PAs Successfully Fight Sleep Disorders

We know driving or making other decisions while under the influence of alcohol is dangerous. Drowsiness can be just as detrimental. Inadequate sleep depresses motor skills, sharp thinking and concentration. Sleep deficiency is also linked to an increased risk of cardiovascular disease, heart failure, stroke, diabetes and hypertension. Indeed, the American Sleep Association reports that 50-70 million U.S. adults have a sleep disorder.

Today, hundreds of Certified PAs combat this health problem by treating sleep disorders, encouraging healthy sleeping habits, and educating patients on sleep's role in holistic wellness.

Certified PAs complete an intensive general medical education, pass rigorous certification and recertification exams, and earn substantial continuing education credits to prepare us to deliver the highest standards of care. We also work closely with collaborating physicians as we move into specialized areas.
I spent six weeks with a pulmonologist learning to treat patients for common sleep disorders like sleep apnea and insomnia. At our sleep center, I consulted patients, ordered in-lab sleep studies, diagnosed patients, and managed treatment plans. On average, a full-time sleep medicine PA may see 60-75 patients each week.

Too often patients misjudge the severity of their symptoms or dismiss the importance of restful sleep altogether. The challenge for clinicians is to convince patients to take their sleep health seriously. We can do so by championing good sleeping habits in every practice setting and specialty and referring the appropriate patients to sleep medicine specialists.

Some common symptoms that brought patients to our sleep centers were: 
• Excessive weight: A patient who is overweight and chronically tired should be screened for a sleep disorder. Patients who are tired tend to subsidize tiredness by eating more food, grabbing more caffeine and sugar, and creating a cycle of unhealthy eating habits. The extra weight is a common risk factor for sleep apnea which accounted for about 80 percent of my cases.
• Severe snoring: Snoring alone doesn't confirm one is suffering from a sleep disorder, but a sleep study can determine whether snoring is symptomatic of a more severe problem.
• Daytime drowsiness: I used the Epworth Sleepiness Scale to determine whether excessive sleepiness may be a health concern that warrants further diagnoses. This tool allows patients to self-assess their likelihood of falling asleep during eight normal, low activity situations.
• Witnessed gasping during sleep (observed apneas): Often the patient's partner is concerned because the patient is gasping for air while sleeping and/or having pauses in their breathing prior to the gasping.

These symptoms can cut into an adult's prescribed eight hours of sleep, and carry risks for patients' short and long-term health. Fortunately, treatment options are available, effective and customizable based on financial, environmental and physical needs. For example, weight loss may be the best prescription for an overweight patient suffering from sleep apnea. However, since it takes a while to lose excess weight, a continuous positive airway pressure (CPAP) machine or oral appliance may be a good solution for someone who has a normal body mass index. Alternatively, implanting a hypoglossal nerve simulator to increase in airflow may be an option.

For insomnia patients, cognitive behavioral therapy can be used to monitor sleeping habits, influence lifestyle adjustments, and reduce patients' dependency on sleeping pills. Whatever the disorder, patients typically feel a world of difference after treatment because they often don't realize how much sleep deprivation is diminishing their quality of life.

The patients that come in telling us they have a sleep problem are the easy ones to screen. It is important, though, to recognize the patients who don't complain about their sleep but should also be screened for sleep apnea-the ones with cardiovascular disease, heart failure, atrial fibrillation, stroke, diabetes, and hypertension.  Also, pre-operative patients should be screened as well as pilots and drivers needing FAA and DOT exams for the licenses.

 
Three easy questions to ask: 1) do you snore? 2) are you tired? 3) are there any observed apneas at night?  If the answer of any of these questions is yes, then the patient should be referred to a sleep medicine team, so they can be effectively evaluated for sleep apnea.

Treating sleep apnea can help decrease HbA1c, lessen the number of drugs a patient takes for hypertension, reduce the number of times atrial fibrillation reoccurs, and decrease post-operative complications. 

Ultimately, the end goal is to find sleep solutions that get patients back to living their best lives. To do so, Certified PAs have joined other sleep medicine specialists to reduce the adverse effects of inadequate rest and ensure sleep health takes a front seat in patients' total well-being.

Laura Jarvis, PA-C worked in sleep medicine for over four years at the Allina Health Sleep Medicine Clinic in St. Paul, Minn. She currently practices in dermatology and virtual care, and has also worked in primary/integrative medicine, ear, nose and throat care and urgent care at clinical facilities throughout the Minneapolis/St. Paul area.