Sleep: Appreciated Mostly When It's Lacking

Sleep is something we often take for granted and something one does not appreciate or think about much…until it is unattainable. When it is absent or elusive, it becomes almost an obsession.

Night sky

Although understanding of all the benefits of sleep continues to emerge, the topic has been trending for quite some time.

In fact, it is one of the most common questions parents have at pediatrician visits, and, according to the Centers for Disease Control and Prevention (CDC), an estimated 50-70 million adults in the US alone have sleep or wakefulness disorders.

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MCW's faculty includes several physicians who are board-certified in sleep medicine – all from different disciplines – who provide a breadth and depth of sleep specialty expertise.

Physicians in the department of pediatrics (pediatric pulmonary and sleep medicine) practice at Children's Hospital of Wisconsin (Children's), while physicians in the departments of medicine (pulmonary and critical care), neurology and otolaryngology practice at Froedtert Hospital. This broad reach and the size and scope of an academic health system allow physicians to take a multidisciplinary approach to treating sleep disorders.

These pediatric and adult teams work closely with other MCW departments/divisions including psychology and behavioral medicine, oral/maxillofacial surgery and plastic surgery. Through collaboration, new methods and guidelines have been established, such as screening children for sleep apnea in the Down's Syndrome Clinic. There also is an accredited sleep medicine fellowship that provides training for several fellows per year.

The most common sleep disorders for children are obstructive sleep apnea, insomnia, restless leg syndrome and narcolepsy. Adults who lack sleep are tired – but children with sleep loss become overactive to overcome their sleepiness and exhibit fidgeting, restlessness and lack of focus.

"As a result of their symptoms, children who have sleep disorders are oftentimes misdiagnosed with Attention Deficit Hyperactivity Disorder (ADHD)," says Hari Bandla, MD, MCW associate professor in pulmonary and sleep medicine (pediatric) and medical director of the Sleep Program. "Thus, we share with primary care providers that patients with ADHD should be evaluated for sleep problems. Discussions on sleep should be encouraged at every well-child visit."

Several environmental factors contribute to insomnia or poor sleep, including 24/7 technology and competing priorities.

Lynn D'Andrea, MDLynn D’Andrea, MD
Medical Director of Pulmonary Services, Children's Hospital
Section Chief, MCW Division of Pediatric Pulmonary and Sleep Medicine

"We know that children who sleep well at night have more energy and are able to learn better the next day in school. We teach parents and children techniques to become good sleepers. Often, if our recommendations are followed, children should be sleeping better in two to three months."

Adults with insomnia also are treated with cognitive behavioral therapy techniques – in addition to medication – to improve their sleep.

Sometimes poor sleep occurs because of obstructive sleep apnea (OSA), the most common sleep disorders in adults and children. OSA is characterized by repeated episodes of upper airway narrowing or collapse during sleep. Patients with OSA stop breathing repetitively during sleep; this is known as apnea. Repeated episodes of apnea can lead to daytime fatigue and increase a person's risk for heart attack, stroke, high blood pressure and even death.

In children, the most common cause of sleep apnea is enlarged tonsils and adenoids; many adults with OSA are overweight. "As a pulmonologist and sleep specialist, there is a natural intellectual curiosity for the interplay between sleep and breathing," Dr. Bandla shares. "The opportunity and resources to conduct research on sleep disorders enhances treatment options, helps gain a greater awareness of the consequences of the disorder, and allows the ability to better identify those at risk to begin treating them faster and avoid further health issues."

B. Tucker Woodson, MDB. Tucker Woodson, MD, MCW professor of otolaryngology and communication sciences, is a nationally and internationally recognized expert in OSA. In the past, surgical treatment for adult sleep apnea was incisional and focused on taking out tissue to make the airway bigger. Dr. Woodson, however, was at the forefront of developing and advancing more minimally invasive ways to alleviate the symptoms, including reconstructing or rearranging the tissue versus taking it out. This tactic proved more successful, and led the way for additional research and treatments, including innovations in minimally invasive radiofrequency and plasma surgical techniques, novel transformative methods of palato-pharyngoplasty, tongue and hyoid suspension, and soft tissue tongue surgery.

Dr. Woodson also has been at the forefront of the exciting technology of nerve stimulation therapies for sleep apnea. Dr. Woodson and colleagues at MCW were the first to implant and treat a patient with an electronic pacemaker for sleep apnea. This nerve implant, when simplified, is a pacemaker that opens the airway during sleep. This novel and groundbreaking therapy gives patients who fail or cannot tolerate CPAP (the most common therapy) another option.

"Instead of modifying tissue or bone, this is a physiologic approach to increase muscle tone and stimulate nerves to open up the airway," Dr. Woodson says.

Dr. Woodson, one of the lead investigators in international studies evaluating the device, helped demonstrate that neuromodulation and stimulation therapy can lead to significant improvements for patients with OSA, according to the "STAR Trial" published in the New England Journal of Medicine. After a year, patients using the device had a nearly 70 percent reduction in sleep apnea severity, as well as significant reductions in daytime sleepiness.

"What is really exciting is that many patients who have the implant seem to do clinically better than those with successful CPAP treatment," notes Dr. Woodson. "Those with the implants have improved snoring, daytime sleepiness and sleep-related quality of life."

Technology is on the forefront of sleep disorder research – which is slightly ironic, considering technology is a contributing component to increased sleep disorders.

The best advice for children and adults? "Make sleep a priority; don't cut corners on it," remarks Dr. D'Andrea. "The whole family benefits when everyone has good sleep."

– Holly Botsford
 

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