Sleep center monitors patients for signs of health troubles
People spend up to a third of their lives in bed, but few know that what happens beyond the wall of sleep can affect their health.
High blood pressure, heart disease, stroke, diabetes and depression are all conditions that can be made worse by sleep disorders, said Kevin Wolfe, the new supervisor for the Butler Sleep Center at Butler Memorial Hospital.
Wolfe and Robyn Kerschbaumer, director of operations for outpatient services for the health system, became overseers of the sleep center in February.
Kerschbaumer said the sleep center was determined to be an outpatient service and moved from the respiratory care department.
Wolfe and his team of sleep technologists watch over dreaming patients throughout the night, monitoring their brain activity and breathing to get to the root of problems such as sleep apnea and restless leg syndrome.
“It's the technologists at night that do the actual studies,” said Wolfe, a respiratory therapist before joining the sleep center.
“They register the patient, hook up the leads used to monitor patients' sleep and monitor that patient's EEG (electroencephalography, the recording of electrical activity along the scalp), respiratory effort, EKG (electrocardiogram that measures electrical activity of the heart) and oxygen levels,” Wolfe said.
“At the end of the night, they unhook them and send them home,” said Wolfe.
If this monitoring turns up a problem such as sleep apnea — pauses in breathing or infrequent breathing during sleep — a second trip to the center is scheduled, said Wolfe.
“During a titration study, we hook them up with all the electrodes, belts and monitors and monitor their breathing all night, ”said Wolfe.
In addition, Wolfe said, “We add a continuous positive airway pressure machine, which forces air into the patient's airways. We start out at low pressure and increase to eliminate snoring and sleep apnea events.”“Or there is an oral appliance dentists can prescribe to try and eliminate snoring. It's another form of therapy for the patient,” he said.The monitoring goes on all night at the sleep center on the fourth floor of the hospital.“We have six beds. We can do six studies. We have three techs here, each has two patients a night,” said Wolfe. “There's one sleep technologist on days with me. He reads the studies once they are done and prepares them for the physician to interpret.”Patients are referred to the center by pulmonologists and psychiatrists.“Just about any physician can refer a patient to the sleep lab,” Wolfe said.Although the lab is designed to be as homey as possible, with private baths and full-size beds, the amount of medical equipment draped on the would-be sleeper might negate any comfy feelings.There are tubes in the nostrils to measure how forceful the sleeper's breathing is, probes on the fingers to measure oxygen in the blood, leads on limbs and chins to keep track of muscle tension or leg twitching and belts around the chest and abdomen to measure breathing effort.With enough medical monitors to track an astronaut in orbit, let alone a sleeper in the Land of Nod, Wolfe was asked if the clinical setting makes it hard for patients to actually, you know, fall asleep.“That's what most people think,” said Wolfe. “'How am I going to sleep with all this stuff on?' But once they lay there for a half-hour to 40 minutes, most of them sleep.”“It sounds like a lot of wires, but once we get it bundled up, it goes to one central location,” said Wolfe.He said patients bring their own favorite blankets or pillows, and the spouses of adult patients or the parents of very young patients are allowed to pass the night in a chair in the patient's room.Kerschbaumer said plans are under way to make the sleep center more inviting.
“We are finalizing details on the scope of the work,” she said. “Renovations should begin in the next one to two months.”Kerschbaumer said work would include new paint, blinds, comforters and “aesthetic enhancements.”But improvement won't change the fact that the technicians monitoring the patients have their own sleep schedules disrupted.“It's kind of ironic,” said Wolfe. “Their sleep hygiene is fairly poor. They are working nights, so they are going backward.”“But we also offer daytime sleep studies for patients who do shift work and normally sleep during the day,” he added.Sleep apnea is one of the most common problems encountered at the center.Episodes of shallow breathing or interrupted breathing can disrupt the sleep cycle and rob people of their rest, no matter how long they've slept, said Wolfe.“There are four stages of sleep,” said Wolfe. “In stage 1 or 2, you wake fairly easily. Stage 3 and REM (rapid eye movement) stages are the really restful periods of sleep. The EEG flattens out, your brain is resting. Muscles relax, breathing slows down. That's when sleep apnea starts and kicks you back to stage 2.”Sleep apnea, Wolfe said, could be caused by advanced age, excess weight, a small airway or a neurological condition where the brain fails to send a signal to the muscles to control breathing.Wolfe said in an effort to better determine what is plaguing people as they sleep, the center plans to expand its operations to the health system's satellite locations.“We're going to start home sleep studies,” he said. “Basically, the patient comes to the lab and gets a small unit similar to our monitor. They wear it for one night at home and then we download the information.”The home study device is about the size of a cell phone. It straps onto the chest and has leads that attach to the sleeper's fingers and nose.Kerschbaumer said the home program should start soon.“I would say in the next one to two months. We are working out a contract with the company we will be using to provide the devices,” she said.“Patients will be able to get the devices at physicians' practices. It will bring services close to the public and make them easier to access,” said Kerschbaumer.The data collected isn't nearly as comprehensive as information gathered in the hospital, but the patients do have the luxury of falling asleep in familiar surroundings, Wolfe said.“We are going to start home sleep studies next month as we try to branch out into the community,” Wolfe said. “We need the sleep lab to be more convenient for the patients to reach us. ”To that end, Kerschbaumer said, sometime in the future, the sleep center might be moved to an outpatient location.It's something to sleep on.
