The Sleep Center Addresses an Array of Sleep Disorders
from Clinical Update, Fall 2004
Abstract: The Sleep Center at Wake Forest University Baptist Medical Center offers an array of evaluative and treatment approaches for patients with sleep disorders and a flexible menu of services for referring physicians. The Center includes a 24-hour Sleep Lab where polysomnography is performed in a comfortable, hotel-like setting.
“As a full-service sleep center, we can address just about any sleep-related problem that patients may experience,” says W. Vaughn McCall, M.D., medical director of the Sleep Center at Wake Forest University Baptist Medical Center.
Accredited by the American Academy of Sleep Medicine, the Center includes five physicians who are board-certified in sleep medicine. The Center is multidisciplinary, with faculty members from psychiatry, neurology (including pediatric neurology), pulmonary medicine, otolaryngology and dentistry. It also offers an accredited sleep fellowship.
“This wide distribution of clinical expertise allows us to address virtually any sleep problem that comes through the door,” says McCall, psychiatry chair and section head of geriatric psychiatry at Wake Forest Baptist. He believes that willingness to tackle any sleep disorder is a distinguishing factor of this Sleep Center.
Obstructive sleep apnea, caused by repetitive closure of the upper airway during sleep, is the most common problem seen in sleep programs. Other common disorders include insomnia, parasomnias (unusual sleeping behaviors such as sleep walking) and circadian rhythm disorders (shift work, jet lag and problems that cause people to sleep at odd times).
There is an important distinction between the services of the sleep lab and those of the overall sleep center, says McCall. Some conditions, such as obstructive sleep apnea, can be definitively diagnosed only through polysomnography performed in a sleep lab. Patients with symptoms of obstructive sleep apnea, especially when coupled with cardiovascular disease, are often sent directly to the lab. Other disorders, such as refractory insomnia, cannot be well diagnosed in the lab and require evaluation by a sleep specialist.
The Sleep Center works flexibly with referring physicians, offering sleep lab services alone for those who prefer to manage their patient’s diagnostic data analysis and treatment planning, or, managing the patient through the evaluation and treatment process. About half of the patients seen in the lab are sent directly by physicians who are not part of the Sleep Center.
Patients referred for sleep lab analysis will have their sleep monitored for about eight hours in a private, hotel-like bedroom, one of eight in the lab. Sleep studies are conducted seven nights a week and on weekdays. Last year the lab reported nearly 1,600 procedures.
Research Strengths. Insomnia is a Sleep Center research focus. Recent studies include hypnotic medications used by patients with insomnia caused by depression. The research is important because primary consumers of sleeping pills in the U.S. are people with depression or anxiety, yet these drugs are rarely tested in patients with these diagnoses, McCall said.
Treatment Range. Treatments for sleep disorders may include lifestyle modification (exercise, relaxation therapies), behavioral therapies (stimulus control, sleep restriction) and pharmacologic therapies. For obstructive sleep apnea, treatment options may include nasal continuous positive airway pressure (CPAP), oral appliances designed to protrude the mandible and upper airway surgery.
How Big a Problem Are Sleep Disorders?
Surveys performed by the National Sleep Foundation indicate that 60 percent of adults report sleep difficulties several nights or more each week, and 40 percent say that daytime sleepiness is severe enough to interfere with daily activities at least a few days each month.
At least 40 million Americans experience sleep disorders, but less than 40 percent of American adults have ever been asked about the quality of their sleep by a physician, according to the National Sleep Foundation.
Symptoms that Merit Evaluation:
• Inappropriate and excessive daytime sleepiness
• Uncontrollable and unexpected lapses into sleep (while driving, for example)
• Loud snoring associated with breathing pauses throughout the night, especially in patients who have cardiovascular disease
• Refractory Insomnia—patients who have had longstanding trouble falling asleep and staying asleep through the night and have failed conservative treatment such as behavior modification