CPAP therapy.
The Sleep Laboratory is also keeping up with the latest changes in the way certain sleep disorders are diagnosed. Specifically, Medicare and other insurance companies have recently approved portable testing for the diagnosis of obstructive sleep apnea. In simple terms, patients who are at high risk for obstructive sleep apnea may be appropriate candidates to take home a portable device for diagnosis, instead of having to spend an initial night in the sleep laboratory.
Since many individuals may not be good candidates for home sleep apnea testing, patients who are concerned should speak to their health care provider or contact the sleep lab with questions. Your health care provider should also be able to determine if your sleep problems warrant an evaluation by a sleep specialist. The Sleep Laboratory at Lake Forest Hospital’s main hospital campus will start offering home sleep apnea testing in January of 2009.
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