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Perchance to dream…

Humans spend an average of one-third of their lives asleep and having adequate rest is essential for good health. Unfortunately, broken or disrupted sleep can affect every part of a person’s life — home and work, professional and personal.

And this is not a problem confined to adults.

In recent weeks, safefood warned that lack of sleep puts children at greater risk of being overweight and obese. It may even limit our ability to explore the stars, as recent studies have shown that astronauts experience less-than-optimum levels of rest while in space. Yet sleep medicine is a science still in its infancy. One doctor currently working in this exciting field is Dr Elaine Purcell, Consultant in Respiratory Medicine and Sleep Specialist at the Mater Private.

“Sleep medicine has only recently been recognised as a separate field,” she explains to the Medical Independent (MI). “It draws on a multidisciplinary practice — for example, ENT surgeons are interested in sleep medicine. Psychiatrists, respiratory physicians, neurologists, paediatricians are all interested in sleep medicine.

“When we host our sleep conferences, you’ll have doctors from every discipline in the room and that makes it an exciting field because there’s a lot of collaboration, with a lot of research being done.

“Sleep isn’t just one thing; it involves the brain, breathing and movement. It’s a super specialty.”

However, as sleep is the crossroads of so many specialties, disruptions in sleep can have serious consequences.

If people are sleep-deprived, you see them with refuced immunities, higher blood pressure, and they are more likely to develop heart disease

“Sleep affects everything that we do. It affects our brain function, our memory, our growth, sex drive and immune system; it affects every aspect of health. If anyone isn’t sleeping well, it’s going to have a knock-on effect.

“If people are sleep-deprived, you see them with reduced immunities, higher blood pressure, and they are more likely to develop heart disease. In children, they have stunted growth. In adults, you see poor performance, poor memory, alertness, concentration span, mood problems, anxiety and depression.”

Consultants

There are currently two consultants working at the Sleep Clinic: Dr Purcell, who deals with the paediatric patients, and her colleague Dr Catherine Crowe, who cofounded the Sleep Disorder Clinic in 1994.

“I joined the practice three-and-a-half years ago. Dr Crowe’s background is in psychiatry and mine is in respiratory medicine. We have both completed additional training and fellowships in sleep medicine.”

The clinics at the Mater Private run five days a week, Monday through Friday, and patients can be invited for sleep studies at the hospital during these days. Outside of Dublin, Dr Purcell runs a satellite clinic that alternates between Navan and Drogheda on Tuesdays.

“In my own practices, there has been a huge incremental increase in referrals. It’s getting busier and busier. A lot of patients never knew there was somewhere they could go with their sleep problems. They may be embarrassed to even approach their GP about them,” Dr Purcell explains.

Conditions

While the Sleep Clinic does see patients with conditions such as narcolepsy, restless legs, unintentional violence while asleep and sexsomnia, the most common presentation is obstructive sleep apnoea. Although a common breathing problem, it can lead to a very broken and disturbed sleep. This in turn could contribute to daytime sleepiness and tiredness, putting patients at greater risk of accident.

“Over the longer term, it puts pressure on the heart and contributes to heart disease, arrhythmia, high blood pressure and even strokes. There’s a big push to try and identify people in the earlier stages of the disease. It’s so common; the official numbers are 1-to-2 per cent of children and about 5-to-10 per cent of adults. We think that’s a gross underestimation. It is closely linked with weight, and because there are such a growing number of people who are overweight or obese, we think the number of people with sleep apnoea could be as high as 20 per cent or more of the population.

“We are only diagnosing the tip of the iceberg there.”

This can result in many patients not receiving a diagnosis until adulthood, a factor in the Clinic’s desire to reach out to general practitioners.

“If a patient is very overweight with heart and blood pressure issues, we’d ask that the GP consider sleep apnoea,” Dr Purcell says. However, she adds that this condition is just one of many that can affect sleepers. Sleep disorders such as parasomnias can also undermine a patient’s quality of rest.

“Parasomnias include sleepwalking and night terrors; less common examples are acting out dreams and violence in sleep,” Dr Crowe tells this newspaper. “Stress will exacerbate most of those problems and there’s nearly always a family history. People will sleepwalk more during the Leaving Certificate or following bereavement. It’s not a psychiatric disorder and there is treatment available.

“Dream content is very poorly understood. We do look after people who have nightmare disorder. If they have vivid, life-like dreams or nocturnal hallucinations we will treat that, but won’t examine the dream content itself.”

Treatment

In terms of referrals, Dr Purcell explains that the process is very simple.

“All we need is a small referral letter from a patient’s GP or specialist, with a little information on the patient’s background. The patient is then offered an appointment with one or two of the consultants. They will come to the rooms and if they need a sleep study, we arrange that for them.

“When patients come in for a sleep study, we carry out a non-invasive, painless test; patients spend the night in a sleep laboratory and are connected to different monitors, which monitor everything — brain waves, breathing etc. And we meet them the next morning and go through the results and decide on treatment.”

For sleep apnea, patients can be treated in three or four ways, Dr Purcell continues.

“The main way is with a CPAP, a small breathing device patients wear in bed at night; there’s also a dental device, a special gumshield, and then there’s conservative treatment — they are encouraged to lose weight and stay off their back.”

According to the Clinic’s website, more than 1,500 patients have been treated with CPAP since 1995.

“Only very rarely is surgery indicated,” Dr Purcell adds. “Surgery is only relevant in a small number of patients.”

Treatment overview: When a diagnosis is made

The Sleep Disorders Clinic is run on multidisciplinary lines and once diagnosis is confirmed, treatment may be carried out by a variety of professionals, depending on the problem.

  • Full diagnostic polysomnography (full sleep study)
  • CPAP titration studies (initiating treatment for sleep apnoea)
  • Multiple sleep latency testing (MSLT) — testing for narcolepsy
  • Maintenance of wakefulness testing (MWT)
  • Actigraphy (to assess body-clock issues)
  • Overnight oximetry (measuring oxygen levels during sleep)
  • Cognitive behavioural therapy for insomnia
  • CPAP compliance monitoring (to ensure appropriate usage of CPAP)

Sleep Clinic,

Mater Private Hospital,

Tel: 01 811 7713

Fax: 01 811 7713

Email: sleepdepartment @gmail.com

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