Lab targets sleep apnea’s wake-up calls

New sleep lab part of a broad effort to counteract the dangers of disrupted breathing.
November 13th, 2017

Back in 2009, Vincent Cobb found himself in a hotel room in Broomfield. He wasn’t there for a business trip but rather to find out if there was any way he could get a good night’s sleep.

Vincent Cobb got help from the UCH sleep lab and clinical providers after struggling for eight years with obstructive sleep apnea.

That just wasn’t happening at his Arvada home, said Cobb, 58. His wife had noticed his sporadic sleep patterns, which were accompanied by periods of snoring, interrupted breathing and gasping for air. Cobb wasn’t aware of those problems, but he found himself struggling at times to stay awake at his job as a mental health and recovery therapist. On occasion he’d fight off sleeping at the wheel as he waited for a long traffic light to change.

“It got to the point where I had to schedule my sessions at work during peak hours and right after I had coffee to avoid dozing off,” he said.

His wife was concerned about his nighttime breathing – or lack thereof – and pushed him to get a sleep study through a well-known local institution, which was how he landed in a hotel bed. The idea was to monitor Cobb’s oxygen saturation and breathing patterns while he slumbered to determine if he had obstructive sleep apnea. The condition, which has a variety causes, occurs most often when the throat muscles relax during sleep, blocking the airway.

Home sleep study kits include a probe fitted to a finger to measure oxygen levels throughout the night.

Waiting to exhale

It’s a common problem that too often hides in plain sight, said Tim Wimbish, director of the Comprehensive Lung and Breathing Program at UCHealth University of Colorado Hospital, which opened a new, four-bed sleep lab in Denver’s Stapleton neighborhood in June.

Wimbish noted that an estimated 90 percent of cases of sleep apnea go undiagnosed. “Most of these people would benefit from some sort of intervention,” he said. The sleeplessness and fatigue caused by sleep apnea is “a safety concern for the individual and the community,” Wimbish added.

The condition also can exacerbate a host of health problems, added Crintz Scott, practice manager of UCH’s sleep lab. These include heart disease, stroke and diabetes. At least one study concluded that obstructive sleep apnea may impair memory, Scott added.

A CPAP machine sits beside the bed in one of the sleep rooms. Techs hook study patients to the machine if they reach a designated number of “incidents” that indicate obstructed breathing.

A common solution is a CPAP (continuous positive airway pressure) machine, which delivers oxygen through a tube and mask to keep the airway open. A few days after Cobb’s 2009 hotel sleep study visit, he got a call from a medical supply company notifying him that the study physician had ordered him a CPAP machine and asked him when he wanted it hooked up – and how much he needed to pay for it. The problem was, Cobb had never received a follow-up consultation or gotten to see the results of the study. He said thanks but no thanks to the prescription.

“I just figured I’d deal with it myself,” he said. He went on a “major diet.” He lost about 50 pounds, getting his weight down to about 200. Those steps helped him sleep better and made life a little easier for himself and his wife. He exercised more, which improved his energy levels and stabilized his resting heart rate.

Multiple culprits

But over time, he regained a bit of the weight, exercised less and the daytime lethargy returned. After two more sleep studies with the same institution – both in a dedicated lab instead of a hotel room – that led to a failed experiment with a BIPAP (bilevel positive airway pressure) machine, he got a referral from his primary care physician at UCH to see Katherine Green, MD, an otolaryngologist and fellowship-trained sleep medicine specialist with the University of Colorado School of Medicine.

Before sending Cobb for another sleep study, Green examined his nose and throat and found an important source of his apnea.

“My tonsils were huge and taking up a lot of space around my airway,” Cobb said.

Green’s examination points up an important misconception about sleep apnea, Scott said. Being overweight can contribute to the condition, but there are many other factors that contribute to it. For example, she noted that at age 12, her son was an avid soccer player with a body mass index of 22. Yet he too suffered from sleep apnea because of outsized tonsils.

“People need to know that there is often nothing they did wrong to cause their sleep apnea,” Scott said.

In March, Green performed a tonsillectomy to create more space in Cobb’s airway, which he said improved his sleep. Green added that she didn’t anticipate that the procedure would eliminate his breathing problems but rather that it would remove the obstruction that had made previous efforts to fit him with a BIPAP and CPAP difficult.

After Cobb healed, Green set him up with a sleep study at UCH to get a clear reading of his oxygen levels and breathing patterns. With that, she ordered the study so she could fine-tune the settings on a CPAP machine for him.

Quiet, please

In August, Cobb visited the lab, which is in a quiet second-floor corner above UCHealth’s A.F. Williams Family Medicine Clinic. Six registered sleep technicians staff the facility, which is open 24 hours, seven days a week. They earn the certification through a combination of online courses and clinical practice. Scott, who is a respiratory therapist, completed 800 clinical hours to earn her certification. Others must complete 1,500 hours.

One of four rooms at the UCH sleep lab. It operates around the clock, seven days a week.

The techs check patients in, then usher them into rooms with comfortable beds, televisions and bathrooms. They attach electrodes to the patient’s head and eyes. These pick up and transmit brainwave signals and eye movements that chart the stages of sleep. They also attach a belt to the chest and stomach to check for regular and interrupted breathing. A probe fitted to an index finger measures oxygen levels. A CPAP machine sits on a table next to the bed.

The signals are sent through cabling in the ceiling to a control room, where the techs monitor patients throughout the study. They look for “events,” such as breathing disruptions and drops in blood oxygen, that indicate obstructive sleep apnea, Scott said. If a patient crosses a predetermined threshold – five events per hour for those with conditions like high blood pressure or 15 for healthy patients – the techs enter the room, put the CPAP mask on the patient and monitor him or her the rest of the night to calibrate the oxygen flow.

After the study, techs send the results on to the UCH Sleep Clinic for review. Green or one of her fellow sleep medicine specialists then speak with their patients about treatment options, which range from lifestyle changes to breathing assistance equipment, like BIPAP and CPAP, to surgery – all of which UCH is staffed to handle.

Device helps sleep techs position and attach electrodes that monitor a patient’s brain activity during sleep study.

After his study, Cobb received a new nose mask for his CPAP machine. He said he’ll meet with Green in mid-October to review all the information from the study. He said he plans to work on losing weight, but understands the importance of using CPAP – and of getting a full evaluation of the kind Green provided.

“It’s very clear that losing weight alone will not fix this,” he said.

As for his night in the sleep lab, Cobb said he was pleasantly surprised – and wrote a note to Scott to express that.

“Having done three previous studies, I was a little apprehensive about the process,” he said. Expecting a difficult night, he cancelled his appointments at work for the following day. As it turned out, though, he woke up during the study only once.

“The bed was very comfortable and the room was quiet,” he said. “The techs met me at the door, welcomed me, and were very accommodating. We worked around the sleep wear and they hooked me up in no time. They showed a lot of concern.”

Wimbish noted that many patients will not need a full-blown study in the lab. Rather, they will go home with equipment in a tidy black box that monitors breathing rates and oxygen saturation levels.

“For those who have never been diagnosed with sleep apnea, the ideal situation is to use the home test,” Wimbish said. “Sometimes the problems we identify can be easy things to manage.”

About the author

Tyler Smith is a freelance writer based in metro Denver.