Presented to: Samaritan Regional Health System · The most prevalent sleep disorder seen in a sleep...

S l e e p M e d . T h e f i r s t n a t i o n a l b r a n d i n s l e e p s e r v i c e s .

S l e e p D i s o r d e r L a b o r a t o r y M a r k e t i n g P l a n b o o k

S l e e p M e d i n c o r p o r a t e d7 0 0 G e r v a i s S t r e e t • S u i t e 2 0 0 • C o l u m b i a , S C 2 9 2 0 1 • 8 0 0 . 3 7 3 - 7 3 2 6 • w w w. s l e e p m e d . m d

Presented to:

SamaritanRegional HealthSystem

S l e e p M e d i n c o r p o r a t e d

7 0 0 G e r v a i s S t r e e t • S u i t e 2 0 0 • C o l u m b i a , S C 2 9 2 0 1 • 8 0 0 . 3 7 3 - 7 3 2 6 • w w w. s l e e p m e d . m d

Marketing Recommendation

You have contracted with SleepMed to provide sleep diagnostic laboratory services. You are contractually

obligated to provide space, billing and marketing for the service -- and SleepMed will provide the rest:

(1) medical director training and oversight; (2) technical labor; (3) equipment; (4) supplies; (5) scheduling

and precertification; (6) technical oversight; (7) laboratory operation and (8) quality assurance. To assist

you with the marketing of your new sleep service, this marketing plan with a variety of customized mas-

ters has been provided by SleepMed for your use.

As with any physician referred service, ongoing communication to four primary groups is very important:

(1) Hospital Family (i.e. employees, board members, chaplains, volunteers, etc.); (2) Medical Staff;

(3) Employees of Major Employers; and (4) Community at Large. The following plan has been

developed to aid you in increasing the number of physician referrals and self-referrals to your sleep

service. As you review each recommendation, please review the corresponding exhibit.

Although a disc containing this planbook has been provided for your convenience in making changes and

additional copies, you must have desktop publishing software on your computer to be able to open the

planbook file on the CD. If you do not have this software, your ad agency or commercial printer will

probably have it and can make any changes needed.

GOAL

The goal of your sleep program is to provide excellent sleep diagnostic services for patients suffering with

sleep disorders.

TARGET MARKET

The most prevalent sleep disorder seen in a sleep disorder laboratory is sleep apnea. The typical profile

of a sleep apnea patient is an overweight, middle-aged adult who snores loudly and complains of being

continually tired. Therefore, marketing efforts should be targeted to adults between the age of 35 and 55.

STRATEGIES

The two most effective strategies to create an ongoing stream of referrals to your sleep lab are:

(1) educating referring physicians, especially family practice doctors and Pulmonary,

Neurology, Cardiology and ENT specialists; and

(2) educating the workforce of the top 10-20 businesses in your service area.

These and other effective strategies are provided on the following pages for your use.

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HOSPITAL EMPLOYEES, BOARD OF DIRECTORS, CHAPLAINS, VOLUNTEERS, ETC.

☯ If payroll envelopes are an option, include a stuffer to educate and increase awareness among

hospital employees (See Exhibit A).

☯ If stuffers are not an option because the hospital uses computerized self-sealing payroll

vouchers, include a computerized message on the earning receipt, such as:

“Did you know . . . one of every four people have a sleep disorder and some disorders

can be extremely serious. We now conduct sleep studies to help our physicians

diagnose and treat sleep disorders. For more information or a referral to our sleep specialist,

call (800) 939-0399.

☯ The above message could also be used as a broadcast message on the hospital’s computer electronic

mail system and telephone voice mail system.

☯ If informational flyers are an option, post flyers at time clocks, on bulletin boards and in

high-traffic employee areas, such as break/training rooms, restrooms, elevators, cafeteria, etc.

(See Exhibit B).

☯ If announcements at board of directors, chaplains, volunteers and department directors meetings are

an option, pass out an informational piece and give a 2-5 minute presentation (See Exhibit C).

☯ To improve the sleep hygiene of your workforce, run an article in the your hospital’s employee

newsletter which promotes good sleep hygiene and provides referral information for those who feel

that their problem is serious and may need medical attention (see Exhibit D).

☯ If the hospital has a physician referral service, contact this department and make sure the medical

director is listed as a sleep specialist for the treatment of all sleep disorders. Ask that self-referrals

be sent to their office.

☯ Directional signage not only will assist patients in finding your sleep disorder laboratory, it will serve

as a continuous educator and reminder to members of the hospital family that you offer this

service. This is also true with internal employee and physician telephone directories.

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MEDICAL STAFF AND OUTLYING REFERRAL PHYSICIANS

☯ Send a letter, announcement or informational flyer to your full medical staff, outlying physicians

and their administrators/office managers (see Exhibit E).

☯ Post an informational flyer in the your physician lounge and in all physician break rooms

within the hospital, at all satellite locations and in medical office buildings (see Exhibit E).

☯ Schedule your sleep specialist to give a 5-20 minute presentation at upcoming medical department

meetings, medical staff retreats and medical association meetings (see Exhibit F).

☯ Schedule your sleep specialist to give a 30 minute luncheon program on sleep disorders to the

administrators and office managers of area medical practices (see Exhibit F).

☯ Host a luncheon or dinner seminar for referring physicians and schedule your sleep specialist to

give a 30-60 minute presentation on sleep disorders (see Exhibit F).

☯ Assist the sleep specialist with communications, scheduling and handouts for sleep disorder

inservices at key referring practices (see Exhibit G). Usually, over 50% of sleep disorder referrals

come from family practitioners. Therefore, target this group for on-site physician inservices by

the medical director. The best results are achieved when these are held as luncheon meetings

(with lunch provided by the hospital) and the Director of CardioPulmonary joins the medical director

and participates in the inservice. The Director should be responsible for bringing handouts and

visual aids.

BUSINESS NETWORK (Employees of Major Employers)

☯ Request that sleep stuffers be included in payroll envelopes. In most communities, the top twenty

businesses usually employ about 75% of the area’s workforce. This is an extremely cost effective

way to reach your insured population (see Exhibit A).

☯ Offer a sleep article for publication in their employee newsletter (see Exhibit D).

☯ Offer to conduct worksite seminars on sleep disorders and provide a 30-minute presentation on sleep

disorders and how they affect productivity (see Exhibit F).

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COMMUNITY AT LARGE

☯ To assure that patients can find you, make sure that directional signage communicates your

hospital’s “Sleep Disorder Laboratory” location easily.

☯ Make sure that the “Sleep Disorder Laboratory” is listed in the local telephone directory.

☯ If you have a website, set up a link to www.sleepmed.md and your patients can access our

free interactive sleep disorders self-test..

☯ Send a press release announcing the opening of the sleep lab. Sleep disorders and technological

advances in treatment are trendy news stories to the media at the present time. Keep them abreast

of interesting cases where the patients are willing to be shadowed by a reporter through the patient’s

pre-examination, the study and the course of treatment (Exhibit H).

☯ Obtain approval from your local newspaper for a 10-part physician column provided by your

sleep specialist on sleep science and disorders (Exhibit I). This column serves to educate your

community while attracting a wider range of sleep disorders to your sleep specialist.

☯ To educate your community and increase awareness of your new sleep lab service, run newspaper

ads (Exhibit J) and announcer-read radio spots (Exhibit K). Also, book a sleep specialist for TV

and radio talk shows where sleep disorders and treatments can be discussed.

☯ Send an invitational letter to working age, professional groups and invite them to book a sleep

specialist as a sleep disorder speaker (Exhibit L). Or, offer a seminar to the general public on

sleep disorders and have a sleep specialist speak (Exhibit M and Exhibit F).

☯ For display racks in the hospital and at referring physician’s offices, print and distribute patient

information brochures (Exhibit N). The brochure can also be used to hand out at speaking

engagements, etc.

☯ If the hospital has a physician referral service, contact this department and make sure your sleep

specialist is listed for the diagnosis and treatment of all sleep disorders. Ask that self-referrals

be sent to the sleep specialist’s office.

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TABLE OF EXHIBITS

☯ Envelope Stuffers Exhibit A

☯ Flyer Exhibit B

☯ Meeting Handout Exhibit C

☯ Newsletter Article Exhibit D

☯ Announcement to Physicians Exhibit E

☯ CEO Letter to Physicians Exhibit E

☯ Flyer for Physician Lounge Exhibit E

☯ Community Slide Presentation & Scrip Exhibit F

☯ Invitation Letter for Physician Inservice Exhibit G

☯ Fact Sheet for Physician Inservice Exhibit G

☯ Sleep Disorder Assessment Form Exhibit G

☯ Sleep Disorder Training Guide Exhibit G

☯ Press Release Exhibit H

☯ 10-Part Physician Column Exhibit I

☯ Newpaper Advertisements Exhibit J

☯ Radio Public Service Announcement Exhibit K

☯ Speaker’s Bureau Letter Exhibit L

☯ Health Education Seminar Advertisement Exhibit M

☯ Tri-Fold Brochure Exhibit N

Page 5

ENVELOPE STUFFERS/HANDOUTS FOR

HOSPITAL EMPLOYEES, PRACTICE EMPLOYEES

AND BUSINESS EMPLOYEES --

OR FOR USE AS A SMALL SPACE AD OR

AS HANDOUTS AT A HEALTH FAIR

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Sleepy? Snore? Be a part of the new WAVE in healthcare!

We’re catching some waves that

can have a dramatic effect for those

who suffer from sleep disorders.

The figures are staggering . . . one

out of every four people suffer from a

sleep disorder and some disorders

are extremely serious. For instance,

someone with severe sleep apnea

(where a person stops breathing for

about 10 seconds as many as 600

times per night) is at very high risk.

They typically snore, go through a

brief period of silence and then gasp

for air. During the day they feel

unrested and irritable.

Sleep apnea can be detected

though the evaluation of a person’s

sleep waves. Once the condition is

diagnosed by a sleep disorder physi-

cian, a treatment plan may begin.

For more information or a referral

to our sleep disorder specialist, call

us today.

(800) 939-0399
























us today.

(800) 939-0399
























us today.

(800) 939-0399

If you think you might have a sleep disorder,

take this self-test and learn more . . .

YES NO

� � Have you been told by a friend or family member that you snore?

� � Do you often feel tired or have a headache when you awaken in the morning?

� � Do you frequently awaken during the night?

� � Have you been told you have pauses in your breathing during sleep?

� � Do your legs jerk frequently or feel uncomfortable/restless before or during sleep?

� � Do you often find yourself falling asleep when you don’t intend to, such as while

viewing television or while driving?

SCORE:

If you answered “YES” to two or more of the above questions, you might benefit

from a sleep consultation. Please keep in mind the above test is only an indicator,

not a diagnosis which only a physician can give.



us today.

(800) 939-0399



YES NO








SCORE:






us today.

(800) 939-0399



YES NO








SCORE:






us today.

(800) 939-0399

SNORING . . . an epidemic that can be silenced.



us today.

(800) 939-0399

In a recent family opinion poll it was

revealed that 90 million Americans over

the age of 18 snore -- 37 million of them

on a chronic basis. Few have sought

treatment because they view snoring as a

social nuisance.

However, the reality is that snoring is a

medical symptom for something as simple

as the common cold -- to something as

potentially life-threatening as severe sleep

apnea.




us today.

(800) 939-0399






social nuisance.





apnea.




us today.

(800) 939-0399






social nuisance.





apnea.

One out of four people suffer from sleep disorders . . .

and some disorders can be life-threatening.



us today.

(800) 939-0399

Sleep restores our bodies and our minds

-- without it, we suffer.

People who have sleep disorders may

experience fatigue, irritability, depression,

reduced attention, reduced concentration,

reduced memory, more frequent illnesses,

lost productivity, and workplace or car acci-

dents from falling asleep at the job or at the

wheel.

The sleep disorder laboratory was

established for the diagnosis and treatment

of all types of sleep disorders.





us today.

(800) 939-0399









wheel.








us today.

(800) 939-0399









wheel.




Sleep Problems Have Become a Modern Epidemic . . .

Sleep problems have become a modern epidemic

that is taking a catastrophic toll on our bodies and

our minds. It’s estimated that 65 million Americans -

- one out of every four people -- suffer from serious

sleep disorders that undermine the quality of their

sleep and overall health.

We recognize that for the victims of disordered

sleep, the night is a source of anguish, not rest. As

a result, we provide a “state of the art” sleep disor-

der service for those with sleep disorders such as

sleep apnea and chronic snoring.

For a referral to our

sleep specialist, call:

(800) 939-0399















(800) 939-0399















(800) 939-0399

FLYER TO EDUCATE EMPLOYEES --

FOR POSTING NEXT TO TIME CLOCKS, ON

BULLETIN BOARDS, BREAKROOMS, ETC.

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Sleepy? Snore?

Be a part of

the new WAVE

in healthcare!

If you think you might

have a serious sleep

disorder . . .

see your doctor and if

referred to a sleep

specialist . . .

a sleep study may

find your problem and

determine treatment.

For more information or a referral to

our sleep medicine specialist, call:

(800) 939-0399

Sleep Disorder Laboratory at SRHS • 1025 Center Street • Ashland, OH 44805

IN-HOUSE HANDOUT FOR

DISTRIBUTION AT MEETINGS

WHERE THE SERVICE IS ANNOUNCED

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Attention Directors,

Chaplains and Volunteers

If you think you might have

a serious sleep disorder . . .

see your doctor and if referred

to a sleep specialist . . .

a sleep study may be conducted

to diagnose your problem

and prescribe treatment.

Did you know?

❒ One in four people have a

sleep disorder

❒ Sleep disorders may be life

threatening

❒ Sleep disorders are treatable

when diagnosed

❒ Diagnosis can be done in a

sleep disorder laboratory

❒ Our Sleep Disorder Laboratory

will be operated by SleepMed

❒ Dr. Laurie Mooney will serve as

the medical director and

provide consultation and

interpretation services

❒ Call for more information or a

referral to our sleep specialist

(800) 939-0399

NEWSLETTER ARTICLE FOR

USE IN EMPLOYEE NEWSLETTER

OR FOR BUSINESSES TO USE IN

THEIR EMPLOYEE NEWSLETTER

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Sleepy? Snore? Be a part of

the new WAVE in healthcare!

At Samaritan Regional Health

System we’re catching some

waves that can have a dramatic

effect for those who suffer from

sleep disorders.


out of every four people suffer

from a sleep disorder and many

sleep disorders may be life-

threatening.

For instance, someone with

severe sleep apnea (where a

person stops breathing for about

10 seconds or more as many as

600 times per night) is at very high

risk.


period of silence, and then gasp




through the evaluation of a

person’s sleep waves. Once the

condition is diagnosed by a sleep

disorder physician, a treatment

plan begins.

Good Sleep Hygiene

Tips For Having

A Good Night’s Sleep:❒ Check the environment for things

that may be disrupting your sleep

such as too much light or noise.

Try to keep your bedroom at 65°F.

❒ Use your bed and bedroom for

sleeping, not watching TV, reading

or paying bills, etc.

❒ Follow a regular schedule for

sleeping and waking, even on

weekends.

❒ Exercise in the late afternoon to

unwind. Don’t exercise just before

bed (it can wind you up again!).

❒ Watch what and when you eat. A

big or late evening meal may make

you drowsy, but your digestive

system may keep you awake later.

An empty stomach may also make

you toss and turn.

❒ Watch what you drink, as well,

avoiding caffeine for six hours be-

fore bedtime. Avoid alcohol before

bed -- it may put you to sleep, but

you’ll sleep poorly. Warm milk can

help you sleep, though.

❒ Other tips include: refuse to worry,

take warm baths or listen to music

to relax, or try deep breathing or

progressive relaxation exercises.


Dr. Laurie Mooney, a sleep

medicine specialist, will serve as

the medical director of our Sleep

Disorder Laboratory. As such, Dr.

Mooney will provide sleep consul-

tation, interpretation and follow-

up services.

When a sleep study is ordered,

the patient will be sent to our

laboratory for this painless,

non-invasive overnight proce-

dure.

The Sleep Disorder Laboratory

is operated by SleepMed, a

nationally respected sleep

diagnostic company. Highly-

trained sleep technologists will

perform the sleep studies.

Call for more information or a

referral to our sleep medicine

specialist.

(800) 939-0399

PHYSICIAN NOTIFICATIONS & EDUCATION

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July 1, 2006

Dear Doctor:

We are very pleased to announce the opening of our Sleep Disorder Laboratory. In an effort

to provide convenient patient access to sleep disorder diagnosis, we have contracted with

SleepMed to provide diagnostic services. Dr. Laurie Mooney, a sleep specialist on our medical

staff, will serve as our medical director and interpreting physician for the service.

You have the option of ordering sleep studies directly once you have been inserviced by Dr.

Mooney or you may refer the patient to Dr. Mooney for a sleep consult. The purpose of the

inservice is to expand your knowledge on the signs and symptoms of sleep disorders, provide

you with assessment tools to help you diagnose these patients, help you understand when it is

appropriate to order a study, and to review the treatment options that are currently available

when you are managing your patient’s care.

If you are interested in scheduling an onsite inservice for you and the other doctors in your

practice -- or to schedule one of your patients for a sleep consultation -- call Dr. Mooney’s office

at (419) 207-2566. If you’re directly ordering a sleep study for your patient, call SleepMed at

(800) 939-0399 and ask for our scheduling coordinator. The scheduling coordinator will obtain

patient information from you and provide you with a date and time for the sleep study. If that

appointment is convenient for your patient, SleepMed will send the patient a confirmation notice.

Or, if it is more convenient, you can make arrangements with our scheduler to fax in your sleep

study order.

Whether the sleep study is ordered by you or Dr. Mooney, you will receive a copy of the scoring

summary report from SleepMed within a few days after the study and a copy of the interpretation

from Dr. Mooney, shortly thereafter.

Please keep in mind that apnea is the most prevalent of over 80 recognized sleep disorders

seen in sleep laboratories and it affects 4-6% of the adult population, usually overweight adults

between 35 and 55 years of age. The majority of apnea cases can be uncovered by asking

three important questions: (1) Are you sleeping well at night? (2) Do you snore? and (3) Are

you tired during the day?

Thank you for your support of this valuable new diagnostic program.

Sincerely,

Danny Boggs, FACHE

President/CEO

Samaritan Regional Health System

is proud to announce

the opening of its

Sleep Disorder Laboratory.

Laurie Mooney, MD, D.ABSM,

a physician specializing

in sleep medicine,

will provide local consultation

and reading services.

To Order Consults:

Dr. Laurie Mooney (419) 207-2566

To Order Studies Directly: (800) 939-0399

ATTENTION DOCTORS:

Samaritan Regional Health Systemannounces the opening of its

Sleep Disorder Laboratory

Medical Director

Laurie Mooney, MD, D.ABSM

To order studies directly:

(800) 939-0399

To order sleep consults:

Dr. Laurie Mooney (419) 207-2566

Statistics:

• One out of every four individuals

have sleep disorders

• 4% have chronic sleep apnea

Sleep Apnea Symptoms:

• excessive daytime sleepiness

• stentorian snoring

• gasping or choking awakenings

• awakenings for uncertain reasons

• restless sleep

• non-refreshing sleep

• poor memory

• poor intellectual function

• irritability

• personality changes

• morning headaches

• confusion

Look and Ask to Detect Apnea

Patients rarely present with a sleep disorder. If

the patient is middle-aged (35-55) and overweight

with a 17 1/2” neck size, they fit the physical

profile. If they fit the profile and answer “yes” to

the following 3 questions, suspect apnea:

(1) Do you sleep poorly at night? (2) Do you

snore loudly? (3) Are you tired during the day?

Interview Bed Partners

Every effort should be made to interview the

patient’s bed partner who may have observed

the sleeping patient and witnessed apneic

events (snore-pause-gasp cycles).

POWER POINT PRESENTATION FOR

INFORMATIONAL MEETINGS WITH

EMPLOYEES AND FOR

COMMUNITY PRESENTATIONS

Call the Customer Service Area at Respironics

at (800) 345-6443 for Your Free CD, Entitled

“The Great Awakening”

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MAILOUTS AND TRAINING AIDS

FOR USE WITH ON-SITE

PHYSICIAN INSERVICES

CONDUCTED BY A SLEEP SPECIALIST

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July 1, 2006

Dear Doctor:

Disordered sleep is one of the most common medical conditions we face today, but the

most underdiagnosed and undertreated. A survey to medical schools in 1993 indicated

that less than two hours of curriculum was devoted to the topic of sleep. When you

consider that one out of four people suffer from a sleep disorder, you realize the critical

need for care of these patients.

For that reason, Dr. Laurie Mooney, who is the medical director of our Sleep Disorder

Laboratory, will be available to offer you and your staff an opportunity to learn more

about the diagnosis and treatment of sleep disorders. Beginning next month, Dr. Mooney

can be scheduled to conduct an onsite inservice for the doctors and clinical personnel at

your practice. While one hour would be preferred, he is willing to make adjustments to fit

your patient scheduling needs.

Furthering your education in this area is important to your patients. For that reason, take

a minute, read the fact sheet that has been enclosed and review the patient assessment

form. If Dr. Mooney can be of assistance in providing a review of sleep disorders, contact

his office at (419) 207-2566 and schedule an inservice.

With Warm Regards,

SLEEP DISORDER LABORATORY

Danny Boggs, FACHE

President/CEO

Enclosures: Fact Sheet

Two-Sided Patient Assessment Tool




FACT

One out of every four people suffer from a sleep disorder and sleep disorders have become one of the most underdiagnosed and undertreated

medical conditions of our time. Why? Because patients aren’t aware of the seriousness of their sleep problem, therefore they don’t bring it to the

attention of their doctor -- and unless doctors proactively ask pertinent sleep-related questions, it becomes more difficult to diagnose an underly-

ing sleep disorder condition that may be causing the symptoms that have been described by the

patient. And when a sleep disorder is not treated early, it can lead to serious, even life-threatening, car-

diac and neurological problems -- which are far more costly to treat.

Sleep apnea is the most prevalent sleep disorder. The typical profile of a sleep apnea patient is an

overweight, middle-aged male that snores loudly and has a 17 1/2” neck. Relaxation of the muscles

during sleep combined with the excessive fatty tissue in the back of the throat and surrounding airway

may cause the airway passage to tighten (loud snoring) and then collapse (breathing stops). This

results in a “snore - pause - gasp” cycle that may be repeated up to 600 times each night. The patient

is aroused with each gasp, but typically does not remember the awakenings. Consequently, the sleep

debt or deprivation builds over time and the patient’s general health and quality of life is greatly compromised. Losing weight may solve their apnea

condition, but often they lack the energy to exercise because of accumulated sleep deprivation.☯

IDENTIFYING PATIENTS WITH SLEEP DISORDERS

An easy way to begin is placing assessment questionnaires in your waiting area. Patients may take

the time while waiting to complete an assessment that can be shared with the doctor during the con-

sultation. Or, take a more proactive stance and have your front desk receptionist ask that patients

complete the questionnaire with every visit. A sample questionnaire is attached for your review and

use in making copies. ☯

REFERRAL TO A SLEEP SPECIALIST

If you have a patient that shows signs of a sleep disorder, a referral to a sleep specialist would be appropriate.

The sleep specialist examines the patient, determines if an overnight sleep study is indicated and, if so, orders

a study, interprets the scored results, provides the results to the patient, and begins treatment. The referring

physician is also provided with the study results and a copy of the interpretation and planned treatment. Quite

often for apnea patients being treated with CPAP, a second night’s study is needed to properly titrate air pressure.

To schedule a consult with Dr. Laurie Mooney, call (419) 207-2566. For doctors who

prefer to order a sleep study directly, call (800) 939-0399 or fax your order to (800) 972-0107.

Sle

ep

Dis

ord

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sm

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tYes No

❒ ❒ 1. I have been told that I snore.

❒ ❒ 2. I have been told that I hold my

breath while I sleep.

❒ ❒ 3. I have high blood pressure.

❒ ❒ 4. My friends and family say that

I’m often grumpy and irritable.

❒ ❒ 5. I wish I had more energy.

❒ ❒ 6. I get morning headaches.

❒ ❒ 7. I often wake up gasping for breath.

❒ ❒ 8. I am overweight.

❒ ❒ 9. I often feel sleepy and struggle to

remain alert during the day.

❒ ❒ 10. I frequently wake with a dry mouth.

❒ ❒ 11. I have difficulty falling asleep.

❒ ❒ 12. Thoughts race through my mind

and prevent me from getting to sleep.

❒ ❒ 13. I anticipate a problem with sleep

several times a week.

❒ ❒ 14. I often wake up and have trouble

going back to sleep.

❒ ❒ 15. I worry about things and have

trouble relaxing.

❒ ❒ 16. I wake up earlier in the morning

than I would like to.

❒ ❒ 17. I lie awake for half an hour or

more before I fall asleep.

❒ ❒ 18. I often feel sad or depressed

because I can’t sleep.

❒ ❒ 19. I have trouble concentrating at

work or school.

❒ ❒ 20. When I am angry or surprised, I

feel like my muscles are going limp.

❒ ❒ 21. I have fallen asleep while driving.

Yes No

❒ ❒ 22. I often feel like I am in a daze.

❒ ❒ 23. I have experienced vivid dreamlike

scenes upon falling asleep or

awakening.

❒ ❒ 24. I have fallen asleep in social settings

such as movies or at a party.

❒ ❒ 25. I have vivid dreams soon after

falling asleep or during naps.

❒ ❒ 26. I have “sleep attacks” during the

day no matter how hard I try to stay

awake.

❒ ❒ 27. I have episodes of feeling

paralyzed during my sleep.

❒ ❒ 28. I wake up at night with an

acid/sour taste in my mouth.

❒ ❒ 29. I wake up at night coughing or

wheezing.

❒ ❒ 30. I have frequent sore throats.

❒ ❒ 31. I have heartburn at night.

❒ ❒ 32. During the night I suddenly wake

up feeling like I am choking.

❒ ❒ 33. I have noticed (or others have

commented) that parts of my body

jerk during sleep.

❒ ❒ 34. I have been told that I kick and

jerk during sleep.

❒ ❒ 35. When trying to go to sleep, I

experience an aching or crawling

sensation in my legs.

❒ ❒ 36. I experience leg pain or cramps at

night.

❒ ❒ 37. Sometimes I can’t keep my legs

still at night, I just have to move

them to feel comfortable.

❒ ❒ 38. Even though I slept during the

night, I feel sleepy during the day.

Scoring the Assessment

Questions 1 - 10: Yes # ____ No # ____ (If you answered YES to three or more questions, you have symptoms of

SLEEP APNEA. This is a potentially serious disorder which causes you to stop breathing repeatedly, often hundreds of times in the

night during your sleep.)

Questions 11- 18: Yes # ____ No # ____ (If you answered YES to three or more questions, you have symptoms of

INSOMNIA. This is a persistent inability to fall asleep or stay asleep.)

Questions 19- 27: Yes # ____ No # ____ (If you answered YES to three or more questions, you have symptoms of

NARCOLEPSY. This is a lifelong disorder characterized by sleep attacks during the day).


GASTROESPHAGEAL REFLUX. This disorder is caused by acid “backing up” into the esophagus during sleep.)


PERIODIC LIMB MOVEMENT DISORDER or RESTLESS LEGS SYNDROME. PLMD is the uncontrollable leg or arm jerks during

sleep and RLS is the uncomfortable feelings in the legs at night.)

Apnea

Sleep apnea is a condition that was discovered only

recently (in 1965, in Europe). Between 70 and 90 percent

of those who suffer from it are men, mostly middle-aged,

and usually overweight. The vast majority snore heavily.

The problem is a neuromuscular one that results in the

partial closing of an airway called the nasal pharynx while

one sleeps. Up to 10% of the male population, up to 5% of

all adult women, and up to 40% of all Americans over the

age of sixty may suffer from some form of sleep apnea.

There is some evidence that sleep apnea is caused by a

defect in the central nervous system.

Scientists estimate that 30 million Americans snore -- and

that 2.5 million of them suffer from sleep apnea. Snoring is

common. It is a universal nuisance, a condition as

common as the cold -- and the sources of countless

confrontations between husbands and wives since time

began. Snoring is caused by impaired breathing as we

sleep, and the older we get the more likely we are to snore.

Overall, one of every eight Americans snores. And it is

estimated that almost 60% percent of the men and 45% of

the women who have reached their sixties snore.

Light snoring may be a minor nuisance, but when snoring

becomes loud and disruptive, and when it is accompanied

by extreme sleepiness or sleep attacks during the daytime,

it should be taken seriously. It could be a sign of sleep

apnea, a life-threatening condition that results from the

blockage of one's breathing during sleep. Those who

suffer from sleep apnea actually stop breathing as they

sleep -- perhaps as often as several hundred times per

night. Patients seem to gasp for breath in their sleep, and

the oxygen level in their blood becomes abnormally low. In

severe cases, the patient may actually spend more time

not breathing than breathing! Those who suffer from

apnea do a lot of loud and intermittent snoring during the

night. They may have the sensation of choking, and may

move about a great deal while in bed. Excessive sweating

often occurs during sleep. There often is an irregular

pounding of the heart as the patient gasps for breath.

People who have sleep apnea may suffer from early-

morning headaches and feel excessively sleepy throughout

the day. Hallucinations sometimes occur while the patient

is awake but feeling extremely sleepy. Memory

deterioration, personality changes, and impotence are

common. Rapid weight gains, often approaching obesity,

often occur. Sufferers are hard to awaken, and if they are

suddenly awakened, they frequently do not know where

they are. Upon awaking, those who suffer from the

"snoring sickness" usually will not recall having

experienced an apneic episode in their sleep. A period of

disorientation sometimes occurs immediately after waking.

During such periods, the individual may have difficulty with

his memory and give inappropriate answers to questions,

acting as if he did not hear it or failed to understand what

was asked. The excessive daytime sleepiness caused by

sleep apnea may produce fatal pulmonary and

cardiovascular complications. Cardiovascular problems

resulting from the illness may include blood pressure,

irregular heart rhythm, or deterioration of the heart muscle

and its ability to pump blood, which can result in heart

failure, heart attack or stroke. Apnea patients have twice

the usual prevalence of hypertension, three times as much

heart disease, and four times as much cerebrovascular

disease. Other potential consequences include stroke,

neuropsychiatric problems, cognitive impairment, sexual

dysfunction, and injury due to accidents. Once a person

develops sleep apnea, he appears to have it for life. At

least a million people are severely impaired by the ailment,

and twice that many are partially impaired. Unfortunately,

95% of them remain undiagnosed and untreated.

Gastroesophageal Reflux

This is a disorder in which the patient can wake from sleep

with a sour taste in the mouth or a burning discomfort or pain

in the chest (heartburn). The pain is usually substernal, with

a feeling of general chest pain or tightness similar to that due

to angina. The pain appears to be caused by gastric fluid or

contents that have been regurgitated from the stomach into

the esophagus and pharynx. Awakenings from sleep

associated with the discomfort can lead to a complaint of

insomnia. This is a chronic, unrelenting- disease that is

rarely cured. Lower esophageal sphincter pressures, gastric

emptying, peristaltic efficiency of the esophagus, obesity or

pregnancy may be predisposing conditions. It is estimated

that 7-10% of the general population has daily heartburn and

as much as one-third has weekly heart-burn. This disorder

is more common in those over 40 years of age.

Insomnia

The form that sleep problems take for the great majority of

sleep sufferers is called insomnia -- the inability to fall

asleep, stay asleep, or to sleep well. It is safe to say that

almost all of us suffer from it in one form or another at some

time in our lives. Some people are inclined to suffer

insomnia during times of stress, much as other people might

suffer headaches or indigestion. A troubled marriage, a sick

child, or an unrewarding job can often disrupt people's sleep.

However, we tend to be troubled by the unusual, the

uncommon, the unfamiliar things that occur in our lives --

and so, passing changes in our sleep patterns may alarm us.

The effects of insomnia are predictable. If sleep is reduced

to five hours per night, even if only for a span of two nights,

alertness, vigilance, and creativity all suffer. Sleepy people

are less ambitious and less productive. Their performance

on cognitive tasks involving memory, learning logical

reasoning, arithmetic calculations, pattern recognition,

complex verbal processing, and decision-making has been

shown to be impaired by sleep loss. Still, most of us will find

that with the passing of the external event that has caused

the insomnia, or with some simple changes in habit, regular

sleep returns. However, for some, the solution is less

simple. Insomnia, then, is a symptom, not an illness. It is a

condition in which people frequently are unable to get to

sleep for as much as an hour after they turn in, awaken

frequently during the night, or waken early and are unable to

go back to sleep. Long term insomnia, however, can be

serious enough to radically degrade the quality of the

sufferer's life. Researcher's speculate that the body

produces a sleep-inducing chemical, as yet unidentified, that

accumulates while we are awake. As the chemical builds up

over a period of time, we become sleepier and sleepier, and

we eventually doze off. Our biological clock in our brains

control the time at which we go to sleep and the time at

which we awake. However, a number of conditions -- both

internal and external -- can cause this process to go awry.

For example, pregnancy brings on insomnia. Women are

more likely to suffer from insomnia than men by a ratio of 30-

40 percent. In addition, appetite suppressants suppress

sleep and smokers take longer to fall asleep and sleep more

lightly than those who do not smoke. Shift workers have

more trouble with insomnia than others with 40-80 percent

have difficulty with sleep. Little wonder: the average shift

worker sleeps between two and four hours less each night

than the day worker.

Narcolepsy

Narcolepsy is a neurological disorder, possibly resulting

from a biochemical defect that affects the neurotransmitters

in the central nervous system. It generally first appears in

a individual's teens, but can occur at any age. It is rare,

however, for narcolepsy to first appear in someone who is

past forty. Narcolepsy afflicts both sexes equally and tends

to run through families. Suffers tend to get poor grades in

school and to have numerous study problems due to their

inability to read, study, concentrate, memorize or pay

attention. Later in life, this places limitations on their

career alternatives, resulting in a low level of job

satisfaction, frequent job loss, a loss of income, and low

self-esteem. Narcoleptics tend to have poor interpersonal

relationships, become alcoholics, have high divorce rates,

suffer from a decreased sexual libido and impotence, and

experience a great deal of depression and other psychiatric

problems. One person in every 1,000 is affected and they

complain of excessive daytime sleepiness, often expressed

as tiredness, lack of energy or irresistible sleepiness. They

may suddenly drop off to sleep at any time. Most

commonly, attacks occur while the individual is watching

TV, reading, listening to a lecture or engaging in an activity

that does not have their full attention, but can also occur

while walking, bike riding, eating, talking or driving.

Periodic Limb Movement Disorder/

Restless Leg Syndrome

Just before falling asleep, many people feel an

uncomfortable, Not always painful, sensation deep in their

thighs, calves and/or feet. Vigorous movement usually

eases it enough for the sufferers to get to sleep, but the

next day they may feel sleepy and fatigued. Sometimes,

they may complain of an itching, crawling sensation in their

legs, as if a current were running through them. People

suffering from periodic limb movement disorder, also

known as restless leg syndrome, experience irritability, a

lack of motivation, poor job performance, and difficulty

maintaining appropriate relationships within the family or

society as a whole. What happens is that these people

have experienced repetitive jerks and twitches of the leg

muscles, followed by literally hundreds of related

awakenings throughout the night. Their restorative sleep,

the slow-wave and REM portions of their sleep cycle, has

been disturbed. The same symptoms can be experienced

during the day, particularly when the sufferer is attempting

to relax. The condition affects 2-5% of the population and

is most common among those who are middle-aged and

older. It is rare among children. It may be hereditary, or it

might result from a variety of medical problems, such as

kidney disease, withdrawal from certain medications, some

metabolic disorders, diabetes, anemia, or disorders of the

spinal or peripheral nerves. Pregnant women frequently

develop it, but the symptoms usually disappear after

delivery. Families may have a predisposition to suffer from

the ailment. Studies also have shown that the condition

may result from a shortage of Vitamin E, iron or calcium;

and vitamin and mineral supplements are often prescribed.

Sometime leg exercises will produce a satisfactory cure; on

other occasions, drugs may be required. The ailment

seems to affect men and women equally, and an attack can

occur whenever the individual sits or lies down, although it

is more frequent -- and severe -- at night.

Sleep Disorder Training GuideSleep Disorder Laboratory at Samaritan Regional Health System

Consultations with Dr. Laurie Mooney: (419) 207-2566

To Schedule Sleep Studies Directly: (800) 939-0399

Sleep Disorders

Obstructive Sleep Apnea

Central Sleep Apnea

Mixed Sleep Apnea

Narcolepsy

Insomnia

Restless Leg Syndrome

Periodic Limb Movement

Sleepeating

Sleeptalking

Sleepwalking

Night Terrors

Sleep Related Violence

Gastroesphageal Reflux

Jet Lag Syndrome

Shift Work Syndrome

Sudden Infant Death Syndrome

Bedwetting

Advanced Sleep Phase Syndrome

Delayed Sleep Phase Syndrome

. . . plus over 60 others.

Leading Treatments for Apnea

CPAP - 90% Success Rate

Surgery - 50-70% Success Rate

Dental Appliance - 50% Success Rate

Treatments for Apnea & Other Disorders

CPAP

BiPAP

Sleeping Positional Changes

Alcohol Discontinuance

Sleeping Pill Discontinuance

Weight Loss

Stress Management

Nocturnal Ventilation

Medications

Oxygen Therapy

Dental Appliances

Removal of Adenoids and Tonsils

Removal of Nasal Polyps/Growths

Removal of Tissue in Airway

Uvulopalatopharyngoplasty

(UPPP) & Other ENT Surgeries

Radio Frequency Energy

Mandible Reconstruction

Correction of Structural Deformities

Tracheostomy

Gastric Stapling for Morbidly Obese

Bright Light Therapy

Illustration A

Normal Airway During Sleep

Illustration B

Closed Airway During Sleep

Superior Lip

Palaloglossal Arch

Fauces

Palatopharyngeal Arch

Palatine Tonsil

Tongue

Interior Lip

Uvula

Soft Palate

Hard Palate

Nasal Cavity

Soft

Palate

Larnyx

Trachea

Illustration C Illustration D

PRESS RELEASE FOR THE

LOCAL NEWSPAPER

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NEWS RELEASE

DATE: July 1, 2006

SUBJECT: Samaritan Regional Health System Announces the

Opening of its Sleep Disorder Laboratory

FROM: Erin Al-Mehairi, Mktgt

(800) 257-9917

FOR IMMEDIATE RELEASE

ASHLAND/OH -- Samaritan Regional Health System announces the opening of the

Sleep Disorder Laboratory for the diagnosis and treatment of potentially serious sleep

disorders, such as sleep apnea, excessive snoring, narcolepsy, restless leg syndrome

and periodic limb movement disorder.

“Recognizing and treating some sleep disorders in the early stages may prevent more

serious cardiovascular and neurological problems, which can be very expensive to

treat.” stated Danny Boggs, FACHE, President/CEO of Samaritan Regional Health

System. He continued, “We are extremely fortunate to have Dr. Laurie Mooney, Board

Certified Sleep Specialist, serving as the medical director for our Sleep Disorder Labora-

tory, thus giving us the opportunity to improve patient access and expand our preventa-

tive commitment to include sleep diagnostics.”

“Sleep disorders affect one out of every four individuals,” stated Dr. Mooney. He

continued, “Left untreated, many serious conditions, such as sleep apnea, may have

life threatening consequences due to the toll taken on the cardiovascular and neurologi-

cal systems.” Research indicates that approximately 4-6% of the population suffers

from sleep apnea, the most prevalent of all sleep disorders. Dr. Mooney explained that

the profile of the typical apnea patient is an overweight, middle-aged adult, between the

ages of 35 and 55, who snores loudly, complains of being tired during the day and

usually has a 17 1/2” neck size or greater.

- MORE -

Sleep Disorder Laboratory Opens

Page Two

Those with sleep apnea will usually have the following symptoms: excessive daytime

sleepiness; stentorian (loud) snoring; gasping or choking awakenings; awakenings for

uncertain reasons; restless sleep; non-refreshing sleep; poor memory; poor intellectual

function; irritability; personality changes; morning headaches; and confusion. Bed

partners and house mates will frequently describe loud snoring with intermittent silent

periods terminated by loud, or resuscitive snorting. Those with the condition may be

unaware of their sleep pattern, but are aware that they wake up each day unrefreshed

and, many times, irritable.

For patients who suspect they may have a sleep disorder, they should bring it to the

attention of their family physician or make an appointment for a consultation with Dr.

Mooney by calling (419) 207-2566. During the sleep consultation, Dr. Mooney will

obtain a general medical history and sleep history, plus conduct a physical examination.

He will then determine if an overnight sleep study and additional tests are needed to

conclusively diagnose the problem. If a sleep study is needed, he will schedule the

study, interpret the results, and begin the patient on an appropriate treatment plan.

“The overnight sleep studies are conducted by highly trained sleep technologists while

patients enjoy the comfort of private sleep rooms,” said Carol Herman, RN, Director of

Remote Sites where the service is located. He continued, “The technologist greets the

patient when they arrive in the evening, educates them on what will occur, and begins

their set-up for monitoring.”

Set-up involves the placement of various electrodes on the surface of the patient’s

scalp, face, chest, and lower leg to monitor brain waves, eye movements, respiration,

heart rate and muscle activity. There are no injections, drugs, or x-rays associated with

this procedure -- and no pain associated with the placing or wearing of electrodes. A

second night at the laboratory may be required for patients diagnosed with sleep apnea.

Treatments can range from airway pressure appliances, medication, lifestyle changes,

weight loss, ENT surgery and laser therapy, dental appliances, light therapy, and internal

body clock adjustments. The treatment or treatments recommended depend upon the

type of sleep disorder diagnosed.

# # #

10-PART PHYSICIAN NEWSPAPER COLUMN

FOR THE LOCAL NEWSPAPER

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The Modern Science of Sleep and Dreams

Part 1 of a Ten-Part Series

provided by Laurie Mooney, MD, D.ABSM

Board Certified Sleep Specialist

ASHLAND/OH -- Since recorded history, sleep and dreams have captured the imagination and inter-

est of man. Modern science has discovered much about our sleep and in a ten-part series, we will

explore what goes on when we sleep and the effects of sleep loss.

What is sleep?

Sleep is a behavioral state characterized by very little physical activity and almost no awareness of

the outside world. Most scientists think sleep is vitally important and research continues to learn

exactly what sleep does. What we do know at this stage of research is that without sleep we would

die. It is as necessary as the air we breathe and the food we eat.

Our bodies tell us when we need to sleep and when sleep has done its job. Following normal sleep

we feel rested and know that we have slept enough. In addition to this obvious benefit, research

clearly shows that learned knowledge is retained during normal sleep which affects our memory

function. Normal sleep also aids in the development of growth hormones in children and strengthens

the immune system for everyone.

Sleep is actually made up of two different states: (1) non-rapid eye movement sleep (NREM); and (2)

rapid eye movement sleep (REM) or the dream state. During REM sleep you can watch the sleeper’s

eyes move around beneath closed eyelids. Some scientists think that the eyes move in a pattern that

relates to the visual images of the dream. We are almost completely paralyzed in REM sleep with

only the heart, diaphragm, eye muscles and the smooth muscles (intestines and blood vessels)

operating during sleep. Our deepest stages of sleep are REM and stages 3 and 4 of NREM. We are

most easily awakened during stage 1 and 2 of NREM sleep. Scientists have learned that the four

stages of NREM and REM sleep, occurring in a continuous cycle while we sleep, are necessary for

memory function, productivity and overall good health.

The timing of sleep and wakefulness is controlled to a great extent by our exposure to the natural light

and dark cycles of the earth. All humans tend to sleep in the dark and move about in the light. Our

internal biological clocks are sensitive to light and have evolved over the ages in close approximation

to the 24-hour light-dark cycle of our world.

How much sleep should I get?

Not everyone has the same sleep needs. However, it is true that most people need about eight hours

of sleep a night. Only 10 percent of the population needs more or less. Newborn babies average

sixteen to eighteen hours of sleep a day. By the end of their first year, most babies sleep twelve to

fourteen hours a day. This declines over their adolescent period and levels off at eight hours per

night until they reach their teens. Between the ages of twelve and twenty, young people need an

hour more sleep than do pre-teens. The need for sleep actually increases during the second decade

of life. With eight hours of sleep, the daytime alertness of teens is severely impaired. In spite of this

increased need, peer pressure and other external pressures force many young people to turn in the

opposite direction. Once in our twenties and through the rest of our lives, the average person re-

quires about eight hours of sleep per night although the “bed time” and “rise time” may shift as we

age.

Why do we dream?

The reason we dream is unknown. However, dreaming is an integral part of sleep and appears to be

unavoidable. It provides necessary stimulation to the brain while giving us a safe and socially accept-

able way to fulfill our wishes and dreams. Learning specialists feel that dreaming is important for

consolidating what we have learned while we were awake so that we can remember facts and prob-

lem solutions for years to come.

Doctors believe that many common features of dreams stem from the physiological paralysis that

naturally occurs during REM sleep. For example, many people dream about falling, being unable to

get away from a pursuer or unable to move fast enough to prevent an accident. All of these kinds of

dreams have the common feature of movement impairment which may stem from the brain’s recogni-

tion of paralysis during REM sleep.

Many people believe that we can solve problems during dreams and there are experiments showing

that during REM sleep some people have heightened telepathic capabilities. Dream interpretation

can also give insight into what problems are being faced and how well the person is coping. People

who frequently have disturbing dreams may have a psychological problem that requires professional

attention.

What are the best ways for most of us to get a good night’s sleep?

1. Stick to a regular schedule of going to bed and getting up at the same time every day.

2. Exercise regularly in the morning or early afternoon, but not within five hours of bedtime.

3. Stay away from drinks containing caffeine after about 4pm.

4. Avoid alcohol which may disturb sleep patterns and cause early morning awakenings.

5. Be careful about sleeping pills. Long term use may lead to increased insomnia.

6. Find the right room temperature for you and maintain it throughout the night.

7. Try to relax before going to bed (i.e. warm bath, read a light novel, listen to music, etc.)

8. Do not eat heavily before going to bed.

In Part 2, we’ll explore snoring and sleep apnea, its causes and affects. Upcoming articles will cover

a variety of sleep disorders, the associated symptoms and treatment options.

Dr. Laurie Mooney, a sleep specialist, serves as the medical director for the Sleep Disorder

Laboratory at Samaritan Regional Health System. To schedule an appointment with Dr.

Mooney call his office at (419) 207-2566.

# # #


Part 2 of a Ten-Part Series: Snoring and Sleep Apnea



ASHLAND/OH -- Sleep research, just as with space and ocean exploration, help us uncover answers

to what has been a complex mystery. Sleep medicine is in its infancy, but this field has also benefit-

ted from the major technological advances made over the past few decades. To date, sleep re-

searchers have identified approximately 80 different sleep disorders. Of these disorders, snoring and

sleep apnea are the most prevalent.

What causes snoring?

Snoring is viewed by most as a social nuisance. In reality, snoring is a medical symptom for some-

thing as simple as the common cold -- to something as potentially life-threatening as severe sleep

apnea. Snoring is the sound made by air passing through irregularities and narrowings in the throat

and windpipe. Snoring can occur when someone breathes in or breathes out. Snoring in itself is not

dangerous, but it can be the first stage in the development of apnea. Weight gain, sedation or any-

thing else that further constricts the oropharyngeal airway could turn a chronic snorer into a sleep

apnea patient.

Should snoring be treated?

Those who snore should be seen by a doctor to determine if the snoring may result in cardiopulmo-

nary consequences, such as high blood pressure or episodes of sleep apnea. But, there may be

ways of reducing a person’s snoring without major medical intervention. There is nothing wrong, for

example, with trying to ask an otherwise healthy snorer to change sleeping positions. As a matter of

fact, it is a good sign if a change of position -- rolling over on the side, for instance -- will stop a

person’s snoring. If snoring stops when sleeping on their side, doctors suggest special pillows or a

tennis ball sewn into the back of the pajama top.

For more severe snoring that cannot be remedied by simple measures, a doctor may suggest other

treatments, such as dental appliances, breathing strips, or an outpatient procedure to remove or

reduce excessive or obstructive tissue in the back of the throat or upper palette.

Light snoring may be a minor nuisance, but when snoring becomes loud and disruptive, and when it

is accompanied by extreme sleepiness or sleep attacks during the daytime, it should be taken seri-

ously. If snoring involves a repetitious cycle of “snore, pause, snort” or, in other words, the person

snores, stops breathing for a few seconds and starts again with a loud snort, the sleeper most likely

suffers from sleep apnea and should seek the immediate treatment of a qualified doctor.

What is sleep apnea?

Sleep apnea is a condition that was discovered only recently (in 1965, in Europe). Between 70 and

90 percent of those who suffer from it are men, mostly middle-aged, and usually overweight. The

vast majority snore heavily. The problem is a neuromuscular one that results in the partial closing of

an airway called the nasal pharynx while one sleeps. Up to 10% of the male population, up to 5% of

all adult women, and up to 40% of all Americans over the age of sixty may suffer from some form of

sleep apnea.

How do you recognize the signs of apnea?

Those who suffer from sleep apnea actually stop breathing as they sleep -- perhaps as often as

several hundred times per night. Patients seem to gasp for breath in their sleep, and the oxygen level

in their blood becomes abnormally low. In severe cases, the patient may actually spend more time

not breathing than breathing.

Those who suffer from apnea do a lot of loud and intermittent snoring during the night. They may

have the sensation of choking, and may move about a great deal while in bed. Excessive sweating

often occurs during sleep. There often is an irregular pounding of the heart as the patient gasps for

breath.

People who have sleep apnea may suffer from early-morning headaches and feel excessively sleepy

throughout the day. Hallucinations sometimes occur while the patient is awake but feeling extremely

sleepy. Memory deterioration, personality changes, and impotence are common. Rapid weight

gains, often approaching obesity, often occur.

Sufferers are hard to awaken, and if they are suddenly awakened, they frequently do not know where

they are. Upon awaking, those who suffer from the "snoring sickness" usually will not recall having

experienced an apneic episode in their sleep. A period of disorientation sometimes occurs immedi-

ately after waking. During such periods, the individual may have difficulty with his memory and give

inappropriate answers to questions, acting as if he did not hear it or failed to understand what was

asked.

What can occur if apnea goes untreated?

Sleep apnea may produce fatal pulmonary and cardiovascular complications. Cardiovascular prob-

lems resulting from the illness may include blood pressure, irregular heart rhythm, or deterioration of

the heart muscle and its ability to pump blood, which can result in heart failure, heart attack or stroke.

Apnea patients have twice the usual prevalence of hypertension, three times as much heart disease,

and four times as much cerebrovascular disease. Other potential consequences include stroke,

neuropsychiatric problems, cognitive impairment, sexual dysfunction, and injury due to accidents.

Once a person develops sleep apnea, he appears to have it for life.

At least a million people are severely impaired by the ailment, and twice that many are partially im-

paired. Unfortunately, 95% of them remain undiagnosed and untreated.

How is apnea diagnosed?

Any person who suspects they may have sleep apnea should ask their family doctor for a referral to a

doctor who specializes in sleep disorders. If referred to a sleep specialist, the doctor will obtain a

medical history and ask sleep-related questions, may perform a physical examination, and may ask to

interview the patient’s bed partner. If the sleep specialist feels an overnight sleep study is indicated,

the patient may be referred to a sleep lab at the nearest hospital. In the sleep lab, the patient’s brain

waves, muscle activity, leg and arm movements, heart rhythms, and other body functions will be

monitored during sleep. With this information, the doctor can properly diagnose the patient’s condi-

tion and begin the patient on an appropriate treatment plan.

How is apnea treated?

Physicians usually treat sleep apnea by providing pressure support for the walls of the airway during

sleep with a technique called continuous positive airway pressure given through the nose -- nasal

CPAP for short. While the idea of wearing such a mask all night long may seem unappealing, most

patients learn to use CPAP quickly and adapt to wearing the device whenever they sleep. The vast

improvement in the quality of the patient’s life seem to far outweigh any inconveniences. In some

cases where an abnormality is involved, surgical widening of the airway or repositioning of the jaw

may be needed. For less serious cases, weight reduction, respiratory stimulants, drugs to increase

muscle tone in the back of the throat, and dental appliances may be the recommendation of the

doctor.

In Part 3, we’ll explore periodic leg movement and restless leg syndromes, their causes and affects.

Upcoming articles will cover a variety of sleep disorders, the associated symptoms and treatment

options.




# # #


Part 3 of a Ten-Part Series: Periodic Limb Movements and Restless Legs



ASHLAND/OH -- Millions of Americans have serious sleep problems and their lives could be vastly

improved by getting a reliable night’s sleep. It is estimated that one-third or 80 million people either

sleep too little, too much or fitfully. The failure to get a good night’s sleep has become a problem of

epidemic proportions. Two disorders that are somewhat similar in nature -- and either cause fitful

sleep or the inability to get to sleep -- are periodic leg movement disorder (PLMD) and restless leg

syndrome (RLS).

What is periodic leg movement disorder (PLMD)?

This disorder usually occurs while a persons sleeps. The unaware sleeper has a repetitive series of

leg jerks in combination with the extension of the big toe and partial bending of the ankle, knee and

sometimes hip. PLMD can result in fragmented, restless sleep and complaints of insomnia or exces-

sive daytime sleepiness. In addition, for serious sufferers the disorder can produce anxiety and

depression.

What causes PLMD?

PLMD can be associated with, or evoked by, a variety of medical conditions, such as chronic uremia

(kidney disease) and other metabolic disorders. Taking antidepressants can induce or aggravate this

disorder as can the withdrawals from a variety of drugs. This disorder is rare in children and

progresses with advancing age to become a common finding in up to 34% of patients over the age of

60 years. PLMD can accompany sleep apnea (refer to Part 2 in this series) and narcolepsy (look for

Part 4 in this series) -- and has been reported in

up to 15% of people suffering with insomnia.

How is restless leg syndrome (RLS) different from PLMD?

Many who suffer from RLS has described the feeling in their legs usually between the ankle and the

knee as an “aching,” “discomforting,” “creeping,” “crawling,” “pulling,” “prickling,” “tingling,” or “itching”

sensation. These sensations and associated leg movements begin just before falling asleep and can

usually be relieved by getting up and walking around, but returns again once in bed and just before

falling asleep. RLS can delay sleep onset for hours, whereas PLMD may occur during sleep with the

sleeper unaware of their partial awakenings throughout the night.

What causes RLS?

More common in females, RLS can be associated with pregnancy, anemia (blood disorder), uremia

(kidney disease) and rheumatoid arthritis. Most, if not all, patients with RLS show periodic leg move-

ments during sleep. Unlike those with PLMD only, people who suffer with both conditions may show

involuntary limb movements even while awake. This condition can produce severe insomnia, psycho-

logical disturbance and depression.

How are PLMD and RLS diagnosed?

Any person who suspects they may have PLMD or RLS should ask their family doctor for a referral to

a doctor who specializes in sleep disorders. If referred to a sleep specialist, the doctor will obtain a



the patient may be referred to a sleep lab at the nearest hospital. In the sleep lab, the patient’s leg

movements, brain waves, muscle activity, arm movements, heart rhythms, and other body functions

will be monitored during sleep. With this information, the doctor can properly diagnose the patient’s

condition and begin the patient on an appropriate treatment plan.

How are these disorders treated?

A variety of medications and sedative drugs are available for the treatment of movement disorders.

Also, treatment of associated conditions can prove to be effective. When this condition develops with

pregnant women, the symptoms usually disappear after delivery. Studies also have shown that the

condition may result from a shortage of Vitamin E, iron or calcium. As a result, vitamin and mineral

supplements are often prescribed. Sometime leg exercises will produce a satisfactory outcome.

In Part 4, we’ll explore narcolepsy, a sleep disorder involving a chemical imbalance in the brain.

Upcoming articles will cover a variety of sleep disorders, the associated symptoms and treatment

options.




# # #


Part 4 of a Ten-Part Series: Narcolepsy



ASHLAND/OH -- Sleep influences the most fundamentally important aspects of our lives, such as

resistance to disease, work performance and productivity, and safety on our highways. With most

people, sleep can be more restful with the modern safety assurances provided by security and fire

alarm systems in our homes. Just as we rely on their proper functioning while we sleep, so do we

rely on the proper functioning of our brain, heart and lungs while the rest of our anatomy shuts down

during sleep. If the brain does not work properly while we sleep, serious consequences such as

narcolepsy can occur.

What is narcolepsy?

Narcolepsy is a genetically transmitted disease, probably caused by an imbalance of one or more

neurotransmitters (brain chemicals) in the part of the brain that controls REM sleep. Abnormalities of

the body’s immune system may also be involved. This disorder may produce cataplexy -- or the loss

of muscle control associated with expressions of emotion, especially anger and laughter.

Narcoleptics sleep anywhere from 8 to 12 hours out of every 24 but find themselves falling asleep in

some of the most bizarre circumstances. These sleep attacks can occur during a conversation, at a

meeting, at the theatre, really anywhere and at any time. Since a narcoleptic advances to REM sleep

or the dream state almost immediately, hallucinations are common.

The hallucinations, or “waking dreams” as described by some, can sometimes appear as terrifying

apparitions, just as the narcoleptic falls asleep causing them to thrash out or appear frightened of

something that no one else can see. When this occurs in public, it is no wonder that narcoleptics with

this disorder are thought to be mentally ill or have a psychiatric disorder.

Accidents due to sleepiness, hallucinations and cataplexy can occur in almost any situation, but

commonly occur while driving, operating dangerous equipment, in the home, or at regular employ-

ment. Serious social consequences can result because of the sleepiness and can lead to marital

problems or the loss of employment. Adolescents with this disorder may have educational difficulties

which may prevent advanced educational opportunities.

What causes narcolepsy?

While there are reports of people getting narcolepsy after a disease or injury to the brain, recent

studies have linked narcolepsy to certain genes, specifically the genes on chromosome number six.

Narcolepsy, after sleep apnea (refer to Part 2), is the second most common cause of disabling day-

time sleepiness. It afflicts about one person in every thousand throughout the world and is about as

common as multiple sclerosis.

Narcolepsy most commonly begins in the second decade, with a peak incidence around 14 years of

age. Excessive sleepiness is usually the first symptom to appear, with loss of muscle control (cata-

plexy) appearing either at the same time or at a later date. This disorder can run in families and will

usually begin at the same age with each member.

How is narcolepsy diagnosed?

Any person who suspects they may have narcolepsy should ask their family doctor for a referral to a



interview the patient’s bed partner. If the sleep specialist feels a sleep study is indicated, the patient

may be referred to a sleep lab at the nearest hospital. The sleep study will involve a regular overnight

polysomnogram, immediately followed by a multiple sleep latency test (MSLT) during the next day, to

monitor the patient’s brain waves, muscle activity, leg and arm movements, heart rhythms, and other

body functions during both their nighttime sleep and daytime naps. With this information, the doctor

can properly diagnose the patient’s condition and begin the patient on an appropriate treatment plan.

How is narcolepsy treated?

Medications are now available to effectively treat narcolepsy. In addition to taking medication to

control the abnormal tendency to fall asleep at inappropriate times, medication also suppresses REM

sleep and helps control the symptoms of cataplexy, sleep paralysis and hallucinations. Although

cataplexy can be controlled to some extent with medication, many narcoleptic patients learn to control

their emotions in order to avoid cataplectic episodes.

In Part 5, we’ll explore insomnia, a sleep disorder that affects up to 36% of American adults. Upcom-

ing articles will cover a variety of sleep disorders, the associated symptoms and treatment options.




# # #


Part 5 of a Ten-Part Series: Insomnia



ASHLAND/OH -- The vast majority of us take sleep for granted. It is just something that we do, like

eating or taking a shower. But -- as we have learned -- getting a good night’s sleep is a problem of

major proportions for a substantial part of our population. Studies have found that 36% of American

adults have some type of insomnia and 9% have chronic sleep difficulty. In some special groups --

shiftworkers or psychiatric patients -- the prevalence is closer to 65%.

What is insomnia?

Insomnia is the inability to fall asleep, stay asleep, or to sleep well. It is safe to say that almost all of

us suffer from it in one form or another at some time in our lives. Some people are inclined to suffer

insomnia during times of stress, much as other people might suffer headaches or indigestion. A

troubled marriage, a sick child, or an unrewarding job can often disrupt people’s sleep. However, we

tend to be troubled by the unusual, the uncommon, the unfamiliar things that occur in our lives -- and

so, passing changes in our sleep patterns alarm us.

The effects of insomnia are predictable. If sleep is reduced to five hours per night, even if only for a

span of two nights, alertness, vigilance, and creativity all suffer. Sleepy people are less ambitious

and less productive. Their performance on cognitive tasks involving memory, learning, logical reason-

ing, arithmetic calculations, pattern recognition, complex verbal processing, and decision-making has

been shown to be impaired by sleep loss.

Still, most of us will find that with the passing of the external event causing insomnia, or with some

simple changes in habit, regular sleep returns. However, for some, the solution is less simple.

What are the major types of chronic insomnia?

There are five major categories, each with its own treatment regime. 1. Psychiatric insomnia is the

most common (35%) and is caused by psychiatric disorders with depression and anxiety being the

resulting symptoms. 2. Stress-conditioned insomnia affects 15% of chronic sufferers with stress at

the root of their problem and their symptoms fluctuate throughout the year as a reaction to life events.

Many of these patients “try very hard” to fall asleep, but the ensuing anxiety and tension serve to

arouse them further and, frequently, the sleep problem continues even after stressful life events are

long since past. 3. Physiological insomnia occurs in about 30% of chronic insomnia patients. With

these sufferers, the root cause of their insomnia is from leg jerks, breathing problems, pain-related

disorders (such as arthritis), or internal body clock disorders. 4. Poor sleep habit insomnia is found

both as a “stand alone” disorder and at other times as part of other disorders. This type of insomnia

(15%) is associated with alcoholism, addiction to sleeping pills and/or other drugs, excessive caffeine

use, and irregular sleep schedules. 5. Pseudo-insomnia affects 10% of the chronic insomniacs and

describe those who are convinced they are not sleeping when in actuality they are. For these

pseudo-insomniacs, denial of the facts may be a strategy to avoid facing underlying psychological

problems.

How is insomnia treated?

For depression or anxiety-induced insomnia, when the depression or anxiety is treated through a

comprehensive psychiatric approach, the insomnia disappears. For stress-induced insomnia, undo-

ing the vicious cycle of negative conditioning and substituting a positive approach to sleeping im-

proves most of these patients in five weeks.

Most sleep doctors will ask an insomniac suspected with having poor sleep habits to keep a dairy, a

record of sleep-wake behavior for several weeks. In many cases, this will provide insights into the

cause of the insomnia and allow for a treatment involving good sleep hygiene. With the aid of an

overnight sleep study, doctors can further determine if an insomniac’s body clock needs to be ad-

justed and, if so, chronotherapy may be used for some types of insomniacs. With this technique, the

insomniac’s bedtime is delayed each night to later hours, literally taking bedtime around the 24-hour

cycle until eventually an earlier bedtime is achieved.

Sleeping pills or medications are generally most effective for short-term, non-chronic insomnia. Or,

they may be used on a short term basis for chronic insomniacs before another treatment plan begins.

However, in chronic insomniacs, non-drug techniques are more effective. Because of this, sleeping

pill usage is on the decline.

In Part 6, we’ll explore fibromyalgia, a syndrome that is characterized by musculoskeletal pain,

chronic fatigue, unrefreshing sleep, and increased tenderness in specific anatomic regions of the

body. Upcoming articles will cover a variety of sleep disorders, the associated symptoms and treat-

ment options.




# # #


Part 6 of a Ten-Part Series: Fibromyalgia and Sleep



ASHLAND/OH -- Although many things conspire to prevent the miraculous healing affect of sleep, it

remains a major contributor to our overall physical and emotional health throughout our lives. Sleep

medicine research is continually contributing to our understanding of the profound affects caused by

sleep deprivation. For instance, fibromyalgia was thought at one time to be caused by inflammation,

although there was no evidence of inflammation or arthritis. Others theorized that it was a psychiatric

condition and it is now believed that depression and anxiety are the result, not the cause. Today,

there is better evidence that fibromyalgia is due to an abnormality of deep sleep.

What is fibromyalgia?

Fibromyalgia is a common and disabling disorder affecting 2-4% of the population, women more often

than men. Despite the condition’s frequency, the diagnosis is often missed. Patients with

fibromyalgia usually ache all over, sleep poorly, are stiff on waking, and are tired all day. They are

prone to headaches, memory and concentration problems, dizziness, numbness and tingling, itching,

fluid retention, and crampy abdominal or pelvic pain and diarrhea.

What causes fibromyalgia?

This disorder often runs in families, suggesting an inherited predisposition. It may lie dormant until

triggered by injury, stress, or sleep disturbance. It has been suggested that chronic fatigue and

irritable bowel syndromes are all just different facets of the same underlying disorder. Minor trauma

or changes in the weather, particularly cold or dampness, appear to exacerbate the muscle discom-

fort.

Abnormal brain waveforms have been found in deep sleep in many patients with fibromyalgia, as well

as low levels of growth hormone, important in maintaining good muscle and other soft tissue health.

The growth hormone is produced almost exclusively in deep sleep and its production is increased by

exercise.

How is fibromyalgia diagnosed?

Any person who suspects they may have fibromyalgia as a result of a sleep disorder should ask their

family doctor for a referral to a doctor who specializes in sleep disorders. If referred to a sleep spe-

cialist, the doctor will obtain a medical history and ask sleep-related questions, may perform a physi-

cal examination, and may ask to interview the patient’s bed partner.

During the physical examination, the physician will search for multiple tender points in characteristic

locations, such as the neck muscles at the base of the skull, midway between the neck and shoulder,

the muscle over the upper inner shoulder blade, below the side bone at the elbow, the upper outer

buttock, the hip bone, just above the knee on the inside, the lower neck in front, and the edge of

upper breast bone. To qualify for a diagnosis of fibromyalgia, patients much ache all over and have

tenderness in at least 11 of 18 different spots when pressure is applied.

If the sleep specialist feels a sleep study is indicated to obtain a reading of deep sleep patterns to

confirm the diagnosis, the patient may be referred to a sleep laboratory at the nearest hospital. The

sleep study will involve a regular overnight polysomnogram to monitor the patient’s brain waves,

muscle activity, leg and arm movements, heart rhythms, and other body functions during sleep. With

this information, the doctor can confirm the patient’s diagnosis and begin the patient on an appropri-

ate treatment plan.

How is fibromyalgia treated?

Taking medication by itself has relatively little effect on fibromyalgia symptoms. Successful treatment

requires active involvement of the patient in their own care, including: (1) medication to improve deep

sleep; (2) regular sleep hours and an adequate amount of sleep; (3) daily gentle aerobic exercise;

(4) avoidance of undue physical and emotional stress; (5) treatment of any coexisting sleep disor-

ders; and (6) patient education. If any of these steps are omitted, the chance of significant improve-

ment is greatly reduced.

Patients with fibromyalgia should probably give up caffeine completely as even one cup in the morn-

ing can sometimes disrupt sleep at night and may also directly increase muscle pain and headaches.

Eliminating alcohol consumption after your evening dinner and weight loss for those who are over-

weight may improve the quality of one’s sleep. Other sleep disorders that may aggravate

fibromyalgia are obstructive sleep apnea (Part 2), snoring (Part 2), periodic limb movements (Part 3)

and insomnia (Part 5).

In Part 7, we’ll explore parasomnias, such as bruxism, enuresis, nightmares, REM behavior disorder,

sleep eating, sleep paralysis, sleep talking, sleep terrors, and sleep walking. The parasomnias are

disorders of arousal, partial arousal, and sleep stage transition. Upcoming articles will cover a vari-

ety of sleep disorders, the associated symptoms and treatment options.




# # #


Part 7 of a Ten-Part Series: Parasomnias



ASHLAND/OH -- Sleep is not merely “time out” from daily life. It is an essential element for mental

and physical restoration. Millions of Americans of all ages, however, regularly fail to get a good

night’s sleep. One such group is those suffering from a “parasomnia.” Parasomnia is a term used to

describe disruptive sleep-related events. These behaviors and experiences generally occur during

sleep, and in most cases are infrequent and mild. At times they may occur often enough or become

so bothersome that medical attention

is necessary.

What are the major groups of parasomnias and their general cause?

There are four major groups and they are: (1) arousal disorders; (2) sleep-wake transition disorders;

(3) REM sleep associated disorders; and (4) other parasomnias. Many of the parasomnias are be-

haviors and experiences activated by the central nervous system.

What are parasomnia arousal disorders?

The most common of the parasomnias are arousal disorders and they include: (1) confusional arous-

als, sleepwalking, and sleep terrors. Experts believe that the various arousal disorders are related

and share some characteristics. Essentially, these occur when a person is in a mixed state, both

asleep and awake, and often emerging from the deepest stage of non-dreaming sleep. The sleeper

is awake enough to act out complex behaviors, but is still asleep and not aware of or able to remem-

ber these activities.

• Confusional Arousals - They are most common in infants and toddlers, but also seen

in adults. It begins with crying and thrashing around in bed with the sleeper appearing

confused and upset, but resisting attempts to comfort or console. Lasting up to half an

hour, the sleeper is hard to awaken during the episode, but usually the sleeper will

awaken and want to return to sleep.

• Sleepwalking - Commonly seen in older children, sleepwalking can range from simply

getting out of bed and walking around the bedroom to prolonged and complex actions,

such as going to another part of the house or outside. These events rarely indicate any

serious underlying medical or psychiatric problem and rarely cause injuries, however,

simple precautions can enhance safety.

• Sleep-Related Eating - This rare disorder of eating during sleep, without conscious

awareness, can occur often enough to result in significant weight gain. Although it

can affect both sexes and all ages, it is most common in young women.

• Sleep Terrors - The most extreme and dramatic of the arousal disorders, sleep terrors

often begin with a “blood-curdling” scream or shout, and can produce signs that

suggest extreme terror, such as dilated pupils, rapid breathing, racing heart, sweating,

and extreme agitation. During an episode, the victim may bolt out of bed and run

around the room or even out of the house, possibly hurting themselves during this

frenzied event. The sleeper generally does not remember it upon awakening.

What are sleep-wake transition disorder parasomnias?

These disorders occur in the transition from wakefulness to sleep, or from sleep to wakefulness, or,

more rarely, in sleep stage transitions. All of these disorders can occur often or to a severe degree in

otherwise healthy persons and can lead to discomfort, pain, embarrassment, anxiety, or disturbance

of a bedpartner’s sleep. These parasomnias include: (1) rhythmic movement disorder; (2) sleep

starts; (3) sleep talking; and (4) nocturnal leg cramp.

• Rhythmic-Movement Disorder - The most commonly recognized of this sub-group is

headbanging, headrolling, and bodyrocking. Rhythmic humming or chanting may

accompany these movements and may be quite loud.

• Sleep Starts - A sudden brief jerk or contraction that sometimes are associated with the

sensation of falling, a sensory flash, or a visual dream or hallucination. A sharp cry

may occur and the subject may not recall the jerk or contraction.

• Sleep Talking - Talking during sleep may be an annoyance to bedpartners or other

household members, but the sleeper is usually unaware or unaffected by this disorder.

Usually the sleep talking is brief, infrequent, and devoid of signs of emotional stress.

• Nocturnal Leg Cramps - This disorder causes painful sensations in the calf of the

leg or in the foot during sleep, one or two episodes nightly, several times a week. The

cramp can usually be relieved by local massage, heat, or movement of the affected limb.

What are parasomnias usually associated with REM sleep?

These parasomnias typically are associated with the REM sleep stage. They include nightmares,

sleep paralysis, sleep-related painful erections, REM sleep-related sinus arrest, and REM sleep-

behavior disorder.

• Nightmares - Frightening dreams that usually awaken the sleeper from REM sleep.

• Sleep Paralysis - A period of time either at sleep onset or upon awakening where

the victim is unable to move.

• Sleep-Related Painful Erections - This disorder is characterized by penile pain that

occurs during erections, typically during REM sleep.

• REM Sleep Sinus Arrest - This is a cardiac rhythm disorder and causes sinus arrest

during REM sleep in otherwise healthy individuals.

• REM Sleep Behavior Disorder - Punching, kicking, leaping and running from the bed

during attempted dream enactment will occur on a frequent basis and medical

attention is usually sought after injury has occurred to either the person or bedpartner.

What are miscellaneous parasomnias?

They are sleep bruxism (teeth grinding), sleep enuresis (bed-wetting), sleep-related abnormal

swallowing syndrome (choking), nocturnal paroxysmal dystonia (seizures), sudden unexplained

nocturnal death syndrome (sudden unexplained death in adults), primary snoring (non-apneic snor-

ing), infant sleep apnea, congenital central hypoventilation syndrome (breathing cessation), sudden

infant death syndrome (unexplained death in infants), and benign neonatal sleep myoclonus (limb

jerks in neonatals).

When should a parasomnia be medically treated?

While some parasomniacs do not require medical treatment, a victim should seek a medical evalua-

tion when: (1) potentially dangerous behavior could cause injury or health hazards; (2) extreme

disturbances are creating hardships on other family members; and (3) excessive sleepiness is expe-

rienced during the day.

In some cases these disorders can be triggered by other conditions, such as sleep apnea (Part 2),

heartburn, or periodic limb movements (Part 3). Therapy can include medical intervention with pre-

scription drugs, or behavior modification through hypnosis or relaxation/mental imagery.

In Part 8, we’ll explore dyssomnias or circadian rhythm sleep disorders, such as with jet lag,

shiftwork, delayed sleep phase syndrome and advanced sleep phase syndrome. Upcoming articles

will cover a variety of sleep disorders, the associated symptoms and treatment options.




# # #


Part 8 of a Ten-Part Series: Dyssomnias and our Circadian Rhythms



ASHLAND/OH -- When our meals, our activities, and our sleep habits no longer coincide with our

customary routine, our mental and physical performance is impaired. Environmental cues, especially

daylight, are no longer synchronized to our internal body clocks, causing us to have trouble sleeping,

experience sleepiness during the daytime, suffer gastrointestinal problems, and be troubled by a

reduced attention span.

What is a dyssomnia and its cause?

As humans, our internal body clocks or circadian rhythms typically find us active by day and asleep at

night. Yet millions of Americans struggle with work or school schedules which disrupt the body’s

natural tendencies toward when to sleep and when to rise. As a result, circadian rhythm sleep disor-

ders, or dyssomnias, occur, such as jet lag syndrome, shift work sleep disorders, delayed sleep

phase syndrome, and advanced sleep phase syndrome.

• Jet Lag Syndrome - Difficulty in initiating or maintaining sleep following rapid

travel across multiple time zones, thus resulting in excessive sleepiness, decreased

performance and gastrointestinal problems.

• Shift Work Sleep Disorder - This disorder may occur in workers who do not work a

standard daytime schedule. It consists of insomnia or excessive sleepiness and the

condition usually persists for the duration of the work shift period.

• Delayed Sleep Phase Syndrome - Teens or young adults, particularly college

students, are victims of this disorder in which those who experience it generally go

to bed late, have difficulty falling asleep and then sleep late in the morning.

• Advanced Sleep Phase Syndrome - Commonly seen among the elderly or those

who live indoor or isolated lives, those with this disorder have trouble staying

awake in the evening, but awaken before the sun comes up.

How is a dyssomnia diagnosed?

Any person who suspects they may have a dyssomnia should ask their family doctor for a referral to a




the patient may be referred to a sleep lab at the nearest hospital. In the sleep lab, the patient’s brain

waves, muscle activity, leg and arm movements, heart rhythms, and other body functions will be

monitored during sleep. With this information, the doctor can properly diagnose the patient’s condi-

tion and begin the patient on an appropriate treatment plan.

How are dyssomnias treated?

In the majority of circadian rhythm disorders, the underlying problem is the individual cannot sleep

when sleep is desired, needed or expected. As a result of sleep episodes coming at inappropriate

times, the wake periods occur at undesired times. Therefore, complaints of insomnia or excessive

sleepiness is common among this group.

For those who travel across multiple time zones frequently, most sleep physicians will recommend

that you maintain your home schedule when traveling or arrive a few days earlier so that you can

adapt to the new time zone before an important business meeting.

For those who work on second, third or rotating shifts, it is recommended that the same schedule be

maintained throughout each week, rather than following a regular wake-sleep schedule during days

off -- and to request that only forward rotations be made (i.e. from the 4pm-midnight shift to the mid-

night-8am shift to the normal day shift, etc.).

Chronotherapy -- or time therapy -- is used for delayed and advance phase syndromes. This involves

moving the patient’s bedtime forward for delayed syndrome and backwards for advance syndrome

until the patient is readjusted to a more desirable bedtime. Artificial lights -- or bright light therapy --

several times brighter than ordinary room lights can also be helpful.

In treating dyssomnias, sleep physicians typically use a combination of medications, chronotherapy,

and bright light therapy to help the body reset its circadian rhythm.

In Part 9, we’ll explore the importance of dreaming and REM sleep. Upcoming articles will cover a

variety of sleep disorders, the associated symptoms and treatment options.




# # #


Part 9 of a Ten-Part Series: Dreaming & REM Sleep



ASHLAND/OH -- The experience which we would all agree constitutes dreaming involves a good

deal of action and several senses such as vision, hearing and touch. This type of experience occurs

most often in REM sleep.

What is REM sleep?

Every night during normal sleep, we continually repeat five stages of sleep and in this order:

(1) Sleep Stage I which occurs at onset of sleep; (2) Sleep Stage 2; (3) Sleep Stage 3;

(4) Sleep Stage 4; and (5) Sleep Stage REM. While stages 3 and 4 are considered to be the deep-

est sleep, generate the largest secretion of growth hormones, and are the most restorative, this fifth

stage of sleep, REM, is the one with the highest brain activity, characterized by enhanced brain me-

tabolism and vivid imagery or dreaming. REM sleep is usually 20-25% of total sleep time.

What happens during REM sleep?

During REM sleep you can watch the sleeper’s eyes move around beneath closed eyelids. Some

scientists think that the eyes move in a pattern that relates to the visual images of the dream. We are

almost completely paralyzed in REM sleep with only the heart, diaphragm, eye muscles and the

smooth muscles (such as the intestines and blood vessels) spared from the paralysis of REM sleep.

Why do we dream?

The reason we dream is unknown. However, dreaming is an integral part of sleep and appears to be

unavoidable. Scientists theorize that dreaming may provide necessary stimulation to the brain from

within the brain itself, thereby compensating for the loss of stimulation from the environment that is

all-but-eliminated while we lie in bed asleep -- or may be a safe and socially acceptable way to fulfill

our wishes and desires. Learning specialists feel that dreaming is important for consolidating what

we have learned during wakefulness so that we can remember facts and problem solutions for years

and years. Whatever dreaming actually does, the sleep in which dreaming occurs seems to be nec-

essary for life itself.

What do people dream about most?

Doctors believe that the common features of dreams stem from the paralysis that occurs during REM

sleep. For example, many people dream about falling, being unable to get away from a pursuer or

being unable to move fast enough to prevent some accident. All of these kinds of dreams have the

common feature of movement impairment which may stem from the brain’s recognition of paralysis

during REM sleep. Dreams with themes of independence and self-reliance correlate well with suc-

cessful resolution of life experiences, whereas, themes of dependency and helplessness may indicate

the opposite. This may very well be at the root of the age-old advice, “sleep on it.”

When does unpleasant dreaming pose a medical problem?

Several sleep disorders exist that are associated with REM sleep, such as nightmares, sleep paraly-

sis, and REM behavior disorder. Certain personality characteristics appear to be associated with the

presence of frequent nightmares, such as schizophrenia or mental illness. Therefore, treatment of

the personality disorder may be necessary to eliminate the nightmares in some cases.

With sleep paralysis, the sleeper feels paralyzed and cannot move their arms, legs, body or head at

sleep onset or upon awakening. Some experience difficulty in breathing. Most with this condition find

that if they will relax and return to sleep, their next awakening will be normal. When sleep paralysis

impairs mental well being or interferes with a person’s ability to carry out school or work demands,

medical attention should be given to this disorder.

With REM behavior disorder, punching, kicking, leaping, and running from the bed during attempted

dream enactment occur frequently and usually correlate to the actions in the dream. Because REM

sleep behavior disorder occurs during REM sleep, it typically appears at least 90 minutes after sleep

onset. Medical attention is often sought after injury has occurred to either the person or a bedpartner.

In our final Part 10, we’ll explore the sleep disorder evaluation and laboratory process.




# # #


Part 10 of a Ten-Part Series: Sleep Evaluations & Sleep Laboratories



ASHLAND/OH -- There is no perfect answer as to when someone should consult a specialist for a

sleep problem. A good rule of thumb is to see a specialist if your sleep problem persists for a month

or more despite following your doctor’s advice and prescriptions. However, you should get expert

help immediately if you have experienced dangerous symptoms such as waking up with chest pain or

shortness of breath -- or falling asleep at an inappropriate time such as while in a meeting at work, at

an enjoyable party, or while driving a car.

How do I find a doctor that specializes in sleep disorders?

As sleep medicine is a relatively new specialty of medicine, most doctors with expertise in sleep

medicine are usually board certified in either sleep medicine, pulmonology, neurology, psychiatry and

psychology. If you cannot find a sleep specialist through your family doctor or hospital, check in the

telephone directory’s yellow pages under sleep medicine or sleep laboratory. You may need to be

formally referred to the sleep specialist by your family doctor, depending on your insurance plan.

Once referred to a sleep specialist, what occurs during the evaluation visit?

The doctor will obtain a general medical and sleep history, conduct a physical examination, and

possibly require an interview with your bed partner. The case may be reviewed by other consulting

physicians such as ear, nose and throat specialists, cardiologists, etc. While the doctor may suspect a

particular sleep disorder after the evaluation, he will determine if a sleep study and additional tests

are needed to conclusively diagnose the problem. If a sleep study -- or polysomnographic session --

at the sleep laboratory is needed, the doctor determines what such a session might entail.

What happens during a sleep study?

Sleep studies are typically conducted during the normal hours that a person considers to be bedtime.

As a result, patients usually arrive for appointments at a sleep laboratory around 8-9pm and leave the

next morning. Most laboratories are staffed by trained experienced polysomnographic technologists -

- or, in other words, sleep technicians who have received specialized training in the field of sleep

disorders.

Upon arrival, the sleep technician will begin the process of placing electrodes (special sensors) on

your scalp, forehead, temples, eyelids, under the nose, chin, chest, finger, and calves. For the

patient’s ease and education, the technician should explain the purpose of each electrode as it’s

being placed. Electrodes are usually placed using a type of medical affixative which does not cause

any pain or discomfort. This process usually takes about an hour. After the placement of the sleep

monitoring gear, the patient is free to relax until bedtime.

At bedtime, the technician will attach the long leads (wires) from the patient’s attached electrodes to

computer monitoring equipment next to the patient’s bed. Again, there is no pain or discomfort.

While it may seem a bit awkward for the patient to sleep with the many wires placed from them to the

monitoring equipment, it should not create any discomfort nor impair a patient’s normal ability to get

up during the night to use the restroom.

While the patient sleeps, a sleep technician will be collecting data and monitoring the patient on sleep

diagnostic equipment. The following morning, the technician wakes the patient, removes the gear

and the patient is discharged.

What happens following the sleep study?

After the session in the sleep laboratory, the data must be evaluated for sleep phases and for patho-

logical events. This process involves several hours of a technician’s time and one to two hours of the

sleep specialist’s time, as well as extensive use of laboratory computing equipment. This process

usually takes seven to ten business days. Sleep specialists can then make a diagnosis and recom-

mendation for treatment.

Usually a patient is scheduled for a follow-up appointment with the sleep specialist about two weeks

after their sleep study to discuss the results and begin a treatment plan. Treatments can range from

airway pressure appliances to medication, lifestyle changes, weight loss, ENT surgery and laser

therapy, dental appliances, light therapy, and internal body clock adjustments. The treatment (or

treatments) recommended depends upon the type of sleep disorder diagnosed. With some treat-

ments, the patient must return for a second night at the sleep lab.

How much will the diagnostic process cost?

The doctor and sleep lab fees are usually billed separately, but the overall diagnostic cost is usually

between $2000 and $3000. This typically includes the initial evaluation by the sleep specialist, the

ten-hour sleep study conducted by a polysomnographic technologist, two to fours hours of analysis

time by another polysomnographic technologist, one to two hours of analysis interpretation by the

doctor and the follow-up visit with the doctor.

Are evaluations and sleep studies covered by health insurance?

Most insurance companies will reimburse between 70% and 90% of the actual bill. In most cases,

the patient will be responsible for any portion of the bill left unpaid by the insurance company. On the

other extreme, if a patient is on Medicare or Medicaid and your sleep problem is psychologically-

based, little financial help can be expected from health insurance.




# # #

NEWSPAPER ADS -- OR USE AS

INFORMATIONAL FLYERS OR HANDOUTS

E

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Laurie Mooney, MD, D.ABSM


Announcing . . .


announces the opening of its

Sleep Disorder Laboratory,

under the medical direction

of Laurie Mooney, MD, D.ABSM,

for the diagnosis and treatment

of sleep disorders, such as

apnea, narcolepsy, and

chronic snoring.

If a sleep disorder is suspected,

an overnight sleep study

in our “state of the art”


may be needed to

properly diagnose and treat

your condition.

Call (419) 207-2566 to schedule

a physician consultation with Dr.

Mooney.

INSERT

PHOTO

HERE

Sleepy? Snore?

Be a part of

the new WAVE

in healthcare!

For more information or a referral to

our sleep medicine specialist, call:

(800) 939-0399


If you think you might have a sleep disorder, take this self-test and learn more . . .

YES NO

❒ ❒ Have you been told by a friend or family member that you snore?

❒ ❒ Do you often feel tired or have a headache when you awaken in the morning?

❒ ❒ Do you frequently awaken during the night?

❒ ❒ Have you been told you have pauses in your breathing during sleep?

❒ ❒ Do your legs jerk frequently or feel uncomfortable/restless before or during

sleep?

❒ ❒ Do you often find yourself falling asleep when you don’t intend to, such as

while viewing television or while driving?

SCORE



not a diagnosis, which only a physician may give.

ZZZZZZZZZSNORING

An epidemic that can be silenced.

In a recent national family opinion

poll it was revealed that 90 million

Americans over the age of 18 snore

-- 37 million of them on a chronic

basis.

Few have sought treatment be-

cause they view snoring as a social

nuisance.

However, the reality is that snoring

is a medical symptom for some-

thing as simple as the common

cold -- to something as potentially

life-threatening as severe sleep

apnea. Left untreated, apnea

usually leads to cardiovascular and

neurological problems.

So, if you or someone you

love is a chronic snorer,

call (800) 939-0399 for more

information or a referral to

our sleep specialist.

Chances are, if you do, you won’t

be the only one who sleeps better.



Prolonged periods without a good night’s sleep can

have a profound affect on our mental and physical

well-being. You reach a point where you feel like

your world is crumbling and your future is no longer

in your hands.

But don’t feel alone. One out of every four people

have sleep disorders. Sleep disorders can range

from sleep apnea to insomnia to narcolepsy -- each

very different.

Someone with sleep apnea has no problem falling

asleep, but they do not sleep well when they do.

They typically snore with pronounced pauses and

gasps for breath throughout the night. Those with

insomnia suffer from not being able to sleep enough

or, in many cases, not at all.

Those with narcolepsy sleep, but not properly.

Because of their lack of REM sleep -- or typically

known as the dreamstage of sleep -- they fall

asleep many times during the day and during

inappropriate times, such as during meetings, while

driving or in the middle of a conversation.

If you suspect you may have a sleep disorder and

need a pair of helping hands to help you put your

life back in order, call (800) 939-0399 for more

information or talk to your regular physician about

a sleep evaluation.

An initial evaluation and an overnight sleep study at

our sleep disorder laboratory may be all that’s

needed to determine the treatment plan that’s right

for you.

Help may be closer than you think.

Lack of sleepgetting you down?


If you’re the bed partner of

someone who snores, a

good night’s

sleep may be

in your future

. . . and his!

Although people who snore are often the target

of many bad jokes and the occasional victims of

middle-of-the-night elbow thrusts, snoring is no

laughing matter.

Loud snoring may be a signal that something is

seriously wrong with breathing during sleep. Snor-

ing indicates that the airway is not fully open, and

the noise of snoring comes from the efforts to force

air through a narrowed passageway. For an esti-

mated five in 100 people -- typically overweight,

middle-age men -- extremely loud snoring is the

first indication of a potentially life-threatening sleep

disorder called Sleep Apnea.



a result, a full range of diagnostic and treatment

services for all types of sleep disorders is conve-

niently available at our hospital.

If you suspect that you or someone you love

has a sleep disorder, call (800) 939-0399 for a

referral to our sleep specialist.


and some disorders can be fatal.

Sleep restores our bodies and our

minds -- without it, we suffer.





lost productivity, and workplace accidents

or car crashes from falling asleep at the job

or at the wheel.

As a result, a full range of diagnostic

services for all types of sleep disorders is

conveniently available in our “state of the

art” sleep disorder laboratory.

So if your job depends on your getting a

good night’s sleep on a consistent basis,

call (800) 939-0399 for a referral to our

sleep specialist. Their job may help you

with yours.


This can be an embarrassing, but more importantly, danger-

ous problem. Whether you fall asleep on the job, behind

the wheel or during social occasions, you are not alone.

In fact, one out of every four Americans have a sleep

disorder and many can be seriously life-threatening. The

sobering truth is 10 million Americans suffer from sleep

apnea which causes you to stop breathing for several

seconds all through the night. Another 15 million suffer from

chronic insomnia or the inability to fall asleep. Another 5

million endure serious sleep disorders due to shift work.

And over 250,000 suffer from narcolepsy or excessive

sleepiness.

We are now able to effectively diagnose and treat

the majority of sleep disorders due to the many

advances in sleep science and technology. If your

sleep problem is more serious than simple good

sleep hygiene, treatments such as airway pressure

appliances, medications, weight loss, minor surgery,

dental appliances or monitoring equipment may

solve your problem and give you a new lease on

life.

So if your job depends on your getting a good

night’s sleep on a consistent basis, call

(800) 939-0399 for areferral to our sleep specialist.

Their job may help you with yours.


If you can’t help falling asleep

on the job, maybe we can.

Sleep Problems Have

Become a Modern

Epidemic . . .

Sleep problems have become a modern epidemic that is taking a catastrophic toll on our bodies and

our minds. It’s estimated that 30-40 million Americans -- one out of every four people -- suffer from

serious sleep disorders that undermine their sleep quality and their health.

We recognize that for the victims of disordered sleep, the night is a source of anguish, not rest. As

a result, our “state of the art” sleep disorder laboratory provides diagnostic services for a full range of

sleep disorders.

If you suspect that you or someone you love has a sleep disorder, call (800) 939-0399 for a referral

to our sleep specialist.




(800) 939-0399

ANNOUNCER-READ

PUBLIC SERVICE ANNOUNCEMENT --

OR PAID RADIO ADVERTISEMENT

E

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SUBJECT: Announcer Read Radio Spot for Sleep Disorder Service

LENGTH: 60 Seconds

CONTACT: Erin Al-Mehairi, Mktgt

(800) 257-9917

SLEEP RESTORES OUR BODIES AND OUR MINDS. WITHOUT IT, WE SUFFER.

PEOPLE WHO HAVE SLEEP DISORDERS MAY EXPERIENCE: (1) FATIGUE;

(2) IRRITABILITY; (3) DEPRESSION; (4) REDUCED ATTENTION, CONCENTRA-

TION AND MEMORY; (5) MORE FREQUENT ILLNESSES; (6) LOST

PRODUCTIVITY; (7) WORKPLACE ACCIDENTS OR CAR CRASHES FROM FALL-

ING ASLEEP ON THE JOB OR AT THE WHEEL.

ONE OUT OF EVERY FOUR PEOPLE HAVE SLEEP DISORDERS -- AND SOME

DISORDERS ARE POTENTIALLY LIFE-THREATENING, SUCH AS CHRONIC SLEEP

APNEA WHERE A PERSON STOPS BREATHING AS MANY AS 600 TIMES OVER

THE COURSE OF A NIGHT. LOUD SNORING IS A TYPICAL SYMPTOM. LEFT UN-

TREATED THIS CONDITION CAN DRAMATICALLY INCREASE A PERSON’S RISK

FOR HEART DISEASE.

HOWEVER, ADVANCES IN TECHNOLOGY PROVIDE EFFECTIVE WAYS TO TREAT

MANY SLEEP DISORDERS. FOR MORE INFORMATION OR A REFERRAL TO THE

SLEEP SPECIALIST AFFILIATED WITH THE SLEEP DISORDER LABORATORY AT

SAMARITAN REGIONAL HEALTH SYSTEM, CALL (800) 939-0399. ENJOY THE

MANY BENEFITS OF A GOOD NIGHT’S SLEEP.

-- 60 SECONDS --

SPEAKER’S BUREAU LETTER

TO PROFESSIONAL OR BUSINESS GROUPS

E

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July 1, 2006

Dear Professional Association:

One out of every four people suffer from sleep disorders -- and some sleep disorders can be

fatal. Sleep restores our bodies and our minds -- without it, we suffer. People who have sleep

disorders may experience fatigue, irritability, depression, reduced attention/concentration/

memory, more frequent illnesses, lost productivity, and workplace accidents or car crashes

from falling asleep at the job or at the wheel.

Our “state of the art” Sleep Disorder Laboratory was established to diagnose and treat a

full array of sleep disorders. Dr. Laurie Mooney, a sleep specialist, is the medical director of

this service and is now available to speak to professional associations on the subject of sleep

disorders.

As you plan your upcoming year’s programs, keep in mind how many people in your group

could benefit from his message. Dr. Mooney is prepared to deliver a program from 20

minutes to one hour in length. A slide projector and screen would be needed. A sixty-day notice

would be most appreciated.

If you’re interested in scheduling Dr. Mooney for a speaking engagement, please call his office

at (419) 207-2566.

Sincerely,

Erin Al-Mehairi

Mktgt

Newspaper Advertisement for

a Free Sleep Disorder Seminar

E

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B

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M

Sleepy? Snore?

Be a part of

the new WAVE

in healthcare!

If you think you might

have a serious sleep

disorder . . .

see your doctor and if

referred to a sleep

specialist . . .

a sleep study may

find your problem and

determine treatment.

If you would like to attend a FREE seminar on sleep disorders

presented by Dr. Laurie Mooney, who specializes in sleep disorders,

on July 1, 2006 from 7-8pm at

Samaritan Regional Health System, call (800) 257-9917

and reserve your seat today.


TWO BROCHURE OPTIONS FOR HOSPITAL AND

REFERRING PHYSICIAN WAITING AREAS

First option is a two-color, tri-panel and the

second option is a full-color, four-panel that is

available for your purchase through our printer.

E

X

H

I

B

I

T

N

Pre

paring for

a

Good N

ight’s S

leep

☯☯C

heck t

he e

nvironm

ent

☯☯U

se b

ed f

or

sle

epin

g

☯☯F

ollow

a r

egu

lar

schedule

☯☯E

xerc

ise 4

-5 h

ours

befo

re

bedtim

e

☯☯W

atc

h w

hat/w

hen y

ou e

at

☯☯D

on’t s

moke

☯☯R

efu

se t

o w

orr

y

☯☯Take a

warm

bath

☯☯L

iste

n t

o q

uie

t m

usic

☯☯T

ry r

ela

xation e

xerc

ises

Sle

ep D

isord

er

Self-T

est

Yes

No

❏❏

Have y

ou b

een t

old

by a

friend

or

fam

ily m

em

ber

that

you s

nore

?

❏❏

Do y

ou o

ften f

eel tire

d o

r have a

headache w

hen y

ou a

waken in

the m

orn

ing?

❏❏

Do y

ou f

requently a

waken d

uring

the n

ight?

❏❏

Have y

ou b

een t

old

you h

ave

pauses in y

our

bre

ath

ing d

uring

sle

ep?

❏❏

Do y

our

legs jerk

fre

quently

or

feel uncom

fort

able

/restless

befo

re o

r during s

leep?

❏❏

Do y

ou o

ften f

ind y

ours

elf f

allin

g

asle

ep w

hen y

ou d

on’t inte

nd t

o,

such a

s w

hile v

iew

ing t

ele

vis

ion

or

while d

rivin

g?

If y

ou a

nsw

ere

d “

yes”

to tw

o o

r

more

of th

e a

bove q

uestions,

you m

ight benefit from

a s

leep

consultation.

If y

ou

or s

om

eo

ne y

ou

lo

ve h

as a

sle

ep

dis

ord

er,

we c

an

help

.

If y

ou’v

e t

ried o

ur

tips f

or

gett

ing a

good

nig

ht’s s

leep a

nd t

he s

elf-t

est

indic

ate

s

that

you m

ay

want

to s

eek m

edic

al

att

ention,

see y

our

regula

r physic

ian o

r

call f

or

a r

efe

rralto

our

sle

ep s

pecia

list.

The p

hysic

ian w

ill obta

in a

medic

al

his

tory

and c

onduct

a p

hysic

alexam

ina-

tion -

- and m

ay w

ish t

o t

alk

with y

our

bed p

art

ner

about

your

sle

epin

g a

nd

wakin

g b

ehavio

r.

Based u

pon t

he p

hysic

ian’s

evalu

ation,

you m

ay b

e s

chedule

d t

o s

pend o

ne o

r

two n

ights

in t

he h

ospital’s s

leep labora

-

tory

where

your

bra

in w

aves,

muscle

activity,

leg a

nd a

rm m

ovem

ents

, heart

rhyth

ms,

and o

ther

body f

unctions c

an

be m

onitore

d d

uring s

leep.

With t

his

info

rmation,

the p

hysic

ian c

an

pre

scribe a

tre

atm

ent

pla

n t

hat’s r

ight

for

you.

Let

us h

elp

you a

chie

ve a

good n

ight’s

sle

ep a

nd h

ave a

positiv

e im

pact

on t

he

“rest”

of

your

life

.

Sn

ori

ng

&

Sle

ep

Dis

ord

ers

The

dia

gnosis

& t

reatm

entof

sle

ep a

pnea

(800)

939-0

399

Sle

ep

Dis

ord

er

Labora

tory

at

SR

HS

1025 C

ente

r S

treet

Ashla

nd,

OH

44805

SC

OR

E

On

e o

ut

of

fou

r p

eo

ple

su

ffer

fro

m s

leep

dis

ord

ers .

. .

an

d

so

me

sle

ep

dis

ord

ers c

an

be

ve

ry

serio

us.

We

re

co

gniz

e t

hat

for

vic

tim

s o

f dis

or-

de

red

sle

ep,

the n

igh

t is

a s

ourc

e o

f

an

gu

ish,

not

rest.

Sle

ep r

esto

res o

ur

bo

die

s a

nd o

ur

min

ds.

Without

it,

we

su

ffe

r.

Pe

op

le w

ho h

ave s

leep d

isord

ers

may

exp

erie

nce:

☯☯F

atigue o

r daytim

e d

row

sin

ess

☯☯Ir

rita

bility

☯☯D

epre

ssio

n

☯☯R

educed a

ttention,

concentr

ation

and m

em

ory

☯☯M

ore

fre

quent

illn

esses

☯☯Lost

pro

ductivity

☯☯W

ork

pla

ce a

ccid

ents

or

car

cra

shes

from

fallin

g a

sle

ep o

n t

he job o

r at

the w

heel

Sn

orin

g .

. .

an

early

warn

ing

sig

na

l.

Alth

ou

gh m

any p

eople

who s

nore

are

ofte

n t

he t

arg

et

of

many b

ad jokes a

nd

the

occasio

nal vic

tim

s o

f m

iddle

-of-

the-

nig

ht

elb

ow

thru

sts

, snoring is n

o

lau

gh

ing

matter.

Lo

ud

\fully o

pen,

and t

he n

ois

e o

f snoring

co

me

s f

rom

the e

ffort

s t

o f

orc

e a

ir

thro

ug

h a

narr

ow

ed p

assagew

ay.

For

an

estim

ate

d f

ive in 1

00 p

eople

--

typic

ally

ove

rwe

ight, m

iddle

-aged m

en -

-

extr

em

ely

loud s

norin

g is t

he f

irst

ind

ica

tio

n o

f a p

ote

ntially life-t

hre

ate

nin

g

sle

ep

dis

ord

er

called s

leep

ap

nea

.

In a

dults t

he s

noring m

ay b

eso loud t

hat

it’s

heard

thro

ughout

the h

ouse -

- or

even b

y t

he n

eig

hbors

. T

he s

leeper’

s

snoring is u

sually inte

rrupte

d b

y p

auses,

then g

asps -

- re

vealing t

hat

the s

leeper

inte

rmitte

ntly h

alts b

reath

ing.

Som

e p

eo-

ple

do n

ot

bre

ath

e a

t all f

or

up t

o 7

5%

of

their s

leep t

ime.

Th

e p

hysic

al

or n

eu

ro

log

ical

cau

se o

f sn

ore .

. .

pau

se .

. .

gasp

!

Apers

on’s

muscle

s,

inclu

din

g t

hose

used f

or

bre

ath

ing,

rela

xm

ore

during

sle

ep t

han d

uring w

akin

g h

ours

. F

or

sle

ep a

pnea s

uffere

rs,

either

the t

hro

at

muscle

s r

ela

x t

o d

angero

us levels

(phys-

ical causes)

or

they r

ela

x t

o a

norm

al

degre

e,

but

the b

rain

forg

ets

to s

end a

message

to t

he m

uscle

s t

hat

contr

ol

bre

ath

ing (

neuro

logic

al causes).

W

hen

physic

al pro

ble

ms c

reate

this

patt

ern

, th

e

conditio

n is c

alled o

bstru

ctive sleep

ap

nea

, and w

hen n

euro

logic

al pro

ble

ms

cre

ate

this

patt

ern

, th

e c

onditio

n is

refe

rred t

oas c

en

tral sleep

ap

nea

.

Obstr

uctive s

leep a

pnea is the m

ost

com

mon a

nd s

evere

form

of apnea.

With O

SA

the b

ase o

f th

e t

ongue a

nd

the u

vula

rela

x a

nd s

ag c

ausin

g t

he

airw

ay t

o c

ollapse a

nd s

om

etim

es

clo

se c

om

ple

tely

. W

hen t

he p

assage-

way s

ags,

obstr

ucting t

he a

irw

ay,

the

loud s

noring is p

resent.

H

ow

ever,

when

the s

noring s

tops o

r pauses,

the

sle

eper

periodic

ally s

tops b

reath

ing.

Th

e la

ck o

f o

xyg

en

ca

use

sth

e s

lee

pe

rto

aw

ake

n a

nd

“g

asp

” fo

r b

rea

th.

Th

is

cycle

ma

y b

e r

ep

ea

ted

as m

an

y a

s 6

00

tim

es

pe

r n

igh

t.

Pa

use

s w

he

re b

rea

thin

g

ha

s s

top

pe

d m

ay la

st

for

ten

se

co

nd

s o

r

mo

re e

ach

tim

e.

Wh

ile

mo

st

OS

Asle

ep

ers

do

no

t re

me

m-

be

r a

wa

ke

nin

g m

an

y t

ime

s d

urin

g t

he

nig

ht, t

his

co

nd

itio

n p

uts

an

en

orm

ou

s

str

ess o

n t

he

he

art

to

circu

late

blo

od

.

Blo

od

pre

ssu

re r

ise

s a

nd

ma

y s

tay e

le-

va

ted

afte

r e

ach

cycle

. T

his

ma

y

acco

un

t fo

r so

me

de

ath

s d

urin

g s

lee

p o

f

pe

op

le w

ho

we

nt

to b

ed

in

go

od

he

alth

.

Sm

alle

r-th

an

-no

rma

l ja

ws,

larg

e t

on

gu

es,

en

larg

ed

to

nsils,

or

tissu

es t

ha

t p

art

ially

blo

ck t

he

en

tra

nce

to

th

e a

irw

ay a

re

oth

er

co

nd

itio

ns t

ha

t m

ay c

au

se

ob

str

uc-

tive

sle

ep

ap

ne

a.

Cen

tral sle

ep

ap

nea b

eco

mes m

ore

co

mm

on

as p

eo

ple

gro

w o

lder.

The a

irw

ay s

tays o

pen w

ith c

entr

al sle

ep

apnea,

how

ever

the d

iaphra

gm

and c

hest

muscle

s s

top w

ork

ing.

Lack o

f oxygen

sig

nals

the b

rain

causin

g t

he s

leeper

to

aw

aken a

nd r

esum

e b

reath

ing.

On

e in

fo

ur

pe

op

le a

ge

60

an

d o

lde

r

exp

erie

nce

dis

ord

ere

d b

rea

thin

g d

urin

g

sle

ep

. F

or

mo

st, t

he

pro

ble

m is m

ild

. I

t

be

co

me

s m

ore

fre

qu

en

t a

nd

se

ve

re f

or

tho

se

wh

o h

ave

co

ng

estive

he

art

fa

ilu

re

or

ne

uro

log

ic d

iso

rde

rs.

Mo

st

pe

op

le

with

ce

ntr

al sle

ep

ap

ne

a a

re m

ore

aw

are

of

fre

qu

en

t a

wa

ke

nin

gs

tha

n t

ho

se

with

ob

str

uctive

sle

ep

ap

ne

a.

Sle

ep H

ygie

ne T

ips

for

Bet

ter

Sle

ep

❒

Avo

id n

app

ing

dur

ing

the

day

time

❒

Elim

inat

e d

istr

actio

ns f

rom

the

bed

room

❒

Sle

ep in

a d

ark,

qui

et, c

ool &

com

fort

able

roo

m❒

U

se t

he b

ed fo

r sl

eepi

ng &

sex

(no

TV o

r ea

ting)

❒

Follo

w a

reg

ular

sch

edul

e fo

r b

edtim

e❒

E

stab

lish

a re

gula

r b

edtim

e ro

utin

e❒

E

xerc

ise

at le

ast

3 ho

urs

bef

ore

bed

time

❒

Wat

ch w

hat/

whe

n yo

u ea

t❒

A

void

larg

em

eals

clos

e to

bed

time

❒

Avo

idca

ffein

e cl

ose

to b

edtim

e❒

A

void

nic

otin

e cl

ose

to b

edtim

e❒

A

void

alc

ohol

clo

se t

o b

edtim

e❒

R

efus

e to

wor

ry b

y p

rop

erly

man

agin

g st

ress

❒

Take

a w

arm

bat

h b

efor

eb

edtim

e❒

Li

sten

to

qui

et m

usic

bef

ore

bed

time

❒

Try

rela

xatio

n ex

erci

ses

bef

ore

bed

time

Ho

w’s

Your

Sle

ep?

Che

ck a

ny o

f th

e fo

llow

ing

that

ap

ply

to

yo

u.

❒

Sno

relo

udly

❒

Sel

f-aw

aren

ess

or b

edp

artn

er o

bse

rvat

ions

tha

tyo

u st

op b

reat

hing

or

gasp

for

bre

ath

dur

ing

slee

p❒

Fe

el s

leep

y or

doz

e of

f whi

le w

atch

ing

TV, r

ead-

ing,

driv

ing

or e

ngag

ed in

dai

ly a

ctiv

ities

❒

Diff

icul

ty in

sle

epin

g3

nigh

ts a

wee

k or

mor

e(e

.g.,

trou

ble

falli

ngas

leep

, wak

e fr

eque

ntly

dur

-in

gth

e ni

ght,

wak

e to

o ea

rly a

nd c

anno

t ge

tba

ck t

o sl

eep

or w

ake

unre

fres

hed)

❒

Unp

leas

ant,

tin

glin

g, c

reep

ing

feel

ings

or

nerv

-ou

snes

s in

you

r le

gs w

hen

tryi

ng t

o sl

eep

❒

Inte

rrup

tions

to

your

sle

ep (e

.g.,

nigh

ttim

ehe

artb

urn,

bad

dre

ams,

pai

n, d

isco

mfo

rt,

nois

e,sl

eep

diff

icul

ties

of f

amily

mem

ber

s, li

ght

orte

mp

erat

ure)

❒

Wei

ght

incr

ease

in t

he la

st 5

yea

rs❒

H

igh

blo

od p

ress

ure

❒

Mem

ory

and

con

cent

ratio

n d

iffic

ulty

If yo

u an

swer

ed y

es to

two

or m

ore

of th

ese

ques

-tio

ns,y

ou m

ay s

uffe

r fro

m a

sle

ep d

isor

der.

Wha

t is

a s

leep

stu

dy?

A s

imp

le, p

ainl

ess

over

nigh

t p

roce

dur

ew

here

you

rb

rain

wav

es, m

uscl

e ac

tivity

,le

g m

ovem

ents

, hea

rtrh

ythm

s an

d o

ther

bod

y fu

nctio

ns c

an b

e m

onito

red

by

ahi

ghly

-ski

lled

sle

ep t

echn

olog

ist

whi

le

you

slee

p.

The

slee

p d

ata

is s

core

d,

inte

rpre

ted

by

a sl

eep

sp

ecia

list,

and

sen

tto

you

r or

der

ing

phy

sici

an.

Your

res

ults

and

dia

gnos

isar

e p

rovi

ded

to y

ou b

yyo

urp

hysi

cian

, who

will

rec

omm

end

the

mos

tap

pro

pria

te t

reat

men

t p

lan

for

you.

Will

I n

eed

to

tak

e ti

me

off

wo

rkto

have

a sl

eep

stu

dy?

Unl

ess

you

wor

ka

nigh

tsh

ift, t

his

shou

ldno

t b

e ne

cess

ary.

A

pat

ient

’s s

tud

y us

ually

beg

ins

in t

he e

veni

ng a

nd is

com

ple

ted

bef

ore

7am

--

enab

ling

him

or

her

togo

to

wor

k fo

llow

ing

the

slee

p s

tud

y.

Will

my

insu

ranc

eco

ver

my

slee

p s

tud

y?M

ost

maj

or in

sura

nce

com

pan

ies,

as

wel

las

Med

icar

e, p

rovi

de

cove

rage

for

sle

epst

udie

s, b

ut it

isal

way

s ad

vise

dw

ith a

nym

edic

al p

roce

dur

e to

ver

ify c

over

age

with

your

insu

ranc

eco

mp

any

bef

ore

sche

dul

ing

a sl

eep

stu

dy

app

oint

men

t.

AAbb

oouu

tt oo

uurr SS

lleeee

pp

SSpp

eecc

iiaallii

sstt ..

.. ..

John

Q.

Pub

lix,

MD

, a

slee

p s

pec

ialis

t w

ho is

boa

rdce

rtifi

ed in

p

ulm

onar

y m

edic

ine,

isth

em

edic

al d

irect

orof

our

slee

p d

isor

der

lab

orat

ory

at C

omm

unity

Med

ical

Cen

ter.

He

has

over

ten

yea

rs o

f ex

per

ienc

e in

slee

p m

edic

ine

and

over

20

year

s of

ex

per

ienc

e in

pul

mon

ary

med

icin

e.

If yo

u w

ould

like

to

sche

dul

e a

slee

p

cons

ulta

tion

with

Dr.

Pub

lic,

call

his

offic

eat

123

.456

-789

0.

KKee

yy rr

eeaa

ssoo

nnss

ttoo

uussee

oouu

rr ss

lleeee

pp

ddiiss

oorrdd

eerr ss

eerrvv

iiccee

::

• C

onve

nien

t ac

cess

• T

imel

y ap

poi

ntm

ents

• C

lear

pat

ient

educ

atio

n•

Qua

lifie

d s

pec

ialis

t &

tec

hnol

ogis

ts•

Frie

ndly

and

pro

fess

iona

l ser

vice

• C

omfo

rtab

le f

acili

ties

• T

imel

y re

sults

and

tre

atm

ent

• P

ositi

ve p

atie

nt o

utco

mes

6003

-030

3

Sle

epD

isor

der

Lab

orat

ory

at S

RH

S10

25 C

ente

r S

tree

t A

shla

nd,

OH

4480

5

SSllee

eepp

DDiiss

oorr

ddee

rrss

&& SS

nnoo

rriinn

gg

QQ &&

AAQQ

&& AA

56

We’

veal

l hea

rd t

hese

bad

joke

s, b

utsn

or-

ing

is n

o la

ughi

ngm

atte

r. L

oud

snor

ing

may

be

a si

gnal

tha

t so

met

hing

isse

rious

lyw

rong

with

your

bre

athi

ngd

urin

gsl

eep

.

Sno

ring

is a

sig

n th

at t

he a

irway

is n

ot f

ully

open

and

that

air

is b

eing

forc

ed t

hrou

gh a

narr

ow p

assa

gew

ay.

Whi

le 1

0%to

30%

ofad

ults

snor

e, f

or m

ost

of t

hem

, sn

orin

g ha

sno

ser

ious

cons

eque

nces

.

How

ever

, for

2%

to 4

%of

ad

ults

, lou

d h

abit-

uals

norin

g is

the

firs

t in

dic

atio

n of

ap

oten

tially

life

-thr

eate

ning

dis

ord

er -

-ob

stru

ctiv

e sl

eep

ap

nea.

Tho

se w

hosu

ffer

wit

h sl

eep

ap

nea

do

n’t

bre

athe

pro

per

ly d

urin

gsl

eep

. The

yd

on’

tg

et e

noug

h o

xyg

en a

ndth

eir

slee

p q

uali-

ty is

po

or.

Look

for

the

war

ning

sign

s of

sle

ep a

pne

a:•

Ext

rem

ely

loud

sno

ring

•R

epea

ting

pat

tern

s of

“sn

ore,

pau

se,

gasp

” re

veal

ing

bre

athi

ng s

top

s an

dst

arts

•W

akin

gup

fre

que

ntly

•E

xtre

me

slee

pin

ess

dur

ing

the

day

•Fa

lling

asle

ep w

hile

at

wor

kor

whi

led

rivin

g•

Wor

kpla

ce a

ccid

ents

or

car

cras

hes

•C

once

ntra

tion

diff

icul

ties

•Lo

st p

rod

uctiv

ity•

Forg

etfu

lnes

s•

Irrit

abili

ty•

Anx

ious

ness

•D

epre

ssio

n•

Moo

d o

r b

ehav

ior

chan

ges

•M

ore

freq

uent

illn

esse

s•

Mor

ning

head

ache

s•

Loss

of

inte

rest

in s

ex•

Mal

e er

ectil

e fa

ilure

Sle

ep is

a b

asic

nece

ssit

y o

f lif

e.

It is

as

imp

ort

ant

to o

ur h

ealt

h an

d w

ell-

bei

ng a

sai

r, fo

od

and

wat

er.

Whe

n w

e ge

t a

good

nig

ht’s

sle

ep,

we

awak

e fe

elin

g re

fres

hed

, al

ert

and

rea

dy

tofa

ce t

he m

any

chal

leng

esof

our

dai

ly r

ou-

tine.

Whe

n w

e d

on’t,

we

suffe

r. O

ur jo

bs,

rel

a-tio

nshi

ps,

pro

duc

tivity

, hea

lth a

nd s

afet

y --

as w

ell a

s th

e sa

fety

of th

ose

arou

nd u

s --

are

put a

tris

k.

In a

rec

entp

oll c

ond

ucte

d b

y th

e N

atio

nal

Sle

ep F

ound

atio

n, w

e le

arne

dth

at 7

4% o

fA

mer

ican

adul

ts a

re e

xper

ienc

ing

a sl

eep

ing

pro

ble

m a

nd m

ore

than

one

third

are

so

slee

py

dur

ing

the

day

tha

t it

inte

rfer

es w

ithd

aily

act

iviti

es.

Sle

ep A

pne

a an

d s

nori

ng, w

hich

aff

ect

4% o

f ad

ult

men

and

2%o

f ad

ult

wo

men

,ar

e no

laug

hing

mat

ter.

“He

snor

ed s

o lo

ud,

he p

eele

d t

he p

aint

off

the

wal

ls.”

“W

hen

she

snor

es,

she

soun

ds

like

a ja

ckha

mm

er.”

“N

o w

ay a

mI s

harin

g a

room

with

him

on

our

retr

eat

-- h

is s

norin

gke

eps

me

awak

e.”

“E

very

one

in o

urne

igh-

bor

hood

can

hea

r he

r sn

orin

gat

nig

ht.”

Ob

stru

ctiv

esl

eep

ap

nea

mo

st o

ften

stri

kes

ove

rwei

ght

adul

ts.

Exc

essi

ve f

atty

tis

sue

may

par

tially

blo

ckth

e en

tran

ce t

o th

e ai

rway

or

may

nar

row

the

airw

ay,

caus

ing

the

airw

ay t

o co

llap

se.

NO

RM

AL

AIR

WA

YB

LOC

KE

DA

IRW

AY

Fem

ale

horm

ones

and

a d

iffer

ence

in t

hroa

tan

atom

y m

ay p

rote

ct w

omen

unt

ilm

enop

ause

. H

owev

er,

as w

omen

age,

the

yb

ecom

em

ore

susc

eptib

le t

o ob

stru

ctiv

esl

eep

ap

nea.

Ther

e is

usu

ally

no o

bvio

us p

hysi

cala

bnor

-m

ality

,bey

ond

ob

esity

, th

at in

terf

eres

with

ap

erso

n’s

bre

athi

ng d

urin

g sl

eep

; b

ut s

ome

phy

sica

lcon

diti

ons

can

pla

y a

role

.

A s

mal

ler-

than

-nor

mal

jaw

, la

rge

tong

ue,

nasa

lob

stru

ctio

ns a

nd e

nlar

ged

ton

sils

can

be

fact

ors

whi

ch c

ause

ob

stru

ctiv

e sl

eep

apne

a.

Peo

ple

who

do

no

t se

ek d

iag

nosi

s an

dtr

eatm

ent

for

slee

p a

pne

a m

ay s

uffe

r lif

e-th

reat

enin

g c

ons

eque

nces

in

add

itio

n to

a d

ecre

ased

qua

lity

of

life.

Ifyo

u su

spec

ta

slee

p d

isor

der

, b

ring

it to

the

atte

ntio

n of

you

r p

hysi

cian

.

12

34

If yo

u ha

ve m

any

of t

he “

war

ning

sign

s” f

orsl

eep

ap

nea

and

you

do

not

seek

med

ical

care

, yo

u m

ay b

e in

crea

sing

you

r ris

k fo

r:

•

high

blo

od p

ress

ure

•he

art

dis

ease

•he

art

atta

ck

•st

roke

•fa

tigue

-rel

ated

mot

or v

ehic

le a

nd w

ork

acci

den

ts

An

over

nigh

tsle

ep s

tud

y in

a s

leep

dis

ord

erla

bor

ator

y m

ayb

e ne

eded

for

you

r p

hysi

cian

top

rop

erly

dia

gnos

e an

d t

reat

you

r sl

eep

dis

ord

er.

The

mo

stco

mm

on

trea

tmen

t fo

ro

bst

ruct

ive

slee

p a

pne

a is

Co

ntin

uous

Po

siti

ve A

irw

ay P

ress

ure

or

CPA

P.

CPA

P p

rovi

des

a g

entle

flow

of

pos

itive

pre

ssur

e ai

r th

roug

h a

nasa

l mas

k to

kee

pth

e ai

rway

open

dur

ing

slee

p.

With

CPA

P t

hera

py:

•B

reat

hing

bec

omes

reg

ular

•S

norin

gst

ops

•B

lood

oxy

gen

leve

l bec

omes

nor

mal

•R

estf

ul s

leep

is r

esto

red

•Q

ualit

yof

life

is im

pro

ved

•R

isks

show

n ab

ove

are

dra

mat

ical

lyre

duc

ed

Oth

erth

erap

ies

incl

ude

surg

ery,

ora

l app

li-an

ces,

lifes

tyle

mod

ifica

tions

(sle

ep h

ygie

ne,

wei

ght

loss

, ex

erci

se,

suffi

cien

t ho

urs

ofsl

eep

), an

d a

void

ance

of a

lcoh

ol,

sed

ativ

es,

hyp

notic

s an

d t

obac

co.

Dear Sleep Service Customer:

Over the years, we have had a number of clients ask if they can purchase a customized brochure throughus to help them with the marketing of their sleep service.

We are pleased to announce that this service is now available -- and very easy to use through our commercialprinter, Printsouth Printing Inc. A sample of the proposed brochure is attached for your review. As you reviewthe brochure, the inside panels 1-4 have been mass-produced in an effort to pass along “economyof scale” cost savings to you on this glossy full color piece -- but you’ll have complete control over the cover,back panel and outside panels 5-6.

You may choose any of the following options -- and the quantity you need:

Once you have decided your preferences above, you can contact Corinne Alford at Printsouth in one of the following ways:

Corinne Alford, Vice President PHN: 803.796-2619 FAX: 803.796-2744 EMAIL: [email protected] Printing Inc.1114 Silstar RoadWest Columbia, SC 29170

Once billing information has been obtained and payment arrangements made, you can send in your logo, other artwork (photos, artillustrations, map), and/or copy to Printsouth via the mail or electronically. PrintSouth will send you a proof for your approval and willdistribute the completed brochures to the person and address you provide below:

• Panel 5: ❐ Keep as is ❐ Use, but changes are needed ❐ Delete & use hospital-provided copy and/or artwork

• Panel 6: ❐ Keep as is ❐ Use, but changes are needed ❐ Delete & use hospital-provided copy and/or artwork

• Back: ❐ Feature your medical director ❐ Add a map and/or directions ❐ Feature a general hospital statement❐ List contact numbers to order a consult and/or a sleep study ❐ Any other information of your choice❐ Show a photo of your patient sleep room ❐ Hospital logo with address and contact numbers only

• Cover: ❐ Use as is, but with your logo ❐ Use the closed eyes artwork, but delete the patient/tech photo❐ Use hospital-provided artwork for the cover that includes your logo and/or a patient photo of your lab

• Quantity: ❐ 1,000 - $883 ❐ 2,500 - $1,020 ❐ 5,000 - $1,250 ❐ 10,000 - $1,720 (Plus shipping charges)$.88 each $.41 each $.25 each $.17 each

Ship the brochures to:

Name : _____________________________________________________ Title: _____________________________________

Business Name: _______________________________________________________________________________________

Business Street Address: _______________________________________________________________________________

City: _______________________________________________ State: ______________ Zip: __________________________

Purchased &Authorized by: _____________________________________________ Title: _______________________________ Date: ______________

6002-0303

Presented to: Samaritan Regional Health System · The most prevalent sleep disorder seen in a sleep...

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Transcript of Presented to: Samaritan Regional Health System · The most prevalent sleep disorder seen in a sleep...