Our mission at Tri-State Pulmonary Associates, Inc. is to provide compassionate and high quality, cutting edge care for patients with common and unusual pulmonary and critical care diseases, and sleep disorders. Tri-State Pulmonary Associates is a regional leader in the delivery of pulmonary, critical care, and sleep medicine services in the Greater Cincinnati area. Our experienced, nationally recognized team of eight physicians and two nurse practitioners is committed to providing quality, patient-centered care in a timely fashion.
Cincinnati Magazine consistently ranks Tri-State Pulmonary Physicians among the top pulmonologists in the Greater Cincinnati area. We utilize cutting-edge medical technology that allows us to provide the highest standard of care. We deliver comprehensive care for all lung and breathing conditions/ diseases for patients in the hospital, outpatient rehabilitation and our many locations throughout the tristate area. Our services include:
Our Pulmonologists—also known as Pulmonary Specialists or Lung Doctors—are all board certified in Pulmonary (Lung) Medicine. Pulmonologists deal with the causes, diagnosis, prevention and treatment of diseases affecting the lung. They provide pulmonary consultations for patients in outpatient clinics as well as for those in the hospital. Services include pulmonary consultations, treatment and follow-up and high-risk pre-operative evaluations. Our physicians help analyze and treat people that are short of breath or have low oxygen levels.
Our physician’s clinical area of expertise includes:
Acute Lung Injury
Acute Respiratory Distress Syndrome (ARDS)
Chronic Obstructive Pulmonary Disease (COPD)
Control of breathing
Interstitial Lung Disease
Occupational Lung Disease
Pulmonary Vascular Disease
Unexplained Shortness of breath
Diagnostic tests –
Pulmonologists use many different diagnostic tools to evaluate the structure and function of the lungs. Patients are frequently asked to have a chest x-ray, cat scan and basic breathing tests, called pulmonary function tests.
Despite the availability of effective asthma treatments and evidence-based management guidelines focusing on asthma control, many patients have asthma that is difficult to effectively treat. Our comprehensive asthma treatment program is physician driven and patient managed. Patients are given the tools they need to effectively manage their asthma symptoms.
What is Asthma?
Asthma is a chronic lung disease that makes it difficult to move air in and out of the lungs. It affects people of all ages. Asthma can be serious and life threatening, requiring every day management of symptoms. There is no cure for asthma, but with the right care it can be managed. To learn more about more about asthma click here http://www.lung.org/lung-health-and-diseases/lung-disease-lookup/asthma/learn-about-asthma/what-is-asthma.html.
Treatment of Asthma
The physician/patient relationship is very important in successful asthma care. Our physicians work with the patient to create an individualized asthma treatment plan. Two types of medicines are used to treat asthma: long-term control and quick-relief medicines. Long-term control medicines help reduce airway inflammation and prevent asthma symptoms. Quick-relief, or "rescue," medicines relieve asthma symptoms that may flare up. Your initial treatment will depend on the severity of your asthma. Follow up asthma treatment will depend on how well your asthma action plan is controlling your symptoms and preventing asthma attacks.
Unfortunately, there still remain situations when traditional management guidelines are not effective in controlling asthma exacerbations. When this happens we then look to other methods of treatment such as bronchial thermoplasty. Bronchial thermoplasty (BT) is a minimally invasive bronchoscopic procedure performed in three outpatient procedure visits, each treating a different area of the lungs and scheduled approximately three weeks apart. After all three procedures are performed; the bronchial thermoplasty treatment is complete. BT may be appropriate for patients 18 years and older whose asthma is not well-controlled with inhaled corticosteroids and long acting beta agonists.
The Alair® Bronchial Thermoplasty System (the Alair® System) delivers thermal energy to the airway wall in a precisely controlled manner in order to reduce excessive airway smooth muscle (ASM). Reducing airway smooth muscle decreases the ability of the airways to constrict, providing long-lasting asthma control and improving the quality of life for patients with severe asthma.
Risks may include:
•Increase and worsening of asthma-related respiratory symptoms in the period immediately following BT
•These events typically occur within a day of the procedure and resolve on the average within seven days with standard care
•There is a small possibility (3.4% per procedure) that the temporary worsening of asthma symptoms after a procedure may result in the patient being admitted to the hospital for management of asthma symptoms.
Evaluation of Lung Nodules and Lung Cancer
It is not uncommon to discover lung nodules on a CT scan looking for other disorders. In general, the majority of lung nodules are benign. Tri-State Pulmonary Physicians provide quick evaluation of lung nodules and recommend future treatment or evaluation when needed. The earlier lung cancer is detected the greater the survival rate. Our physicians are participating in The Christ Hospital Health Networks Lung Cancer Collaborative. We network with a team of physicians that specialize in and provide state-of –the-art treatment of lung cancer. Tri-State Pulmonary Associate physicians are skilled in the latest medical diagnostic and interventional pulmonology procedures that help in early diagnosis of lung cancer. Electromagnetic Navigational Bronchoscopy and Endobronchial Ultrasound are the most progressive, up-to-date medical procedures used in the diagnosis of lung cancer. We recognize that time is essential when diagnosing and treating patients with lung cancer. Patients referred to us with suspicious lung nodules, lung masses or lung cancer is given priority in scheduling. Our physicians and office staff will work you and your staff to streamline the referral process. Once the patient is seen in our office any need procedures are scheduled at The Christ Hospital within one week, usually sooner. If needed, referrals to other health care providers are made immediately. We strive to keep the referring physician involved in the care process and provide timely updates on patient progress.
Electromagnetic Navigation bronchoscopy (ENB or commonly called Navigational Bronchoscopy) aids in the biopsy of lung nodules (spots in the lung) that would normally be difficult to reach with minimal trauma and enables the physician to diagnose and possibly treat benign and malignant lung disease (cancer). Navigational Bronchoscopy also provides the ability to detect lung disease and lung cancer earlier, even before symptoms are evident, enhancing treatment options for patients.This technique also allows the pulmonologist to place markers to help radiation oncologists locate and target treatment to cancerous lesion sites and avoid radiating health lung tissue. In patients with poor lung capacities, these markers also assist thoracic surgeons in preforming minimally invasive lung resection.
Endobronchial ultrasound system (EBUS) is an ultrasound probe on the tip of a bronchoscope allows a doctor to biopsy lymph nodes with more precision. EBUS increases the likelihood of a correct diagnosis significantly.
Bronchoscopy is the most common interventional pulmonology procedure. Biopsies, bronchial lavage, stents, balloon bronchioplasty and removal for foreign objects are performed. For people with lung cancer or other cancers, interventional pulmonology biopsies can often accurately identify spread of cancer into lymph nodes. This can prevent unnecessary surgery or help determine the best choice for treatment.
Intrabronchial Valves is a device to control prolonged air leaks of the lung or significant air leaks that are likely to become prolonged following certain lung surgeries. The intra bronchial valve (IBV) is designed to limit airflow to parts of the lungs down past the valve, allowing mucus and air movement in the healthy portion of the lung. The valves block the injured tissue from inhaled air, reducing the leak and enabling natural healing.
Bronchial Thermoplasty is an interventional pulmonology procedure for certain people with severe asthma that can’t be controlled with medications. During bronchoscopy, a doctor applies a heat probe to the walls of the airways. The heat destroys the smooth muscle layers whose constriction contributes to asthma symptoms.
Pulmonary function tests are a group of tests that measure breathing and how well the lungs are functioning. These tests are routinely ordered to help diagnose lung disease and to track the progression of lung diseases. These basic tests help your physician broadly classify lung diseases into a category such obstructive lung disease (COPD, bronchiectasis, etc.) or restrictive lung disease (pulmonary fibrosis, obesity, etc.)
Prior to your initial visit your pulmonologist will need a full pulmonary function test. Your pulmonologist will review your test with you at the time of your visit. These tests will be scheduled at our office either prior to your appointment or the day your appointment. Usually patients can have testing performed the same day as their appointment. Tests are then scheduled annually or as clinically indicated.
State of the art technology is used to perform patient testing. Your comfort is very important and our machine, the Medgraphics™ Platinum Elite Plethysmograph allows for maximum patient comfort. It has a patient friendly atmosphere with an intercom system that allows for easy communication between the therapist and the patient. Testing includes spirometry with bronchodilator assessment, lung volume testing and diffusing capacity testing.
Our lab manager is a Registered Respiratory Therapist (RRT) as well as a Registered Pulmonary Function Technologist (RPFT). She has in depth background in Pulmonary Function testing and Respiratory Therapy. Our technicians are Respiratory Therapist (RRT) with training in pulmonary function and are either certified (CPFT) or registered pulmonary function technologists (RPFT). All pulmonary function personnel work under the supervision a pulmonologist.
How to Prepare for the Test
• Do not eat a heavy meal before the test. A full stomach may keep your lungs from fully expanding.
• Do not smoke or due intense exercise for 4 to 6 hours before the test.
• You will get specific instructions if you need to stop using bronchodilators or other inhaled medicines. You may have to breathe in medicine before or during the test.
• Wear loose clothing that doesn’t restrict your breathing in any way.
• Avoid food or drinks with caffeine. Caffeine can cause your airways to relax and allow more air than usual to pass through.
• Wear your dentures. They help form a right seal around the mouthpiece of the machine.
• Plan to use your hearing aid during testing.
Tell the technologist if you:
• Have had a recent chest pains or heart attack
• Take medicine for lung problems such as asthma. You may need to stop taking some medicines before testing.
• Are allergic to any medicines.
• Have had a recent surgery on your eyes, chest, or belly, or if you have had a collapsed lung.
Why PFT’s are ordered:
• If there are symptoms of lung disease
• As part of a routine physical
• To monitor the progress of lung disease and the effectiveness of lung medications
• To evaluate how well the lungs are working prior to surgery.
• Pulmonary Function Tests can help diagnose asthma, allergies, chronic bronchitis, respiratory infections, lung fibrosis, bronchiectasis, COPD (Chronic Obstructive Pulmonary Disease/emphysema), asbestosis, sarcoidosis, scleroderma, pulmonary tumor, lung cancer and many other lung diseases.
What to expect
You will breathe through a mouthpiece and wear a nose clip during the testes to keep air form leaking through the mouth and nose during the test.
Depending on the test you have ordered you will inhale and exhale as instructed by the technician. You will be asked to inhale and exhale as hard and as fast as possible. You may also be asked to breathe in and out as deeply and rapidly as you can for 15 seconds.
Some tests may be repeated after you have inhaled a medicine that expands the airways in your lungs. You may be asked to breathe a special mixture of gases. These mixtures are always safe and have no health risks.
If you have body plethysmography, you will be asked to sit inside a small enclosure. It’s similar to a telephone booth with windows that allows to see out and a speaker to that you may communicate with the technologist at all time during the test. The booth measures small changes in pressure that occur as you breathe.
It is very important to follow the instructions the technologist gives you, the accuracy of your test depends upon it. Let the technologist know if you do not understand the instructions, they will be happy to explain the instructions in a manner which you can understand.
Testing can take up to one hour depending on the tests you are having.
For a healthy person, there’s little or no risk in taking these tests. If you have a serious heart or lung condition, discuss your risks with your doctor.
Your pulmonologist will discuss your test results with you at your appointment. If you would like, test results can be sent to your primary care physician.
Different measurements that may be found on your report after pulmonary function tests include:
• Diffusion capacity to carbon monoxide (DLCO)
• Expiratory reserve volume (ERV)
• Forced vital capacity (FVC)
• Forced expiratory volume in 1 second (FEV1)
• Forced expiratory flow 25% to 75% (FEF25-75)
• Functional residual capacity (FRC)
• Maximum voluntary ventilation (MVV)
• Residual volume (RV)
• Peak expiratory flow (PEF).
• Slow vital capacity (SVC)
• Total lung capacity (TLC)
Our pulmonologists staff the Christ Hospital Medical Intensive Care Unit and The Critical Connection (The Christ Hospital Electronic Intensive Care Unit). We also provide pulmonary support to two Long Term Acute Care Hospitals; UC Drake Hospital within The Christ Hospital and Select Hospital at Good Samaritan Hospital. We care for critically ill patients with severe diseases, both pulmonary and other medical conditions.
Our physicians also work with the emergency room physicians when needed. While they are not staffed in the emergency room, they are frequently called upon when additional assistance is need in caring for patients. Our physicians are all trained in all current emergency resuscitation and lifesaving skills needed to care for all types of patients.
Physicians can be called upon to perform emergency procedures such as intubation, thoracentesis, chest tube placement, central venous catheter placement and mechanical ventilation management. Our physicians may be called upon for assistance in any location in The Christ Hospital.
Critical Care Medicine, also known as intensive care unit medicine, is a subspecialty that involves caring for patients with complex, often life-threatening illnesses. These patients may have varying degrees of organ failure related to any number of diseases, such as severe infections, drug overdoses, gastrointestinal bleeding events, heart attacks, strokes, seizures, or other non-surgical illness. Critical care physicians also play a supportive role in post-operative patients who require mechanical ventilation or prolonged stays in the intensive care unit.
While in the intensive care unit, TriState Pulmonary doctors supervise and teach resident physicians.
Our physicians are all board certified in critical care medicine and provide a range of critical care services, including, but not limited to the following:
This procedure, performed after sedation is administered, is used to establish mechanical ventilation. A tube is inserted into the main airway, the trachea to allow positive pressure ventilation.
MANAGEMENT OF MECHANICAL VENTILATION
Mechanical ventilation is indicated for a variety of reasons, including life-threatening decreases in oxygen level, for airway protection in patients with decreased mental status, and in patients who have impaired gas exchange in the lungs.
CENTRAL VENOUS CATHETER PLACEMENT
A central venous catheter is an IV that is placed in a large vein in the neck, upper chest, or groin. These catheters, placed using sterile techniques under ultrasound guidance, are used to administer fluids and medications and to measure pressures in the blood vessels.
CHEST TUBE PLACEMENT
A chest tube is a small plastic tube inserted into the pleural spaceafter the patient is given adequate anesthesia. The chest tube is used to drain air or fluid from the pleural space, a potential space between the chest wall and lungs. Large fluid or air collections in the pleural space can lead to serious medical problems; tube placement allows proper drainage.
Bronchoscopy is a procedure performed after the patient is sedated with IV medications. Subsequently, a camera at the end of a thin scope is introduced into the lungs, typically via the nose or if the patient is mechanically ventilated, through the breathing tube. Because the patient is sedated, it is not typically an uncomfortable procedure. Bronchoscopy can be used to inspect the air pipes for abnormalities. Bronchoscopy can also be used to sample lung tissue in the evaluation of various diseases.
Tri-State Pulmonary Associates is committed to providing state of the art, efficient in the diagnosis and management of pulmonary diseases, critical illness, and sleep disorders. Our physicians, all of whom are board-certified in Pulmonology and Critical Care Medicine, and nurse practitioners supervise the care of patients in The Daniel Drake Long-term care unit located in The Christ Hospital.The expertise of UC Health’s Daniel Drake Center for Post-Acute Care is available at The Christ Hospital. This 26-bed, long-term acute care unit provides the same high level of care available at Daniel Drake Center’s Hartwell location for patients recovering from medically complex illnesses and injuries. The unit’s team of highly skilled, specialty trained medical professionals includes:
*Downloaded from http://uchealth.com/danieldrakecenter/locations-directions/christ-hospital-mt-auburn 4/2017
Tri-State Pulmonary Associates, partnered with The Christ Hospital, offers Critical Connections, an electronic intensive care unit, providing 24-hour critical care coverage to patients in the Intensive Care Units at The Christ Hospital.
This team monitors every aspect of the patient’s condition 24 hours a day, seven days a week. Vital signs, medications, test results, imaging results and other real-time information is monitored continuously. Critical Connections physicians and critical care nurses interpret this information and work with the bedside nurses and physicians to enhance care. Also, computers process the various pieces of patient-generated data, generating alerts to care providers when changes in clinical status are detected.
The Critical Connections nurses and physicians can electronically interact with the patient and staff via 2-way camera connections. This enables the patients to receive medical intervention right away. Patients take less time to recovery and spend less time in the ICU and hospital.
Excellent staff at the patient’s bedside, powerful technology, and board certified critical care physicians with critical care registered nurses in Critical Connections allow us to provide the very best care possible.
The Tri-State Pulmonary Associates Sleep Center specializes in diagnosis and treatment of sleep disorders. Our sleep center is staffed with board-certified sleep doctors who will work with you to assess and treat sleeping problems. Sleep disorders are conditions that prevent a person from getting restful sleep and, as a result, can cause daytime sleepiness and dysfunction. According to the National Sleep Foundation, about 70 million Americans suffer from a sleep disorder, but most of them go undiagnosed or under-diagnosed.
Sleep Conditions and Evaluation
There are approximately eighty different types of sleep disorders. Insomnia, sleep apnea, restless legs syndrome, and narcolepsy are the most important sleep disorders. Obstructive Sleep Apnea (OSA) affects an estimated 18 million Americans and occurs when the tongue and other soft tissues relax during sleep and obstruct the airway. This causes recurrent awakening and leads to daytime sleepiness or fatigue and increased risk of heart attack, stroke, weight gain, and high blood pressure.
For patients experiencing restless sleep, daytime sleepiness or insomnia, the first step is a comprehensive evaluation by one of Tristate Pulmonary Associates board certified sleep specialists; Dr. Karthik Kanagarajan or Dr. Sunil Dama to examine the cause of the sleep problem. Our registered sleep technologist and registered respiratory therapist work with our physicians to formulate your care plan to deal with any sleep or related health issues.
Since many sleep problems can be associated with lung disorders, having physicians dedicated in the care of pulmonary health truly makes for comprehensive care at Tristate Pulmonary Associates. Our sleep care physicians are not only board certified in sleep medicine but also in pulmonary and critical care medicine. You cannot find a more qualified team in the greater Cincinnati area.
Pre-Screening for Obstructive Sleep Apnea
To see if a sleep study might be necessary, please Click HERE to take our pre-screening questionnaire for Obstructive Sleep Apnea. These results will be sent to our office.
Epworth Sleepiness Scale
Click HERE to take the Epworth Sleepiness Scale questionnaire.
*Please share your results of this questionnaire with your doctor.
if you are suffering from insomnia; please document your sleep times in the sleep diary. This will help your sleep physician to understand your sleep pattern completely.
To print a sleep diary, Click HERE
*Please share your results of this journal with your doctor.
Common Sleep Problems
Snoring and Obstructive Sleep Apnea (OSA)
Obstructive sleep apnea (OSA) is the repeated collapse of the upper airway. Symptoms of OSA include snoring while sleeping, waking up at night and tiredness in the morning. Sleep study may be necessary to diagnose the OSA.
Insomnia is trouble falling asleep or staying asleep during the night and may be a symptom of other health problems. Insomnia can be caused by many factors, including psychological, environmental, lifestyle, or physical/psychiatric illness.
Narcolepsy is a tendency to sleep at inappropriate times and constant daytime sleepiness. Symptoms include excessive daytime sleepiness, sudden loss of strength in muscles, sleep attacks (sleep paralysis), and continual sleepiness and tiredness that cannot be fully relieved by any amount of sleep.
Restless Leg Syndrome
Restless legs syndrome (RLS) is an uncomfortable feeling that occurs in legs when they are still, especially at bedtime. RLS can interfere with travel or the use of transportation. It is important to determine whether there are any conditions (such as iron deficiency, kidney problems, diabetes, arthritis, etc.) which may be contributing to the RLS. Once these are treated or excluded, treatments of RLS include medications and, if necessary, iron supplements.
Excessive Daytime Sleepiness
Excessive daytime sleepiness (EDS) is a common complaint. According to the National Sleep Foundation 2000 Omnibus Sleep in America Poll: `a sizable proportion of adults (43%) report that they are so sleepy during the day that it interferes with their daily activities a few days per month or more; and, one out of five (20%) experience this level of daytime sleepiness at least a few days per week or more’. The most common cause of daytime sleepiness is insufficient sleep, which may reflect poor sleep hygiene (behaviors impacting sleep) or self-imposed or socially dictated sleep deprivation. Sleep-related breathing disorders and Periodic limb movements of sleep are also very common causes of daytime sleepiness. A variety of medical conditions may be associated with sleep fragmentation, including arthritis, fibromyalgia, spondylosis, chronic pain of any nature, asthma and chronic obstructive pulmonary disease.
Nightmares are vivid nighttime events that can cause feelings of fear, terror, and/or anxiety. Usually, the person having a nightmare is abruptly awakened from REM sleep and can describe detailed dream content. Usually, the person having a nightmare has difficulty returning to sleep. Nightmares can be caused by many factors including illness, anxiety, the loss of a loved one, or negative reactions to a medication. Call your doctor if nightmares occur more often than once a week or if nightmares prevent you from getting a good night’s sleep for a prolonged period of time.
A person experiencing a night terror or sleep terror abruptly awakes from sleep in a terrified state. The person may appear to be awake, but is confused and unable to communicate. They do not respond to voices and are difficult to fully awaken. Night terrors last about 15 minutes, after which time the person usually lies down and appears to fall back asleep. People who have sleep terrors usually don’t remember the events the next morning. Night terrors are similar to nightmares, but night terrors usually occur during deep sleep. People experiencing sleep terrors may pose dangers to themselves or others because of limb movements. Night terrors are fairly common in children occurring in approximately 5% of them mostly between the ages of three to five. Children with sleep terrors will often also talk in their sleep or sleepwalk. This sleep disorder, which may run in families, also can occur in adults. Strong emotional tension and/or the use of alcohol can increase the incidence of night terrors among adults.
Sleepwalking occurs when a person appears to be awake and moving around but is actually asleep. They have no memory of their actions. Sleepwalking most often occurs during deep non-REM sleep (stages 3 and 4 sleep) early in the night and it can occur during REM sleep in the early morning. This disorder is most commonly seen in children aged eight to twelve; however, sleepwalking can occur among younger children, the elderly and adults. Sleepwalking appears to run in families. Contrary to what many people believe, it is not dangerous to wake a person who is sleepwalking. The sleepwalker simply may be confused or disoriented for a short time upon awakening. Although waking a sleepwalker is not dangerous, sleepwalking itself can be dangerous because the person is unaware of his or her surroundings and can bump into objects or fall. In most children, it tends to stop as they enter the teen years.
Confusional arousals usually occur when a person is awakened from a deep sleep during the first part of the night. This disorder, which also is known as excessive sleep inertia or sleep drunkenness, involves an exaggerated slowness upon awakening. People experiencing confusional arousals react slowly to commands and may have trouble understanding questions that they are asked. In addition, people with confusional arousal often have problems with short-term memory and have no memory of doing these things the following day.
Rhythmic Movement Disorders
Rhythmic movement disorder occurs mostly in children who are one year old or younger. A child may lie flat, lift the head or upper body, and then forcefully hit his or her head on the pillow. Rhythmic movement disorder, which also has been called “head banging,” also can involve movements such as rocking on hands and knees. The disorder usually occurs just before a person falls asleep.
Sleep talking is a sleep-wake transition disorder. Although it usually is harmless, sleep talking can be disturbing to sleep partners or family members who witness it. Talk that occurs during sleep can be brief and involve simple sounds, or it can involve long speeches by the sleeper. A person who talks during sleep typically has no recollection of the actions. Sleep talking can be caused by external factors including fever, emotional stress, or other sleep disorders.
Nocturnal Leg Cramps
Nocturnal leg cramps are sudden, involuntary contractions most commonly of the calf muscles during the night or periods of rest. The cramping sensation may last from a few seconds to 10 minutes, but the pain from the cramps may linger for a longer period. Nocturnal leg camps tend to be found in middle-aged or older populations, but people of any age can have them. Nocturnal leg cramps differ from restless legs syndrome as the latter usually does not involve cramping or pain. The cause of nocturnal leg cramps is not known. Some cases of the disorder can occur without a triggering event, while other causes of leg cramps may be linked to prolonged sitting, dehydration, an overexertion of the muscles, or structural disorders (such as flat feet). Muscle-stretching, exercise, and adequate water intake may help prevent leg cramps.
People with sleep paralysis are not able to move their body or limbs either when falling asleep or waking up. Brief episodes of partial or complete skeletal muscle paralysis can occur during sleep paralysis. Sometimes sleep paralysis runs in families, but the cause of sleep paralysis is not known. This disorder is not harmful, but people experiencing sleep paralysis often are fearful because they do not know what is happening. An episode of sleep paralysis often is terminated by sound or touch. Within minutes, the person with sleep paralysis can move again. It may occur only once in your lifetime or can be a recurrent phenomenon.
Irregular Heart Rhythms
A cardiac arrhythmia – – the medical term for an irregular heart rhythm – – is a change from the normal rate or control of the hearts contractions. People who have coronary artery disease and whose blood oxygen is lowered by sleep-disordered breathing may be at risk for arrhythmias, which take place during REM sleep. Continuous positive airway pressure (CPAP) treatment may reduce this risk.
REM Sleep Behavior Disorder (RBD)
People with rapid eye movement (REM) sleep behavior disorder act out dramatic and/or violent dreams during REM sleep. REM sleep usually involves a state of sleep paralysis (atonia), but people with this condition move the body or limbs while dreaming. Usually, RBD occurs in men aged 50 and older, but the disorder also can occur in women and in younger people. It differs from sleep walking and sleep terrors in that the sleeper can be easily awakened and can recall vivid details of the dream. In the diagnosis and treatment of RBD, potentially serious neurological disorders must be ruled out. Polysomnography (sleep tests) and drug treatments also can be involved in the diagnosis and treatment of this disorder.
Sleep Bruxism (Teeth Grinding)
Sleep bruxism – – or teeth grinding – – involves the involuntary, unconscious, excessive grinding or clenching of teeth during sleep. It may occur along with other sleep disorders. Sleep bruxism may lead to problems including abnormal wear of the teeth and jaw muscle discomfort. The severity of bruxism can range from mild cases to severe cases that involve evidence of dental injury. In some cases, grinding can be prevented with the use of a mouth guard. The mouth guard, supplied by a dentist, can fit over the teeth to prevent teeth from grinding against each other.
Sleep Enuresis (Bedwetting)
In this condition, the affected person is unable to maintain urinary control when asleep. There are two kinds of enuresis – – primary and secondary. In primary enuresis, a person has been unable to have urinary control from infancy onward. Primary bedwetting appears to run in families. Children are more likely to have it if their parents or siblings had it as children. In secondary enuresis, a person has a relapse after previously having been able to have urinary control. Enuresis can be caused by medical conditions (including diabetes, urinary tract infections, or sleep apnea) or by psychiatric disorders. Some treatments for bedwetting include behavior modification, alarm devices, and medications.
Nocturnal Paroxysmal Dystonia (NPD)
This disorder is sometimes marked by seizure-like episodes during non–REM sleep. Most evidence points to NPD being a form of epilepsy. Episodes of NPD typically recur several times per night.
We are proud to offer in home sleep studies for our patients. Tri-State Pulmonary Sleep Disorder Center meets the strict standards of care set forth by the American Academy of Sleep Medicine (AASM). We also work with the Christ Hospital to provide in-lab sleep studies. All sleep studies are evaluated by a certified sleep medicine physician.
Home Sleep Study
Once evaluated, your doctor might recommend a sleep study if necessary to determine whether sleep apnea is contributing to your sleepiness. A home sleep study is a cost-effective way of screening for sleep apnea in the convenience of your own bed, which we recommend whenever possible. You will be seen by a sleep technician after the physician evaluation for a demonstration of how to conduct a proper home sleep study in the comfort of your own home environment.
In-Lab Sleep Study
If the physician feels that you are not a candidate for home sleep study testing, you will be referred to a sleep lab where you will undergo a sleep study to help diagnose your sleep problems. For sleep lab testing, patients arrive in the evening and are prepared by the sleep technician, who connects sensors at multiple points. The study is somewhat like spending a night in a hotel with the difference of having sensors attached to one’s body while being watched in a sleep. The patient is videotaped during the sleep study, while the sensors record leg movements, chest movements, heart rate, oxygen levels and snoring patterns. Breathing patterns and oxygen levels can then be correlated to sleep stages and sleeping positions. When clinically indicated, the patient can be assessed during the day, using a daytime study, called a multiple sleep latency test (MSLT). This measures the level of sleepiness experienced during the day and is especially helpful for diagnosing conditions like narcolepsy.
Treatment of Sleep Disorders
Our doctor recommends a customized treatment plan for each patient based on the severity of the condition and other compounding factors. Our treatment options are multi-dimensional, treating the needs of the whole person. Treatment plans include: weight loss intervention, medications, CPAP, BIPAP, AUTOPAP, dental appliances, CBT (Cognitive Behavioral Therapy) and Inspire sleep therapy. Changes in lifestyle may be prescribed, including weight loss, better sleep hygiene, and avoidance of substances such as coffee, tea, tobacco and alcohol.
The most effective treatment plan, with a success rate of 80 percent, is use of a continuous positive airway pressure (CPAP) machine. CPAP machines, typically covered by insurance under medical equipment, involve wearing a light mask over the nose during sleep. A small, quiet air pump attached to the mask with a long flexible tube sends pressured air through the narrowed nasal passages. The air pressure is customized to each patient so that it is gentle enough to allow normal sleep and breathing, but strong enough to prevent apnea and sleep interruptions. Our sleep center provides onsite education and set up of CPAP, BIPAP and AUTOPAP home health care devices. Our registered sleep technologist and registered respiratory therapist are specialists in sleep care therapy.
Cognitive Behavior Therapy
Cognitive Behavioral Therapy (CBT) helps you change actions or thoughts that hurt your ability to sleep well. It helps you develop habits that promote a healthy pattern of sleep. The most common forms of CBT include stimulus control, sleep restriction, relaxation training and biofeedback, cognitive control and psychotherapy, and sleep hygiene. (The American Associate for Sleep Medicine, http://www.sleepeducation.org/treatment-therapy/cognitive-behavioral-therapy)
Tri-State Pulmonary Associates one of the first sites in the United States to offer Inspire® therapy for people suffering from Obstructive Sleep Apnea (OSA). Inspire sleep therapy is the newest FDA approved fully implantable sleep therapy device used to treat moderate to severe obstructive sleep apnea. Inspire therapy utilizes first-of-its-kind technology—a small, fully implanted system that has been clinically proven to significantly reduce sleep apnea events and significantly improve quality of life measures.
This therapy represents a major advance in sleep apnea treatment, especially for vulnerable patients who cannot achieve benefit from CPAP. Untreated moderate to severe OSA places patients at increased risk for cardiovascular disease, accidents, and death. Inspire therapy provides us with an effective new treatment to use in a select group of our CPAP intolerant patient population.