Local center helps patients determine why their nighttime is troubled
Originally published September 14, 2011 at 11:35 a.m., updated September 14, 2011 at 8:11 p.m.
About the center
• What: Wenatchee Valley Medical Center’s Sleep Center
• Began operating: Late 1990s as an at-home program; expanded to separate building with in-center sleep units in 2003
• Offers: Six bedrooms equipped with monitoring devices
• Employs: Three technicians, mostly working at night
WENATCHEE — For the most part, Tamara Steffen got used to the snoring.
It was when it stopped that she worried.
“He would have 10-seconds-or-greater pauses in his breathing, then he would just gasp,” the Wenatchee woman said. “That would happen maybe three to four times a night, and I said, ‘We’ve got to do something. I think we really need help.’ “
Her husband of 15 years, Chad Steffen, 38, did do something. In July, he got an overnight evaluation at the Wenatchee Valley Medical Center’s Sleep Studies Center, where he was diagnosed with obstructive sleep apnea.
“I would actually stop breathing nearly 100 times a night,” Chad said. “Periods would range from a couple of seconds to 30 seconds.”
Now, he’s sleeping better with the help of a continuous positive airway pressure (CPAP) machine. It keeps his airway open and Tamara now finds herself listening to silence.
“I’m sure we will be a lot more harmonious now,”she said.
Chad is one of about 110 patients who go through the sleep center every month. Dr. Dave Daniel, the center’s medical director, estimated that 70 percent of those patients have obstructive sleep apnea, a condition in which the airway muscles collapse when the person is asleep. Without treatment, that condition can lead to high blood pressure, heart disease and diabetes.
About 20 percent of the patients have upper airway resistance syndrome, in which people snore and struggle to breath but their airways do not collapse.
Five to 10 percent have central sleep apnea, in which the airway is open but the brain has neglected to tell the body to breathe, Daniel said. People with these conditions often have had strokes or are on pain medications, which decrease the drive to breathe.
The remainder of patients have narcolepsy, a neurological disorder that affects the control of sleep and wakefulness; or they have unexplained daytime sleepiness.
Before the medical center began a sleep program in the late 1990s, patients with sleep issues were referred to facilities in Seattle or Spokane. The Wenatchee program began small, with patients being studied at home. Then it expanded to a two-bed facility in the medical center’s hospital. A three-month waiting period for those beds prompted the opening of the current six-bed center in 2003. It is located at Miller and Westwood streets.
The facility is the only sleep lab in North Central Washington accredited with the American Academy of Sleep Medicine.
A common misconception is that the sleep center treats insomnia, Daniel said. People with that condition should be referred to a behavior health professional because their condition may be associated with depression, anxiety or stress. Those conditions are best treated by cognitive behavioral therapy.
Before patients are referred to the sleep center, they have a consultation with a member of the sleep medicine department who evaluates them for risk factors. While being overweight can add to sleep problems, the biggest sign is the size of a person’s neck, Daniel said.
That’s because a larger neck means more tissue mass is weighing down on the airway. For a man, the risk begins at 17 inches in circumference; for a woman, it’s at 16 inches.
Symptoms that prompt people to see a sleep specialist often include snoring, being tired when they wake up, having trouble concentrating during the day and falling asleep during down time.
“I’ve had patients fall asleep in the drive-through line at McDonald’s,” Daniel said. “They bump the car in front of them and realize, ‘Uh oh, I was asleep.’ ”
Others are prompted by spouses or loved ones who complain that the person snores loudly and gasps for air at night.
“I saw a guy in the office the other day who stopped breathing 120 times an hour,” Daniel said. “It’s normal to stop breathing five times per hour. We all have apneas; it’s just how many you’re having that defines the problem.”
Problems associated with untreated apnea include high blood pressure, heart disease and diabetes.
“You can also be looking at heart attacks, congestive heart failure, atrial fibrilation and other heart rhythm disturbances, pulmonary hypertension, and waking up in the middle of the night with angina,” Daniel said.
Treatment options for apnea include oral appliances made by a dentist, and the CPAP machine that Steffen uses. It comes with a mask that fits over a person’s nose. The mask is connected to a machine that pumps humidified air through a hose.
Daniel said the CPAP machine was invented in the 1980s, replacing tracheostomies as the treatment for obstructive sleep apnea.
“It is life-changing and life-saving,” he said of the CPAP machine.
Dee Riggs: 664-7147
How the sleep center works
Patients usually check in about 7 p.m. and are hooked up to a variety of sensors. There are electrodes on the eyes to detect rapid-eye movement; on the chin to detect muscle tone in the face; air flow sensors on the nose to detect if the patient is moving air; and chest and abdomen belts to measure how hard the person struggles to breathe.
Daniel noted that patients who may be anxious about getting to sleep can be given a short-acting sleep medication that will not interfere with testing.
Data from the night’s sleep is sent over the Internet to a scoring company, and is usually returned in two weeks. For patients with serious conditions, turnaround time can be as fast as 24 hours.
— Dee Riggs, World staff
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