EXPERT
Ankur Patel
Sleep Medicine Specialist | Sleep Medicine
I am grateful for the specialty training I received from some of the best in the field of Sleep Medicine. Their passion ignited mine, and I can say without embarrassment that I am a true sleep "nerd". We're really just at the tip of the iceberg on our knowledge of sleep and sleep disorders - with rapidly changing technology and new science from brilliant researchers coming to light daily, it's a cutting-edge field full of excitement ("the final frontier" of medicine, as I often say!). But with all the rapid sprints forward, the practice of Sleep Medicine harkens back to the true fundamental art of medicine - the relationship we can cultivate with our fellow human beings in providing the clues to resolve issues and promote healing. This beautiful juxtaposition of superficially opposing concepts strikes the balance that has been both my motivation and goal in pursuing and practicing in the field (whose Academy symbol, most appropriately, is a yin-yang).
10 years
Experience
Ankur Patel
- Camas, WA
- University College Dublin
- Accepting new patients
No results found
Are there any medications for insomnia?
There certainly are! Everyone has a different philosophy, and mine is that, unless I really have to prescribe potent substances to force your brain to fall asleep, I try to avoid READ MORE
There certainly are!
Everyone has a different philosophy, and mine is that, unless I really have to prescribe potent substances to force your brain to fall asleep, I try to avoid it.
Time and again, research has shown the best, first-line therapy for insomnia is cognitive behavioral therapy for insomnia (CBT-I). I think it's gotten to the point now where programs are well-developed and technology has made it quite accessible for everyone!
If CBT-I hasn't / doesn't work, and all other avenues have been explored, then yes, medications are likely to be needed and can be extremely helpful!
Everyone has a different philosophy, and mine is that, unless I really have to prescribe potent substances to force your brain to fall asleep, I try to avoid it.
Time and again, research has shown the best, first-line therapy for insomnia is cognitive behavioral therapy for insomnia (CBT-I). I think it's gotten to the point now where programs are well-developed and technology has made it quite accessible for everyone!
If CBT-I hasn't / doesn't work, and all other avenues have been explored, then yes, medications are likely to be needed and can be extremely helpful!
Is sleep apnea curable?
Curing sleep apnea may really depend on what one means by "cure". Can we manage it so it's not a problem anymore? Of course! Can we get rid of it without and thus not require READ MORE
Curing sleep apnea may really depend on what one means by "cure".
Can we manage it so it's not a problem anymore? Of course!
Can we get rid of it without and thus not require any further intervention? It depends.
Sleep apnea is a result of anatomy - to put it simply. The cause of the anatomic change is multifactorial. One of the more common issues connected to sleep apnea is obesity - but even carrying a little extra weight can contribute. Thus, managing weight and optimizing diet and exercise has the potential to be curative.
On the other hand, a large enough subset of the population does not fall into the overweight or obese category of body habitus yet still have sleep apnea. In such situations, the anatomy is still the culprit, but weight loss is unlikely to have a profound impact. The logical leap is surgical, of course, but the risk:benefit ratio is particularly unfavorable when other non-surgical interventions are currently available.
Thus, patients may be subject to a "chronic" diagnosis of sleep apnea and require a device (oral appliance, PAP, nerve stimulator) to ensure it is no longer a contributor to suboptimal health, but the requirement of some support may always remain.
Can we manage it so it's not a problem anymore? Of course!
Can we get rid of it without and thus not require any further intervention? It depends.
Sleep apnea is a result of anatomy - to put it simply. The cause of the anatomic change is multifactorial. One of the more common issues connected to sleep apnea is obesity - but even carrying a little extra weight can contribute. Thus, managing weight and optimizing diet and exercise has the potential to be curative.
On the other hand, a large enough subset of the population does not fall into the overweight or obese category of body habitus yet still have sleep apnea. In such situations, the anatomy is still the culprit, but weight loss is unlikely to have a profound impact. The logical leap is surgical, of course, but the risk:benefit ratio is particularly unfavorable when other non-surgical interventions are currently available.
Thus, patients may be subject to a "chronic" diagnosis of sleep apnea and require a device (oral appliance, PAP, nerve stimulator) to ensure it is no longer a contributor to suboptimal health, but the requirement of some support may always remain.
How long is the treatment for insomnia?
This is a tough question! Insomnia is a particularly complex issue and it takes a fair bit of work to determine what might be causing it before diving into treating it. I often READ MORE
This is a tough question! Insomnia is a particularly complex issue and it takes a fair bit of work to determine what might be causing it before diving into treating it.
I often start by parsing out the concept of insomnia as a symptoms vs. insomnia as a pathology - more often than not, it is a symptom (though not always the case!). In those cases, we may need to dig a little deeper to find out what else can be the cause (another sleep disorder, stress, other medical conditions, medications, etc.).
If it is a pathology of its own, we often need to team up with the mental health specialists - psychiatrists - to work out a good plan to find the solution. Most often, there is some subtle other connection to an underlying mental health condition that is only showing up as insomnia!
So as far as duration: it really depends.
If we can nail down the cause and it's a simple, straightforward diagnosis, then we may we sorted within a few weeks.
If it's more complex, and truly a 'pathology', then, like any chronic condition, it might be a more long-term journey.
I often start by parsing out the concept of insomnia as a symptoms vs. insomnia as a pathology - more often than not, it is a symptom (though not always the case!). In those cases, we may need to dig a little deeper to find out what else can be the cause (another sleep disorder, stress, other medical conditions, medications, etc.).
If it is a pathology of its own, we often need to team up with the mental health specialists - psychiatrists - to work out a good plan to find the solution. Most often, there is some subtle other connection to an underlying mental health condition that is only showing up as insomnia!
So as far as duration: it really depends.
If we can nail down the cause and it's a simple, straightforward diagnosis, then we may we sorted within a few weeks.
If it's more complex, and truly a 'pathology', then, like any chronic condition, it might be a more long-term journey.
Cheyne-Stokes Respirations
Hi Mr. Gorrecht - I am sorry to hear about your circumstance. I hope you've been getting some more positive feedback since posting your note! From a very grossly oversimplified READ MORE
Hi Mr. Gorrecht -
I am sorry to hear about your circumstance. I hope you've been getting some more positive feedback since posting your note!
From a very grossly oversimplified overview, and presuming a few things about your medical history only, I will say: No. This is not really a "death sentence". It's just a little tricky to manage - but that's where a good sleep specialist can help!
Rather than the Inspire device, you might take a look at the Remede system (https://remede.zoll.com/). (I have absolutely no affiliation, endorsement, or other association to any device manufacturers).
It is unusual for Cheyne-Stokes respiration to be present without central apneas (and sometimes, those patterns get a little murky on the sleep studies - but it's another 'rule of thumb' type of thing). The assumption I am making is that you have some cardiac history (based on your mention of a pacemaker as well), and it's not unusual for these two medical conditions to coincide. In fact, we often discuss this with cardiologists in exhaustive detail as we can help each other succeed in managing!
From a sleep standpoint, I would make sure you get a thorough cardiac workup (if you have not already!) and have a frank discussion with the cardiologist about that whole situation. Often, ensuring they've fully optimized the cardiac function can itself alleviate some of the severity of the sleep issues. On the sleep side of things, if it remains that you have the breathing and apnea patterns without any changes, the device implantation might be your best bet. (And a bonus of having a good cardiac team is that it is our highly skilled friends who place pacemakers that also can place the Remede device!)
I wish you the best as you venture forth!
- A Patel
Please note that any advice offered is simply for education and information, and should not be implemented without consulting a healthcare provider with whom you have or may develop an established relationship.
I am sorry to hear about your circumstance. I hope you've been getting some more positive feedback since posting your note!
From a very grossly oversimplified overview, and presuming a few things about your medical history only, I will say: No. This is not really a "death sentence". It's just a little tricky to manage - but that's where a good sleep specialist can help!
Rather than the Inspire device, you might take a look at the Remede system (https://remede.zoll.com/). (I have absolutely no affiliation, endorsement, or other association to any device manufacturers).
It is unusual for Cheyne-Stokes respiration to be present without central apneas (and sometimes, those patterns get a little murky on the sleep studies - but it's another 'rule of thumb' type of thing). The assumption I am making is that you have some cardiac history (based on your mention of a pacemaker as well), and it's not unusual for these two medical conditions to coincide. In fact, we often discuss this with cardiologists in exhaustive detail as we can help each other succeed in managing!
From a sleep standpoint, I would make sure you get a thorough cardiac workup (if you have not already!) and have a frank discussion with the cardiologist about that whole situation. Often, ensuring they've fully optimized the cardiac function can itself alleviate some of the severity of the sleep issues. On the sleep side of things, if it remains that you have the breathing and apnea patterns without any changes, the device implantation might be your best bet. (And a bonus of having a good cardiac team is that it is our highly skilled friends who place pacemakers that also can place the Remede device!)
I wish you the best as you venture forth!
- A Patel
Please note that any advice offered is simply for education and information, and should not be implemented without consulting a healthcare provider with whom you have or may develop an established relationship.
