The following was first published in the April 1999 Rancho Los Amigos Post-Polio Support Group Newsletter and is reprinted here with kind permission of the author, Mary Clarke Atwood and the Rancho Los Amigos Post-Polio Support Group.
SLEEP DISORDERS OF PPS
Frisca Yan-Go, M.D.
Reported by Mary Clarke Atwood
Editorial assistance by V. Duboucheron and F. Yan-Go
Rancho Los Amigos Post-Polio Support Group Newsletter - April 1999
Dr. Frisca Yan-Go is Medical Director of the Sleep Disorders Center, UCLA Medical Center. She and Dr. Susan Perlman, UCLA Post-Polio Clinic, work together as part of a team approach to developing treatment plans for patients with PPS at the University of California, Los Angeles (UCLA) Medical Center. Dr. Yan-Go also serves at UCLA as Associate Clinical Professor of Neurology; Co-Physician of the Headache Clinic; and Co-Physician of the Autonomic Disorders Clinic.
This report is based upon Dr. Yan-Go's presentation to the Post-Polio Support Group of Orange County, CA in May 1998. It includes information on normal sleep patterns, breathing problems, sleep apnea, plus tips for a better night's sleep. The research report, "The Value of Sleep Studies in Post-Polio Patients", concludes that polio survivors who are experiencing sleep or respiratory problems should have a sleep study.
If breathing problems are not recognized, diagnosed, and treated, the PPS patient may be susceptible to cardiopulmonary morbidity and mortality.
Within a 24 hour cycle there are a main sleep rhythm plus a "siesta" time rhythm which is not as strong. Dr. Yan-Go tells patients that when it is time for a break at work, don't get coffee, take a snooze instead. She says it is ok to sleep on the job -- but on your own time, not on company time.
|What is normal?|
These two types of sleep occur in a normal adult within a 90 - 120 minute cycle. Usually there are about 4 of these cycles during a night. NREM sleep is thought of as an idling brain in a moveable body. REM sleep is thought of as a highly active brain in a "paralyzed" body (except for eye and breathing muscles). REM sleep is important for thinking, memory, and mood. As a person ages, the quantity of REM sleep decreases from about 25% to 20% of total sleep. When comparing time asleep to time in bed (for sleep efficiency) the average is 85%.
If a polio survivor is having breathing problems during the daytime, these problems will increase at night. Why? Because the brain must choose between breathing rhythm and sleeping rhythm. Naturally, it selects breathing because this function is essential to life. The breathing process exchanges chemicals so that the body can survive. Sleeping is just a necessary function. Whatever interrupts breathing interrupts sleep; when sleep is interrupted a person is more fatigued during the daytime.
Some people with PPS may be experiencing the following symptoms, which may indicate sleep disturbance:
These symptoms may be caused by:
If these causes are not recognized, diagnosed, and treated the PPS patient may be susceptible to cardiopulmonary morbidity and mortality.
|What is Sleep Apnea?|
There are two types of sleep apnea: obstructive and central.
1. Symptoms of Obstructive Sleep Apnea include:
2. Central Sleep Apnea occurs when the brain fails to send the message to breathe. [Oxygen therapy is usually not recommended for polio survivors. It can cause a decreased respiratory drive so that the brain turns off the need for ventilation.]
|Sleep Apnea Treatment Options|
1. Behavioral treatment options:
2. Mechanical treatment options:
3. Pharmacologic treatment options:
4. Surgical treatment options:
Caution: these may result in rebound insomnia
Sleep studies were conducted on ten UCLA PPS patients with sleep complaints (three male, seven female). Only one of these people had normal sleep with a 93% sleep efficiency (determined by time in bed divided by sleeptime). Average sleep efficiency is 85%.
Of the nine patients with abnormal sleep studies, four had moderately abnormal sleep efficiency ranging between 39% - 78% but a normal respiratory disturbance index and no significant sleep apnea. Two of these four showed a higher than normal number of arousals for no apparent reason, and one showed periodic leg movement disturbances of 33 per hour. None of these four patients required assisted ventilation.
The remaining five patients had sleep efficiency ranging from 5% to 65%. All of them had presumptive alveolar hypoventilation [defined under Breathing Problems], three of them requiring ventilatory assistance. All had serious sleep disordered breathing, with respiratory disturbance indexes between 0 and 82 and significant worsening of their chronic alveolar hypoventilation. In addition, one patient suffered prolonged oxygen desaturation (less than 60%) lasting up to 15 minutes in both NREM and REM sleep. Two patients with tracheostomies required nocturnal mechanical ventilation assistance. Another patient required a tank respirator during sleep and developed severe obstructive sleep apnea.
Dr. Yan-Go, et al, concluded that sleep studies should be performed on PPS patients with sleep or respiratory complaints. PPS patients with or without alveolar hypoventilation may have sleep apnea while patients with hypoventilation may be further compromised during sleep. These patients require nocturnal mechanical ventilation, preferably using a positive pressure device to avoid the development of sleep apnea.
This study published in Mayo Clinic Proceedings, March 1998 reported similar results. It identified three patterns of sleep disturbance -- obstructive sleep apnea, hypoventilation, and a combination of both. It concluded that sleep related disordered breathing is a late sequela of poliomyelitis and clinical evaluation should include information about sleep.
If you are having sleep or breathing problems, seek help. Ask your sleep partner if he/she is aware of any problems you may have. Sleep studies should be performed on PPS patients with sleep or respiratory complaints in order to recognize, diagnose, treat problems, and help prevent further complications.
For more information:
Frisca Yan-Go, M.D.
Suite B 200
300 UCLA Medical Plaza
Los Angeles, CA 90024-6975
The Rancho Los Amigos Post-Polio Support Group meets the 4th Saturday,
from 2:00-4:00 in Downey, CA.
Contact: RanchoPPSG@hotmail.com for more information.
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