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School of Medicine
NeuroNow - The Sleep Center is Booming
The Sleep Center is Booming
Date: June 1, 2009
Rachel Salas and Charlene Gamaldo bring an uncommon perspective to a common problem.
Are you already on your third cup of coffee this morning? Can’t remember a time you felt well-rested? It’s no wonder: We’re a sleep-deprived society.
Most Americans get less than seven hours of sleep per night, according to the Johns Hopkins Sleep Disorders Center. Yet current research indicates most people require seven and a half to eight and a half hours of sleep nightly to function their best—emotionally, cognitively and physically. Furthermore, sleep deprivation can magnify the severity of other sleep disorders, including sleep apnea and restless legs syndrome.
The Sleep Disorders Center takes a wide-ranging approach to sleep medicine, a young discipline that has only recently been acknowledged by the American Board of Medical Specialties. Once the sole domain of pulmonologists, sleep medicine now involves neurologists, psychiatrists, otolaryngologists, pediatricians and even dentists.
“What’s really interesting about sleep medicine is that by having those different backgrounds, specialists can bring their unique perspective to the research and clinical aspect of sleep,” says Assistant Director Charlene Gamaldo, who was recruited in 2006 as the first neurologist at the Sleep Disorders Center. She was joined two years later by neurologist Rachel Salas.
Sleep apnea is one of the most common reasons patients are seen in the sleep center. People with sleep apnea stop breathing repeatedly during the night, often waking up multiple times without being aware of it. During each apnea event, their lungs collapse like a deflated balloon, and blood oxygen levels can drop. “So in the morning, they don’t feel rested and restored because throughout the night, they’re basically suffocating,” says Gamaldo. Not only does sleep apnea result in extremely fragmented and poor-quality sleep, it may be linked with risk factors for heart disease, hypertension and stroke.
Most often, patients are diagnosed with a combination of sleep issues. “We treat patients with narcolepsy, restless legs syndrome, periodic limb movements, circadian rhythm disorders,” says Salas. “Many patients who come in for sleep apnea end up having one of these other conditions. We tackle the whole picture.”
They start by performing a thorough sleep history on each patient. If they suspect sleep-disordered breathing, they may order a sleep study. In that case, patients spend a night at the center, bringing along their usual things from home, like their toothbrush and pajamas. In a private room, they’re hooked up to EEG leads on their head and face to monitor muscle tone and eyelid movements, and to other monitors that examine airflow, respiratory efforts and leg movements.
Sometimes, a patient presents such a textbook case of sleep apnea that it can be diagnosed in a couple of hours. Treatment is often the therapeutic CPAP breathing device, which stands for continuous positive airway pressure.
“If we suspect a patient may possibly have narcolepsy or idiopathic hypersomnia [sleepy all the time for no apparent reason], we do an overnight sleep study followed the next day by a series of nap challenges so we can gauge the degree of sleepiness,” says Salas. No matter what issues a patient comes in with, treatment always includes not only diagnostic components, but education and counseling as well.
“As physicians and particularly as neurologists, we may not always have a cure or treatments for the medical conditions that we diagnose,” says Gamaldo. “But that’s not the case with sleep medicine, which now offers excellent options—ranging from behavioral,pharmacologic and surgical techniques—for all of the sleep conditions that we treat. In many cases our treatments can even be curative, as in the case of CPAP therapy for sleep apnea or treating iron deficiency in restless legs syndrome. Regardless of the condition, we help patients make considerable improvements in their quality of life and overall well-being.”
For more information: 443-287-3313 or hopkinsmedicine.org/neuro