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Wednesday, May 4, 2016

BVRMC specialists set to expand sleep apnea study

Tuesday, September 18, 2001

The Greek word "apnea" literally means "without breath."

For millions of people living with sleep apnea disorder, sleeping without breath is an all-too-familiar part of their nightly routine.

Now, area residents may be able to find relief from the condition at the Buena Vista Regional Medical Center.

Specialists at BVRMC are offering to help patients by providing a sleep study lab and clinic in the cardiopulmonary section of the hospital.

Larry Schubert, CRT, the chief cardiorespiratory therapist at BVRMC, said sleep apnea has become a concern of many over the past few years, and the sleep study, which began six years ago, has become an important part of his weekly routine.

"The procedure here has increased dramatically in popularity and attendance over the past few years," Schubert said. "I've been here over 20 years, and when I started I had not even heard of sleep apnea. Now we have two full-time people working with it here at the hospital."

The demand is so high for the service that the Wednesday night sleep lab is now set to increase its number of sessions from one to two times per week, and Schubert said people arrive at the center from many northwest Iowa communities.

"We've had patients from Pocahontas, Sac City and Cherokee, and we're looking at expanding that to Ida Grove and elsewhere," Schubert said. "The regional concept for us is big. We want to serve Storm Lake, but we also want to serve as many from the area as we possibly can."

Storm Lake's lab is set up on an attended basis, which means Schubert and Karyn Brophy, PSGT, stay throughout the night to keep tabs on each of the two patients which can be observed.

Both said there were numerous benefits from having this type of setup available.

"When we were in the process of starting this up, we wanted an attended lab because we wanted to see what was happening firsthand," Schubert said. "We have specialists documenting everything that is happening, and we're able to get more information and diagnose these patients better. It's something that's very helpful to us."

"We monitor the heart rate, oxygen levels, brain activity, everything," Brophy said. "We are able to keep track of all of the vital signs of the patient and really have excellent information to begin to help him or her."

Beginning at 8 p.m., the two hook patients up with wires to monitor their breathing and body flow throughout the night, and then keep a watchful eye on them until dawn breaks the next morning.

During the study, patients must stop breathing for at least 10 seconds and have at least a three percent drop in their oxygen level to count as one episode, and if there are more than 30 episodes, they are considered a candidate to start receiving treatment for sleep apnea.

Schubert said it does not take long to diagnose someone who has the disorder.

"Many of the people that come in here have 30 episodes within the first three hours," Schubert said. "It's pretty remarkable. There really is no middle ground with this. A patient either has sleep apnea or doesn't have sleep apnea."

After the person finishes the initial study, the sleep team then does a vigorous follow-up, as they call patients numerous times after they leave the lab, asking to see if their problems with the condition have persisted.

"We're very aggressive with our follow-up procedures, and that's something we take pride in," Schubert said. "We want to work with our patients and be able to help them the best we can, and follow-up calls and helping with treatment information is something we take seriously, because sleep apnea is serious."

Sleep apnea has become a major blip on the United States health radar, as the National Institute of Health has stated more than 12 million Americans are affected by it, roughly the same number as those who suffer from adult diabetes.

There are two types of the disorder, obstructive and central, but obstructive sleep apnea is the more prevalent of the two, and is the condition Schubert and Brophy find most often in their studies.

In obstructive sleep apnea, the muscles in the walls of the throat relax while one sleeps, collapsing on themselves and blocking the flow of air through the area.

After 10 to 30 seconds with no air, the brain is alerted and causes the person to rise to a lighter level of sleep. With this, the walls of the throat tense up again, the obstruction is relieved and breathing occurs.

This can happen hundreds of times during a night, and both specialists said this causes patients to receive little rest.

"People may have been in bed for eight hours or so, but they've really only gotten a good amount of sleep for maybe two or three hours," Schubert said. "It's not uncommon for this blocking-unblocking cycle to happen many times over the course of a night."

"Your brain needs seven to eight hours of deep sleep to properly function," Brophy said. "Many don't get any deep sleep, and their bodies become very deprived because of that."

Sleep apnea is considered a serious medical condition because it can cause a number of adverse effects, including high blood pressure, a increased risk of stroke or heart failure and severe drowsiness.

Risk factors include being male, middle-age, overweight and having enlarged tonsils or adenoids, which can block your airways.

The use of alcohol, sedatives and tranquilizers, which relax the throat muscles, also can increase the chance of sleep apnea striking a person.

Schubert said symptoms include loud snoring, a morning headache, a spouse noticing the lack of breathing and being very tired all day long. It is estimated 30 to 60 percent of people with severe daytime drowsiness suffer from sleep apnea.

"Every person we've had in here has said they're tired during the day," Schubert said. "Every time there is an obstruction the brain is aroused, so they're never able to fall into a deep REM sleep. There are five stages of sleep, and these patients never make it out of the first stage."

The severity of the disorder changes from case to case, as each person is uniquely affected by it. Schubert said sleep apnea stages can range from mild discomfort to to life-threatening.

"Nearly every case is not life-threatening, because many of these people have been living with this for years before coming in," Schubert said. "But there was one case a while ago where a man stopped breathing for 75 seconds, and we were prepared to use emergency protocol. We sent a CPAP mask home with him that night."

To combat sleep apnea, candidates are given a CPAP (continuous positive airway pressure) mask, which delivers air at a higher pressure than the surrounding air.

"Once the mask is on, snoring is stopped instantly," Schubert said. "It's incredible how it works. When they put the mask on, they go to stage four right away, and are able to experience REM sleep. I've had people wear it for the first time and tell me they haven't slept that good in years."

Schubert said one person even took his CPAP mask with him on a fishing trip with friends up to Canada, plugging it in a cigarette lighter and allowing it to run on a 12-volt battery.

"The masks have been life-changing," Schubert said.

"There was one gentleman from the area who got fired from his job because he was so tired during the day that he slept during his job," Schubert said. "When he came in, we saw that he was very positive, helped him get a mask, and he now has his job back."

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