Spring 2015

Sleep. Most of us do not get enough. Some will not. Others cannot.

For those in the latter group – adult or child – rest easy. The sleep medicine services at Bridgeport Hospital can help.

Patients are referred by their physicians for a variety of reasons. Among them:

• Obstructive and central sleep apnea (interrupted breathing during sleep)
• Obesity hypoventilation syndrome (breathing disorder causing low blood oxygen and high blood carbon dioxide levels)
• Insomnia (inability to fall or stay asleep) Periodic limb movement disorder (involuntary movement during sleep)
• Narcolepsy (sudden intrusion of sleep into wakefulness)
• Parasomnias (abnormal movements, behaviors, emotions, perceptions and dreams)

Two Sleep Center Programs

Depending on their patients’ needs, referring physicians have two options: Yale New Haven Children’s Hospital (YNHCH) Sleep Center at Bridgeport Hospital; and the Center for Sleep Medicine at Bridgeport Hospital.

• Yale New Haven Children’s Hospital Sleep Center, which expanded to the Bridgeport campus in December 2014, treats patients from infancy through their teenage years.
• The long-established Center for Sleep Medicine at Bridgeport Hospital treats adults, as well as pediatric patients from age three.

A Focus On Pediatric Patients

For children, step one is a diagnostic evaluation, noted Craig Canapari, MD, director of YNHCH sleep centers – the only Connecticut sleep centers with board-certified pediatric pulmonologists and pediatric sleep technicians caring exclusively for children from infancy through their teens.

“Sometimes, a diagnostic evaluation will show a sleep study isn’t necessary,” he explained. That is because sleep problems can result from medical conditions, behavioral disorders or developmental problems. When a study is scheduled, an overnight sleep test can include measuring a patient’s breathing, carbon dioxide and oxygen levels, brain activity and quality of sleep.

Studies are conducted in one of two colorful, “kid friendly” rooms using advanced testing equipment. This includes video recording and capnography (monitoring carbon dioxide in respiratory gases) on all studies.

Obstructive sleep apnea is the most common problem among pediatric and adult patients, said Dr. Canapari. “Treatment options vary depending on age and the child’s underlying medical problem. The most common treatment is removing the adenoids and tonsils by surgery.”

Some children, especially those who are older or obese, may need further treatment after surgery, he added. “One commonly used option is continuous positive airway pressure (CPAP), which delivers air pressure using a mask selected for best fit and comfort.”

Air pressure provided through the mask prevents the airway from being obstructed. “Most people tolerate CPAP well and many patients are quite successful with it,” he noted.

A Pediatric Success Story

CPAP proved effective for Jeanine Cato, age 13. The Bridgeport resident was referred to the YNHCH sleep center at Bridgeport in December 2014 by an ear, nose and throat specialist. “We found that we could have Jeanine treated in Bridgeport instead of having to go to New Haven,” said her mother Katherine. There, the staff confirmed her sleep apnea.

Kids have different needs. Yale New Haven Children’s Hospital sleep center technicians are skilled in dealing with these needs and know how to respond.
– Craig Canapari, MD

“She stayed overnight and they explained what to expect,” added Katherine. “After the study, I was told Jeanine had a serious case of sleep apnea and that I needed to start CPAP immediately.”

Follow-up visits in January and March reinforced CPAP’s effectiveness. “It is working very well for her,” noted Katherine.

Children express many of the same problems as adults, from being sleepy during the day to narcolepsy to difficulty sleeping at night and insomnia. But as children, their reactions to CPAP masks and other equipment are often significantly stronger.

“Kids have different needs. YNHCH sleep center technicians are skilled in dealing with these needs and know how to respond,” said Dr. Canapari. The technicians are expert at making children as well as nervous parents comfortable so they can acquire the necessary high-quality studies, which are then interpreted by the sleep center physicians.

Treating Adults, as well

For patients at the Center for Sleep Medicine at Bridgeport Hospital, studies are conducted either in a sleep lab located in the Bridgeport Holiday Inn or at home. “Deciding on whether the lab or home study is best depends on what we’re looking for,” said Armand Wolff, MD, medical director of the Center for Sleep Medicine at Bridgeport Hospital.

Now, I get a good night’s sleep and feel refreshed,” said Leonard. “I can’t remember what it was like to have a good night’s sleep. It’s life-changing.

“I can’t say enough about the staff at the sleep center,” added Leonard. “They treat you with compassion and respect, and they’ve made a big difference in the quality of my life.”

Improving and Maintaining Quality of Life

While all outcomes might not qualify as life-altering, they do make a significant difference. “Our patients, especially adults, can improve the quality of their sleep, increase their energy level, possibly decrease their risk of cardiovascular disease and perhaps better control problems like hypertension and diabetes,” said Dr. Wolff.

“For children, improving the quality of their sleep can also help them become more successful in school and elsewhere, and it makes a significant difference for their families,” added Dr. Canapari. “We’ve experienced a very high degree of satisfaction with our pediatric patients and their families,” he added.

Our patients can improve the quality of their sleep, increase their energy level, possibly decrease their risk of cardiovascular disease and perhaps better control problems like hypertension and diabetes.
– Armand Wolff, MD

Improving the quality of sleep is one thing. Maintaining it is another, which is why follow-up care is important. “It’s critical to ensure success,” noted Dr. Canapari. “How often we follow up with our patients is determined by their underlying problem and their current clinical status,” said Dr. Wolff. For example, with CPAP patients, it’s every three months, noted Dr. Canapari.

For patients with insomnia, especially adults, “They benefit more from cognitive behavior therapy (psychotherapy treatment) than medications,” said Dr. Wolff. “We try to avoid medications with insomnia, especially when it is chronic.”

Both Dr. Wolff and Dr. Canapari agree that one of the sleep centers’ best assets and a key to their patients’ success are the clinical specialists. “They work very closely with our patients to educate them about their sleep disorder and treatment, and they troubleshoot issues patients might have,” added Dr. Wolff.

Along with the physicians at the sleep center, the clinical specialists help deliver the high-quality, comprehensive care for a broad spectrum of sleep disorders that patients expect. That level of care makes it possible for everyone treated at the sleep centers to rest easy.

Center for sleep medicine

Bridgeport Hospital

267 Grant Street

Bridgeport, CT

203.384.3817

• Armand Wolff, MD. medical director of sleep medicine, adult patients
• Jeff Kwon, MD. adult patients
• Rochelle Turetsky, MD. pediatric sleep specialist and adult patients

Yale New Haven children's hospital at Bridgeport hospital campus

Bridgeport Hospital

267 Grant Street

Bridgeport, CT

203.688.1240