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Physician Information
Services | Sleep Medicine

At Mecklenburg Neurological Associates we have Board Certified Sleep Specialists, Kenneth T. Ashkin, MD, Carolyn E. Hart, MD and Michael M. Amiri, MD. Here are their answers to some common sleep-related questions.

Sleep Medicine 1: Sleep Disorders Centers
What Is A Sleep Disorders Center?

It is a medical facility for diagnosing and treating patients with sleep-related disorders. These conditions include difficulties in falling asleep, staying asleep or remaining awake. The most serious symptoms of sleep disorders are daytime sleepiness, excessive use of sleeping pills, nighttime chest pains, morning headaches, heavy snoring and breathing irregularities during sleep.

A center’s services are provided by professionals experienced in sleep-related disorders and sleep-exacerbated disease. Specialty consultants with certification in neurology, pulmonary medicine, psychiatry and psychology are always available.

Basic Sleep Patterns

Most adults need seven to eight hours of sleep at night although some people need less than four and other more than ten. When an individual’s sleep is adequate, that person should feel alert throughout the day. We can determine our sleep needs by measuring daytime alertness. Some people fall asleep at times when they should normally be able to stay awake. This symptom is very dangerous. Such abnormal sleep is a sign of several different sleep disorders and can be successfully treated.

Sleep patterns change with the aging process. Infants may sleep up to 16 hours per day, while the elderly may experience more disturbed sleep and a greater need for naps. Daytime naps may disturb sleep for some people, but for others they are a normal part of a healthy sleep-wake pattern.
Everyone dreams every night – and in color. Some people do not recall their dreams, leading them to think that they never dream. Dreams can enrich our lives by their imaginative content and psychological meaning, but they can also become nightmares and cause sleep problems.

General Information On Sleep Disorders

Insomnia is a symptom that may be caused by many conditions. Some of them are psychological (chronic depression or temporary stress), environmental (noise) or psychological (chronic breathing disorder or temporary pain). Another common cause of insomnia is misuse and overuse of sleeping pills.

Cannot Sleep At Proper Time
When the regular pattern of sleeping and waking is disrupted, some individuals find that it is difficult to resume a sleep-wake schedule that fits their needs. This may be caused by shift work or other changes in schedule. Some complaints of insomnia or daytime sleepiness may be due to undiscovered changes in the sleep-wake rhythm.

People who are too sleepy during the day and feel muscular weakness when they are angry, surprised, or amused may have narcolepsy. Sometimes narcoleptics experience terrifying dreams or hallucinations just as they fall asleep. Narcolepsy often emerges in young adulthood and is a life-long medical disorder.

Sleep Apnea and Snoring
Snoring is not always just a normal annoying occurrence. If light, it may be indeed by trivial. However, heavy snoring may be a symptom of a serious sleep disorder called sleep apnea.
People with sleep apnea stop breathing again and again during sleep. These apneas last 10 to 90 seconds and may occur several hundred times a night. The symptoms of sleep apnea are excessive daytime sleepiness, high blood pressure and heavy snoring.

Oxygenation Problems
When people have chronic breathing problems or lung disease, their symptoms often worsen during sleep. Complete evaluation of such respiratory diseases sometimes require measurement of blood oxygenation during sleep.

Nocturnal Myoclonus
People who have periodic leg movements (nocturnal myoclonus) during sleep may not get proper rest and feel they have either insomnia or excessive sleepiness.

Nightmares and Night Terrors
Nightmares are frightening dream experiences which can later be recalled. These may occur at any age. Night terrors are often accompanied by an anguished scream – yet the victim seldom recalls the experience. Night terrors generally disappear after adolescence. The causes of nightmares and night terrors are unknown.

Bedwetting, Sleepwalking and Sleeptalking
These disorders are common in childhood. Bedwetting is particularly common.
Sleepwalking is also common in childhood and can be dangerous. Sleepwalkers should be protected by reducing the risk of falling and removing other dangers from their bedroom. Sleeptalking is also common. Sleeptalking is usually incomprehensible and rarely of psychological significance. Most important is to determine whether the troublesome behavior is benign or a sleep-related epileptic seizure.

What Can Be Done About A Sleep Disorder?
Most of the disorders mentioned can be effectively treated once they have been accurately diagnosed. Some conditions require medication. Others may require a change in daily habits and working schedule. When sleep apnea is present, weight loss or an upper airway operation may be necessary to diminish the serious health risks.
It is important to emphasize that correct treatment can be undertaken only after the real medical condition has been accurately diagnosed.

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Sleep Medicine 2: Sleep Apnea
What is Sleep Apnea?
Sleep apnea refers to non-breathing episodes during sleep, occurring as frequently as several hundred times per night. Loud, irregular snoring occurs as the person attempts to breathe at the end of each apneic episode. Although the individual may have had a full night’s sleep, he still feels tired during the day.
This surprisingly common sleep disorder is an illness which can progress in severity and become life-threatening if not detected and properly treated. Over twenty million (20,000,000) Americans suffer from sleep apnea.
Although it seems to be more common in middle-age men and affects 40% of all people over sixty years of age, anyone at any age may develop sleep apnea.

Three Types Of Sleep Apnea
Obstructive sleep apnea (most common) is caused by an obstruction from the tonsils, uvula or fatty tissue, or by involuntary muscle relaxation which blocks airflow during sleep.
Central sleep apnea is caused by the brain failing to send proper signals to regulate breathing.
Mixed sleep apnea refers to a combination of central and obstructive types.

A routine medical examination cannot reveal the main symptoms of this illness because the patient’s respiration remains normal while awake. Proper diagnosis of the severity and type of sleep apnea can only be determined by special monitoring of the individual’s sleep. These tests are available at accredited sleep centers which use highly sensitive, technical equipment.
Sleep apnea can develop into life-threatening health problems. During apneic episodes, the oxygen content of the blood decreases causing blood pressure to rise sharply and the heart to slow down or stop. Sleep apnea can cause personality changes, morning headaches, hypertension, irregular heart rhythm, impotence and even death.

Symptoms That No Amount Of Sleep Will Cure
Very often a person suffering from sleep apnea may not be aware of his loud snoring and breathing irregularities during sleep. The spouse is usually the first to recognize the symptoms and is disturbed during the night by loud snoring or restless movements of the bed partner. The person may only recognize that he is excessively tired during the day, even though he slept through the night.

Symptoms while asleep:
· Loud irregular snoring, snorting or gasping for breath
· Sudden body movements before the person starts to breath again
· Excessive sweating during sleep
· Irregular pounding or beating of the heart when gasping for breath

Symptoms while awake:
· Excessive daytime sleepiness, fatigue
· Complaints of insomnia or lack of restful sleep
· Rapid weight gain sometimes to the point of obesity
· Confusion or brief memory loss upon awakening
· Unexplained morning headache
· High blood pressure
· Impotence
· Personality changes

Sleep Apnea can generally be treated very effectively once properly diagnosed and categorized as to type and severity. Treatments for each type of sleep apnea may include:

Obstructive sleep apnea:
· Weight loss
· Surgery to remove airway blockage
· The nasal CPAP (Continuos Positive Airway Pressure), a device worn over the nose that is attached to an air compressor which keeps airways open

Central sleep apnea:
· Medications

Mixed sleep apnea:
· The same as for obstructive apnea
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Sleep Medicine 3: Narcolepsy, The Sleeping Illness
What is Narcolepsy?
Narcolepsy is a life-long neurological illness, primarily characterized by sudden uncontrollable sleep attacks and persistent daytime sleepiness.

Narcolepsy affects more than 500,000 Americans and symptoms arise as early as the onset of puberty and continue throughout life. Recent scientists have confirmed a genetic marker for this disease confirming that narcolepsy may be hereditary. A child with a parent having narcolepsy has one chance in twenty of being affected.
Symptoms may vary from mild to totally disabling and may appear suddenly or gradually over a period of years. With narcolepsy, a person’s entire lifestyle is dominated by sleep attacks resulting in a constant battle to stay awake. Sudden uncontrollable sleep attacks may occur at any time or during any activity (such as driving, eating or talking). Concentration and memory recall may be greatly restricted by excessive daytime sleepiness and limited daytime alertness. Secondary psychological problems may become serious causing severe depression for the narcoleptic who feels misunderstood and alone in his sleepy world.

Symptoms That No Amount Of Sleep Will Cure
Excessive daytime sleepiness, despite a full night’s sleep, may include constant fatigue and dullness of mind.
Uncontrollable sleep attacks, lasting from minutes to hours, may occur suddenly at inappropriate times when others normally would be alert.

Cataplexy, (affecting 70% of all narcoleptics) is a sudden loss of muscle tone or muscle weakness usually triggered by extreme emotions such as laughter, anger, fear, elation or surprise. An attack may range from a brief experience of muscle weakness (sagging of the jaws or bucking of the knees) to profound loss of muscle tone resulting in total body collapse. During the attack, the person remains conscious but is unable to speak or regain physical control for a brief time.
Automatic behavior refers to doing tasks, (usually routine in nature) without conscious thinking. Later the person is unable to recall details of having done a task.

Sleep Paralysis refers to the inability to move upon falling asleep or waking up. The person has conscious awareness of not being able to move the body.

Hypnagogic hallucinations are intense, vivid dream-like experiences which occur between wakefulness and sleep. Hallucinations can involve some or all of the human senses, making it difficult to distinguish from reality. Experiences may be frightening or interesting. Accompanied with sleep paralysis, the individual may experience a terrifying nightmare, but be unable to "escape" from the frightening object (such as dreaming an intruder is breaking into the house, but being unable to move or call for help).

Treatment is available. Narcolepsy can be properly diagnosed by monitoring an individual’s sleep at an accredited sleep center. Even though narcolepsy is a life-long illness, the symptoms for most narcoleptics can be managed with a careful balance of medications, educational support and personal care. By understanding and accepting the sleepy nature of this disorder, narcoleptics can adjust their lifestyles to maximize their daily their daily alertness and lead as full a life as possible.

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Sleep Medicine 4: Falling Asleep Can Be As Easy As Counting Sheep
Everyone knows that a good night’s sleep makes the difference between feeling good or grumpy the next day; between functioning at peak performance or stumbling sluggishly through the day.
Research tells us that sleep is as vital to our health and well-being as a balanced diet or exercising regularly. We spend 1/3 of our lives sleeping, more time than working or playing. This important part of active living restores and prepares our body for daytime alertness and better health.

Today’s busy lifestyle, late meals, too much coffee, irregular schedules, and unnecessary stress can cause sleep problems. Experts tell us that we need to develop good routine sleep habits. Each person in evaluating their own sleep habits should:

Try These Tips:

1. Develop regular sleep habits. Each individual must determine how much sleep he requires at night to be fully alert and energetic during the day.

2. Slow down and unwind before bedtime. Try reading for pleasure, a warm glass of milk, or a relaxing soak in the tub.

3. Get up the same time seven days a week, no matter how well you have slept. This maintains your biological clock and will result in establishing a fairly regular bedtime.

4. Your bedroom should be a comfortable resort for sleeping. Dark…cool…quiet.

5. Breathe deeply to induce drowsiness. Take a series of three very slow, deep breaths, exhaling fully each time. This helps break tension.

6. Exercise daily to promote good sleep. This releases energy and mental tension. Late evening exercise disturbs peaceful sleep.

7. Accept occasional nights with less sleep. They’re part of life. Although uncomfortable, all of us experience a few nights when sleep is more difficult.

8. If your sleep is still disturbed, ask for help. Contacting a sleep specialist in a fully accredited sleep center will help determine possible physical factors involved. They also can give you other tips on specific sleep habits you can apply.

Avoid the following:

1. Don’t try to force yourself to sleep. If you can’t fall asleep within 15-30 minutes, go into another room and do something relaxing until you feel sleepy.

2. Napping during the day. Although naps might be refreshing, they tend to decrease the amount of sleep at night. Exceptions: Narcoleptics sometimes need a refreshing nap before driving a car or to ward off later sleep attacks.

3. Strenuous mental and physical activities in the evening. The mind and body should relax before sleeping.

4. Caffeine in the evening which disturbs sleep. All coffee (even decaffeinated), most teas, colas, and chocolate contain caffeine. (Did you know it takes three hours for one cup of coffee to leave your system?)

5. Smoking before bedtime. Nicotine is a stimulant. Smoker’s coughing may disrupt sleep.

6. Alcohol in the late evening. the sedation tends to wear off in 2 – 3 hours and causes disturbed sleep in the latter half of the night.

7. Long-term use of sleeping pills. This may produce a dependency and can reduce the quality of sleep.

8. Going to bed on an empty stomach, especially if you are dieting. Mild, fruit juice (unsweetened), a banana, or yogurt keep your stomach satisfied without adding too many calories.

9. Taking problems to bed. Try relaxing yourself into sleep with soothing music or pleasant imagery (like walking on the beach in a cool breeze). Counting sheep is the oldest trick in the book for a simple reason – it works! According to research, this technique distracts both sides of the brain with soothing, repetitive activity – you literally bore yourself to sleep.

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