The Kazmir Center for Sleep Disorders: Bringing Restful Nights to Restless People

For millions of people with chronic sleep problems, it would be a dream to return to the days of sleeping like a baby. Research shows that 40 percent of Americans have difficulty sleeping a few times per week; while 1 in 3 says insomnia strikes nearly every night. Although insomnia is the most common complaint, there are other sleep disorders that can have adverse effects and may initially go undiagnosed.

“A sleep disorder can last for a few nights, causing minor inconvenience, or become a pervasive illness affecting all aspects of a person’s daytime life,” says Mangala Nadkarni, M.D., Medical Director of The Kazmir Center for Sleep Disorders at Saint Barnabas Medical Center. Dr. Nadkarni is board-certified in Neurology, Clinical Neurophysiology and Sleep Medicine.

The Kazmir Center for Sleep Disorders offers a full range of services used in the evaluation, diagnosis and management of sleep-related disorders in adults and children. The Center is equipped with the latest in monitoring equipment, providing the opportunity for daytime testing and full overnight sleep studies.

When Insomina Becomes Serious
As we all know, transient insomnia can follow a stressful event in life, such as a death in the family. Insomnia is actually considered to be a physiologic response to grief. However, in some individuals, this problem can turn into chronic insomnia. Dr. Nadkarni explains that individuals with chronic insomnia (defined as sleeplessness that has lasted for three months or more) develop habits that perpetuate their inability to sleep.

“The individual begins to fear going to bed and actually has ‘performance anxiety’ associated with his or her inability to sleep,” says Dr. Nadkarni. “The thought of nighttime turns into a nightmare itself.” She recommends that anyone with extended insomnia should seek medical attention before the condition becomes chronic, as chronic insomnia is “very difficult to treat.”

Lack of sleep can have serious consequences. Research has shown that people who are sleep deprived perform as poorly on driving tasks as those who are operating at the legal alcohol limit. Insomniacs have sleep problems that fall into three areas:

Common Sleep Problems
Sleep Apnea (also called Sleep Disordered Breathing) patients actually stop breathing while asleep, generally for more than five times per hour and for longer than 10 seconds per occasion. The problem is more common in women and in those who are overweight—especially in men with a collar size greater than 16 inches.

While patients may not wake up during the episodes, the quality of their sleep is poor. This can lead to symptoms such as sleepiness during the day, lack of energy, memory problems and can manifest as a mood disorder. Patients with severe sleep apnea are more likely to have high blood pressure that is difficult to treat, heart attacks and strokes. They are also likely to get involved in motor vehicle accidents.

A diagnosis of sleep apnea is made through a sleep study. The general treatment is a specialized sleep mask that applies pressure to the airways. A weight loss program and possible referral to an ear, nose and throat specialist may be recommended, depending on the severity of the condition.

Women are the primary patients who suffer from a sleep disorder called Upper Airway Resistance Syndrome. Although the individual does not stop breathing during sleep, loud snoring affects quality of sleep. Diagnosis and treatment would be the same as for an individual with sleep apnea.

In children, enlarged tonsils and adenoids can cause poor sleep quality and resultant symptoms that mimic Attention Deficit Disorder (ADD). The treatment would be removal of the tonsils and adenoids.

Restless Leg Syndrome or Periodic Leg Movement Syndrome occurs when the individual has prickly sensation or cramps in the legs during evening hours and when the person kicks spontaneously. If the kicking continues during sleep, it can be problematic for the bed partner. These individuals need evaluation to determine the cause of the condition, which can vary from iron deficiency to a condition that requires medications.

In the REM stage of sleep, the body experiences paralysis so that the dreamer does not act out his or her dream. Those with REM Behavior Disorder do not experience this paralysis. One of Dr. Nadkarni’s patients dreamed that he was being chased and then suffered a severe injury after leaping over his bed while sleeping. This condition occurs in REM sleep, unlike those who sleepwalk during a non-REM stage. Patients may need a sleep study to confirm the diagnosis and be treated with medications.

Narcolepsy is the most disabling sleep disorder of all. It can result in excessive sleepiness during the day, with the person even falling asleep in mid conversation in severe cases. Patients may even think they are hallucinating as dreams enter their waking moments. Often patients are embarrassed to discuss these symptoms for fear of being labeled as a psychiatric case. Narcoleptics are generally treated with medication.

Being robbed of sleep can have a disastrous effect on a person’s life as well. Patients who have successfully sought treatment through The Kazmir Center for Sleep Disorders feel rejuvenated by their new sleep patterns.

“They tell me that they have never felt this awake before during the day,” says Dr. Nadkarni. “Their nighttime problems no longer adversely affect their daily lives and the lives of their families.”

For an appointment with The Kazmir Center for Sleep Disorders at Saint Barnabas, please call (973) 322-9800.

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When Bedtime is a Hazard: Snoring May Signal a Health Risk

After 20 years of practice, sleep specialist John Penek, M.D., FCCP, can tell immediately when he walks into the examination room if the patient has come to discuss a snoring problem. That is because the majority of times the snorer is accompanied by a spouse.

“Most of the time they are brought in by a wife who can’t take it anymore,” says Dr Penek. “The snorer is defensive and says things like, ‘If my wife would stop elbowing me in the side all night, then I’d have a good night’s sleep.’ They have no idea of the extent of the problem or the larger health implications.”

Snoring A to Z
Snoring occurs when the airway channel relaxes during sleep and becomes a conduit for air-induced vibration. When there is an obstruction in the airway, structures in the throat vibrate together, producing sound. The spectrum of snoring ranges from an undetectable sound to levels as high as 90 to 120 decibels. The highest range is not far from the noise emitted by a jet aircraft at takeoff, which has been measured at 140 decibels.
Although snorers tend not to awaken themselves, they may greatly disrupt the sleep of a bedpartner. In addition, the sound may be damaging. A study in the Journal of Otolaryngology found that bed partners of those who snore showed significant noise-induced hearing loss in the ear most exposed to the snoring.

Larger Health Issues
According to Dr. Penek, there is strong evidence that snoring can be dangerous to your health.

“Snoring, especially heavy snoring that disturbs bedparter sleep, is often associated with a condition known as sleep apnea, which may indicate an increased risk of hypertenstion, cardiac arrythmias and sudden death during sleep,” he relates.

As many as 30 percent of men and women in midlife with high blood pressure also have problems with snoring and sleep apnea, which are curable causes of elevated blood pressure.

Individuals with snoring and sleep apnea conditions are also at a significantly higher risk for automobile and industrial accidents. According to a study in the Medical Post, snorers are six times as likely as non-snorers to have accidents while driving.

Sleep Apnea
Some snorers suffer from a condition known as sleep apnea. Sleep apnea results in a complete or near complete obstruction to airflow for 10 seconds or more. A person with a typical case of sleep apnea will have apneas of 10 to 60 seconds or longer, and will have 5 or more per hour during sleep. Sleep apnea can occur from obstructed airflow, or from a problem with the central nervous system.

“A drop in oxygen alerts the brain to a problem, and the brain kicks the person out of deep sleep into a more shallow sleep,” says Dr. Penek. “Most patients have not slept properly in decades.”

Sleep apnea can cause excessive sleepiness, which in turn can result in automobile accidents, lack of concentration, significantly reduced energy levels. For people suffering from heart trouble or stroke, sleep apnea makes their condition worse because of the lack of sleep and reduced oxygen levels and an increase in high blood pressure.

Patients who may have sleep apnea are diagnosed with a medical history and an overnight evaluation at the Kazmir Center for Sleep Disorders. Treatment involves the use of a C-PAP (continuous positive airway pressure), a breathing device that keeps the airway free of collapse.

Treatment for Snoring
For snorers who do not have sleep apnea, there are a variety of treatments. These can include:

Risk factors for snoring include obesity, allergies, being male or a post-menopausal female, a deviated septum, consumption of alcohol before bed, eating late night meals and smoking.

Patients who no longer snore find themselves far more rested in their waking hours, says Dr. Penek. And their partners enjoy a much needed rest as well.

“It’s hard to sleep when you’ve got a bear lying next to you,” says Dr. Penek. “When the sound is gone, the bed partners sleep is no longer so severely impaired.”

For information about The Kazmir Center for Sleep Disorders, please call (973) 322-9800.

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Getting More Sleep Can Help Combat Obesity

For the millions of Americans struggling to maintain a healthy weight, getting more sleep may prove to be part of the answer. A recent study presented at the 2004 North American Association for the Study of Obesity has found a correlation between the amount of sleep a person gets each night and their chance of becoming obese.

"Physicians have known for some time now that people who have problems sleeping are more likely to have heart attacks, strokes, and high blood pressure that is difficult to treat, as well as concentration and behavioral problems,” says Mangala Nadkarni, M.D., Medical Director of The Kazmir Center for Sleep Disorders at Saint Barnabas Medical Center. “This study provides further evidence that getting the right amount of sleep directly affects a person’s ability to maintain a healthy weight.

According to the study, individuals who get less than four hours of sleep per night were 73 percent more likely to be obese than those who got the recommended seven to nine hours. Research showed that people who averaged five hours a night were 50 percent more likely to be obese and those who got six hours have a 23 percent greater risk.

Though people burn less calories while sleeping, evidence exists linking sleep and the various neural pathways that regulate food intake.

For individuals who are concerned about their weight, seeing a sleep specialist might prove to be as helpful as meeting with a nutritionist or beginning an exercise program.

The Kazmir Center for Sleep Disorders at Saint Barnabas offers a full range of services used in the evaluation, diagnosis and management of sleep-related disorders in adults and children. The Center is equipped with the latest in monitoring equipment, providing the opportunity for daytime testing and full overnight sleep studies.

Treatment is offered for various sleep-related disorders, including snoring, insomnia, Sleep Apnea or Sleep Disordered Breathing, Upper Airway Resistance Syndrome, and Restless Leg or Periodic Leg Movement Syndrome.

“Patients who have successfully sought treatment through the Sleep Disorders Center feel rejuvenated by their new sleep patterns, which results in a better quality of life,” said Dr. Nadkarni.

For more information about sleep disorders or to make an appointment with The Kazmir Center for Sleep Disorders at Saint Barnabas, please call (973) 322-9800.

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Women and Sleep
Mangala Nadkarni, M.D.
Medical Director, The Kazmir Center for Sleep Disorders at Saint Barnabas Medical Center

Sleep isn't just "time out" from daily life. It is an active state that is important for renewing our mental and physical health each day. When we sleep, our bodies rest but our brains are active. Sleep lays the groundwork for a productive day ahead. Research has shown that a lack of restful sleep results in daytime sleepiness, increased accidents, problems concentrating, poor performance on the job and in school, and possibly, increased sickness.

Women are twice as likely as men to have difficulty falling asleep or staying asleep and even then their sleep complaints are often not taken seriously by health care workers. In the young adulthood of women, sleep disturbances are usually associated with the menstrual cycle, pregnancy and motherhood. In the menopausal years, research has shown, a woman's sleep pattern is susceptible to hormonal changes.

The Menstrual Cycle and Sleep
Some women awake more frequently and experience other sleep disturbances during their premenstrual state, while others report excessive daytime sleepiness, fatigue and longer sleep hours. Usually these problems disappear when menstruation begins, although some women may continue to have lingering problems.

Changes in women's bodies occur at different times in the menstrual cycle and may affect sleep. A National Sleep Foundation (NSF) poll found that 50 percent of menstruating women reported bloating that disturbed their sleep. On average, these women reported disrupted sleep for two to three days each menstrual cycle. Poor quality sleep is more likely at the beginning of the menstrual cycle when bleeding starts. While a healthy sleeper spends about 15-20 percent of his or her sleep time in deep sleep, NSF research suggests that women with PMS experience less deep sleep (about 5 percent of their total sleep) all month long.

Pregnancy and Sleep
Pregnancy-related sleep disturbances are well known and well accepted. In a NSF poll, 78 percent of women reported more disturbed sleep during pregnancy than at other times. Sleep-related problems also become more prevalent as the pregnancy progresses.

Most women report daytime fatigue and the need for longer nighttime sleep. Overall sleep efficiency - the proportion of time spent actually asleep - begins to decrease by the second trimester and continues to decrease in the third trimester. In the third trimester several things can cause sleep disturbances: leg cramps, backache, heartburn, movement of the fetus and increased frequency of urination. Once the baby is born; physical stresses of pregnancy are replaced by demands of the baby's feeding schedule and awakenings. After delivery, getting enough rest continues to be very important as severely disturbed sleep has been linked to postpartum depression and child abuse.

Pregnancy Sleep Tips:
Special "pregnancy" pillows may help you sleep better. Or, use regular pillows to support your body.

Menopause and Sleep
In the perimenopausal period many women experience sleep disturbances with changing levels of sex hormones. Overall amount of deep sleep decreases, sleep becomes lighter and more awakening occurs during the night. Hot flashes (unexpected feelings of heat all over the body) and night sweats can cause repeated awakenings and feeling of anxiety. The resultant sleep deprivation may cause daytime fatigue, irritability and depression.

Decreasing levels of estrogen cause hot flashes, which are usually accompanied by sweating. In a NSF poll, 36 percent of menopausal and postmenopausal women reported hot flashes during sleep. On average, they occurred three days per week and interfered with sleep five days per month. Hot flashes persist for an average of five years. While total sleep time may not suffer, sleep quality does. Hot flashes may interrupt sleep; frequent awakenings cause fatigue the next day.

Deciding what, if any, product to use to alleviate these symptoms and, if so, for how long, are questions a woman should discuss with her physician. The answer will depend on personal and family medical history.

Other Sleep Disorders
These sleep disorders/manifestations are more prevalent in women. They include:

• Restless Leg Syndrome: Patients describe this condition in several ways including leg cramps, tingling, numbness in legs, electric sensation or a Charlie Horse. In young women one of the common causes of this condition is iron deficiency anemia. Iron deficiency anemia can occur during pregnancy or due to heavy bleeding from uterine fibroids. In older populations this may represent a disorder by itself.
• Sleep Disordered Breathing: There are two forms for this condition. Patients with Increased Upper Airway Resistance Syndrome generally experience loud snoring and excessive fatigue and/or daytime sleepiness. Sleep Apnea Syndrome is less common in women during the premenopausal period unless the female is overweight or obese. It has also been linked to polycystic ovaries. In the postmenopausal period the prevalence of sleep apnea syndrome in women is almost equal to men.
• Depression: One of the features of endogenous depression (depression due to chemical imbalance and not necessarily to circumstances alone) is early morning awakenings. Patients usually wake up around 3 a.m. and cannot return to sleep.
• Nocturnal Eating/Drinking Syndrome: This syndrome is thought to be an illness by itself; although, some patients report that they are attempting strict daytime dieting.

The presence of one sleep disorder does not exclude another coexisting sleep disorder, therefore, patients benefit by having a comprehensive evaluation and, if necessary, a sleep study. Improving sleep quality results in improved quality of life. After all, the key to a long, happy, healthy life is to sleep well, eat well and exercise.

For an appointment with The Kazmir Center for Sleep Disorders at Saint Barnabas, please call (973) 322-6600.

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Helping Your Children Get the Rest They Need for the Upcoming School Year

For many kids going back to school can be a time of excitement and anticipation. But, after a summer lazy afternoons and staying up late, it might be hard for parents to change their kids’ summer sleep habits once the school year begins.

“Helping ensure that your child gets enough sleep once school begins will help them focus on their school work and have a healthier, safer, and more productive school year,” says Mangala Nadkarni, M.D., Medical Director of The Kazmir Center for Sleep Disorders at Saint Barnabas Medical Center in Livingston. “Most children require 10 to 12 hours a sleep each night. Less sleep can cause concentration and behavioral problems.”

According to Dr. Nadkarni, it is best for parents to begin changing their children’s sleep schedules a few weeks before school starts. She suggests limiting nap times and moving bedtimes back a half hour every few days until you reach the time you would like your child to go to sleep during the school year.

To help parents plan a back to school sleep schedule, The National Sleep Foundation and the Kazmir Center for Sleep Disorders at Saint Barnabas offer the following tips that should be maintained throughout the school year.

• Begin the routine now. Parents should start their child's school sleep routine at least one to two weeks before opening day by introducing a gradual change in their child's sleep schedule, such as going to bed 15-30 minutes earlier each night. This can make it easier for children to adjust their sleeping patterns to meet the new school schedule.
• Establish a regular bedtime and wake up time. Parents and children should plan a daily schedule that includes the basic daily sleep requirements for particular age groups. This schedule should be maintained on the weekends, though students can be permitted to sleep in one or two hours on weekend mornings if necessary. While individual sleep needs can vary, the amount of sleep suggested by sleep experts for particular age groups is:

• Create a bedtime routine. Bedtime routines are important, regardless of a child's age. It should include at least 15-30 minutes of calm, soothing activities. Prior to bedtime, encourage quiet time with some relaxing activities. Discourage television, exercise, computer and telephone use, and avoid caffeine (found in beverages, chocolate and other products).
• Achieve a balanced schedule. Identify and prioritize activities that allow for downtime and sufficient sleep time. Help students avoid an overloaded schedule that can lead to stress and difficulty coping, which contribute to poor health and sleep problems.
• Be a role model. Parents and guardians can be role models for school aged children by establishing their own regular sleep schedule and a home environment conducive to healthy sleep habits
• Become a sleep advocate. Take steps to encourage:

For more information about sleep disorders or The Kazmir Center for Sleep Disorders at Saint Barnabas Medical Center, please call 973-322-9800.