For the week of December 24 - 30, 2002

Who’s sleepless in 
the valley?

New laboratory at hospital 
detects sleep problems

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"It’s a diagnosis that had to wait for the technology to come along. We clearly very much under appreciated the problem."

— DR. KENNETH BRAIT, Neurologist at St. Luke’s

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By GREG MOORE
Express Staff Writer

Dr. Kenneth Brait, a neurologist, tells of a patient who was arrested for beating his wife one night. The accusation seemed strange—the man was one of the nicest guys Brait had met, and he professed to have no recollection of the event. Yet, the evidence was there—the man’s wife showed clear signs of injury.

Had he been arrested a generation ago, the man may have been convicted. But recently developed technology allowed doctors to analyze the man in a sleep lab. They determined that he had a neurological disorder that caused him to become violent during periods of REM sleep, a sleep stage characterized by rapid eye movement and dreaming.

Jim Houghtaling, a respiratory therapist at St. Luke’s Wood River Medical Center, demonstrates how a patient would be hooked up at the hospital’s sleep lab. Express photo by Willy Cook

That was a highly unusual case, but people here with less dramatic sleep problems can benefit from the same technology in a sleep lab operating at St. Luke’s Wood River Medical Center since August. Brait said about eight to 10 people a month have used the lab to have their sleep disorders diagnosed.

"Many patients come in with symptoms they don’t realize are due to sleep problems," Brait says. "It’s a diagnosis that had to wait for the technology to come along. We clearly very much under appreciated the problem."

However, the lab is not for everyone who feels more tired than he or she would like to be. For one thing, it’s expensive—$1,700. Secondly, many causes of poor sleep can be diagnosed without such elaborate machinery. An example is a malfunctioning thyroid gland, which can make you feel drowsy during the day or hyperactive at night.

"When someone says they don’t sleep as well as they’d like, it’s the duty of the physician to ask more questions," Brait says. "The doctors here in town have really done a fabulous job of sorting out the people who need to be tested."

The sleep lab can detect such disorders as apnea, which interrupts breathing, recurrent seizures, and involuntary leg movements. Any of those conditions can leave a person waking up feeling exhausted, but not knowing why. The lab also monitors heartbeat, which can become irregular as the result of some sleep disorders.

Carlene Gaston, a polysomnography technician, studies the electronic waves generated by the brain of a sleeping patient. The squiggles reveal how long the patient was in various stages of sleep. Express photo by Willy Cook

With its $60,000 worth of equipment, the lab measures brain, eye and muscular activity, as well as breathing. Pairs of electrodes attached to the patient’s head transmit information to a machine that records an electroencephalogram, known as an EEG. The series of squiggles tell the technician what stages of sleep the patient was experiencing and for how long.

There are five stages of sleep, with Stage 1 being light sleep, and Stage 3 being deep sleep in adults. Generally, only young children enter into the even deeper Stage 4 sleep. Deep sleep occurs more during the first half of the night.

"You want a significant percentage of your sleep to be in that stage," Brait says.

Stage 5 is REM sleep, with its own characteristics and brain wave patterns. The average person has about three periods of REM sleep each night, lasting between 10 and 30 minutes each. REM sleep is imperative to maintain normal physical and psychological functioning.

The lab detects sleep apnea by monitoring breathing. Apnea is largely an anatomical problem, most common in overweight, middle-aged men with big necks. Episodes of apnea can occur up to 400 times a night, for 30 seconds at a time. Its consequences can be worse than just poor sleep—sufferers commonly develop high blood pressure and heart disease from the body’s attempts to force more oxygen into the blood.

The sleep lab not only detects the condition, but is able to artificially pump more air into the lungs. Once diagnosed, the condition can be treated at home with a similar machine.

One reason a night at the sleep lab is so expensive is because a technician has to stay up all night with the patient. That’s so he or she can hook up electrodes and tubes that fall off, visually confirm the electronic data and treat any serious conditions, such as seizures.

The lab also monitors body movements. A common cause of poor sleep is nighttime leg jerks. Brait tells of one patient who complained of poor sleep, and whose wife said his legs jerked all night. After the lab recorded 450 jerks in one night, Brait prescribed a medication to control the movements.

"He said, ‘For the first time in 50 years, I woke up feeling good.’"

 

The Idaho Mountain Express is distributed free to residents and guests throughout the Sun Valley, Idaho resort area community. Subscribers to the Idaho Mountain Express will read these stories and others in this week's issue.