Ahmer Ali, MD

Sleep Medicine

Background about Northwest Neurology Founded in 1983 Doctors who start here spend their whole career here, no “revolving door” Focus on getting patients seen and also maintaining close follow up Spend more time with patients than most specialists Doctors all trained at Rush, Northwestern, University of Chicago, University of Illinois, Stanford, Mayo clinic… A downtown opinion close to home

Access New patients can be seen in as little as 24 hours 22 total providers Largest independent neurology practice in Illinois Saturday office hours

Subspecialties Sleep Memory and Cognition Center MS Epilepsy Movement Disorders Headache/Migraine Neuro-rehabilitation/Physiatry Women’s Neurology Neuromuscular Vascular Neurology/Neuro-hospitalist service Concussion

Common Sleep Problems Snoring Pauses in breathing in sleep (apneas) Daytime sleepiness and fatigue Trouble falling asleep Trouble staying asleep Abnormal movements or behaviors in sleep

Obstructive Sleep Apnea Episodes of partial or complete obstructions of a part of the upper airway during sleep Drops in oxygen levels = increased stress on the body Awakening at night Symptoms Snoring Waking up gasping for air/choking Pauses in breathing Waking up to urinate Daytime sleepiness and/or fatigue Dry mouth in morning Morning headache Mood trouble Trouble with concentration

Why is Sleep Apnea Important? A cause of daytime symptoms: sleepiness, fatigue, trouble with concentration, morning headaches Increase stress on the heart and cardiovascular system Higher risk of stroke, hypertension, abnormal heart rhythms, diabetes Increase risk of car accidents Estimated that over 20 million people have sleep apnea Risk factors include age, male gender, obesity, and craniofacial structures

Testing for Obstructive Sleep Apnea Polysomnogram (Sleep study) In lab Home Sleep study will detect number of apneas that occur during that night of sleep Reported as AHI (Apnea-Hypopnea Index) = # of apneas/hypopneas on average per hour of sleep AHI < 5 = normal AHI 5-15 = mild AHI 15-30 = moderate AHI 30 = severe

Treatments PAP (Positive Airway Pressure) Gold standard treatment Device that delivers air pressure (not oxygen) through a tubing and mask Different types of mask: Full face, nasal, nasal pillows Types of therapy CPAP (continuous positive airway pressure) BiPAP ASV (adaptive servo-ventilation) iVAPS or AVAPs (Volume assured pressure support) Mandibular advancement devices, AKA oral appliances Custom fitted dental device that brings lower jaw forward at night Appropriate for mild and moderate forms of sleep apnea

CPAP machine

Full Face Masks

Nasal Masks

Nasal Pillow Masks

Follow up CPAP Oral appliance Monitor use: average number of hours used, average number of apneas/hypopneas that still occur (AHI recorded from device) Address any issues with the device, the pressure setting, or mask and work to fix those issues Oral appliance Check for effectiveness by repeating a home sleep study to see how many apneas/hypopneas are occurring while wearing the oral appliance Follow with sleep specialist and dentist to address potential issues, including comfort related issues

Insomnia Trouble falling asleep and/or trouble staying asleep A state of hyperarousal A common problem that can lead to Dissatisfaction and frustration with sleep Daytime fatigue or sleepiness Decreased energy Trouble with concentration and cognitive function Mood trouble

What causes insomnia Poor sleep hygiene and habits Lifestyle and work factors Various medical problems Depression, anxiety, pain, menopause, thyroid disease, respiratory issues such as asthma, etc Medications Acute life stress or situations Can be a good or bad life event For some people it can be a lifelong problem; for others it can develop at some point in life

How is insomnia diagnosed Based on the history Sleep logs/diaries can help to make diagnosis and monitor response to treatment Sleep study is not required Unless another sleep problem, such as obstructive sleep apnea, is suspected

Treatment of Insomnia Non medication based approaches Medications Cognitive Behavioral Therapy for Insomnia Medications Zolpidem (Ambien) Zaleplon (Sonata) Eszopiclone (Lunesta) Doxepin (Silenor) Ramelteon (Rozarem) Suvorexant (Belsomra) Melatonin Triazolam

Cognitive Behavioral Therapy for Insomnia A program that addresses mental (or cognitive) and behavioral components related to trouble sleeping Components Cognitive therapy Sleep hygiene Stimulus control Sleep restriction, aka sleep consolidation Relaxation techniques

Restless Legs Syndrome An uncomfortable sensation in the legs, often described as a “creepy, crawly” feeling that occurs in the evening or with prolonged resting causing an urge to move legs to get rid of the sensation Symptoms get better or resolve with moving the legs Symptoms return once movement stops

Restless Legs Syndrome Causes Iron deficiency, kidney disease, pregnancy, medications, idiopathic Testing Ferritin and iron studies Treatment Iron supplementation if needed Medications Dopamine agonists: Pramipexole (Mirapex), Ropinorole (Requip), Rotigotine (Neupro) Gabapentin, Lunesta

Parasomnias Abnormal movements, behaviors, perceptions related to sleep Includes Nightmares Sleep talking Sleep walking Dream enacting behaviors Yelling, kicking, punching, shoo-ing/swaying, trying to get out of bed It looks like you are acting out or responding to what is occurring in your dreams Testing and treatment varies based on the type of behavior and frequency of events

Thank You!!! If you have any sleep concerns you would like to address, please call and make an appointment at Northwest Neurology Phone number: 847-882-6604