“A well-spent day brings happy sleep.” — Leonardo da Vinci
Except for those with sleep problems.
WHETHER IT’S DIFFICULTY FALLING ASLEEP or problems staying asleep, a poor night’s sleep is a bad way to start the day.
University Hospitals Portage Medical Center neurologist Marvin Sih, MD, offers help and hope to area residents who find themselves tossing and turning when they should be snoozing.
“With the proper diagnosis and treatment, most sleep problems can be treated successfully,” says Dr. Sih, who is board certified in sleep medicine.
Typical problems he can help with run the gamut from insomnia to narcolepsy and include everything in between, such as sleep apnea, sleepiness, sleepwalking, and leg movements.
Like any health or medical problem, the critical first step in developing an effective treatment plan for sleep problems is to determine the exact diagnosis. “My first move is to identify whether the patient can’t fall asleep, can’t stay asleep, or can’t wake up,” Dr. Sih explains. “To do this, I have the patient describe his or her bedtime routine, and we talk about how long it takes them to fall asleep, whether they snore or kick their legs and if they yell or do something else they shouldn’t be doing in their sleep.”
Other information he gathers at the first appointment includes whether the person wakes up during the night and cannot fall back asleep, what time he or she starts their day, whether they nap during the day, and their emotional state during the day.
Serious Sleep Interruption
Obstructive sleep apnea is the most common sleep problem that Dr. Sih treats. “Snoring and daytime sleepiness are symptoms often related to sleep apnea,” he says. “Most people with sleep apnea snore, but not everyone who snores has sleep apnea.
“People with sleep apnea experience interrupted sleep. Their airway collapses during sleep, lowering their blood oxygen,” he explains. “That causes defensive mechanisms in the brain to kick in that arouses the brain repeatedly. In severe cases, this happens from tens to sometimes a hundred times a night. For patients with sleep apnea, sleep usually is not refreshing.”
Daytime sleepiness is usually one of the obvious results of sleep apnea, but more importantly, sleep apnea is potentially life threatening. Untreated sleep apnea increases the person’s risk for high blood pressure, poor blood sugar control, stroke, abnormal heartbeats, and heart attack. Fortunately, treatment to control sleep apnea can reduce these risks.
The starting point for patients with suspected sleep apnea is a sleep study. The UH sleep lab in the area is at the UH Streetsboro Health Center. At the sleep lab, the patient is connected to sensors that monitor brain activity, blood oxygen levels, leg motion, snoring, and breathing. A computer records the signals, and the patient is video-recorded while sleeping for possible later review, with a sleep technician in another room.
After the test, Dr. Sih reviews all the data to make a definitive diagnosis. If the sleep test confirms a diagnosis of sleep apnea, many times the first line-treatment is a CPAP (continuous positive air pressure) machine that keeps the upper airway open while a person is sleeping.
“I always educate the patient about sleep apnea and CPAP before starting treatment. When patients understand their problem and why CPAP is necessary, treatment is more successful,” Dr. Sih notes. “In 95 percent of cases, if the patient tolerates CPAP and uses it as prescribed, it controls the problem, which means fewer than five episodes of stopped breathing during the night.”
Help for the Sleepless
Insomnia – the inability to fall asleep or stay asleep – usually doesn’t have a physical cause, which can make treating it challenging. “For most patients, insomnia has behavioral causes, related to what we call ‘poor sleep hygiene,’” Dr. Sih explains. “This refers to habits and environment that interfere with sleep, such as a bedroom that is not adequately darkened, screentime during bedtime, or drinking caffeine or exercising too close to bedtime.”
Dr. Sih helps patients identify the pre-bedtime behaviors that may be interfering with their sleep and then works with them to develop a strategy to improve their sleep hygiene.
“A sleeping pill is usually not the answer,” Dr. Sih stresses. “Pills are intended for short-term use, such as those who have temporary reasons for their insomnia,” he stresses. “Insomnia usually is a chronic problem,
and there is no good pill to treat it.”
The good news is that insomnia can be treated effectively, if the patient is willing to commit to making behavioral changes and has realistic expectations, Dr. Sih notes. A patient also may have other medical or psychiatric issues that contribute to or cause insomnia. He advises his patients at the outset that successful treatment is a process and not an immediate fix.
Sleep issues are not the only possible reason for daytime sleepiness or tiredness, Dr. Sih notes. When his evaluation shows these symptoms are related to another underlying health or medical problem, he conducts further testing and evaluation if he suspects a neurologic issue, or refers the individual to his or her primary care provider or another specialist for other types of problems.
Dr. Sih sees patients at UH Portage Medical Center, 6847 N. Chestnut St., Ravenna. Call 330-297-2401 to make an appointment.