This is an excellent article laying out a multi disciplinary approach to the treatment of sleep patients. This article is aimed at the patient however it sets out the goals of the program very well. These programs are springing up around the country and I expect will become the standard.
Sleep apnea affects 18 million Americans, and a CPAP device is the gold standard for treating the condition.
But sometimes patients don’t find success with the device for a variety of reasons.
“Some have really diminished quality of life,” says Dr. Ron Caloss, an oral and maxillofacial surgeon at the University of Mississippi Medical Center.
For those patients, alternatives such as dental appliances and surgery are available. But determining which option is ideal can be taxing on patients, often causing them to see a variety of specialists separately.
Beginning April 27, UMC will bring together four specialists at a biweekly clinic at the University Pavilion on Friday afternoons so patients seeking an alternative to the CPAP can be assessed. The health care providers will include a sleep medicine specialist, a dentist, a surgeon and an ear, nose and throat doctor. Patients will meet with all the specialists at one visit. Then the specialists will meet to discuss each patient’s case and determine the best treatment plan.
“This approach is mainly for cases that cannot tolerate standard treatment, which is CPAP,” says Dr. Alp Baran, a sleep medicine specialist, psychiatrist and director of UMC’s Sleep Disorders Center.
Not being able to tolerate treatment may have something to do with the discomfort of the device, disturbing a bed partner or the fact a person travels often. Some patients battle depression and decreased libido, lose jobs and can’t maintain relationships.
CPAP stands for continuous positive airway pressure. It is a machine that increases air pressure in the throat. The air is forced through with a mask that covers the nose, the nose and mouth or prongs that fit into the nose.
The multidisciplinary team approach is not unique to academic medical centers, but it’s not universal either. Baran, who has worked at UMC for 14 years, has been aware of the approach through his connections with the University of Michigan Medical Center, where he trained. That university’s program serves as a model for UMC’s.
While the medical center does offer specialty services to patients needing treatment beyond a CPAP device, the services have never been offered in this organized fashion. UMC is starting the new approach now because certain dental and surgical staff have expressed a special desire to pursue it, according to Baran.
Two of those people are Caloss and Dr. Andrea Lewis, an ear, nose and throat doctor who is also a sleep medicine specialist. Lewis has been with UMC seven months and is one of three ENT doctors nationwide who completed a fellowship in sleep medicine.
ENT doctors often perform some surgeries on sleep apnea patients to remove adenoids, tonsils, nasal polyps or tissue that blocks airways. But studying sleep medicine takes research a step further.
“It’s a niche for ENT at bigger academic settings,” Lewis says. The fellowship gave her insight that some sleep apnea patients were not being adequately treated.
“It’s not a one size fits all (and there’s) a lot of misinformation,” patients obtain when being shuffled around from doctor to doctor, Lewis says.
Another team member will be Dr. Shelley Taylor, a dentist in the Department of Otolaryngology at UMC. She and colleague Dr. Harold Kolodney accept referrals from Lewis to manage sleep apnea patients and fit them with dental appliances when a CPAP isn’t tolerable and surgery isn’t needed or desired.
The devices are used for those with mild to moderate sleep apnea and work by repositioning the lower jaw and the tongue to increase the nasal airway.
“Patients need to know their options,” Taylor says. She sees the clinic as the perfect space for patients to be properly informed and for the specialists to learn from each other.
Although options are available, Baran stresses the CPAP is the most effective treatment for nearly all patients. A CPAP prescription follows a sleep study of being monitored in a controlled setting. Patients should try the device for at least a couple of weeks before seeking alternative treatment.
“It takes some getting used to. Nobody likes it when they first try it, but results can be excellent,” Baran says.
Regardless of what treatment is prescribed, proper and close follow-up is essential for all sleep apnea patients, including repeat sleep tests.
Even when snoring – a common indicator of sleep apnea – is eliminated, a person may still have the sleep disorder. Losing weight doesn’t always fix the problem either, Baran says. Some thin people have sleep apnea. Facial structure can play a role. No medications work reliably well unless the disorder is mild and can be attributed to chronic rhinitis, which can respond to allergy medications.
Often times patients who don’t find success with the CPAP may not come back for follow-up treatment, Lewis says, which puts their health at greater risk.
Last month, the American Stroke Association linked severe sleep apnea to increased risk of silent strokes and small lesions in the brain.
The key is to get a diagnosis, seek treatment and understand that, if a CPAP doesn’t work for whatever reason, alternatives are available.
“It (clinic) really is a neat thing that’s gonna be beneficial to patients,” Caloss says.
Shanderia K. Posey
Published in the ClarionLedger.com