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HEALTH CONNECTION

Professionals tackle sleep disorders

By David Chilton
Special to the Toronto Sun


Everyone has the odd off night when getting to sleep seems next to impossible. But when infrequent periods of sleeplessness become a regular feature of turning in then it's time for some professional help from a family doctor or, increasingly, one of the numerous sleep disorder clinics found in the GTA.
A patient is prepared for a sleep study in the Sleep Medicine Program at The Michener Institute.


So just what causes sleeplessness? Susan Nash, technical director of the Sleep Institute of Ontario, says there are many sleep disorders, but the big three are sleep apnea, periodic limb movement and insomnia.

With sleep apnea, says Nash, the sleeper's airway closes off for sometimes 20 seconds or longer. A struggle then ensues because the sleeper's muscles are trying to force him to breathe. Consequently, he's woken up perhaps hundreds of times a night. Sleep apnea is common among men, especially if they're over 40 and overweight, and the snoring that accompanies it can be a source of real friction between bedmates, says Nash.

Muscle spasms

PLM is characterized by frequent muscle spasms that keep the sleeper awake and is distinct from "restless legs syndrome" although they can occur simultaneously.

The third villain of the piece is insomnia, which can have many causes, whether psychological or conditioned, and is no doubt familiar to many people who've had the occasional night tossing and turning and watching the clock tick towards 5 a.m.

The main treatment for sleep apnea is CPAP or continuous positive airway pressure, says Nash. Sufferers spend a night in a sleep clinic with a mask over their nose as a pump blows air into their airway. The idea, Nash explains, is to find the minimum amount of pressure required to keep sleepers breathing normally.

Anyone who attends a sleep disorders clinic will see a doctor and a technologist. The latter are almost always registered respiratory therapists or registered nurses, with many of them -- such as Nash -- having the RPsgT or registered polysomnographic technologist designation.

In Toronto the Michener Institute for Applied Health Sciences teaches a RPsgT course once a year.

Nancy Brown, chair, continuing professional education, at the Michener says the Institute takes up to 20 students for two weeks of full-time classroom and lab study. That's followed by 72 hours working in a sleep disorders clinic under the supervision of a certified RPsgT. After 18 months working in the field, graduates of the Michener program can write the international certifying exam for RPsgTs, Brown says.

To get into the program at the

Michener, applicants need to be a registered respiratory therapist, an RN or have a Bachelor of Applied Health Science degree with patient care experience. Tuition is $2,850 and this year's class started April 25. A qualified RPsgT can earn up to $22 an hour.

Good job prospects

The job prospects for sleep disorder technologists are good because the job prospects for doctors who specialize in that area are good.

"If someone (a doctor) chooses that as a specialty they would never run out of patients," Nash says.

Dr. James MacFarlane, from the Sleep Disorders Clinic, says, "Everybody has runs of difficult nights and they can get into (sleep) patterns that perpetuate the problem."

There's no substitute for professional advice (OHIP pays for sleep disorder treatments), but MacFarlane offers some commonsense suggestions for anyone suffering the occasional sleepless night.

In general avoid too much booze before bedtime: "A lot of people don't know that alcohol is not a friend of sleep," MacFarlane says.

He also says don't smoke -- good advice for anyone, sleepless or not -- and never go to bed hungry. Don't eat a full meal either, but MacFarlane says it's OK for some light carbohydrate snacks to take the edge off a sleeper's appetite.



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