Deep in sleep

Already in pyjamas and slippers, Vitor Pereira gets ready for a very different kind of night. For the next eight hours, he’ll be sleeping with a network of sensors stretching from his head to his toes. There are so many of them that Elisabete Patrício, the cardio-pneumologist that looks after and monitors these patients one night every week, takes almost an hour and a half to attach them all. Between 13 electrodes are needed on the scalp simply to register brain activity (plus 22 more throughout the body).

Preparations for an examination at the sleep lab. begin at 9pm. First, the patients’ biostatistics are taken – their weight, height, measurements round the neck, waist and hips.

Contrary to what you might expect, the laboratory isn’t located in any of Faro Hospital’s buildings. Due to lack of space on site, it functions out of the apartment block at the entrance to the city that also houses Faro’s pneumological unit.

Now, it’s little after 11pm. The “bedroom” is small, simple and calm. Patrício connects the last electrical cables to the electronic box (Embla N7000) that will pass all data in real-time through to the computer. She tucks in Vitor Pereira’s sheets, and leaves.

“Are you comfortable? Do you need anything?” she asks before closing the little window and turning out the light.

Already, information on Vitor’s heart and respiratory rates is showing on the monitor. An infrared camera, set on the ceiling, tracks the patient – without disturbing him. In a few minutes, the driver, originally from Coimbra, is deeply asleep…

A one-year wait

The majority of patients requiring a “respiratory pathology of sleep” consultation are those suffering from “excessive sleeping” – not lack of sleep, and it’s mainly sleep during the day. It’s ironic, but daytime sleeping is one of the consequences of disorders like sleep apnea.

Faro Hospital has been studying problems like this since 2002, on an out patient basis. In other words, patients have been taking home portable units that register their cardio-respiratory activity while they sleep in the comfort of their own homes. The practice still continues today. The problem is that whenever they need a “polysomnogaphic exam” (sleep lab testing - a technique that guarantees a much more detail study of the patient’s condition), many Algarvians have had to travel to Lisbon.

It was only in 2008 that the necessary infrastructure and equipment could be organised to set up the Algarve’s first laboratory.

But due to a substantial waiting list for this speciality, there’s a long road to travel before patients actually get here. According to José Romero, it takes people roughly a year to get a consultation once it has been booked.

Nonetheless, the doctor from Huelva is positive about progress.

Today “consultations go ahead two afternoons per week, and on each afternoon we manage to see between 10 and 15 people” he told us. Indeed, almost a thousand patients have found relief from their disorders here.

It’s only when a serious situation is detected that patients have to spend a night at the lab. – with priority given to people with professions that could be potentially dangerous (i.e. bus/ truck/ train drivers, etc.), or those with health problems associated with nighttime issues.

Right now, the laboratory does an average of two studies per month.

Snoring – a danger sign

“It seems perfectly normal. Men snore, and women – particularly after the menopause – also”, explains Dr José Romero.

Thus, many people with sleep apnea don’t even know that they suffer from it. “Many times, the spouse thinks the snoring is simply a sign of age, or tiredness. It is often other relatives that recognise the danger sign and encourage recourse to medical help”.

“What happens is that the snoring is a form of intermittent breathing. It has times when it stops”, explains the doctor who was amazed to witness one patient who stopped breathing for two long minutes – every time his lungs filled up with air.

Such oxygen deprivation can bring serious health consequences. “Today there are a lot of studies that link diabetes and hypertension with sleep apnea”, he added.

The problem affects people of all ages. “We still don’t really know how this disorder develops. The average patient coming to see us will be between the ages of 50 and 60 – but we also have a certain number of children. In their case, the disorder is often associated with tonsil problems”.

Other problems

And sometimes, when respiratory anomalies are being investigated during sleep, the doctor discovers more complex disorders, neurological in origin.

Such is the case with narcolepsy – a complicated name for a chronic disorder that causes excessive daytime sleepiness (EDS), at home, at work or in the middle of traffic.

Another example is periodic limb movement disorder (abbreviated as PLMD, and also known as “restless legs syndrome”). “This is characterised by the patient making a series of repetitive movements during the night”.

The activity prevents people from relaxing and sleeping peacefully, and the result is that they don’t get proper rest and feel sleepy all day.

“Insomnia is also a frequent complaint – but that’s not what we treat here. It would be wonderful (ideal) if we could have a unit that dealt with all sleep disorders here”.

Cure and satisfaction

In the case of sleep apnea, patients don’t require drugs or painful treatment of any kind. They simply need a change in lifestyle. “With many, we simply prescribe a nasal spray, and different dietary-hygiene habits. We encourage people to lose weight, reduce their alcohol consumption.

Smokers, for instance, should try to give up tobacco”.

The worst-case scenario calls for a small portable ventilator (known as CPAP, standing for Continuous Positive airway pressure). “You’d think that sleeping with a mask on, connected to an air-tube, would be quite an aggressive form of treatment – but patients get used to it very quickly and are grateful for the relief”, said Romero.

For the doctor, what’s much more important than discovering the cure is that patients find happiness again. “Improvement is spectacular! Patients are so thankful for the way they feel. They rest better and recover quality of life”, he explains.

“We spend a third of our lives asleep – or trying to sleep, and it seems that Medicine has rather forgotten sleep. There’s still so much to discover… Recently, I did a breakdown of all our consultations and came to the conclusion that up until now we have only seen eight to ten per cent of the patients believed to be suffering from sleep apnea here. In other words, there’s still a lot of work to do”…