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Like many of the snores it treats, sleep medicine is booming.
In 1978, the American Academy of Sleep Medicine reported only three accredited sleep facilities in the United States. By 2003, there were 678, a third of which were less than three years old.

"Fifteen years ago, you really didn't hear a lot about sleep disorders, but now you can go on a fishing trip and every one of the six guys there has a CPAP machine with him," said Susan Griffin, LPN, RPSGT. She is co-owner with her husband, Monty, of the six-bed SomnoDiagnostics in Hot Springs, the oldest independent, free-standing sleep center in the state. "People have had sleep disorders all along; we just didn't understand them or have the technology to treat them until recently."

Burke Mays, president and founder of Mays & Associates, a Nashville sleep disorders company with clinics in 26 states, including one in Pocahontas, Ark., said his company fields a lot of questions from physicians and hospitals weighing the advantages of opening sleep clinics in their facilities. He tells them it's smarter and easier than ever. Given adequate space, companies like his can now have an operational sleep clinic, with staff and equipment included, in a hospital or private practice within a month.

"Even with all the growth in the industry, some patients still have to drive over 50 miles to find a sleep clinic," he said. "There's no reason for that. After the physician's doors close for business at 5 p.m., that unused space can be providing sleep studies and making money quite literally overnight."
But it's about more than making a profit off a little loud snoring. The International Classification of Sleep Disorders lists 84 disorders of sleep and wakefulness. Many of these can be quite serious and disruptive, and all contribute to reduced overall wellness and an increased risk for a number of fatal conditions.

Mays & Associates technical director Todd Eiken, RPSGT, who got into sleep medicine more than 20 years ago, said that while the field is growing, physicians who have not had much education in it sometimes regard it as a light, "feel-good" discipline, a frivolous "extra" that patients can do without.
"The reality is, a sleep study is a valid medical test," Eiken said, "and besides greatly increasing the patient's quality of life, it's just good preventative medicine."

Mays said the average cost of a sleep study and the typically prescribed CPAP machine is between $4,000 and $5,000, but emphasized that untreated sleep disorders can lead to hundreds of thousands of dollars in medical bills for conditions such as stroke or heart attack. More and more insurance companies are covering sleep disorders, he said, for precisely this reason.

He said the most commonly diagnosed disorder — obstructive sleep apnea — is one that most sufferers often vehemently deny until they see their own test data. "People tell us, 'I sleep at night. I don't have any problem sleeping; my wife doesn't like my snoring, but I'm snoring so I must be sleeping,'" Mays said. "They aren't aware that they're actually holding their breath 50, 100, even 200 times a night and preventing access to their REM sleep, which they need three or four times a night."

Although sleep apnea sufferers are tired during the day, they rarely realize how exhausted they really are. Mays said, "It's kind of an insidious disease in that it creeps up on you over time, so you just get used to being tired and forget what it's like to feel really invigorated and refreshed after you sleep. So they deny that it exists."

Resistance to the idea of sleeping with a mask on their face and a machine on their nightstand frequently vanishes, Eiken said, when patients rediscover the recuperative sleep they've been missing. "Plus," he said, "CPAP manufacturers have been very successful lately. The first CPAP I saw was bigger than a computer tower, but now they're a whole lot quieter and they're smaller than a Kleenex® box."

Although SomnoDiagnostics treats people for a number of sleep disorders, including insomnia, restless legs syndrome, narcolepsy and complications of asthma and allergies, Griffin said the people she sees most often are overweight men with very thick necks, a hallmark sign of apnea. "I could almost diagnose them when they walk in the door," she said. "It's just such a common sign, though sleep disorders affect men and women of all sizes and ages, even kids."
Due to their special needs, Griffin usually refers pediatric patients to the sleep disorders clinic at Arkansas Children's Hospital. The clinic treats children from around Arkansas and surrounding states with a multidisciplinary team made up of pulmonologists, neurologists, ENT specialists, respiratory therapists, nurses and social workers who all have training or certification in sleep medicine.

Wendy Ward-Begnoche, PhD, who is assistant professor in the Department of Pediatrics at UAMS and a psychologist at the Children's Hospital sleep clinic, said that besides having equipment small enough for children, pediatric sleep patients need a sleep lab that can also accommodate a parent (so the child can get to sleep more easily in the strange place), a compassionate staff and a developmental understanding of how sleep changes over time, from infancy onward.
Sleep disorders in children are particularly easy to miss, Ward-Begnoche said. "Narcolepsy is one that I think gets misdiagnosed in adolescents," she said. "They're written off as sort of lazy, unmotivated teenagers, when they actually have a true neurological difficulty in maintaining alertness."

The clinic also treats children for obstructive sleep apnea, insomnia and a host of other disorders, including treating infants who have difficulty sleeping through the night. Some adolescents have a sleep phase disorder in which they are up all night and sleepy all day.

Ward-Begnoche said that although parents tend to think that their kids' peculiar sleep behavior goes with the territory, it often has roots in medical disorders that if treated, could drastically improve health, alertness and academic performance.

The pediatric clinic now has an alternative treatment plan to the controversial Ferber method, which required parents to let their children cry for long periods. Ward-Begnoche said they also spend a "great deal of time" making sure children and parents are comfortable with their treatment plans and with any equipment they may need, such as CPAP machines.

She said the staff there is happy to take phone calls from physicians with questions or interesting cases to discuss, and will lecture on sleep disorders for groups of physicians when asked.


March 2007

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