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from Prairie Business May 2019

For optimal performance, ‘measure the right things the right way’

it’s hugely important, say the region’s sleep specialists

FARGO, N.D. – In life as in investing, there’s no point in lamenting missed opportunities. The trick is to spot the next Apple, the next Microsoft, the next “big thing” before it rockets up the growth curve.

With that in mind, here’s our guess about a coming big thing in health care.

But be warned:

This news may literally put you to sleep. Here’s why we think sleep is likely to command ever-more attention from scientists, hospitals and society in years to come.

• It’s already happening. “Our Sleep Clinic has grown immensely in the past few years,” said Dr. Kevin Faber, neurologist and medical director of sleep medicine at Sanford Health in Fargo.

“When I got here 12 years ago, I was the second physician; we also had a couple of mid-level providers and a handful of technicians.

“Now, we have triple all of that.” Sanford’s Sleep Clinic is up to 10 beds, 10 providers and 25 technicians and is poised to keep growing.

And Sanford’s not alone. Nationwide, there were very few sleep centers in the 1970s. There are more than 3,000 of them today, including in Fargo, Bismarck, Sioux Falls and other Prairie Business cities, where most major hospitals have one.

Moreover, the market for sleep apnea diagnostic and therapeutic services is expected “to proliferate at a compound annual growth rate of 6 percent during the forecasting

By Tom Dennis

years of 2019-27,” MarketResearch.com is predicting this year.

• The science is still young. “Sleep up until the 1980s was ignored, really,” said Dr. Shaun Christenson, neurologist and sleep-medicine specialist at Essentia Health’s Sleep Study Lab in Fargo.

medical testing procedures, such as brainwave testing for seizures,” Christenson said.

“We saw people stop breathing while they were asleep, for example. And we started wondering, ‘Well, does that have any implications for them?’

“And sure enough, it does.”

In fact, those implications are huge. “Sleep is a large component of our health, and not just cognitive status and mental health,” Christenson said.

“Sleep disorders with sleep deprivation will lead to more risk of cardiovascular diseases such as heart attacks and strokes, and maybe even of cancer.”

Then there’s the impact that sleep – and the lack of sleep – have on performance.

“I had the good fortune of addressing the Bison football team at North Dakota State University a few weeks ago.” Faber said. “And for the first half-hour, I talked with them about how if you want to perform at your peak on the field, you’ve got to protect your sleep.”

When varsity men’s basketball players at Stanford slept longer, their sprinting times and shooting skills improved, researchers found. When varsity college tennis players did the same, they served more accurately.

“Except for occasional circumstances, we thought of it as just a time when you are resting, you are unconscious. And not much else about it was known or was looked into.”

But around that time, researchers noticed “that people were doing odd things during various

Concluded the latter study, “An increase in sleep of approximately two hours per night significantly increased athletic performance in college varsity tennis players.”

And that finding shows up in all aspects of performance, not just sports, as anyone who has driven while drowsy knows.

DR. KEVIN FABER, NEUROLOGIST AND MEDICAL DIRECTOR OF SLEEP MEDICINE AT SANFORD HEALTH IN FARGO, HOLDS AN INSPIRE IMPLANTABLE DEVICE WHILE SITTING ON A BED IN THE SANFORD SLEEP CLINIC. THE INSPIRE DEVICE -- A TREATMENT FOR OBSTRUCTIVE SLEEP APNEA -- MILDLY STIMULATES THE NERVES THAT CONTROL AIRWAY MUSCLES, KEEPING THEM OPEN. IMAGE: NICK NELSON/FORUM NEWS SERVICE

• Some key gains are immediate. When people stop smoking, they’re often hoping to avoid diseases decades from now. When they exercise, they’re likewise trying to improve their long-term odds.

But when sleep-apnea patients at CHI St. Alexius Health’s Sleep Center in Bismarck first put on a CPAP machine, they often feel better within hours, said Tara Vander Laan, respiratory therapist and lead sleep tech at the center.

“The rooms in our Sleep Center look like hotel rooms,” Vander Laan said. “We have queen-size beds, your own TV, your own little bathroom.”

The difference is that the nightstand is full of sleep equipment, and patients get “wired up” for their overnight sleep study before bed. The electronic monitors read heart rate, breathing, brain waves, blood-oxygen levels and other indicators, and the data gets watched all night long by a technician down the hall.

“Sometimes, if the patient stops breathing enough times, the technician will wake them up and put a CPAP mask on them,” Vander Laan said.

“Then in the morning, I’ve heard patients say, ‘I can’t believe it’s morning already,’ ‘I feel so great,’ ‘I haven’t slept that well in years,’ and ‘I don’t think I’ll even need a nap today.’

“It’s the best part of my job,” she said.

Sanford’s Faber agreed. “Fix your sleep now, and over the next few days, watch yourself start to feel better,” he said.

“It’s a very rapid response when we start fixing our sleep. And if it’s something very specific – like obstructive sleep apnea – that’s affecting their blood pressure, blood sugar, cardiac rhythm and cognitive functions, those things also may improve starting right away.”

That’s why psychiatrists, cardiologists and diabetes specialists, among other providers, have started referring patients to sleep centers, he said. They’ve learned it’s very hard to control conditions such as high blood pressure or diabetes in patients with untreated sleep apnea.

• The more we learn, the more we’re fascinated by sleep. You may think we “turn ourselves off” at night, during sleep. But in fact, “sleep is a whole lot more complicated, and it’s a much more active state than you might think,” reports Sleep.org, the website of the National Sleep Foundation.

HEALTHCARE

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WHEN ACTIVATED BY THE REMOTE (CENTER), THE SURGICALLY IMPLANTED INSPIRE DEVICE (BOTTOM RIGHT) GENERATES A PULSE THAT OPENS KEY AIRWAY MUSCLES DURING SLEEP. IMAGE: NICK NELSON/FORUM NEWS SERVICE

“In fact, while you’re getting your zzz’s, your brain goes through various patterns of activity. It’s a predictable cycle that includes two distinct parts – NREM, or Non-REM sleep, plus a REM or ‘Rapid Eye Movement’ cycle.”

During NREM sleep, our bodies slip from drowsiness to deep sleep. During deep sleep – an especially restorative period -- the brain produces slow-frequency delta waves, and “the body repairs muscles and tissues, stimulates growth and development, boosts immune function and builds up energy for the next day,” Sleep.org reports.

Try to wake a person during this period, and it’s almost like waking a bear.

Then comes REM sleep, an enchanting aspect of human life. REM sleep is dream sleep – the period when most dreaming occurs. And it’s

Z Z Z Z TWITTER.COM/PRAIRIEBIZ FACEBOOK.COM/PRAIRIEBUSINESS PRAIRIEBUSINESSMAGAZINE.COM 22 marked not only by your eyes jerking rapidly, but also by near-paralysis of the rest of your body, plus brain-wave patterns so active that they’re hard to tell apart from wakefulness.

What’s the point?

“We don’t yet know,” said Christenson of Essentia.

“Processing memories; that’s probably what’s going on. One of the best analogies I’ve heard is this: A neuron looks like a tree, and you literally have trillions upon trillions of connections between neurons in your brain.”

That’s more connections than there are stars in the sky, he said.

“And when you dream, what’s probably happening is that you are pruning the branches of that tree, so it has appropriate connections and our memories and cognitive functions are stable.”

• Sleep disorder treatments continue to improve. Here’s one of the most recent and novel: The Inspire device.

Approved for patients who have moderate to severe sleep apnea and have failed CPAP therapy, the pacemaker-sized Inspire unit gets implanted just below the collarbone. One lead from the device senses breathing, while the other mildly stimulates key airway muscles, opening them.

“So, people who don’t tolerate CPAP are learning they have another option,” Faber said.

“It’s not just, ‘I’m going to wait to have a heart attack’ or ‘I’m not going to admit that I’ve stopped using my device.’ It’s ‘I’m going to seek treatment, because I’m tired of being tired.’”

Sanford Fargo is one of the few centers in the region where the Inspire treatment is available, Faber said.

“Sleep is one-third of our life, but it’s a third that people have kind of pushed aside,” Faber said.

“But now we know that if we ignore that third of life, it’s probably going to affect the other two-thirds, because the quality and continuity of our sleep directly impact metabolism, cognitive function and cardiovascular function head to toe.

“And it doesn’t matter how or why you become sleep deprived. The effects are going to be felt the next day and over the years, metabolically.

“It’s important stuff.”

Tom Dennis Editor, Prairie Business

701-780-1276 tdennis@prairiebusinessmagazine.com