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By Pacific Sleep Program
October 15, 2019
Category: Services

If you need to undergo a sleep study find out what to expect.

Has one of our Portland and Astoria sleep medicine physicians Dr. Gerald Rich, Dr. Radhika Breaden or Dr. Jennifer Kim told you that you doctorscould benefit from a sleep test, also known as polysomnography? If so, it could be because the symptoms you’re experiencing are warning signs of insomnia, sleep apnea or other sleep disorders. The sooner these sleep disturbances are identified the sooner we can help you get a better night’s sleep. So, here’s what to expect from your overnight exam:

 

It’s Non-Invasive

There is nothing painful or invasive about a sleep study. While you will stay in our modern sleep center overnight we will monitor your brain and bodily activity while you sleep. During the test, you will have sensors placed on certain areas of your head and body to measure everything from blood oxygen levels and heart rate and rhythm to body movement and snoring. The electrodes will not cause discomfort or pain.

 

Bring Your Sleepwear

Just because you are sleeping somewhere new doesn’t mean that you can’t bring along the items that help you sleep. Feel free to bring any personal items that make you feel more comfortable, such as pajamas. We will place the sensors on your body before you go into the room. The private room will be dark and prepped for sleep. Of course, if you have trouble sleeping do not worry. We will still be able to collect the data we need even if you do not get a full night’s rest.

 

You’ll Have to Wait for Results

The results will not be immediate. We will collect the data and then one of our doctors will need to go through the findings. This can take up to one week or more. We will schedule your follow-up appointment so that we can go through your results and then talk to you about any recommended treatment options if you do have a sleep disorder.

 

Test for All Sleep Problems

Dealing with frequent morning headaches? Experiencing extreme daytime fatigue despite getting a full night’s rest? These symptoms could be a sign of a sleep disorder. Unfortunately, many people have problems like sleep apnea and don’t even know it. Furthermore, some sleep disorders can affect your health, so it’s important that you seek proper care if you are experiencing difficulty sleeping. A sleep test can help diagnose,

  • Narcolepsy
  • Sleep apnea
  • Parasomnias
  • Insomnia
  • Circadian rhythm disorders

 

Having trouble falling or staying asleep? Not feeling rested after sleep? If you are dealing with these issues in Astoria or Portland, OR, then call Pacific Sleep Program today to schedule an evaluation. Call Pacific Sleep Program in Portland at (503) 228-4414 or in Astoria at (503) 325-3126.

By Pacific Sleep Program
September 04, 2019
Category: Sleep Apnea
Tags: Narcolepsy  

Learn more about this sleep disorder that affects nearly 3 million people worldwide.

Narcolepsy is a sleep disorder that is believed to affect around 1 in every 2,000 people in the US. Unfortunately, it’s believed that only sleep-apneaabout 25 percent of people with this condition have actually been diagnosed and properly treated. From the office of our Portland and Astoria sleep medicine physicians, Dr. Radhika Breaden, and Dr. Jennifer Kim, here’s what you should know about this sleep disorder.


 What are the symptoms of narcolepsy?

The most obvious symptom of narcolepsy is excessive daytime sleepiness. Those with narcolepsy will experience daytime drowsiness even after getting adequate total sleep time on a regular basis. 

Unlike stereotypical portrayals of narcolepsy in the movies and on the internet, patients with narcolepsy do not typically fall asleep while talking or suddenly slump in the middle of an activity unless their narcolepsy is severe, which is very rare. Instead, most patients with narcolepsy live with their excessive daytime sleepiness during the day and try to control it with caffeine and brief naps whenever they can. However, despite these measures, the sleepiness affects their daily life and function. 

Other symptoms of narcolepsy can include sleep paralysis (waking up during the night with the body feeling paralyzed), hypnagogic or hypnopompic hallucinations (seeing visions or hearing things that are not there as you are falling asleep or waking up) although these symptoms may also be noted with other sleep conditions including sleep deprivation and obstructive sleep apnea. 

Some patients may also have cataplexy. The term cataplexy describes the loss of muscle control in the head, neck or shoulders or buckling of the knees during a time of intense emotion, such as laughter or surprise. Not all patients with narcolepsy have cataplexy. However, the presence of cataplexy can suggest that narcolepsy is present. 
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 When should I see a sleep medicine specialist for consultation?

If you are dealing with the above symptoms and suspect that narcolepsy may be present, it’s important that you turn to our sleep specialists in Portland and Astoria, OR, to find out what’s going on.
 

 How is narcolepsy diagnosed?

In order to be diagnosed with narcolepsy, our sleep doctors will need to perform certain tests. After a careful history, we may recommend a combination sleep study called a Polysomnogram with Multiple Sleep Latency Test (PSG with MSLT).  During a sleep study, we will apply electrodes to the body to record everything from breathing patterns and movement to brain activity while you sleep. If the overnight polysomnogram does not show a clear explanation for the excessive daytime sleepiness, we proceed with the daytime napping test (MSLT) the next day. During the MSLT, a patient will attempt to nap every 90-120 minutes. By observing how rapidly a patient falls asleep and what stages of sleep are noted, Dr. Kim or Dr. Breaden will then determine whether narcolepsy is likely to be present. 

The preparation for a PSG with MSLT follows a standardized protocol which includes adequate total sleep time for the weeks prior to testing, the absence or complete treatment of other sleep disorders such as obstructive sleep apnea, the elimination of medications which may affect testing as well as the elimination of caffeine in the two weeks prior to testing. 
 

How is narcolepsy treated?

Your treatment plan will often include medication and lifestyle modifications to help manage your symptoms and help you get more restorative sleep. Dr. Kim and Dr. Breaden will work with you to find the right medication and treatment options to alleviate your symptoms. 

You may be prescribed medication to control sleepiness and REM sleep intrusion (sleep/wake cycle). In addition to many traditional wake promoting agents, there are several newer medications that may be helpful in promoting more restorative sleep. 
 

Next steps:

If you, a friend or a family member is displaying symptoms of narcolepsy or any other sleep disorder, a consultation with our sleep medicine team may help to determine the next steps in evaluation and treatment. Call Pacific Sleep Program in Portland at (503) 228-4414 or in Astoria at (503) 325-3126. 

By Pacific Sleep Program
June 04, 2019
Category: Sleep Apnea
Tags: sleep apnea  

Sleep apnea isn’t something that you can just treat on your own—it requires proper evaluation and treatment from board certified sleep sleep-apneaapnea doctors in Portland and Astoria, OR, who can determine not just the severity of your sleep disorder but also help you determine the treatment that is right for you. 

That's why our sleep medicine team including Dr. Radhika Breaden and Dr. Jennifer Kim are here to provide you with the care you need to understand and manage your sleep apnea. 

Symptoms of sleep apnea include

  • Snoring
  • Pauses in breathing throughout the night
  • Gasping sounds while sleep
  • Daytime fatigue
  • Trouble concentration
  • Mental fog
  • Increased irritability
  • Depressive or anxiety symptoms
  • Insomnia or restless sleeping
  • Morning headaches
  • Waking up during the night to urinate
  • Acid reflux/heartburn during the night
  • Tooth grinding 

Not all patients with sleep apnea have all or most of these symptoms. The symptoms can also vary in severity based on age. For example, in a child, sleep apnea may manifest as issues of attention or hyperactivity. For women, symptoms may include insomnia alone without any other observed symptoms. 

In order to determine whether sleep apnea is present, we may consider either home sleep testing or in-laboratory sleep testing (at our clinic). There are pros and cons to both types of testing, which we will review with you at the time of your initial consultation. 

Once you’ve undergone a sleep study, the next step is to create a treatment plan for you. This treatment plan will be based on how severe your sleep apnea is as well as other factors, including changes in severity based on position, stage of sleep and other medical conditions you may have. At your follow up appointment, we will review all treatment options including PAP (positive airway pressure), oral appliance therapy, surgery, Inspire neurostimulator therapy, Provent therapy and positional therapy. 

Many patients can also benefit from lifestyle modifications that can help reduce symptoms. Certain lifestyle modifications that our sleep specialists in Portland and Astoria, OR, may recommend include,

  • Losing excess weight or maintaining a healthy weight
  • Quitting smoking
  • Avoiding or limiting alcohol, caffeine, and sedatives

While lifestyle changes can reduce the severity and frequency of your symptoms, you may also require additional treatment, depending on the severity of your sleep apnea. 

One common treatment option is CPAP therapy, in which the patient wears a mask interface over their nose and/or mouth. The mask is attached to a machine that generates a gentle air pressure to apply just the amount of pressure needed to keep the airways open and to prevent airflow obstruction. 

Many patients may also benefit from getting oral appliance therapy. Using a custom-made device that fits over the upper and lower teeth, oral appliance therapy repositions the jaws to prevent the collapse of tissues in the back of the throat. 

Surgical options including the UPPP (uvulopalatalpharyngoplasty) in which the uvula and part of the palate are removed, as well as the MMA (maxillomandibular advancement) in which both the upper and lower jaw are advanced forward to provide more airway space. These surgeries are performed by ENT (Ear, Nose and Throat) surgeons. 

A newer option for treatment is the Inspire neurostimulator therapy, in which an implantable device has electrodes which stimulate the airway muscles to provider structure and tone during the night. Inspire surgery is used in patients who have moderate or severe obstructive sleep apnea with a BMI (body mass index) of 32 or less. 

Other options including positional belts and collars as well as Provent therapy, which are nasal expiratory pressure stickers for the nasal passages that are used predominantly when camping or travelling internationally. 

Pacific Sleep Program has two offices to ensure that patients living in Portland and Astoria, OR, get the comprehensive sleep care that they need. If you suspect that you might be dealing with sleep apnea, we recommend that you schedule a sleep medicine consultation with our clinic. 

By Pacific Sleep Program
March 28, 2019
Category: Sleep Apnea
Tags: Sleep and Weight  

We know that sleep and weight are closely related. A significant amount of metabolic regulation, including the regulation of insulin (which weightregulates our blood sugar), leptin (which regulates our body weight and set point) and ghrelin (which regulates our appetite and sense of feeling full) occurs during sleep. 

We also know that when our weight goes up, it will increase our risk of certain sleep disorders, such as obstructive sleep apnea. As we gain weight, the fat pads by our neck and along our chest wall and abdomen get bigger, which makes it even harder to open the airway and to breathe. 

We know that when sleep is affected, including when we do not get enough sleep or when our sleep is poor quality, our weight goes up. We also know that when our weight goes up, it affects our sleep. It is a vicious cycle. 

At Pacific Sleep Program, we understand this relation and want to help break this vicious cycle by focusing on helping you to get healthy sleep which may in turn help your metabolism and help you lose weight. 

A recent study, which was presented at the Endocrine Society (ENDO) 2019 Annual Scientific Sessions in New Orleans, LA, found that OSA patients undergoing CPAP treatment lost an average of 5.7 pounds more in 16 weeks than OSA patients who did not receive CPAP therapy.

Also per several studies, when people do not get enough sleep, either due to chronic sleep deprivation, insomnia or circadian rhythm disorders, they are more likely to gain weight. 

Contact us at Pacific Sleep Program at our Portland or Astoria location to learn more about how we can help you with your sleep and how this may help you in your journey toward a healthy weight.

By Pacific Sleep Program
March 28, 2019
Category: Health
Tags: Insomnia  

Many people think of insomnia as one specific problem with one treatment. However, just as any type of pain can represent different Insomniacauses in different people, insomnia has different causes in different people. 

First of all, insomnia is often a symptom of some other disorder. Insomnia is defined as any one of 4 basic symptoms – difficulty falling asleep, waking up during the night and having difficulty getting back to sleep, early morning awakening insomnia and nonrestorative sleep insomnia. People can experience more than one of these symptoms.

Insomnia can occur for many reasons. It is often due to another undiagnosed sleep disorder, such as a circadian rhythm disorder (sleeping on a different clock, such as shift work or being on call or circadian rhythm delayed sleep phase, being a natural night owl), sleep apnea/sleep disordered breathing, periodic limb movement disorder but can also be due to mood disorders (it can herald the onset of depression or anxiety disorder or a substance abuse disorder) or be a residual effect of a previous episode of a mood disorder. It can be due to medications or pain issues as well. Unlike other fields of medicine, patients with sleep disorders often have more than one underlying sleep disorder, and all of them need to be treated.

In order to clearly understand insomnia, we need to take a very thorough history of the predisposing factors (“Why me?”) such as genetic insomnia tendency or mood disorders, the precipitating factors (“What got it started?”) such as abuse issues leading to hypervigilance, transitions including parenthood, stressors, shift work in the past, etc., and the perpetuating factors (“Why is insomnia STILL happening?”). 

Our goal during our consultation is to isolate all of the possible perpetuating factors and put together a plan to diagnose and treat these factors. This may involve further testing or other treatment protocols that we approach and apply in a systematic manner. 

Once the above has been addressed, many patients have a conditioned insomnia, in which the brain has been conditioned to have awakenings or arousals. The brain then needs to be retrained on how to sleep again because the coping mechanisms that people adopt for insomnia usually worsen the insomnia – for example, sleeping late because they “did not get a wink all night”, getting up to do relaxing activities or work during the night, “because since I can’t sleep, I might as well do something”, etc.

Many patients ask about using sleeping pills. There are no medical studies that show that the use of long term sleeping pills are either recommended or helpful in insomnia except in certain rare cases, such as after severe traumatic brain injury or other similar conditions. However, sleeping pills may be considered for brief periods if indicated due to particular stressors. The chronic use of sleeping pills is associated with multiple risks, including dementia and fall risks. Some sleeping pills can also be addictive and can cause a rebound insomnia, which can cause a more severe insomnia if the pills are discontinued. 

More importantly, sleeping pills do not actually cure insomnia. A person can take sleeping pills for decades, and at the end of it, they will still have insomnia. The pills have only masked the insomnia. Masking the insomnia problem with pills is not the same as curing the insomnia. Proper treatment of insomnia requires thorough consultation and treatment of all perpetuating causes as well as more detailed treatments such as Cognitive Behavioral Therapy for Insomnia (CBTI). 

Insomnia treatment can be challenging. A nice introduction to insomnia treatment that we sometimes recommend is a book called "Say Goodnight to Insomnia" which outlines some of the strategies that are used in Cognitive Behavioral Therapy for Insomnia. 

For a thorough evaluation for your sleep problems, we recommend that you contact us at our Portland or Astoria location and schedule a consultation. 





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