MANCHESTER — The Sleep Evaluation Center at Elliot Hospital occupies a wing at Homewood Suites near Manchester-Boston Regional Airport. But no one hears the roar of jets.
At 10 p.m. three sleep technicians watch five computer screens and five remote camera images for sleep disruptions or signs of distress. In the adjacent rooms, five patients ages 10 to 75 are connected to a science-fiction movie’s ganglion of wires trailing to their scalps, chins, faces, chest and legs. Sensor-embedded belts encircle their waists.
Most are in deep sleep in the cool hotel suites. The waves on the monitors in the center’s control room make a rhythmic pattern unintelligible to onlookers, but reassuring to the sleep techs.
“We watch the brain slow into a restful sleep,” said Kevin Vigneault, a sleep technician. A sleep study generates roughly 1,000 pages, or screen images, each capturing 30 seconds of slumber.
“If they have night terrors, we want to capture that. We’re kind of the doctors’ eyes and ears,” said Jennifer Reebel, another sleep technician, and a registered nurse. “We can give the doctors the characteristics. Is it loud breathing, or a snore? Sometimes they trust out footnotes.”
Shortly before midnight, the screen changes for a 63-year-old woman. Vigneault points to an unusually jagged line indicating a rapidly contracting heart. “This one is totally weird,” he said. Pre-ventricular contractions or PVCs are common in people of any age, but most prevalent among elders with chronic medical conditions and sleep disturbances. “A few of these in a row would be bad. If she had a run of them, we’d be doing CPR.”
A line above indicates she’s experiencing mini brain arousals every 20 or 30 seconds. “She’s sleeping, but it’s not as restorative,” Vigneault said. He watches for drops in oxygen saturation — how much is circulating in her blood, feeding her body and brain. Her level dips just below the 90 percent benchmark considered safe. While her heart is pumping wildly, the breathing line goes flat, indicating an obstructive sleep apnea event.
“Most people aren’t even aware that they’re waking up, because they need to be awake for more than five minutes to consolidate that memory,” said Jeanetta Rains, a sleep psychologist and clinical director of the sleep center.
For Karen Hill, 67, of Salem, the cumulative effects of poor sleep and low daytime energy started to improve within two weeks of using the most common treatment for sleep apnea: a CPAP, or constant positive air pressure machine, which delivers a constant flow of air through a face mask. Hill’s nighttime breathing disruptions dropped to five or fewer each hour, a normal sleep pattern for any age. She also found relief after losing 35 pounds, which reduced nighttime constriction of her airways.
Donald Stancl, 78, a retired mathematics professor at St. Anselm College, used CPAP for about six years after sleep studies discovered that he stopped breathing 30 to 40 times an hour, which is considered severe. When he was in his mid-60s, the New Boston resident woke up feeling as if he’d never slept. “I’d be very tired by noon. The lectures suffered and grading papers suffered. It took longer to do things and I thought I just had to push myself more,” he said. “I felt fuzzy-brained.”
“What really scared me was my doctor said there might be a link between this and dementia,” Stancl said. “My father had dementia, and I was scared to have dementia. I didn’t want to invite it in.” With CPAP use, “I had a deeper sleep.”
Billie Barry’s problems started three years ago. Plagued by high cholesterol and blood pressure, COPD, spinal stenosis and trouble walking and exercising, she was surprised to learn that her breathing was ceasing 26 times an hour.
“I was so listless and tired,” she said. Falling asleep took 45 minutes. Staying asleep was out of the question. “It was because I wasn’t getting a good airflow,” said the Georges Mills resident, now 74.
CPAP enabled her to wake up renewed, she said, but it wasn’t an instant sell. “Like other people, I thought I’d have to go into another bedroom because my husband and I couldn’t sleep together” because of the noise, but the air flow hisses only when the mask is removed. “Now I look forward to putting it on because it gives me a fresh air flow at night which helps me sleep. No more memory and concentration problems.”
Follow up studies cited by sleep physicians show 80 percent of those who start CPAP treatment continue using it or a similar device — such Bi-PAP (bi-level positive airway pressure), which tailors pressure to inhaling and exhaling, VPAP (variable positive airway pressure) which adjusts to changes in breathing. But some experts say those estimates may be generous because they may not reflect inconsistent or interrupted use.
“Noncompliance is the Achilles heel of all medicine,” Rains said.
“The thing is you have to give it time,” Barry said. “It’s something foreign on your face at night. That feeling of confinement is probably a big deterrent. It was one of the things I was afraid of. But you can live with it.”
Other options for treating obstructive sleep apnea include oral devices that prevent the tongue from rolling back and blocking off the throat. The American Academy of Sleep Medicine has approved oral appliance therapy as first-line treatment for mild to moderate obstructive sleep apnea — and for severe OSA sufferers who can’t tolerate CPAP. The American Academy of Dental Sleep Medicine at www.aadsm.org maintains lists of dentists trained to fit and monitor the mouth appliances.