Mid-South sleep specialists are able to treat patients more effectively than ever due to technological advances and a collaborative approach, yet according to two local physicians, challenges still remain in diagnosing and treating patients.
The medical community is more aware of sleep disorders, and physicians are more likely to refer a patient to a sleep specialist now than a decade ago, according to Neal Aguillard, MD, pulmonologist and medical director for Methodist Healthcare Sleep Disorders Center.
“The evolution of sleep medicine has changed drastically,” Aguillard said. “It is stressed more in medical school and through continuing education. Also, the patient teaches the physician. If a patient spends seven to eight hours in bed each night and is still sleepy, then something is wrong and the physician will refer the patient to us.”
As awareness of sleep disorders has increased, so has the demand for testing and treatment. Patients with suspected sleep apnea, which is the most commonly diagnosed sleep disorder, are sent to accredited sleep centers, where they are interviewed and evaluated overnight in a sleep laboratory. In the past decade, the number of accredited sleep centers has grown nationally from 566 to 2,258, according to the American Academy of Sleep Medicine.
The Methodist Healthcare Sleep Disorders Center read 4,000 sleep studies last year, Aguillard said. The center has seven specialists on staff certified to read sleep studies.
One of the largest hospital-based sleep disorder centers in the country, it treats various types of sleep disorders and sees patients from newborns to advanced age. The center is unique in that there is pediatric neurologist on staff who sees current and former cancer patients from St. Jude Children’s Research Hospital through a partnership between the two hospitals. According to Aguillard, 80 percent of patients treated at the center have some form of sleep apnea, which is when a patient pauses in breathing during sleep.
Aguillard’s team collaborates internally and meets weekly to go over patient cases anonymously to better service a patient’s needs.
“As physicians, we take a multi-disciplinary, team-based approach to diagnosis and treatment,” Aguillard said. “For instance, our neurologist could recommend a certain medicine for a neurological problem a patient may have. We may discover that we need to swap patients depending on the physician’s level of expertise. Each case is unique.”
It is not uncommon that a sleep specialist discovers that a patient has other health issues resulting from sleep deficiency, according to Amado Freire, MD, professor and chief of the University of Tennessee Health Science Center’s division of pulmonary, critical care and sleep medicine.
Additionally, Freire is the program director for the UTHSC fellowship program for sleep medicine. The fellows in the program train in sleep medicine at the Memphis VA Medical Center and Le Bonheur Children’s Hospital.
“We can sometimes find other potential issues when we treat a patient,” Freire said. “Patients who experience sleep deficiency are more likely to suffer from chronic diseases such as hypertension, diabetes, depression and obesity.”
Regarding other health issues discovered during a sleep study, Aguillard said, “For instance, we could determine through a sleep test that a patient has an arrhythmia and refer the patient to a cardiologist. It could be an incidental finding.”
In addition to physicians working together, technological advances have aided in the treatment in sleep disorders.
Typically, a patient who is diagnosed with obstructive sleep apnea must use a continuous positive airway pressure therapy (CPAP) machine to breathe more easily during sleep. A CPAP machine is a mask that covers the nose and mouth. It increases air pressure in a patient’s throat so the airway doesn’t collapse when a patient breathes. A patient must use the machine every night during sleep and is an effective, noninvasive way to treat sleep apnea.
“CPAP machines are very sophisticated now, “Aguillard said. “A decade ago when a patient used it at home, it gave the highest pressure for air flow no matter what. Now CPAP machines can sense when the air pressure should be higher or lower as the patient moves in his or her sleep. They allow us to download information to find out if the patient is using the machine every night at home and if the air pressure is varying. The patient doesn’t have to be seen in the office as much anymore. There is a transfer of data directly to the physician.”
However, insurance restrictions can be an issue for doctors wanting to perform sleep studies inside a sleep center laboratory.
“An overnight sleep study performed in a lab is very expensive and can cost around $3,000 to perform,” Aguillard said. “Commercial insurance won’t always cover it and will opt to cover a home sleep study instead. Sometimes a home screening isn’t always enough or as comprehensive.”
Monitoring patient’s sleep at home involves measuring a patient’s oxygen level, heartbeat, air flow and chest movement. In addition to these measurements, an overnight sleep study performed in a sleep center records and monitors a patient’s brain waves.
“A patient’s brain activity is monitored in a lab, and we can see what goes on inside a patient’s brain when they are asleep,” Freire said. “For example, a patient may only have seizures while he or she is asleep. We can observe and monitor this carefully in the lab. It’s highly effective.”
Aguillard points out that a technician observes the patient the entire time he or she is asleep when the study is performed inside a sleep center.
“At home, machines can be disconnected when a patient sleeps, and we don’t get as accurate data as we do inside a lab,” Aguillard said. “Someone is there constantly monitoring the patient and can adjust the equipment as needed.”
According to Freire, the Mid-South area is underserved due to a shortage of trained sleep specialists.
“There is an insufficient number of physicians to service the Mid-South community in sleep medicine,” Freire said. “The fellows we train are the next generation of providers. We hope they will stay in the area and practice here."
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