Sleep medicine is a medical subspecialty that focuses on diagnosing and treating sleep disorders and other problems leading to sleep disturbance.
Sleep medicine examines the functions of the entire body - the state of the lungs and breathing, the circulatory system, the endocrine system, the musculoskeletal and nervous systems, as well as the mental state of patients.
Sleep disorders can be isolated, but they can also be part of a primary disease.
Difference between sleep medicine and neurology
Often patients who suffer from sleep disorders seek out neurology specialists to help them, for this it is important to highlight the difference between sleep medicine and neurology. Neurologists are physicians who specialize in diagnosing and treating diseases or functional problems of the brain, spinal cord, peripheral nerves and muscles, as well as disorders of the autonomic nervous system.
Neurologists treat diseases such as stroke, brain tumors, chronic headaches, Parkinson's disease, Alzheimer's and other memory disorders. Sleep medicine specialists deal with the symptoms of some of the above diseases.
Some neurology doctors undergo training in sleep medicine and become specialists in this field. Not every neurologist is a sleep medicine specialist, just as not every sleep medicine specialist is a neurology physician. Sleep medicine physicians undergo specialization in a variety of fields, which we will mention below.
Sleep Medicine Specialists are certified by the Sleep Medicine Association and must have previously completed a specialty residency in their respective specialty, followed by a year of sleep medicine training and internship. During this period, they acquire the skills needed to diagnose and create a treatment plan for sleep disorders.
The most common doctors certified in sleep medicine are:
- doctors of anaesthesiology and resuscitation
- specialists in cardiology
- internal medicine specialists
- Neurologists
- otolaryngologists
- doctors of psychiatry
- pulmonologists
The practice of sleep medicine can be carried out in both primary care settings and in established specialized sleep disorders centers. Specialists also collaborate with other medical personnel during treatment.
Psychologists and dental professionals are often an important part of treatment. Some psychologists specialise in treating the effects of sleep disorders (anxiety and depression) and dental professionals assist with the fabrication and fitting of braces (most commonly for bruxism).
The most common primary conditions and sleep disorders are:
- Bruxism (teeth grinding)
- Central sleep apnoea
- Obstructive sleep apnea (OSA)
- Circadian sleep disturbances, including shift work and a non-24-hour sleep-wake rhythm
- Restless legs syndrome
- Complete insomnia
- Sleep disturbances in cancer patients
- Narcolepsy (sudden falling asleep at an unspecified time)
- Hypersomnia (sleeping too long)
- Nightmare disorder
- REM sleep phase disorder
- Sleep walking (somnambulism)
- Snoring
Diagnosis of sleep disorders
Specialists recommend different tests and procedures, depending on the type of problem patients complain of. The most commonly recommended are:
- Blood tests - the aim is to isolate primary conditions leading to sleep disturbance, for example thyroid problems, prolactinoma, thrombophilia and hypertension.
- Keeping a sleep diary - Patients record information related to time in bed and falling asleep, time of waking and degree of daytime sleepiness.
- Sleep Disorder Inventory - A detailed questionnaire is used that includes a comprehensive health history and sleep patterns.
- Polysomnogram - The test is used for a targeted search for the suspected disorder. For example, when sleep apnea is suspected, the patient is examined and observed overnight in an outpatient clinic. If narcolepsy is suspected, patients are again monitored but awakened at certain times (on a series of naps). During monitoring, patients are connected to sensors detecting sleep phases, body movements, oxygen saturation and breathing patterns.
TREATMENT:
Once the exact type of disorder is established, the following types of conservative treatment can be recommended:
- CRAP - mask (Continuous Positive Air Pressure) - a device that is used in sleep apnea. The CRAP-mask keeps the airway open by delivering a constant flow of air through the mask.
- Oral appliances made by dental professionals: in case the patient does not tolerate the CRAP mask, a custom device similar to a retainer can be made to hold the tongue and jaw in the correct position at night in order to prevent airflow blockage through the airway.
- Cognitive Behavioural Therapy - a specialist therapy that focuses on identifying the thoughts and behaviours associated with falling asleep and short sleep duration. New psychological strategies are developed to improve sleep, facilitate falling asleep. Improving sleep hygiene is important in order to create habits that facilitate falling asleep at approximately the same time. Such habits are: creating a pleasant environment for falling asleep without mobile devices and monitor, physical exercise during the day, avoiding stimulants (caffeine and nicotine) at times close to the hour of falling asleep.
- Medication treatment - Medication is often prescribed according to the symptom. There are different groups of medications that can be used in small doses for a problem falling asleep, a problem with sleep duration, restless legs syndrome, narcolepsy or REM phase disorders. Medications used to improve sleep are also called hypnotics. In case the sleep disorder is due to another, underlying disease, very low doses of hypnotics are prescribed in combination with the medication for the underlying disease.
There are also SURGICAL METHODS of treatment:
Surgical approaches are mostly used for people with apnea and snoring.
* Hyoid suspension: The u-shaped hyoid bone in the front of the neck connects to the adam's apple or is suspended by the lower jaw to keep the airway open.
* Insertion of a hypoglossal nerve stimulator: An electrode is implanted and attached to a nerve near the jaw that controls the muscles of the tongue. The implanted "pacemaker" stimulates the electrode during sleep to prevent the tongue from blocking the airway at night.
* For persistent and problematic snoring, use Radiofrequency reduction of the soft palate (RFVTR): A radiofrequency device is used to cause the tissues around the soft palate to contract and tighten, which provides greater airway lumen and facilitates air entry.
* Septoplasty: In cases of nasal septal distortion, septoplasty is applied to provide equal distortion between the two sides of the nose, and thus improve airflow. Concha surgery (in case of hypertrophy of the nasal conchae) is also applied with equal success.
*Uvulopalatopharyngoplasty (UPPP)A: It is mostly used for sleep apnea sufferers.
In this type of surgery, excess tissue is removed and repositioned from the back wall of the throat, resulting in a dilated airway. In severe cases, this type of surgery may be used in conjunction with others of the above.
* Bariatric surgeryA: Many obese patients suffer from sleep apnea and sleep problems. Weight loss in them significantly improves sleep. Bariatric surgery is a proven method of dealing with sleep apnea whose root cause is obesity.
