This common disorder could be disrupting your sleep

This story first appeared in Healthy You - January 2025, The Gazette’s quarterly health publication.

Eastern Iowans may rest easier knowing more effective treatment for sleep disorders like sleep apnea is close at hand.

“When I first started in the field, a lot of people figured ‘I’m getting older, and this is just a part of it,’ not realizing there is treatment for it that can improve their quality of life,’” said Melissa Walsh, executive director of the Eastern Iowa Sleep Center, or EISC.

Patients experiencing chronic fatigue have been referred to EISC since it was launched in 2007 by Cedar Rapids’ hospitals and clinic operators. EISC is a partnership between UnityPoint-St. Luke’s Hospital, Mercy Medical Center and Physicians Clinic of Iowa.

“It was recognizing that we needed a more consolidated approach,” Walsh said. “When we formed, both hospitals each had four beds, and PCI had two beds (for sleep-disorder patients). We basically had to double in size.”

EISC also serves patients at Jones Regional Medical Center in Anamosa, Regional Medical Center in Manchester and Finley Hospital in Dubuque. In addition to obstructive sleep apnea, or OSA, staff treat people with central sleep apnea, or CSA, which occurs when the brain doesn't send the proper signals to the muscles that control breathing, and narcolepsy, a chronic neurological disorder that affects the brain's ability to control sleep-wake cycles. Sleep specialists also deal with insomnia, a term that covers a range of causes from sleep habits to hygiene.

“Narcolepsy is a little bit rarer, but we do see quite a bit of that,” Walsh said. “For certain people, even once their apnea is treated, they do have excessive sleepiness, so they might see us for further testing.”

Awareness of sleep apnea and its relatively common and effective treatment has grown over the past three decades.

OSA is sleep apnea’s most common form, affecting 5-10 percent of the population — a figure that increases to about 20 percent among people over the age of 65. OSA happens when the throat muscles relax during sleep, blocking the airway and disrupting sleep at least five times an hour overnight.

While aging’s effects may be impossible to counter, OSA is more prevalent among those who are overweight or obese, have a thicker neck or narrowed airway, or who smoke. It’s also more prevalent in men and those who have experienced congestive heart failure. The use of alcohol or sedatives can also relax the muscles in the throat.

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“Being obese reduces the space behind the throat,” said Dr. Syed Jawad Shah, Mercy Pulmonology Clinic. “Age is another risk factor; male gender is a risk factor. Every decade that you age, starting maybe at about age 40, the prevalence goes up significantly.”

OSA often leads to loud snoring, a common symptom typically reported by a spouse or partner. While patients may also experience morning headaches, excessive daytime sleepiness, and difficulty focusing attention, it’s those nighttime symptoms that most often bring them to a doctor.

“That happens with a lot of the patients we see at the clinic,” Shah said. “A lot of the patients don’t present with daytime symptoms.”

Once diagnosed with OSA, a patient will undergo a sleep study to better locate its cause and determine the most effective treatment. The study may be conducted during an overnight stay at a sleep lab, but most are done at home, with the patient wearing a blood-oxygen measuring device clipped to a fingertip.

While they perform the same function, Shah prefers to call the in-home method by a different term.

“I always call it a sleep apnea test instead of a sleep study,” he said. “It helps us take the burden off the sleep labs, because we don’t have enough staffing to get the in-lab study. For the most part, just one night is sufficient to diagnose sleep disorders.”

“It has limitations,” PCI neurologist Dr. Scott Geisler said of the home test. Because the home test doesn’t include the full complement of instruments, it can only confirm an OSA diagnosis. A follow-up overnight study in the hospital is often done if symptoms persist despite a “negative” home test.

“Because it scales back so much on the sensors, it can only give us a positive result,” Geisler said. “If it shows five or more sleep problems an hour, we know someone has sleep apnea. If it comes back positive, we can use it as a minimum baseline. Unfortunately, only about 30 percent of the time does someone get that follow-up test.”

The simplest OSA treatment prescribes the use of a mouthpiece that thrusts the lower jaw slightly forward during sleep, keeping the airway clear. But the most common and effective treatment for OSA is continuous positive airway pressure, or CPAP therapy, administered via a machine that delivers a steady stream of pressurized air through a mask.

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“CPAP is the gold standard, just because of how effective it can be,” Shah said.

The evolution of CPAP technology has improved its effectiveness

“The machines are smarter,” Geisler said. “They have a computer brain that follows your breathing needs up and down through the night. The masks are more comfortable. The success rate is quite a bit higher now than it was 10 or 15 years ago because of those advances.”

Still, when CPAP isn’t effective, a more recently developed procedure implants a device that delivers mild stimulation to the throat muscles to keep the airway clear. Marketed as Inspire, the device is similar to an implanted pacemaker with a handheld remote control. It’s especially effective for those with moderate-to-severe apnea, defined as more than 15, 10-second sleep interruptions per hour.

“The wire, instead of going to the heart, goes up the neck to the nerve that controls the tongue,” Geisler said.

“It stimulates the nerve that supplies the tongue,” said Shah, who began Inspire implants at Mercy last year. “It pushes the tongue forward. That creates more space in the back of the throat for the patient to breathe.”

The implant surgery is an inpatient procedure that more than 400 people have undergone at ECSI since 2023.

“We had been trying for years to get the program off the ground,” Geisler said. “Now we have one of the largest patient populations in the country, surprisingly. We have a lot of word-of-mouth referral now.”

“The patients that I see, the majority of them are happy (with Inspire)," Shah said. “Patients will be happy if you select the right patients for it.”