Sleep Disorders Center

The Sleep Lab is in a quiet, cozy space inside the main hospital. For a private room, individualized attention, and a hotel-like experience, ask your doctor to refer you to one of Cayuga Health’s Sleep Labs today. We also offer at-home testing, if appropriate.

About

The Sleep Disorders Center at Cayuga Health is the only nationally accredited center in our region. The Sleep Center received its accreditation status in 2003 from the American Academy of Sleep Medicine.

Lavanya Kodali, MD is the medical director of the Sleep Disorders Center. She is certified with the American Board of Internal Medicine for Sleep Medicine, Pulmonary Disease, and Critical Care Medicine.

Our sleep center process insures our patients receive the highest standard of care. Each of our sleep technicians are board certified as a Registered Polysomnographic Technician (RPSGT). These technicians, under the guidance of our Medical Director, are able to provide diagnostic and therapeutic studies for the complete range of sleep disorders.

Cayuga Health has state-of-the-art equipment which allows enhanced and outstanding diagnostic testing for our patients. We provide Home Sleep Testing for select patients who cannot come to our lab.

There are two locations for the Sleep Disorders Center, either Ithaca or Montour Falls.

A Good Night’s Sleep Doesn’t Have to be a Dream

Everyone dreams when they sleep, but many people simply dream of a good night’s sleep. According to the National Sleep Foundation, approximately 70 million people in the United States are affected by a sleep problem. About 40 million Americans suffer from a chronic sleep disorders, and an additional 20-30 million are affected by occasional sleep-related problems. However, an overwhelming majority of sleep disorders remain undiagnosed and untreated. These disorders and the resulting sleep deprivation can interfere with work, driving, social activities and other aspects of life.

When you sleep, your body rests and your energy is restored. Sleep is an active state separated into 2 different stages. These stages are REM or rapid eye movement, and NREM or non-rapid eye movement. Throughout the night people will cycle through these sleep stages several times.

Characteristics

REM (rapid eye movement)

  • Brain waves, heart rate and breathing are all similar to being awake
  • Voluntary muscles are paralyzed during this stage of sleep
  • Dreams occur during this time
  • The percentage of REM sleep decreases with age

NREM (non-REM sleep)

  • Stage 1: this stage can last from 5-10 minutes. This is the time that you feel you are falling asleep
  • Stage 2: known as light sleep. During this stage, heart rate slows and temperature decreases
  • Dreams occur during this time
  • Stage 3 and 4: This is known as deep sleep or delta sleep. This is the stage of sleep that helps you to feel most rested

Each stage of sleep can last from 5-15 minutes

A sleep cycle consists of all 4 stages and then a period of REM sleep before beginning a new cycle.

These are the most common types of sleep disorders.

Snoring is a common condition that can affect almost anyone of any age. Occasional snoring is not serious, however excessive snoring with interruption of breathing and interference in sleep patterns can have serious effects on your health and should be evaluated by your physician.

Risk Factors

  • Male
  • Overweight
  • Over 40 years old
  • Large neck size
  • Large tongue or tonsils
  • Family history of sleep apnea or snoring
  • Gastric reflux
  • Nasal obstruction, allergies or sinus problems

Causes of Snoring
Snoring occurs when airflow is blocked or obstructed through the nose or mouth.

Nasal passages may be obstructed by allergies, sinus infections, or a physical blockage such as a deviated septum.

During sleep, our muscles relax. Lack of muscle tone or a large neck, tongue or tonsils can all cause the airway to be blocked.

Snoring becomes “Sleep Apnea” when breathing is stopped for more than 10 seconds. This can be caused by either a partial or total obstruction of the airway. During this period of apnea (not breathing), the brain does not have enough oxygen. Our brain then tells us to “wake up” and take a breath. People with severe sleep apnea may stop breathing more than 100 times an hour.

Although the person does not consciously know that they are “waking up” to take a breath, this interference in the sleep cycle can cause excessive fatigue as well as contribute to serious medical problems.

  • High Blood Pressure
  • Stroke
  • Heart Failure and Heart Attacks
  • Diabetes
  • Depression
  • Chronic Fatigue

Insomnia is a sleep disorder characterized by difficulty falling asleep and or staying asleep.

Symptoms

  • Difficulty falling asleep
  • Waking up after falling asleep and cannot get back to sleep
  • Waking up too early and cannot get back to sleep

Treatments

  • Mild insomnia can generally be prevented or treated by practicing good sleep hygiene habits Sleep Hygiene Rules
  • Long term insomnia is generally treated using behavioral techniques. This helps to change behaviors which interfere with sleep, and helps promote and teach behaviors that enhance sleep. Some methods include relaxation and biofeedback therapies
  • Progressive Relaxation Exercises

Further Information

This is a movement disorder which involves excessive movements of the legs. The feeling is often described as a creepy/crawly feelings in the legs that is lessened after movement. When these feeling primarily occur at night, they are referred to as Periodic Limb Movements (PLM’s). These movements cause interruption in sleep and lead to daytime fatigue.

Causes of RLS

  • Low blood iron levels
  • Poor blood circulation in the legs
  • Nerve problems in the spine or legs
  • Muscle or kidney disorders
  • Alcoholism
  • Certain medications

Treatments

  • All underlying causes must be ruled out or treated
  • Home remedies can help with mild or occasional RLS these include:
    • Hot baths
    • Leg Massage
    • Heat or ice
    • Regular exercise
    • Eliminating caffeine and alcohol
    • Stretching legs prior to bed and upon arising
    • Avoid large meals close to bedtime

Medications used to Treat RLS

  • Dopamine precursor- Sinemet
  • Dopamine agonist- Mirapex, Requip
  • Benzodiazepines- Klonopin
  • Anticonvulsants- Neurontin, Gabapentin

Medications that Worsen RLS

  • Antidepressants- Elavil (amitriptyline), Prozac
  • Antihistamines- Benedryl, cold and allergy medications
  • Antiemetics– Compazine, Reglan
  • Lithium
  • Major tranquilizers- haldol, thorazine

“Things that go bump in the night”

These are arousal disorders that occur when a person is in a mixed state of being asleep and awake. There are several types of parasomnias.

Confusional Arousal
These are most common in infant and toddlers but may be seen in adults. This is characterized by crying, thrashing and agitation. The person appears to be awake, but they are not.

Sleepwalking
This is generally seen in older children but can persist to adulthood. This can range from simply getting out of bed to complex behaviors. Sleepwalkers rarely injure themselves but they can put themselves in dangerous situations.

Safety Tips!

  • Clear bedroom of obstacles
  • Sleep on the ground floor
  • Secure windows and doors, install locks and alarms
  • Block stairwells

Treatment is generally not required. Sleepwalking rarely indicates any underlying physical or psychological problems.

Sleep-Related Eating
This is related to sleepwalking and occurs when a person has episodes of eating without any conscious awareness. As with sleepwalking, treatment is rarely required. Simple safety measures should be taken.

Sleep Terrors
These are the most disturbing disorders for those witnessing the behavior. Sleep terrors generally begin with a piercing scream or shout. The person appears to be agitated and terrified. They may run around the house and appear frightened. Sleep terrors differ from nightmares in that the person does not remember the episode after awakening.

Nocturnal Seizures
This type of seizure occurs only during sleep, and are characterized by behaviors such as crying, moving or walking. This condition is generally treated with medications.

REM Sleep Behavior Disorder
During normal REM sleep, all muscles except those used for breathing are paralyzed. In this disorder, the muscles are not paralyzed and therefore dreams may be acted out. These behaviors may be violent and cause harm to the bed partner. Unlike sleep terrors the person will recall their dreams. This condition is most often seen in older men and can be treated with medications.

Narcolepsy is a sleep disorder that is characterized by constant sleepiness and falling asleep at inappropriate times. This tendency to fall asleep is often called “sleep attacks” and can have devastating effects on people’s lives. The cause of narcolepsy is thought to be disorder of the brain that controls wakefulness and sleep. This is not a psychiatric or behavioral disorder.

Symptoms:

  1. Excessive daytime sleepiness. This is constant and is not relieved even with adequate sleep. This is usually the primary symptom that occurs. People often fall asleep at inappropriate times or may become drowsy or foggy in unusual situations.
  2. Cataplexy. This is characterized by sudden, brief losses of muscle control. These are usually triggered by strong emotion, such as laughing, anger or surprise. The severity can range from a feeling of weakness to total collapse.
  3. Sleep Paralysis. This is also a brief loss of muscle control which occurs when falling asleep or waking. A person may be aware of this and be unable to move or speak.
  4. Hypnagogic hallucinations. These vivid, dream-like experiences occur when a person is drowsy. They are frightening, in that a person may be aware and partially awake, but has no control over what is happening.

Diagnosis:

  1. Narcolepsy is generally diagnosed with a polysomnogram (sleep study) which is followed the next day by an MSLT or multiple sleep latency test. During this test you are asked to take several naps throughout the day. During these naps, specific parameters are measured. These parameters help to diagnose Narcolepsy.
  2. Specific instructions for an MSLT

Treatments:

  1. Medications. Specific drugs may be prescribed by your physician. These medications can help to alleviate the symptoms of narcolepsy such as sleepiness, cataplexy or hallucinations.
  2. Behavioral treatment. This includes following a sleep/wake schedule, including naps, caution during dangerous activities and following your physician’s advice.
  3. Environmental management. Education of family, friends and co-workers is essential. Behaviors often can cause friction in the workplace or at home. It is important to inform others that these behaviors cannot be controlled at will.

PATIENT INFO

What to Expect During Your ConsultationPreparing for a Sleep StudyWhat to Expect During Your Sleep StudyTreatment Options for Obstructive Sleep ApneaHow to Cope with Daytime Sleepiness

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