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Regional Sleep Disorder Center

Sleep is essential for good health. Disorders that disrupt sleep prevent your body from restoring itself to a fully functional level. As a result, sleep disorders have a detrimental effect on your quality of life. When we sleep well, we wake up feeling refreshed and alert for our daily activities. Sleep affects how we look, feel and perform on a daily basis, and can have a major impact on our overall quality of life. Shore Health System's Regional Sleep Disorders Center is the first of its kind on Maryland Eastern Shore. It offers comprehensive testing and evaluation of sleep disorders on an outpatient basis in a comfortable, home-like setting.

Common Sleep Disorders

Obstructive sleep apnea is a disorder in which breathing is briefly and repeatedly interrupted during sleep. The "apnea" in sleep apnea refers to a breathing pause that lasts at least ten seconds. Obstructive sleep apnea occurs when the muscles in the back of the throat fail to keep the airway open, despite efforts to breathe. Another form of sleep apnea is central sleep apnea, in which the brain fails to properly control breathing during sleep. Obstructive sleep apnea is far more common than central sleep apnea.

Narcolepsy is a neurological disorder caused by the brain's inability to regulate sleep-wake cycles normally. The main features of narcolepsy are excessive daytime sleepiness and cataplexy. The disease is also often associated with sudden sleep attacks, insomnia, dream-like hallucinations, and a condition called sleep paralysis. Its prevalence in the developed world is approximately the same as that of multiple sclerosis or Parkinson's disease. However, with increased public education about narcolepsy and physician training in the diagnosis and treatment of sleep disorders, these figures are expected to rise.

Restless Legs Syndrome (RLS) is a neurologic sensorimotor disorder that is characterized by an overwhelming urge to move the legs when they are at rest. The urge to move the legs is usually, but not always, accompanied by unpleasant sensations. It is less common but possible to have RLS symptoms in the arms, face, torso, and genital region. RLS symptoms occur during inactivity and they are temporarily relieved by movement or pressure. Symptoms of RLS are most severe in the evening and nighttime hours and can profoundly disrupt a patient's sleep and daily life.

RLS affects approximately 10% of adults in the U.S. Researchers believe that RLS is commonly unrecognized or misdiagnosed as insomnia or other neurological, muscular or orthopedic condition. RLS may also be confused with depression. According to the Restless Legs Syndrome Foundation, approximately 40% of people with RLS complain of symptoms that would indicate depression if assessed without knowledge or consideration of a sleep disorder.

Insomnia, which is Latin for "no sleep," is the inability to fall asleep or remain asleep. Insomnia is also used to describe the condition of waking up not feeling restored or refreshed. Insomnia is the most common sleep complaint among Americans. It can be either acute, lasting one to several nights, or chronic, even lasting months to years. When insomnia persists for longer than a month, it is considered chronic. According to the National Center for Sleep Disorders Research at the National Institutes of Health, about 30-40% of adults say they have some symptoms of insomnia within a given year, and about 10-15 percent of adults say they have chronic insomnia. Sleep specialist Dr. William Dement, Director of the Sleep Disorders Clinic and Laboratory at the Stanford University School of Medicine, explains that people who have trouble sleeping every night without exception for months or years are fairly rare. More often, people experience chronic-intermittent insomnia, which means difficulty sleeping for a few nights, followed by a few nights of adequate sleep before the problem returns.

What Tests are Used to Diagnose Sleep Disorders?

The Center offers the newest equipment for your test – the Nicolet Ultrasomnography system. This is a paperless, computer-generated system designed to perform the sleep study and store data pertaining to your study. The information collected will be coordinated with the clinical laboratory tests and your sleep history, physical examination, psychological profile and any other testing your physician has recommended.

Polysomnography

Two types of tests may be performed. The Night-Time Polysomnogram (NPSG), or the Multiple Sleep Latency Test (MSLT). Both are simple, painless observations of your sleep patterns. The NPSG records your brainwave patterns, muscle tension levels, eye movements and the amount of air you breathe, body movements and your heart rate. The study begins at 8 p.m. or 10 p.m., and ends at approximately 6 a.m. When the technologist wakes you and removes the recording devices, you may shower and dress.

If the problem is sleep apnea (periods of non-breathing during sleep), Continuous Positive Air Pressure (CPAP) may be used. This non-surgical treatment involves wearing a mask over the nose during sleep. A blower gently pushes air through the mask and into the throat. This forced air acts as a splint which keeps the airway open, allowing unobstructed breathing.

The MSLT measures how sleepy you are during the day. During five 20-minute daytime nap periods, your brain activity, muscle tension levels, eye movements and heart rate are recorded and evaluated. Typically, the first nap begins at 9 a.m., and the last nap end at 3 p.m. You will nap at approximately two-hour intervals.

Treatments for sleep disorders

After sleep studies are evaluated, our specialists, in conjunction with your physician, will determine the best treatment plan. The type of treatment used to correct a sleep disorder depends on the type of problem. Most disorders are treated successfully. Treatment for insomnia may include medication, psychological consultations, relaxation routines or biofeedback therapy. As described above, if the problem is sleep apnea, CPAP treatment may be prescribed.

How to Prepare for a Sleep Study

Before you come to the Center, we recommend you prepare yourself by following the suggestions below. These guidelines will help you sleep during the study.

• Avoid naps.
• No hair extensions, braids, weaves or attached hairpieces.
• Get plenty of exercise during the day, but not within two or three hours of your appointment.
• Avoid caffeinated beverages, such as coffee, chocolate, tea or cola, eight hours before your appointment.
• Limit your fluid intake to 16 ounces (2 cups) within three hours of your appointment.
• Please shower/bathe and shampoo on the day of your appointment. Hair should be free of hairspray, mousse, gels, etc.
• Women should be makeup-free when coming to the Center because some recording devices will be applied to your face. Also, please remove all nail polish.
• You will be allowed to use the restroom as needed.
• Please remember this is a test, therefore, except in emergencies, no phone calls are permitted.
• Please take any medications you normally would during the course of the day/evening.
• If you are diabetic, or customarily eat a nighttime snack, bring it with you. The Sleep Center does not provide such items.

What to Expect During a Sleep Study

The same sleep you experience at home will also occur in the sleep lab, except it will be observed and measured. Rarely are any medications required to induce or improve your sleep. When you are dressed for sleep, the polysomnographer will apply approximately 20 electrodes to your scalp and skin. You may feel a slight tingling sensation where the skin is cleaned. Some gauze may be wrapped around your head to help hold the electrodes in place. You may change positions relatively freely and use the adjacent private bathroom as needed. An intercom is provided near the bed so you can be heard at any time. The sleep lab environment is safe and conducive to sleep. It is dark, quiet and pleasing, with controlled, comfortable temperature. If you are scheduled for the daytime nap test, the technologist may leave some of the recording devices on you. They are painless and will not interfere with your waking activity.

Bring Personal Items for Comfort

When you come to the Center, feel free to bring anything you may need during your stay. These personal items may include your favorite nightclothes, robe, reading or writing materials, toilet articles, tape player, a bedtime snack or even your teddy bear! Clean bed linens are provided, but we encourage you to bring your own pillow. For your convenience you will be provided with private shower facilities following your study. A free breakfast pass to the hospital cafeteria will also be provided. If you are having the daytime nap study, you may use the telephone during your wake-time breaks. Please, no social calls during the night-time study. In case of emergency, your family or friends may call the Center.

Our Team:

The Regional Sleep Disorders Center is accredited from the American Academy of Sleep Medicine. Our staff is trained to assist your personal physician in determining the cause and nature of your sleep disorder. After you are referred to the Center, you will be interviewed and examined by a physician with specialized training in sleep disorders. A Registered Polysomnographic Technologist will conduct your sleep study. A Board certified physician will evaluate and interpret your sleep studies and an individual management plan will be developed to treat any problems which are identified.

The Regional Sleep Center Team:

• Peter L. Whitesell, M.D.
• Medical Director
• Board Certified:
• American Academy of Sleep Medicine
• American Board of Internal Medicine
• American Board of Internal Medicine in Pulmonary Medicine

• Douglas Rousseau, RPSGT
• Lead Registered
• Polysomnographic Technologist

• D. Gregg Oliver, M.D.
• Board Certified:
• American Board of Internal Medicine
• American Board of Internal Medicine in Pulmonary Medicine

• Walid Kamsheh, M.D.
• Board Certified:
• American Board of Psychiatry and Neurology

• Peyman Otmishi, M.D.
• Board Certified:
• American Board of Internal Medicine

The full medical resources of Shore Health System are available for referrals, including otolaryngology, maxillofacial surgery, psychological and psychiatric services.

If you have any questions, do not hesitate to ask. Contact us at 410 822-1000, ext. 5338 or 410 476-3771, ext. 5338.

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