Summer 2004
A Good Night's Sleep
The Center for Sleep Medicine helps one woman get
what she was dreaming of:

A Good Night's Sleep

It wasn't that Sandy Arabia didn't get any sleep at all. She knew she was sleeping, because she woke up several times a night. And you can't wake up unless you've been asleep.

So why was she so tired all day long? She was constantly battling fatigue, feeling cranky and groggy.

Her physician, Faye Ahmadian, MD, suspected that Sandy might have obstructive sleep apnea. That's a condition in which people stop breathing for 10, 20, 30 seconds or even more as they sleep. This interferes with normal sleep patterns, and can have serious health consequences: Lack of sleep can contribute to the risk of high blood pressure, heart attack, and stroke.

During the day, people with sleep apnea may fall asleep whenever they relax-while driving, at work, at home in the evening. They may be misdiagnosed with depression or with a lack of ambition. The real culprit, sleep apnea, is often not suspected.

Diagnosing the Problem
Dr. Ahmadian referred Sandy to Bridgeport Hospital's Center for Sleep Medicine, for a polysomnogram. This is a test designed to detect and diagnosis most abnormal sleep patterns.

All Sandy had to do for this study was spend a night in one of the comfortable, hotel-like rooms in the Center for Sleep Medicine, connected to a computer that recorded her every breath, twitch, and blink for analysis.

You might think that a test you can take in your sleep would be a cinch. Not so, says Sandy. "With more than a dozen wires taped or pasted to virtually every part of your body, sleep doesn't come easily," she points out.

But most people sleep better in the Center for Sleep Medicine than they think they will. Sandy actually did sleep most of the night. And over the next hours, the sleep technician in the next room kept a watchful eye on the monitor as Sandy's sleep was mapped in a series of polysomnogram lines.

One line indicated her pulse, one her heart rhythm. One indicated airflow; one showed how much oxygen was in her blood. One line was her snore line. Three lines showed leg, chest, and abdominal movement. One was her brain wave line. One showed eye movements. One even showed the muscle tone of Sandy's chin.

Specially trained sleep scorers summarized and evaluated all of this information. The recorded study, with all of its lines, was then reviewed by sleep specialist Herbert Scherzer, MD, medical director of the Center for Sleep Medicine.

For Dr. Scherzer, those lines were a map of Sandy's night in the Center. First the air would stop flowing, while movement of her chest and abdomen became greater and greater. Suddenly, at the same moment, all of the monitor lines would go crazy. For a few seconds, the leg line would look like the Appalachians. The snore line would look like a thread of frazzled yarn. The brain waves would look like static. Then all of the lines would go back to normal: normal sleep, normal breathing, and a normal heart rate. This pattern happened over and over again, throughout the night.

Sandy's sleep pattern was typical of moderately severe sleep apnea-just as Dr. Ahmadian had suspected.

We Sleep in Stages
"As we sleep, we repeatedly cycle through two stages," explains Dr. Scherzer. "They're called REM (rapid eye movement) and NREM (non-REM). During REM sleep, you are dreaming. Your brain is active, and your eyes tend to dart back and forth. A complete sleep cycle of NREM and REM usually takes about 90-120 minutes."

Both NREM and REM are vital. However, "In order to feel rested," says Dr. Scherzer, "we generally need to spend about 20% of our sleep time in REM sleep. Sandy was getting in only a few minutes of REM-not nearly enough."

Every time she fell into REM, as her polysomnogram lines showed, her chin dropped, her throat muscles relaxed, her airway became blocked, and stopped breathing.

After several seconds with no air coming in and oxygen levels falling, her brain would send out the message-"Hey, I'm suffocating!" Then, as the lines on the polysomnogram showed, Sandy would jerk, snort, and wake up. Not long enough to remember being awake-just enough to unblock her airway. And during REM sleep, this happened to Sandy once every minute.

Trumbull resident Sandy Arabia
The more often it happened, and the longer her airway was blocked, the more stressful each awakening was, and the more her sleep was disrupted. No wonder she was tired all day! Think about it: Sleep with recurrent suffocating episodes can't possibly be restful. Worse yet: Each time it happened, Sandy's blood pressure would rise, and for a few moments she'd be at increased risk of stroke and heart attack.

But once he understood what was causing the problem, Dr. Scherzer could offer Sandy a solution.

Finding a Solution
Among the treatments that can work for people with sleep apnea:

Weight loss
Resolving conditions that block up the nose or irritate the upper airway (such as smoking or acid reflux)
Minor surgical procedures
A dental device that stabilizes the airway.

For Sandy, however, and for many other sleep-deprived people, the best treatment for obstructive sleep apnea is use of a CPAP (continuous positive airway pressure) machine. This small device, which sits on a bedside table, pushes a continuous flow of air through a flexible hose. The air can then be delivered into the nose through small cushions that rest just below the openings of the nostrils, and are held in place with a band around the head. But Sandy and Dr. Scherzer found that it worked better for her if she wore a transparent, cushioned facemask that covered both nose and mouth. There are several models of these, so Sandy was able to select the one that was best for her. The filtered, humidified air is blown through the mask into her lungs to hold her airway open so it can't collapse.

The difference CPAP has made for Sandy has been remarkable. "I sleep better, wake up feeling rested, and can get through the day without snoozing!" she says.

That stay in the Center for Sleep Medicine at Bridgeport Hospital wasn't the best night's sleep Sandy Arabia ever had, but it might have been the most important one. Because now her days are more alert and all of her nights are more restful. Best of all, her blood pressure is lower.

For a free brochure about the Center for Sleep Medicine at Bridgeport Hospital, or for a referral to a physician who is an ex