Thursday, Oct. 25, 2007

Diagnosis of disorders an awakening

Landover resident learns her constant sluggushness is symptom of sleep apnea

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Susan Whitney-Wilkerson⁄The Gazette
Doctors Community Hospital Sleep Center manager Diane Rafferty teaches Alex Pezeshkian of Laurel how to use a Continuous Positive Airway Pressure machine to treat his sleep apnea on Wednesday in Lanham.
Most people have done it: Given one loud, throaty, harsh snort, shaking them from sleep.

But what if what is believed to be snoring is really someone struggling to breathe?

‘‘That’s your body catching breath,” Gloria Sandy said. Last year Sandy was diagnosed with sleep apnea, a sleep disorder where the throat’s airway collapses and leaves someone unable to breathe.

For 13 years, Sandy, an office manager from Landover, said she was constantly tired and feeling sluggish on the job and did not know why. Her metabolism slowed and in more than a decade she gained 50 pounds.

After switching doctors in 2005, Sandy told her new doctor about her symptoms. Convinced she might be suffering from sleep apnea, her doctor recommended Sandy participate in a sleep study at the Doctors Community Hospital Sleep Center in Lanham.

After monitoring her breathing in the first study, Sandy was asked back for a second study to test use of Continuous Positive Airway Pressure, or CPAP machine. The machine is a small box connected to a mask with tubing placed inside the nostrils. The machine blows air down the windpipe to keep muscles from collapsing while the mouth remains closed

‘‘Because you keep your mouth closed, it keeps your windpipe open,” Sandy said. ‘‘It continually blows air down your throat. Because it's doing that you can't open your mouth. A person first using it can't open their mouth—it would probably feel like you are choking.”

Headed by sleep specialist Dr. Riad Dakheel, the Doctors Community Hospital Sleep Center opened in 1996 and performs up to 2,000 sleep studies a year.

Dakheel said the age range of most patients is between 30 and 60 years old and 30 percent to 40 percent of patients who come in for studies have high blood pressure.

Others at risk for sleep apnea typically have suffered from a stroke, are overweight or diabetic.

‘‘We are a full service sleep center which means we’re equipped and trained to address all kinds of disorders. We treat people with sleep apnea with CPAP,” Dakheel said. ‘‘There are some people that would benefit from surgery or oral dental appliances, weight loss and sleeping on their side.”

Doctors Community Hospital is not the only area facility addressing sleep apnea. The Greater Washington Sleep Center contracts doctors and therapists to 20 hospitals in the Washington metropolitan area, including Laurel Regional Hospital Sleep Disorders Center in Laurel and the Greenbelt Sleep Disorders Center.

Jim Woolsey, a registered respiratory therapist for Greater Washington Sleep Center, said he treats patients with other disorders such as central sleep apnea, which he described as not having the impulse to breathe during sleep, and parasomnia, which includes having nightmares, night terrors and sleep walking.

The Doctors Community Hospital sleep center offers 10 sleep rooms with queen-sized beds, personal bathrooms, TVs and DVD players for patients to use during studies.

All 10 rooms are monitored through a camera control room, where sleep study technologists observe patients’ sleeping patterns. One study costs $2,800, and depending on insurance, 80 percent to 100 percent of the cost is covered.

Celeste Williams, a registered polysomnographer technologist who observes patients, said she has seen many patients act out their dreams, sleep walk or talk in their sleep during the study.

Dakheel said nationally, 2 percent of women and 4 percent of men meet criteria for having sleep apnea such as having hypertension, restless sleep, mood swings, decreased libido, morning headaches and obesity. Dakheel said the incidence of sleep apnea is as high as 90 percent in those with resistant hypertension. These are people who need more than two or three drugs to control blood pressure.

Dakheel said more research needs to be done on who is affected by sleep apnea, but said African Americans, Asians and Latinos have high prevalence for the disorder. Dakheel said this is from noticing that people of these races tend to have large and short necks, which is often linked to crowding of throat muscles such as tonsils and the uvula.

Respiratory therapist Diane Rafferty said patients use CPAP machines in the home and are usually covered by medical insurance.

Machines can cost as much as $1,000 but insurance usually covers up to 80 percent of the cost, meaning the average person usually pays about $20 over 12 to 13 months to rent a machine until it’s paid for.

After using the CPAP machine every night for two to three weeks, Sandy felt more energetic. She even recommended her husband, who also suffers from sleep apnea, and now both use CPAP machines to sleep. And Sandy noticed another big change.

‘‘I've only lost about 20 pounds,” Sandy said. But Sandy shrugged the weight loss off. ‘‘I think if you try, you lose more.”

E-mail Natalie McGill at nmcgill@gazette.net.

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