SLEEP MEDICINE Sleep Disorders
SLEEP DISORDERED BREATHING
Obstructive Sleep Apnoea (OSA) is a frequently underdiagnosed, common condition where the relaxed upper airways in sleep collapse during inspiration with a drop in oxygen levels in the bloodstream. This leads to disrupted sleep and chronic sleep deprivation, cardiovascular changes with an increased risk of high blood pressure, heart attacks and stroke, and acid reflux from the stomach. Untreated, OSA can cause severe tiredness during the daytime and reduce a person’s lifespan due to cardiovascular events.
- Our sleep specialist will conduct a detailed assessment and examination of your sleep and possibly symptoms of sleep disordered breathing.
- Where OSA is suspected, a home sleep study will be offered with expert interpretation and reporting of the data. We use the most advanced OSA diagnostics that allow full assessment while you sleep in your own bed.
- Depending on the findings, exact diagnosis and your personal context, the ideal treatment modality will be chosen with you. Our consultant sleep specialist may involve others from our team to offer you a holistic approach.
INSOMNIA AND SLEEP RHYTHM DISORDERS
Problems with falling asleep and with frequent awakenings during the night can be temporary and self-limiting. For some people, however, sleep problems can become severe and profoundly impair their quality of life and wellbeing. Our sleep specialist will make sure that any underlying medical condition that could impair your sleep is diagnosed and effectively treated. For long-term healthy sleep, we will offer you a comprehensive approach that may involve others from our team.
- We will start with a detailed and comprehensive assessment of your sleep, your sleep habits and general health. This may include a two-weeks period of monitoring your sleep-wake pattern continuously using a medical grade actigraphy device and a detailed sleep diary.
- Depending on the initial findings, more detailed investigations may be offered that may also include assessments by other members of our team to make sure your sleep difficulties are being assessed comprehensively and holistically.
- A personalised treatment plan will be developed with you that could include advice on improved sleep habits (Sleepy Hygiene), lifestyle modifications, nutritional advice, and possible psychological treatments, such as Cognitive Behaviour Therapy for Insomnia (CBT-i).
PARASOMNIAS (E.G. NIGHTMARES, SLEEP WALKING, REM-SLEEP BEHAVIOUR DISORDER)
Nightmares, Night Terrors and Sleepwalking, while medically harmless, can be very distressing and disruptive to a person’s life, esp. when sharing the bed with a partner. Sleepwalking and REMBD also bring risks of damage and injury to self and others.
- Our sleep specialist will conduct a detailed assessment and examination of your sleep habits and patterns, starting with your own reports of the events at night. If you have a bed partner, his or her reports may also be helpful in the evaluation. Therefore, if you are comfortable with it, you may want to bring your bed partner along to the appointment.
- Depending on the assessment, a referral for an overnight polysomnogram in a sleep laboratory may be necessary to rule out other conditions that could lead to complex behaviours in sleep, such as REM-Sleep Behaviour Disorder or some forms of epilepsy.
- Further tests and investigations may be needed to complete the assessment (e.g. brain imaging with an MRI scanner, or blood tests).
- Once the diagnosis has been established, a personal treatment plan will be developed with you. This may include contributions from other members of our holistic team.
RESTLESS LEGS SYNDROME AND PERIODIC LIMB MOVEMENTS IN SLEEP
Restless Legs can be distressing and prevent people from falling asleep. In some cases, however, a person may have Periodic Limb Movements in Sleep without Restless Legs and, hence, not be aware of the movements in sleep, unless a bed partner notices them. Periodic Limb Movements can severely disrupt sleep and the only symptom may be severe daytime tiredness without the person being aware of the cause. Hence, this condition can persist for a long time before diagnosis and treatment.
- A detailed assessment of your sleep patterns and general health will be performed by our sleep specialist. This may include a sleep study at your home with an actigraphy device to record limb movements. In some cases, a referral for an overnight polysomnography recording in a sleep laboratory may be necessary.
- Depending on the findings, a personalised treatment plan will be developed with you. This may include addressing other medical problems, or nutritional deficiencies (e.g. Periodic Limb Movements in Sleep can be related to iron deficiency). Our holistic approach may involve other team members from our clinic.
NARCOLEPSY AND CENTRAL HYPERSOMNIAS
Severe daytime tiredness may have many causes, the most common being simply insufficient sleep. However, there are also neurological conditions that can cause severe sleepiness and even overwhelming sleep attacks. Other symptoms may accompany tiredness, such as sudden loss of muscle tone (cataplexy), sleep paralysis and hypnagogic hallucinations when waking up. These are neurological conditions that require specialist diagnosis and treatment.
- Our sleep specialist will conduct a detailed assessment and examination of your sleep pattern and general health. This may include monitoring your sleep-wake pattern with 14 days of actigraphy and a detailed sleep diary.
- Additional tests may be required, such as brain imaging (MRI scan), overnight polysomnography in a sleep laboratory followed by a Multiple Sleep Latency Test (MSLT) and lumbar puncture to obtain cerebrospinal fluid for laboratory investigations.
- A holistic, personal treatment plan will be developed with you. This may include prescription medications, as well as behavioural modifications and natural treatments. Our wider Lanserhof team may contribute to such a treatment approach.
Sleep is one of our fundamental biological functions. It is essential for our health and wellbeing. Even modest lack of sleep can cause severe detriment to our health and impairs our performance on almost every imaginable performance metric. High performance athletes, for example, make sure they get plenty of sleep. Driving performance after only 4 hours of sleep is as bad as being legally drunk!
- Our sleep expert will obtain a comprehensive assessment of your sleep-wake patterns, the demands on your lifestyle (e.g. frequent travel across time zones, late night work in performing arts, etc.) and your personal preferences and objectives.
- Diagnostic tests may be required to complete the evaluation (most likely blood tests). Other clinicians of our team may be required to get involved at this stage to complete the comprehensive and holistic assessment.
- A personal management plan will be developed with you with likely input from others of the Lanserhof team.
Dr Oliver Bernath
Dr Oliver Bernath studied Medicine at the University of Ulm and University College London. After completing his Medical Doctorate thesis in muscle electrophysiology, he trained as a neurologist at the University of Chicago and completed fellowships at the University of California San Francisco in clinical neurophysiology. He trained in Sleep Medicine with the pioneers in the field: in Chicago with Prof Rechtschaffen and then at the world’s first Sleep Disorders Clinic at Stanford University with Profs Dement and Guilleminault. Dr Bernath holds US Board certifications in neurology, neurophysiology and sleep medicine and he is on the General Medical Council specialist register as neurologist in the UK. He led the Northern California Sleep Disorders Center at Kaiser Permanente in San Francisco and now also sees patients at the NHS Sleep Clinic at Guy’s Hospital in London.
- Sleep Disordered Breathing (Snoring, Sleep Apnoea)
- Insomnia, Sleep Rhythm disorders
- Parasomnias (e.g. Nightmares, Sleepwalking, REM-Sleep Behaviour Disorder)
- Restless Legs Syndrome and Periodic Limb Movements in Sleep
- Narcolepsy and Central Hypersomnias
- Sleep Optimisation