Minnesota Health care News September 2011

Page 8


& Jason Cornelius, MD Dr. Cornelius is a board-certified neurologist and sleep specialist practicing with the Minneapolis Clinic of Neurology at their Golden Valley and Maple Grove locations. He is also associate medical director of the North Memorial Sleep Health Centers in Robbinsdale and Maple Grove. What is “sleep medicine”? Sleep medicine is a specialty dedicated to the diagnosis and management of sleep disorders, which affect more than 70 million people in the U.S. There are more than 80 different conditions recognized by the International Classification of Sleep Disorders. We have become increasingly aware of the important consequences that sleep disturbance has on quality of life and overall health. What special training is required to become a sleep medicine doctor? The practice of sleep medicine is multidisciplinary, so its specialists come from a variety of medical training/degree backgrounds including neurology, pulmonology, psychiatry, pediatrics, and otolaryngology. In order to be recognized by the American Board of Sleep Medicine, providers must pass a certification exam in addition to either satisfying practice experience requirements or completing a 12-month fellowship program. What are some common reasons to see a sleep medicine doctor? The most common complaints are difficulty falling asleep or staying asleep, feeling excessively sleepy during the day, and trouble maintaining a regular sleep/wake cycle (usually due to shift work). The underlying problem can range from mild to life-threatening. People become concerned when they experience poor memory/concentration, low motivation, irritability, and/or inappropriate dozing—particularly drowsiness when driving. Patients or their bed partners may also recognize characteristic features of disorders like obstructive sleep apnea, restless legs syndrome, and narcolepsy. What causes obstructive sleep apnea? What are the signs and symptoms? Obstructive sleep apnea (OSA) is caused by a collapse or a narrowing of the upper airway. Normal physiologic changes that take place during sleep can promote OSA in patients with susceptible anatomic features like a large tongue base or extra fatty tissue around the neck. Snoring and pauses in breathing during sleep are clues that the upper airway is narrowed. OSA often leads to daytime sleepiness because sleep at night is fragmented when the brain is woken due to upper airway narrowing. OSA also contributes to a number of serious health problems like high blood pressure, diabetes, heart attack, and stroke.

Photo credit: Bruce Silcox

Are there any new advances in the treatment of obstructive sleep apnea? Continuous positive airway pressure (CPAP) remains the first-line therapy for OSA. Unfortunately, a significant percentage of patients become noncompliant with CPAP. A promising alternative is an upper airway stimulation device. It is implanted like a pacemaker and stimulates a nerve activating muscles that move the tongue forward to prevent collapse of the upper airway during sleep. The patient can activate the device at bedtime using a handheld programmer. The North Memorial Sleep Health Centers in Robbinsdale and in Maple Grove are participating in a study to prove that the device is safe and effective. What kind of metrics and devices are typically used in an overnight sleep study? An overnight sleep study, or “polysomnogram,” involves sleeping overnight in a



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