Sleep plays a critical role in overall wellbeing and good health, affecting mental and physical health, quality of life and safety. The way you feel when you are awake is directly correlated to what goes on when you sleep.
Sleep helps control your metabolism and weight, helps prevent cardiovascular diseases, boosts your immune system, increases cognitive memory function, helps with long- and short-term memory, and promotes stable moods. According to research done at John Hopkins, sleep is vital for brain plasticity and helps with the removal of waste products from brain cells.
Dr. Phillip Nye was drawn into diagnosing and treating sleep disorders because of his experiences as an anesthesiologist.
“I’ve been an anesthesiologist at Indian River Hospital since 2006 and during my practice I saw a lot of patients who I suspected had sleep apnea, but I wasn’t really sure,” said Dr. Nye.
“While I would always ask my patient if they had a good night’s sleep, I found that some became profoundly hypoxic, and their oxygen level dropped during procedures like an endoscopy. As an anesthesiologist, I had to be very careful.
“This how I became interested in sleep medicine. Most of the patients were undiagnosed and untreated. I felt there was a need, and I could make it my subspecialty, so in 2018 I was matched for a fellowship in sleep medicine at Eastern Virginia Medical School where I trained to diagnose and treat sleep disorders in both adults and children.”
Dr. Nye continued: “Sleep medicine was originally a specialty practiced by neurologists and pulmonologist, but in 2011 the American Board of Anesthesiology allowed anesthesiologists to practice sleep medicine. After completing my fellowship, I moved my family back to Vero and opened my sleep medicine clinic last July. Now I juggle my time between working at the hospital as an anesthesiologist and solving sleep disorders at my clinic.”
Sleep apnea is the most common sleep disorder. With this disorder, breathing repeated stops and starts. Approximately 17 percent of females and 30 percent of males have sleep apnea and their risk factors depend on age, sex and comorbidity. Symptoms include snoring and feeling tired even after a full night’s sleep. Moderate to severe sleep apnea can put you at increased risk for hypertension, diabetes, cardiovascular disease and strokes.
“It’s a slow and insidious disease but it is detrimental on the body,” said Dr. Nye. “Micro arousals caused from obstruction in the airways can happen 30 times an hour in severe cases. It’s usually more severe when the patient is in a supine position, lying flat on his back, and the abdomen internal organs push up from the diaphragm to the neck tissue and tongue. Sometimes patients wake up gasping for air and struggling to breathe. This can lead to hypertension and put them at risk for stroke.”
“A lot of patients are on two or more medications for high blood pressure, or they need to lose some weight,” he continued. “With exercise and PAP therapy, they can go down to one med because their blood pressure is under control. Antidepressants can also lead to fragmented sleep and movement during sleep. Caffeine, alcohol and nicotine are other sleep inhibitors.”
When a patient comes into the sleep clinic, Dr. Nye conducts a complete evaluation and looks for many kinds of sleep disorders. Aware of 80 different sleep maladies, he dives deep into the habits and complaints of the patient.
“It’s my job to squeeze out information and get to the nuts and bolts of the problem,” he explained. “Do they sleep too much or too little? Do they drink alcohol or smoke? What medications are they taking? Does their partner witness any signs of sleep apnea? Have they put on weight? Through a series of focused questions, I can formulate a plan, but I always want objective data to confirm the patient’s subjective complaint. I can get that data in the form of a sleep study.”
During an in-lab sleep study, Dr. Nye reads the EMG to detect signs of a sleep disorder. When the study is done at home, he remotely reads the stages of sleep from stage 1, which signals the changeover from wakefulness to sleep, to stage 2, which is the non-REM sleep period of light sleep before you enter deeper sleep, to stage 3, the non-REM sleep period of deep sleep that you need to feel refreshed and, finally, the most important for a diagnosis – REM sleep, which occurs about 90 minutes after falling asleep.
“REM sleep has an increase in cerebral metabolic activity,” said Dr. Nye. “It’s when you get dreams that you can remember. During REM sleep the muscles are very relaxed and the body is still. During this time, the brain is responsible for controlling and relaxing the muscles and inhibits movement during REM sleep. I can see the obstructions significantly more pronounced, particularly under the chin.”
Most sleep apnea can be treated with a PAP (positive airway pressure) device that delivers a stream of compressed air to support the airway during sleep. The traditional CPAP machine provides continuous, steady positive airway pressure through a specially fitted mask.
Auto PAP machines, commonly known as auto-adjusting CPAP, deliver air through the mask only when the patient needs it. This airflow helps keep the airway open, preventing the collapse that occurs during apnea, thus allowing normal breathing.
Since an estimated 1 in 5 Americans are chronically sleep deprived, it’s important to seek help if you notice changes in your body or interrupted breathing at night. Lasting effects of chronic sleep disorders are now being associated with Alzheimer’s and dementia as well as hypertension, stroke and heart attacks.
Talk to your primary care physician first and then get evaluated by a sleep disorder specialist like Dr. Nye.
“My patients who have been put on PAP therapy have described the experience as life changing and often say they never knew they were sleep deprived but now feel full of energy,” concluded Dr. Nye. “It’s been life changing for me, too. Now instead of always putting people to sleep for surgery, I help people get the full night’s restful sleep they need to function during the day.”
Dr. Phillip Nye currently serves on advisory committees for both the American Academy of Sleep Medicine and the Society of Anesthesia and Sleep Medicine. He can be reached at his practice for Neurologic Health and Restorative Sleep at 1485 37th St., Suite 111 in Vero Beach, or call 772-226-6855 for a consultation.