Treating sleep problems improves conditions not typically considered by most physicians.

Over the past decade many Sleep Testing centers have opened throughout the country; most focus on evaluating patients with snoring complaints to determine if they have Obstructive Sleep Apnea (OSA). Once diagnosed these patients are typically placed on CPAP for treatment. Typically a second sleep study is performed to determine the best settings for the CPAP machine, with most centers taking the basic approach  rooted in standards developed when less was known about sleep abnormalities.

As a result, many patients who have abnormalities during sleep are not accurately diagnosed and patients are left without an effective treatment plan. Many patients may have a subtle breathing problem during sleep known as Upper Airway Resistance Syndrome (UARS). Patients with UARS have normal oxygen levels throughout the night and do not stop breathing, but they work harder to breathe and the increased effort causes brief disruptions called micro arousals. Recently accepted minimum standards in the field miss out on the identification of abnormalities such as UARS.

Some centers differentiate themselves in their ability to properly diagnose and treat patients with sleep disturbances by using refined approaches and assessing more sensitive parameters during sleep. Additionally, many conditions not typically thought to be rooted in abnormalities of sleep are now recognized and treated more effectively. In Houston, Jerald H. Simmons, MD, a Triple Board-Certified Neurologist specializing in sleep disorders, directs several sleep centers that clearly stand out from the crowd. His centers use methods beyond what is required by sleep centers for accreditation.

Dr. Simmons points out that "Every path has a starting point and we learn new things along the way. It is great that the field of Sleep Medicine is developing standards but unfortunately the current standards fall short of being able to properly diagnose and treat patients with complicated conditions. By identifying the more subtle abnormalities, we have been successful in providing care to patients who were previously left struggling by the health care system."

In example, a common cause for recurrent morning headaches is OSA or UARS. Many of these patients also have bruxism during sleep (clenching or grinding the teeth at night) and this can lead to TMJ Disorder. Research conducted by Dr. Simmons has shown that bruxism during sleep actually helps keep the airway open by moving the tongue and jaw forward; this is the body's attempt to prevent OSA or UARS. By treating the airway problems during sleep Dr. Simmons and Dental Sleep Specialist Dr.Ron Prehn have demonstrated improvement in both bruxing and TMJ pain.
When appropriate Dr. Simmons treats patients with OSA or UARS by using dental appliances as an alternative to the CPAP machine, and is performing pioneering research on the use of combined treatment approaches using both CPAP with dental appliances.


Additionally, most patients with fibromyalgia have poor sleep. Proper treatment of their sleep problems frequently improves the symptoms of Fibromyalgia. Signals from pain nerve fibers throughout the body constantly send a low level of signals to the brain, but the brain normally filters these out. If the brain is not properly rested it loses the ability to filter these signals which results in common fibromyalgia pain.
Treatments geared to improving sleep continuity restore the brain's pain filter mechanism, and the pain symptoms resolve.

The underlying sleep disturbances causing these symptoms is not always identified by sleep centers, and the treatment opportunities are missed. In many of these patients UARS can be at the root of the problem. Once the sleep disturbance is properly treated, fatigue resolves.

The sleep centers directed by Jerald H. Simmons, MD utilize advanced methods to properly diagnose and treat patients with conditions, such as those described above. Dr.Simmons concludes that "In the future we will look back and see how much we didn't understand, but unless we embrace the knowledge of our experience we will never reach that future perspective."

For more information on sleep disorders and the sleep centers of Dr. Simmons, visit HoustonSleep.net and gain the knowledge you need to obtain a better night's sleep.

Non-Restorative Sleep May Lead To Pain In Older Adults

New researcher indicates that "non-restorative sleep" is the biggest risk factor for the development of widespread pain in older adults.

Widespread pain that affects different parts of the body, a primary characteristic of fibromyalgia, affects 15 percent of women and 10 percent of men over age 50 according to previous studies.

The researchers collected data on pain, psychological and physical health, lifestyle and demographic information from 4,326 adults over the age of 50 who were free of widespread pain at the start of the study (1562 subjects reported no pain and 2764 had some pain). These participants were followed up three years later for the development of widespread pain.

The results, published Feb. 13 in Arthritis & Rheumatology, show that restless sleep as well as anxiety, memory problems and poor health play a role in the development of this type of pain. Specifically, The researchers found that pain status, anxiety, physical health-related quality of life, cognitive complaint and non-restorative sleep were all associated with increased risk of widespread pain development, after adjusting for osteoarthritis (OA).

Three years after the study began the researchers found that 19 percent of the participants had new widespread pain which was worse for those who had some pain at the beginning of the study; of those with some prior pain, 25 percent had new widespread pain. Meanwhile, 8 percent of those with no pain at the start of the study had widespread pain three years later.

Dr John McBeth from the Arthritis Research UK Primary Care Centre at Keele University in Staffordshire, said: "While OA is linked to new onset of widespread pain, our findings also found that poor sleep, cognition, and physical and psychological health may increase pain risk. Combined interventions that treat both site-specific and widespread pain are needed for older adults."
The results showed that non-restorative sleep – gauged by waking up feeling tired and worn out even after getting the usual amount of sleep – "was the strongest predictor of new onset widespread pain."
"We have previously shown that among persons with widespread pain, restorative sleep predicted symptom resolution," the paper said. "Together these data suggest that sleep may offer a modifiable target to improve outcome in this patient group."

Increasing age was linked to a lower chance of developing widespread pain: muscle, bone and nerve pain is more common among older people. Up to 80 percent of people 65 and older experience some form of pain on a daily basis, according to the news release.

While the study finds an association between poor sleep and widespread pain, it does not establish a direct cause-and-effect relationship.

The sleep centers directed by Jerald H. Simmons, MD utilize advanced methods to properly diagnose and treat patients suffering from non-restorative sleep and fibromyalgia.
Dr. Simmons concludes that "In the future we will look back and see how much we didn't understand, but unless we embrace the knowledge of our experience we will never reach that future perspective."
For more information on sleep disorders and the sleep centers of  Dr. Simmons visit www.HoustonSleep.net.

Poor Sleep is Frequently at the Root of Fibromyalgia

For decades, doctors have been challenged in treating patients with a condition known as fibromyalgia. Patients with fibromyalgia complain of pain in various parts of their body, and evaluation by the doctor does not identify any physical cause. There are no inflammation or arthritic changes in the bones to explain the daily difficulties with pain. More than 12 million Americans have been labeled with this diagnosis and treatment options have been limited; for the most part it has consisted of pain medications or medications that dull the nerve pain transmission from around the body to the brain. These medications frequently cause side effects including drowsiness, and their benefits lessen over time.

A new direction in the management of fibromyalgia stems from our growing knowledge of this mysterious disorder. Dr. Jerald H. Simmons, neurologist and founding director of Comprehensive Sleep Medicine Associates (CSMA), says that fibromyalgia is a condition in which the brain's pain-filtering system is fatigued and does not function correctly: "Our brains constantly filter out signals coming in from the nerve fibers throughout the body. This allows us to function without feeling every little impulse coming from all of the nerves. When we sleep, this filter in our brain restores itself in preparation to function throughout the next day. When we are sleep-deprived or have not gotten proper sleep, the filter system begins to malfunction and signals from the nerves that should have been filtered out instead get into the brain and create the sensation of pain."

Another way to describe this is that our pain threshold is lowered by poor sleep, and this relationship between sleep and pain has become increasingly dear. As it turns out, many patients with sleep disorders who have also been identified as suffering from fibromyalgia experience resolution of their fibromyalgia pain as a result of treatment of their sleep disorder. The link between sleep and other conditions has become increasingly clear. "If we improve sleep in fibromyalgia patients, we have seen that the pain improves as well," Dr. Simmons says. "Common sleep disturbances such as obstructive sleep apnea, restless legs syndrome or upper airway resistance syndrome seem to be underlying causes of patients' fragmented sleep. Many of these patients also complain of chronic fatigue syndrome, further implicating sleep disruption as a contributing factor. I have had excellent results from identifying the root of the disrupted sleep and then treating the sleep disturbance."

Dr. Simmons uses a new approach to treat patients with fibromyalgia that have not been identified as having another sleep disorder; it involves Zyrem, a medication originally used for treating narcolepsy. "Now that I'm on Zyrem, I feel better than I have in 20 years," said Nancy Schweining, one of Dr. Simmons' patients. "My pain is gone and I feel like I have my life back." Dr. Simmons expects more doctors to recognize the proper use of this medication, which he said enhances Sleep Wave sleep in patients with fibromyalgia.

If you or someone you know suffers from fibromyalgia, consider the possibility that poor sleep may be at the root of the condition. Evaluation can be provided by Dr. Simmons and his staff at CSMA's sleep centers throughout Greater Houston by calling 281-407-6222 or by visiting www.HoustonSleep.Net.