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.

Patients undergo a full evaluation to determine their needs.

The first step is a new patient evaluation. Doctors screen for symptoms of sleep disorders, look at their sleep habits, their other medical concerns, what medications they are on. Many patients also undergo 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 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.

Treatment is always individual with sleep. It’s important to do a comprehensive evaluation initially to look at the whole person. For example, it’s possible for a patient to have both sleep apnea and restless legs, and they'll need to have both conditions treated to improve their sleep.

Each treatment path is individual, and doctors help each patient determine what they can fit into their lifestyle.

Management of some sleep conditions may involve other specialists.

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

Innovative devices can treat certain conditions such as sleep apnea.

Doctors 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. Doctors connect to the device through an electronic tablet, which allows them 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. Doctors work with a cardiologist to implant the device, then use a tablet to manage the data and settings.

Sleep hygiene coaching can help patients make sustainable changes.

Doctors 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.

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

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