Getting Help for a Good Night’s Sleep

September 30, 2020

A good night’s sleep is a key component of good health but for many, it can be elusive. You went to bed at a respectable hour, fell asleep but still are dragging the next day. The answer could be a sleep disorder that can only be determined via a sleep study to discover how mild or severe that sleep disorder may be. 

Why Am I So Tired?
Constant and loud snoring is common for people with a sleep disorder such as obstructive sleep apnea. Often the person is waking up frequently and not even realizing it. Their airway becomes blocked while they are lying down sleeping and will wake sometimes multiple times an hour as they try to get in enough air, according to John Keeley, Clinical Education Specialist with Persante Health Care, which manages Shore’s Sleep Center. The fallout from not staying asleep or falling into a deep restorative sleep can include high blood pressure and many other health related problems. 

Keeley said in-person sleep studies in the Shore Medical Center Sleep Center are the most effective at monitoring a patient’s sleep patterns and determining how often they are waking up during the night due to obstructive sleep apnea and what help they will need to treat it. 

Help is Available 
For years the CPAP or Continuous Positive Airway Pressure machine has helped people with sleep apnea by keeping the airway open while they sleep. The CPAP has been in use to treat sleep apnea since 1981. There is also a BiPAP machine for patients who have trouble adjusting to the CPAP. Newer methods available to treat sleep apnea include the Inspire therapy along with an oral appliance for mild to moderate sleep apnea. 

Penn Medicine Pulmonologist Dr. Upendra Dhanjal, who sees patients at Shore Medical Center, said the CPAP is the most effective treatment for a vast majority of patients with obstructive sleep apnea. 

“CPAP is recommended so often because it is a 100 percent effective treatment 100 percent of the time if it is used properly and once the patient has adjusted to it,” said Dr. Dhanjal.  

With the CPAP machine, the air pressure is delivered to the patient through a mask that is connected to a hose and to the CPAP machine that pumps the oxygen. According to, the CPAP machines have a ramp feature that starts off with a lower pressure setting and gradually builds to the prescribed pressure. This comfort feature simply makes the pressure at the beginning more tolerable and less immediate.  Once the pressure builds to the required setting, it stays at that setting for the rest of the night.

The BiPAP or Bi-level Positive Airway Pressure is an alternate for the CPAP. Dr. Dhanjal said that some patients have difficulty with the CPAP and find it difficult to exhale against. The  BiPAP drops the air pressure being delivered as the patient exhales and can be set to include a breath timing feature. The higher pressure on the inhale and lower on the exhale allows the patient to get more air in and out of their lungs. 

The Inspire sleep apnea implant is the latest technology in sleep apnea treatment. There is no hose or mask and is instead controlled through a battery operated device implanted in the patient’s neck and chest wall. Dr. Dhanjal said it is like a pacemaker for your tongue. In use for the last 10 years, the Inspire uses an implantable pulse generator, a respiration pressure sensor and a stimulation lead that delivers an electrical impulse to the patient’s hypoglossal nerve located along the side of the neck and leads to the tongue. The closed-loop design of the system senses a patient’s respiratory effort during sleep and provides stimulation to maintain an open airway that works in concert with the patient’s breathing. The procedure to implant the probes for the Inspire is done under general anesthesia and takes several hours to complete.  

Dr. Dhanjal said a patient must fail the CPAP and BiPAP before being considered for the Inspire. “We will have patients that say they cannot use the CPAP but normally that is because there is a problem with the mask fitting properly or they will pull it off during the night,” said Dr. Dhanjal. “It may take some time for the patient to get a proper mask fit, but they are more flexible than the old style of mask and if they just stick with it, they should be successful.”

Oral Appliance
For mild to moderate sleep apnea there are oral appliances that are much like a retainer, according to Dr. Dhanjal. Again, it is for the patient who has failed to adapt to the CPAP or BiPaP. Placed in the mouth as the patient is going to sleep at night, the oral appliance will cause the lower jaw to move forward enough that the airway remains open and the patient stops snoring as much and is able to sleep uninterrupted. 

Why Getting that Good Night’s Sleep is Important
“Your body is going to have a lot of problems if you don’t give it enough sleep,” said Dr. Dhanjal. “Some people think they have insomnia, but really the problem is they can’t breathe so they are waking up and never reaching deep sleep.”  The brain will not be as sharp because you are tired and irritable.  There are problems with cognition and memory issues that may start younger. Dementia may come on faster along with heart failure that can lead to arrhythmias. 

Dream On
Basically with sleep apnea, there is no dream sleep, according to Dr. Dhanjal. “People are likely to be depressed. We all need that deep sleep and we need to dream to rebuild our body every day.”

There are good things that happen when we sleep and a big one is that we eat less. Getting a good night’s sleep is conducive to losing weight. Sleep apnea is more common with overweight patients. Deep sleep will increase the release of the hormone leptin that tells you to stop eating and speeds up metabolism and ghrelin, the hunger hormone is suppressed. Dr. Dhanjal said patients who stay up late at night eat, on average, an extra meal a day. 

To learn more call 855-633-6818. To schedule an appointment with Dr. Dhanjal call 609-365-3100.