Recently it was our pleasure to have Hudson England, Sleep Lab Technician, who works in Dr Shrader's Department at the Star Valley Medical Center speak to us. You can hear his presentation (almost live!) by clicking here. Note that this is a 12MB WAV audio file.

They have a new office going in across from the Medical Center which will have two labs. It has been a busy year. 154 studies averaging 3 per week. A wide variety of types of patients from many areas. We've had a 7-year old and an 11-year old, to an 85-year old. Won't do infants, but children are OK. Some have come from Tetonia, Ogden, Big Piney, Pinedale, and Idaho Falls.

Hudson says that we have an ideal situation and the best facility in Wyoming. He just got back from a sleep conference and we seem to be set up better than many other labs. We have a Registered Technician and the expertise to diagnose and treat many sleep problems.

Q: Don't the people of Star Valley work so hard that they get good sleep naturally? Well, in one sense yes, but most sleep disorders are caused from obstructions. Most patients don't even know they have a sleep disorder, they just know that they're constantly tired.

The condition is called "Sleep Apnea" which means "sleep without air". It is usually caused by an obstruction in the airway, and then called "Obstructive Sleep Apnea". Two major problems: Quality of Life (person snores while spouse can't sleep, and then the snorer falls asleep at work!), and it is a major contributor to high blood pressure, cardiac problems, abnormal heart rhythms, heart attack, heart failure, increased insulin resistance (even non-diabetic patients), stroke, increased traffic and workplace accidents, memory problems, and the ability to think correctly. These are just a few - and relatively major problems. With Sleep Apnea, the longer it goes on, the more damage it does - like getting a cavity in your tooth. Most patients won't come to get a test until they can't sleep and they're having major problems - and for the last 10-20 years! Can it cause death? Well, in the case of auto accidents, most certainly. Reggie White, a famous football athlete, recently died of Sleep Apnea (proven through the autopsy). He died in his sleep from a lack of oxygen, and this was a fit, otherwise healthy person.

Mr. England then showed us pictures of a normal airway and one that has hypopnea - a partial airway "restriction", as opposed to a full "obstruction". With an obstruction, the brain usually tells the body that the there is a blockage, and the brain awakens the body to "move the blocking tissues" and let the person breathe several times a night. With hypopnea there is also an "arousal" by the brain.

With these conditions (an "apneic event"), it is a cycle of events: Your airway collapses, your oxygen level drops, your heart changes rate rapidly, your brain sends out an alarm to wake up and breathe, your sleep is interrupted as you awake and gasp for air, you go back to sleep, your airway collapses, and we're back to the beginning. Again, most patients don't even know they have a problem. Most get referred by their spouse for snoring.

During a sleep test, we measure the apneic events. We have an apnea/hypopnea index that refers to a measurement on an hourly basis of how many of these events a person has. We all have hypopneas and apneas during the night. About 0-5 per hour is a norm. 5-15 is mild. 15-40 is moderate, and over 40 is severe. Our test shows the person's AHI. Here is a patient that had 110 per hour [a graphic is shown].

During a sleep test, many "leads" or electrodes are placed on the patient. The "tracing" or "epic", as it is called, is a chart or graph similar to an EKG or EEG that measures brain waves on 4 channels, sleep stages (1, 2, non-REM sleep, REM sleep, etc.), right and left eye nerves, chin nerve (or leg), snoring, heart rate (2 channels), pulse, airflow (volume) on two channels, lung expansion and contraction, CO2 levels, body position, etc.

Q: We asked why the chin is monitored. The chin is monitored for muscle tone. As you sleep, your muscles relax and you lose muscle tone. In REM sleep, The leg can also be monitored instead of the chin.

Mr. England then showed us comparisons of tracings of normal sleep, mild apneas, and severe apneas, and the "norms" and extents of the readings collected. He also showed us the difference between a "non-assisted" patient, and then one who had a CPAP machine (Continuous Positive Airway Pressure) connected, and how he changes settings on the CPAP machine to help the patient get more normal sleep. We may be able to provide the visual presentation on our web site. Due to all of the "body functions" that are monitored, it can help pre-diagnose other medical problems such as Restless Leg Syndrome, heart problems, etc.

He also showed us that position matters as well. A person sleeping on their back may exacerbate problems as opposed to on their side. Also, a person having apneas during the REM sleep stage as opposed to other stages/times caused more daytime sleepiness because REM sleep is more restorative to the mind than other stages.

Lastly, there is a new type of apnea called "Complex Sleep Apnea", which is a combination of an abnormal mix of air in their lungs and the brain doesn't think it has to breathe, which can only be treated with an "Auto-SV" machine which allows for "servo-ventilation". We are one of the few labs in Wyoming with this equipment and the technical personnel to use it.

Also, a new screening device is out, that can be sent home with the patient (possibly for no charge), that is very small (about the size of a credit card), and clips on a shirt, that measures airflow and other things. Then, if apneas show up, the person can be brought in for a full sleep test.

We may be able to do home sleep testing as well in the future. We are trying to get as many people tested as possible for the lowest cost. (***NOTE: All this is subject to insurance. Please check with the Star Valley Medical Center Sleep Lab for details.)

Q: Are there any foods or supplements that help apneas? Well, not eating before bed helps considerably because gastric/digestive juices can cause Gastric Reflux is a major cause. Exercise and diet can help raise blood flow and lower obesity. There are also no prescription drugs that help. Only sleep position, surgery, or the CPAP machine(s) can help this condition.