Saturday, October 26, 2013

Comprehensive Sleep Medicine Associates, PA welcomes Dr. Gerard Joseph Meskill as Staff Neurologist and Sleep Disorders Specialist.

Dr. Meskill is a neurologist and sleep disorders specialist. He completed his neurology residency at the Hofstra-North Shore Long Island Jewish School of Medicine. The North Shore Long Island Jewish healthcare system is the largest provider of patient care in New York City, with 16 hospitals serving a population of 7 million people spanning three boroughs of New York City and Long Island. The two flagship hospitals of that system, North Shore University Hospital and Long Island Jewish Medical Center, serve as the tertiary care centers for the entire system. Training almost exclusively in those two hospitals, Dr. Meskill was exposed to the full breadth of neurologic disorders, ranging from critical care to outpatient cases, as well as some of the rarest disease processes to common ailments.

After residency, Dr. Meskill switched coasts to continue his training at Stanford University School of Medicine's Sleep Disorders fellowship program. Founded by Dr. William Dement, Stanford's program is recognized internationally as the birthplace of the field and is considered the world's best academic sleep program. Dr. Meskill trained under many of the most recognized innovators in sleep medicine, such as Dr. Dement, considered the father of sleep medicine; Dr. Emmanuel Mignot, the chairman of the program and the world authority on Narcolepsy; and Dr. Christian Guilleminault, one of the world's most published authors in the field of sleep and a major contributor to the discovery of the physiologic mechanisms behind Obstructive Sleep Apnea. Due to Stanford's international reputation and extensive clinical case diversity, Dr. Meskill routinely evaluated and treated both common and rare sleep disorders, ranging from Obstructive Sleep Apnea to Kleine-Levin Syndrome.

Dr. Meskill treats a wide range of neurologic disorders, but like his colleague and fellow Stanford graduate, Dr. Jerald Simmons, he spends majority of his time evaluating and treating sleep disorders. This includes the full spectrum of sleep-disordered breathing, from Upper Airway Resistance Syndrome to Obstructive Sleep Apnea, as well as nocturnal bruxism (teeth clenching/grinding), pediatric and adult ADD/ADHD, Fibromyalgia, Chronic Fatigue Syndrome, TMJ/TMD, Narcolepsy, Restless Legs Syndrome, Periodic Limb Movement Disorder, Epilepsy, and many other disorders. Many of these disorders are related to or are exacerbated by obstructive respirations during sleep. Like Dr. Simmons, Dr. Meskill is trained in the implementation and interpretation of esophageal manometry, which is considered the gold standard measure for detecting sleep-disordered breathing events.

Dr. Meskill is dedicated to improving the standard of care for sleep and neurologic disorders in the Houston area, as well as promoting better understanding of these fields through community education and collaboration with primary care physicians, subspecialists, and community dentists.
 Dr. Meskill has recently published two articles in Huffington Post "Healthy Living": Episodic Excessive Sleepiness in Teens May Represent Kleine-Levin (April 09 2013) and Nocturnal Teeth Grinding May Suggest a Sleep Disorder (October 24 2013).

New Study Shows That Sleep "Cleans the Brain".

A new study funded by the National Institute of Neurological Disorders and Stroke (NINDS) and published in Science shows that sleep increases the flow of cerebrospinal fluid in the brain which in turn flushes harmful waste proteins known as metabolites from the brain. Maiken Nedergaard, M.D., D.M.Sc.  professor of neurosurgery at the University of Rochester and an author of the study discovered the cleaning process while studying the brains of sleeping mice: dubbed the glymphatic system, it pumps cerebral spinal fluid (CSF) through the spaces around the brain cells, flushing waste into the circulatory system where it eventually makes its way to the liver.

Researchers studied the system by injecting dye into the CSF of mice and then observing it as it flowed through the brain using two-photon microscopy- a new imaging technology that allows scientists to see deep inside living tissue- while simultaneously monitoring electrical brain activity. The dye flowed rapidly when the mice were either asleep or anesthetized but barely flowed at all when the same mice were awake.

The researchers also discovered that during sleep brain cells contract, increasing the space between the cells by as much as 60 percent and allowing the spinal fluid to wash more freely through the brain tissue.

One of the waste products of the brain is the protein amyloid-beta, which accumulates and forms plaques in the brains of Alzheimer’s patients. Researchers at Washington University in St. Louis had previously shown that levels of amyloid-beta in mice brains dropped during sleep because of a decrease in production of the protein.“That was an observation that inspired our work,” says Nedergaard. Research in humans has shown that levels of amyloid-beta decline during sleep, as it does in mice, but it’s not yet known if the mechanisms are the same as in mice.

Maiken Nedergaard, M.D., D.M.Sc.
U.S. Department of Health and Human Services: The National Institutes of Health (NIH)
NPR: brains-sweep-themselves-clean-of-toxins-during-sleep
NBC News: good-nights-sleep-scrubs-your-brain-clean

Monday, October 14, 2013

New study suggests that children without regular bedtimes have more behavioral problems.

Researchers from University College London recently completed a long-term study of  babies born in the UK in 2000 to 2002, which regularly surveyed parents about sleep and behavioral problems. After analyzing data for over 10,000 children they discovered that children without a regular bedtime tended to score worse on a measure of behavior problems such as acting unhappy, getting into fights and being inconsiderate.
In three year olds, close to 20 percent of parents said their child sometimes or never went to bed at a consistent time. That fell to 9 percent among five year olds and 8 percent for seven year olds: at seven  those without a regular bedtime scored an 8.5, on average, based on their mothers' reports. That compared to scores between 6.3 and 6.9 for kids who had a consistent bedtime before 9 p.m.
The assessment is scored from 0 to 40, with higher scores indicating more problems. Researchers said one to two points represents a small or moderate difference, but is "meaningful."

Children with attention-deficit/hyperactivity disorder or an autism spectrum disorder were not included in the study. Teachers of seven year olds were also asked to report on their, and gave worse scores to children who didn't have a regular bedtime. Although the researchers accounted for other parent characteristics and family habits, it's still possible kids' behavior problems weren't directly caused by irregular bedtimes.

Nonetheless, the effects that a regular sleep schedule have on your "biological clock" have been well documented. Yvonne Kelly, who led the study says that "If you are constantly changing the amounts of sleep you get or the different times you go to bed, it's likely to mess up your body clock. That has all sorts of impacts on how your body is able to work the following day.

Kids whose parents said they had non-regular bedtimes on every survey growing up had the most behavioral issues, but when children went from having a non-regular bedtime to a regular bedtime on the following survey their behavior scores improved.

Pediatrics (online October 14, 2013)
Non-regular bedtimes tied to kids' behavior problems (Reuters)

Saturday, October 5, 2013

Treating Snoring Problems

SNORING Threatens Your Health!

Snoring can be a sign of  Obstructive Sleep Apnea (OSA), which has been linked to high blood pressure, heart disease and an increased risk of heart attacks and stroke.

For years people have thought of snoring as nothing more than a simple annoyance during the night: snoring is so common that we do not view it as a medical problem.
Snoring typically occurs when the tongue and throat muscles relax during sleep causing the airway space in the back of the throat to narrow. Breathing through a narrow airway causes a vacuum that pulls on the throat's soft tissue causing it to vibrate, which creates the snoring sound.
This vacuum in the throat also spreads to the chest where the heart is located, causing a strain on the heart and the possibility for oxygen in the bloodstream to drop to dangerously low levels.
When these factors occur night after night, year after year, they instigate the problems listed above. Additionally, new studies have also shown OSA causes increased insulin resistance resulting in poorly controlled diabetes.

Studies have demonstrated that in many people, snoring can cause an increase in chest pressures which can influence blood flow in the heart and lungs. This may be the cause of some of the medical problems in people who snore.
Many people who snore have another problem known as sleep apnea. Apnea is a Greek word, which means, "want to breathe." People with obstructive sleep apnea have pauses in their breathing while asleep. These pauses in breathing occur when the airway collapses during sleep. After a few seconds the person briefly awakens, frequently producing a grunting, gasping, or snorting sound.
Obstructive sleep apnea is more common in obese people and more common in men, but it is not just obesity that can cause this problem. People with a small jaw, large tongue, or large tonsils are at higher risk of having this problem as well. In fact, any condition which can narrow the opening in the back of the throat or possibly the nasal passages can increase the risk of obstructive sleep apnea.
It is important to know the consequences of this problem if left untreated.
Some of the more common problems associated with obstructive sleep apnea are excessive daytime sleepiness and an increased risk of high blood pressure, heart attacks and stroke.

What can someone do if they want to know if they have Sleep Apnea?

See your physician and ask about being referred to a sleep disorders center. This is a special testing facility that evaluates people for sleeping problems. If your doctor does not feel this is necessary, don't be discouraged. Most physicians have not been taught very much about sleep medicine in medical school and therefore may not recognize this problem in their patients. Be persistent. You can be seen by a sleep specialist and, if needed, a sleep study can be performed on you during the night.

What can be done if a person snores or has Sleep Apnea?

The most effective treatment to date for sleep apnea is called nasal CPAP (Continuous Positive Airway Pressure). An individual wears a mask on their nose at night that administers air pressure, keeping the upper airway open. This allows the individual to breathe throughout the night without repetitive awakenings. If a person only snores and does not suffer from excessive daytime sleepiness, then CPAP is not the appropriate treatment.

Dental appliances have been used for snoring. Sometimes these devices can also prevent apnea as well. Studies have demonstrated that dental appliances work for snoring and sleep apnea, but not in all patients. Surgery has been used to treat these problems. The most frequently performed surgery is a procedure where the soft tissue in the back of the throat including the uvula is cut away or reduced in size with a new microwave needle or a laser. Although this may work well for snoring, unfortunately most patients who have sleep apnea are not adequately treated with these procedures. There are other more extensive surgeries that can be performed for sleep apnea.

Comprehensive Sleep Medicine Associates, PA. (CSMA) treats the full spectrum of sleep disturbances in patients ranging from pediatrics to geriatrics.

A sleep specialist who is very familiar with these procedures should explain them to you. If you snore at night and think you might have sleep apnea, contact your doctor. If your doctor is not familiar with this type of problem, have him or her contact us directly.

 If you or someone you know has one or more of these symptoms, a sleep disorder may be the cause and an evaluation is needed; help is available by Dr. Jerald H. Simmons and his dedicated team at  CSMA.  Dr. Simmons established CSMA as an outreach program in the Greater Houston area and now has facilities in the Houston Medical Center, Sugar Land and The Woodlands. The Sleep Medicine Specialists at CSMA can help you determine the cause of your sleep problems and restore night after night of healthy, restful sleep.