Combating Sleep Woes

Johns Hopkins Integrated Sleep Medicine treats sleep apnea and other disorders.

Published in Dome - March 2016

At first, Susan Franklin blamed her dog.

When Franklin’s husband gently broached the topic of the increase in her snoring, the Johns Hopkins administrator was horrified. She suggested that their Chihuahua, Louie, who slept nearby, was the culprit.

“It can’t be me,” Franklin told her husband. “I’ve never snored in my life!”

Nevertheless, the senior director of accreditation and certification, who makes sure The Johns Hopkins Hospital meets the high standards of the Joint Commission and other quality agencies, had to admit that something might be wrong with her sleep. “I had been dragging myself up in the morning, never feeling like I had refreshing sleep,” Franklin recalls. “Despite being in bed for eight hours or so, I felt like I only had an hour’s sleep.”

After visiting pulmonologist and sleep specialist Susheel Patil, clinical director of Johns Hopkins Sleep Medicine, Franklin agreed to undergo a sleep study to determine whether her sleep was being disrupted.

According to the National Institutes of Health, as many as 70 million U.S. adults have sleep disorders, which are associated with a growing list of serious health risks. Chronic sleep problems have been linked in recent years to heart disease, stroke, diabetes, obesity, cancer and high blood pressure.

Franklin underwent her sleep study at the Johns Hopkins Outpatient Center. “The staff was really welcoming,” she says. “I went in about 9 at night, they stuck some electrodes to me and I was all tucked in by 10 o’clock.”

The sleep clinic in the Outpatient Center is one of six hospital-based clinics run by the Johns Hopkins Health System across the Baltimore-Washington region. Other locations of Johns Hopkins Integrated Sleep Medicine are at Johns Hopkins Bayview, Howard County General Hospital, Mt. Washington Pediatric Hospital, Sibley Memorial Hospital and the Johns Hopkins Children’s Center. Each facility contains specialists in various sleep disorders.

Sharing Resources, Extending Services

Michael Cole, the administrative director for integrated sleep medicine, explains that the idea to integrate the sleep centers arose two years ago.

“A lot of great work in sleep medicine was happening at various Johns Hopkins institutions, but it was happening independently,” says Cole, who emphasizes that the integration is ongoing. “So we’re bringing it together. For example, why shouldn’t patients at Sibley benefit from expertise at other Johns Hopkins hospitals?”

The Johns Hopkins Health System also maintains part ownership in Sleep Services of America (SSA), a company that offers physicians and patients diagnostic and treatment services for sleep disorders. SSA spans seven states and performed more than 28,000 diagnostic sleep studies last year.

Johns Hopkins Pharmaquip Respiratory and Home Medical Equipment Services, a part of Johns Hopkins Home Care Group, works closely with Johns Hopkins sleep centers and SSA throughout Maryland, the District of Columbia and Northern Virginia. Pharmaquip’s licensed respiratory therapists collaborate with sleep specialists to help manage patients’ therapy and respiratory equipment at home.

Patil says that having a medical equipment company in house makes for smooth care transitions for patients. “It’s better than the fractured care patients might receive at other centers.”

“Like Night and Day”

When Franklin awoke at the Outpatient Center the morning after her sleep study, she left behind valuable data that her movements, oxygen levels and brainwaves generated while she slept. Based on that information, Patil diagnosed Franklin with sleep apnea.

During sleep, the soft tissue at the back of the throat can collapse, either partially or fully, causing temporary suspension of breathing, or apnea. Partial collapses lead to snoring and difficulty breathing. A fully collapsed airway stops breathing altogether. In both instances, the brain sends a wake-up signal to the sleeper, interrupting the sleep to take a breath. The end result is that sleep apnea causes fragmented sleep and insufficient rest.

According to the National Sleep Foundation, more than 18 million Americans have this disorder, although most do not realize it. Risk factors include being male, over 40 and overweight, but sleep apnea can strike anyone at any age.

Patil says sleep apnea is the leading diagnosis in his practice, but it is only one of many sleep disorders. Insomnia, narcolepsy, sleep-related movement disorders and parasomnia—abnormal behaviors, movements or perceptions that occur between stages of sleep—are a few.

“Within Johns Hopkins Sleep Medicine, we see a broad range of patients,” says Patil. “It’s a multidisciplinary group, with pulmonologists, neurologists, psychiatrists and anesthesiologists.”

Franklin credits her visit to Patil with a life-changing, newfound energy. Because of her sleep apnea diagnosis, she was prescribed a continuous positive airway pressure, or CPAP, machine to wear during sleep, which was provided by Johns Hopkins Pharmaquip.

“It’s like night and day,” she says. “I can’t begin to tell you how much better I feel. I wake up refreshed and rested, ready for the day. I wouldn’t think of going a night without it.”

She acknowledges some initial embarrassment in discovering the truth about the snoring issue. “Nobody wants to find out that they snore,” she says. “But my husband was really understanding and sensitive about it.”

And so was Louie the Chihuahua.