Comprehensive sleep medicine for your patients

Patients referred to Novant Health Sleep Medicine are generally adults who are suspected of having sleep apnea, daytime sleepiness without an apparent cause, insomnia and hard-to-manage restless legs. Referrals extend to more unusual situations as well, such as REM sleep behavior disorder where patients act out dreams.

Here are the top benefits Novant Health Sleep Medicine provides to patients.

“We work to improve each patient’s sleep quality and help them obtain the health benefits of better sleep.”

Patients undergo a full evaluation to determine their needs.

Dr. Behrens: “The first step is a new patient evaluation. We screen for symptoms of sleep disorders, look at their sleep habits, their other medical concerns, what medications they are on. For many patients, we also conduct a sleep study, either a home sleep apnea test or a more comprehensive in-lab sleep study, depending on their condition and insurance coverage. An in-lab study can help us identify leg movements and evaluate the patient further for conditions of excessive sleepiness like narcolepsy, as well as behaviors like acting out dreams.”

Treatment plans are customized to each patient.

Dr. Behrens: “Treatment is always individual with sleep. It’s important to do a comprehensive evaluation initially so we can look at the whole person. For example, it’s possible for a patient to have both sleep apnea and restless legs, so we need to diagnose and treat both conditions to improve their sleep.

“We discuss different options with the patient, since different people want to go in different directions. A patient with restless legs may not want to try medication, but they might be willing to try supplements to increase their iron levels, which can affect this condition. Other people want to start on medications right away. We determine what’s good for each patient and what they can fit into their lifestyle.”

Management of some sleep conditions may involve other specialists.

Dr. Behrens: “Our treatment approach also depends on the severity of the patient’s condition. If a patient has severe sleep apnea, we can evaluate their upper airway anatomy to consider tonsil removal or deviated nasal septum surgery. In this case, we could work with an ear, nose and throat specialist as part of treatment.”

Innovative devices can treat certain conditions such as sleep apnea.

Dr. Behrens: “We collaborate with other disciplines to make sure the patient gets the care they need. There is a new device for moderate to severe obstructive apnea called Inspire, which is implanted in the chest wall to stimulate the hypoglossal nerve, moving the tongue forward and opening the airway during sleep. Back at our office, we connect to the device through an electronic tablet, which allows us to download data and adjust settings.

“Similarly, patients with central sleep apnea can benefit from a device called a phrenic nerve stimulator, which stimulates the diaphragm to contract. We work with a cardiologist to implant the device, then we use a tablet to manage the data and settings.”

Sleep hygiene coaching can help patients make sustainable changes.

Dr. Behrens: “We review a patient’s sleep hygiene — both their environment and their habits — as part of their care plan. Habits can involve patients looking at their phone before bed or checking the time during the night when they wake up. Environment can involve whether the patient gets outside in natural light during the day, which can affect the amount of melatonin their brain makes.

“It can take a while to get to know someone and find out what’s going on around sleep that we can help them change. Sleep hygiene plans often need to be revisited. We can recommend a few changes, then have them come back in a few months to reassess.”

The patient’s care plan includes input from their referring provider as needed.

Dr. Behrens: “We make sure to keep referring providers informed about the results of the patient evaluation, including any sleep study results. We often coordinate with the referring providers about medication choices to maximize a patient’s sleep at night and minimize daytime sleepiness. We can also coordinate the management of interrelated conditions, including respiratory health, cardiac health and mental health.”