1. Ahmer Ali, MD

2. Sleep Medicine

3. 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

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

5. 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

6. 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

7. 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

8. 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

9. 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 = moderate
AHI 30 = severe

10. 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

11. CPAP machine

12. Full Face Masks

13. Nasal Masks

14. Nasal Pillow Masks

15. 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

16. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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

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