Bay Recovery is now pleased to provide comprehensive sleep studies in a comfortable setting to our patients. Sleep disorders and chronic pain are intrinsically linked.  It is quite common that an underlying sleep disorder exacerbates existing chronic pain, thereby amplifying its effects.  Another facet to this complex relationship is the fact that being in pain makes falling asleep an arduous task.  An underlying sleep disorder can cause psychological as well as physical impairment.  The results of a sleep study are effective in determining a variety of sleep disorders, which include but not limited to:  

Non-Restorative Sleep

Sleep Apnea

Insomnia

Circadian Rhythm Disorders

Narcolepsy

Night Terrors

Restless Leg Syndrome

Snoring  

Evaluation regarding effects of illness (Pain, Dual Diagnoses, Prescription Drug use and Abuse, Eating Disorders, Post Traumatic Stress Disorder, Addiction and Alcoholism)  

A comprehensive sleep medicine exam by our specialists in Sleep Medicine (Pulmonary, Neurological, Chemical Dependency) and Sleep studies will therefore inevitably aid in diagnosing sleep dysfunction and is an essential component to any recovery process.  Overseeing this program at Bay Recovery is Dr. Bertrand de Silva. Dr. de Silva is a board certified Diplomate of the American Board of Sleep Medicine and has over thirty five years of experience.

Following is a basic breakdown of terminology, as well as what to expect during a sleep study:

Sleep Medicine (Pulmonary, Neurological, Chemical Dependency Medical Specialties)

Polysomnography (PSG) is a test utilized in assessing your oxygen levels, heart and breathing rates, brain waves, and leg/eye movements while asleep.  This test is performed with small pain-less electrodes that are placed on your scalp, chin and temples.  The electrodes remain in place throughout the night while recording the aforementioned information.  Upon waking the following morning, you will have completed the test and the results will be given to your doctor to assess.

Overnight Pulse Oximetry is a test used to measure oxygen levels in the body during sleep.  Low oxygen levels are often an indicator of a sleep disorder such as sleep apnea.

  CPAP is a form of treatment used in cases where the person is experiencing lack of oxygen during sleep.  This treatment is in the form of a mask in which the person wears upon going to sleep.  The mask provides a positive flow of oxygen to ensure the airway is open and oxygen levels are sufficient.

  Maintenance of Wakefulness Test (MWT) is a study conducted in a similar setting as the PSG but during the daytime.  This test is conducted to test how alert a person is and often used to assess the efficacy of prescribed treatment for a sleep disorder. 

Circadian Rhythm sleep disorder
• Disruptions of 24-hour sleep wake cycle

Hypersomnias of Central Origin
• Hypersomnia associated with acute or intermittent emotional reactions or conflicts
• Narcolepsy
• Other hypersomnia

Sleep-Related Breathing Disorders
• Insomnia with sleep apnea
• Hypersomnia with sleep apnea
• Other and unspecified sleep apnea

Sleep Related Movement Disorders
• Restless legs syndrome
• Periodic limb movement disorder

Psychiatric/Behavioral Disorders
• Hyposomnia, insomnia, or sleeplessness associated with anxiety or depression
• Hypersomnia assocated with depression

Insomnias
• Insomnia associated with acute or intermittent emotional reactions or conflicts
• Subjective insomnia complaint

Other sleep disorders
• Nonorganic sleep disorder
• Hyposomnia associated with acute or intermittent emotional reactions or conflicts
• Sleep arousal disorder
• Dysfunctions of sleep stages or arousal from sleep
• Repetitive intrusions of sleep
• Sleep disturbance

Insomnia and Sleep Disorders

Insomnia and/or other sleep disorders are common problems that Bay Recovery Centers deals with in regards to chemical dependency and/or pain.

Sleep Disorders with Pain and Chemical Dependency

The combination of pain and chemical dependency routinely leads to sleep disorders. This occurs as a result of the pain, as well as the medications used to treat the pain. Historically, people are taught that the pain is the reason for the sleep difficulty. This does occur when the pain wakes one up, or is the cause of discomfort that does not allow one to sleep. In the chronic pain arena, many clients do learn to sleep without medication in the face of chronic pain.

Regarding the medications used in the treatment of chronic pain patients, one has to look at how they relate to sleep. The narcotic medications have a direct impact on the sleep centers of the brain. As well as other cognitive and neurological brain functions, ranging from slight to severe. In the severe form, patients do not enter into the deep phases of sleep, and as a result do not achieve restorative sleep. This can be progressive over time and can cause chronic non-restorative sleep patterns with tiredness, fatigue, confusion and altered mental states. This often leads to the use of other medications that affect sleep. These medications can enhance sleep, or have sedative qualities wherein a person will sleep without entering into the deeper sleep phases of restorative sleep. These can include the sleep medications, minor tranquilizers, anti-depressants, anti-seizure medications and major tranquilizers. The Benzodiazapam groups, themselves, affect spontaneous sleep (and cause rebound insomnia). This occurs by affecting the sleep mechanism, and over time can affect the normal sleep cycle. To restore (partially or completely) the normal sleep cycle may require discontinuation of certain medications. To discontinue these medications, one has to go through the process of detoxification and stabilization, which can take from weeks to months to accomplish depending on the medication, dose, duration of use, and individual patient factors. Many other medications also affect sleep. This can result in the use of several controlled medications addictive or dependency potential which becomes a central and routine part of the patient's treatment. All of the controlled medications have the potential to cause progressive problems on sleep and wakefulness in any individual taking them over sustained periods of time.

The end result is a sleep pattern that is significantly impaired. Many of the patients that come to Bay Recovery fear not being able to sleep. This is frequently their worst fear because they have had this problem for such a length of time that they no longer can sleep spontaneously. This is frequently associated with the use of several medications at bed time.

Treatment at Bay Recovery

The treatment at Bay Recovery is directed at restoring the function of the sleep center, and improving and normalizing sleep. The process of restorative sleep allows the clients to feel rested and progressively more alert through the day, with resultant improvement of their mental faculties. Each client is given a treatment plan that transitions their current medications and corrects the problem over time. This process can be looked at as

re-booting the sleep center, analysis to the computer model a computer. The part of the brain called the suprachiasmic nucleus which controls the sleep mechanism is affected so as to restore its function and promote the restoration of sleep as it was originally intended to occur.

Over time our clients find they are better able to nest and are more alert during the day. Some of the clients have additional sleep disorders which are also addressed. There are various ways to treat these long term changes in the brain that occur from these drugs over time.

Alcoholism, Addiction and Sleep

Essentially, all of the drugs that can create chemical dependency and/or abuse, alter the mechanisms of sleep. Either insomnia or hypersomnia (increased sleep) occur as a result of chemical dependency. The severity of the problem correlates with the length of time and the amount of drugs that a person has been on.

We, at Bay Recovery Centers, address the sleep problems that occur and provide education, medication advice and therapy regarding sleep hygiene.

So, if sleep is one of your primary concerns, be aware that at Bay Recovery Centers it is our job to improve the quality of and restore normal sleep, as rather then just “knocking you out” with the usual sedative hypnotic medications.

Jerry N. Rand, M.D.

For more information please contact us confidentially and toll free at (800) 375-7263.