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Sleep Medicine Centers News & Events is a bi-

monthly sleep disorders publication for patients,

professionals, and the general public.

Editor: Mary Ouimette-Kinney. Unless otherwise specified, all articles and images were written or

created by the editor exclusively for Sleep Medi-

cine Centers of WNY. No part of this publication

may be reproduced without express permission

from Sleep Medicine Centers of WNY.

See page seven for subscription information.

Feature... Vacationing, Driving, and Sleep ��Feature... Arrive Alive! Summer Travel Tips� ��

Feature... Dr. Rifkin Named President of State Sleep Society� ��

Investigating… Sleep Apnea (Part 2)� ��Ask The Doc… Dr. Sandra Block on Sleep Apnea� ��

Just for Professionals... Research, Initiatives, CMEs� ��Events... Public & Professional Events, Meetings, Etc.� ��

A Visit With… A Sleep Disorders Center (Part 2)� ��

Patient & Public Resources… Additional Information� ��

Special... Sleep and Summer� ��

In the News… Sleep Medicine Centers of WNY News ��

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Dr. Rifkin To Be Named Presi-dent of NYS Sleep Society. Neu-rologist and SMC medical director Dr. Daniel I. Rifkin recently took office as president of the New York State Society of Sleep Medi-cine. Continued on page 2.

Ash 20th Meeting A Success. Doctors Block and Rifkin contrib-uted to sleep apnea research lead by Marilou I. Ching, M.D. The re-search was presented at the Ash Annual Scientific Meeting May 13, 2005 in San Francisco. The ab-

stract has been posted to the Sleep Medicine Centers website.

Behavioral Sleep Medicine Pro-gram. For help with insomnia, stress-related sleep changes, or adjusting to shift-work call SMC for an appointment with the Be-havioral Sleep Medicine Program.

Sleep Education Center. Visit the SMC website for a wealth of infor-mation about sleep, our services, staff, and facilities:

SMC on Local TV. Local televi-sion talk show AM Buffalo will feature the physicians of Sleep Medicine Centers of WNY on a monthly basis, as part of their health programming. Dr. Sandra Block appeared July 12 to discuss pediatric sleep apnea. AM Buffalo can be seen weekday mornings on WKBW (channel seven).

Dr. Daniel Rifkin appeared on WGRZ Evening News July 13 to discuss sleep disturbance.

www.sleepmedicinecenters.com.

SUMMER 2005

VOL. I, ISSUE 2

www.sleepmedicinecenters.com (716)92-DREAM ©2005

As the hospitable-to-life season once again approaches Western New York, area snowbirds scurry to fit trips to the beach, long hours at the park, and summer vacations into just a few short months. With so many of us on the road, we might want to consider the benefits of a good night’s sleep.

The medical profession has been telling us about the relationship be-tween poor sleep and poor perform-ance for more than a dec-ade. Yet, we still work, play, and drive while drowsy. Conservative estimates by the National Highway Traffic Safe ty Adm in is t ra t ion (NHSTA) reveal drowsy driv-ing as the cause of at least 1 0 0 , 0 0 0 a u t o m o b i l e crashes, 71,000 injuries, and 1,550 deaths each year. This shouldn’t come as news—more than half of all drivers (51%) admit to hav-ing driven while drowsy. Unfortunately most people do not know how tired they really are, or how daytime sleepi-ness affects them. How many of us have assumed that we “can handle it” after a long work shift, or when head-

ing toward a short summer getaway?

Some indications that a driver should stop driving and rest:

Ö�yawning, heavy eyelids, frequent blinking, feeling restless and irrita-ble

Ö�difficulty focusing, daydreaming, wandering thoughts

Ö�difficulty remembering the last few miles/minutes of travel

Ö�drifting from your lane, tailgat-ing, or hitting the shoulder of the road

Ö�feeling tired!

To avoid tiredness, driv-ers can take measures such as resting beforehand, scheduling breaks, and avoiding alcohol. See Arrive Alive! below. Of

course, daytime tiredness not only impairs driving of road vehicles, but also watercraft, such as runabouts and speedboats.

This summer adequate rest may not only save your life on congested highways, but keep you from heading to court, or prison. Our neighbors in

New Jersey recently took action against drowsy driving by enacting Maggie’s Law, which defines drowsy drivers as reckless drivers—who can be convicted of driving felonies includ-ing vehicular manslaughter. A similar law is pending in New York, among other states.

Whether all drowsy driving equates to criminal behavior remains controversial. Some drivers cannot sense a level of tiredness capable of causing an accident; others may have undiagnosed sleep disorders which may not be obvious to them. The greater goal of Maggie’s Law is to in-crease awareness of drowsy driving and provide measures to prevent it.

The greater goal of Sleep Medi-cine Centers of WNY is to provide education about the multitude of con-sequences associated with inade-quate sleep, and to treat those with individual sleep problems. For more about sleep, visit our website at:

www.sleepmedicinecenters.com,

or for information about a sleep con-sultation call (716)92-DREAM.

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��6800(5�75$9(/�7,36��Before Hitting the Pavement:

First, get a good night’s sleep (8 hours for most

people).

� Travel with a companion or someone to share the

driving.

�

Schedule rest breaks every 100 miles or two hours. �

Avoid alcohol, sedating medications, or new medi-

cations which may have unfa-miliar side effects

�

Know the warning signs of fa-tigue and watch for them while either you or a companion is

driving. See Vacationing, Driving, and Sleep, above.

�

After a long day of driving or when tired, stop at a nearby exit

and find a place to sleep for the night.

� While Traveling:

To refresh yourself in the midst of a driving cycle, stop at a rest

area and take a 15-20 minute nap.

Consume caffeine. If taken imme-diately prior to a 20 minute nap,

caffeine will take effect soon after the

�

nap. However, caffeine ingested in the evening will interfere with nighttime sleep.

�

Pace yourself when driving for more than a full day. Taking the time to

rest at night will allow for more wakeful-ness over time than attempting to extend each day with caffeine.

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Adequate rest may not only

save your life on congested

highways, but keep you from

heading to court, or prison.

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©2005 www.sleepmedicinecenters.com (716)92-DREAM

Maintain young children’s sleep-ing and eating schedules; they

are less tolerant of change than older children and adults.

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Continued from page 1.

Since it ’s inception in 1999,The New York State Society of Sleep Medicine (NYSSSM) has sought to promote the legal and professional advancement of the field of sleep medicine in the state of New York. As president, Dr. Rifkin will draw upon a nearly a decade of experience in the field of sleep medicine to confront cur-rent issues. ”The business of sleep medicine directly impacts how sleep medicine practices are able to treat patients,” remarked Dr. Rifkin.

Rifkin added that sleep disor-ders centers must maintain a high professional standard for a unique group of professionals. For exam-

ple, physicians must add Sleep Disorders Medicine to an exist-ing specialty, such as Neurology or Pulmo-nology. As well, sleep (PSG) techni-cians, who conduct sleep studies, require specific training which is regulated by the field of sleep medicine and by the greater medical profession. These goals must be realized in the context of serving thousands of patients.

Dr. Rifkin’s term will last one year, during which time he will continue to see the many patients who comprise his own practice. “I’m sure that I will do as much learning as leading,” he added.

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p le a s u ra b le s u m m e r .

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:KR�,V�/LNHO\�WR�'ULYH�'URZV\"�Ö�Young Drivers-especially males un-

der 26 years old

Ö�Shift Workers (those who work 2nd or 3rd shift, or rotating shifts)

Ö�Those who work long hours or more than 60 hours per week

Ö�Commercial Drivers, particularly long haul drivers

Ö�Those with undiagnosed or untreated sleep disorders

Ö�Business travelers, who may drive long hours or experience jet lag

Perhaps you

do not have a

“sleep disorder” like sleep ap-

nea or narcolepsy, yet certain condi-

tions such as weather and travel seem to make

a good night’s sleep nearly impossible. Sleep disturbance

related to the summer season sometimes stems from:

�KHDW��WUDYHO��FKDQJHV�LQ�QRUPDO�URXWLQH��DOOHUJLHV�� The physicians of Sleep Medicine Centers of WNY take all sleep prob-

lems seriously. If you have a chronic sleep problem or one that appears

intermittently, and that problem interferes with your life, contact SMC for

an evaluation:

(716)92-DREAM. For more information about our services or about

sleep disorders, visit our website at: www.sleepmedicinecenters.com


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Many of the 18 million Americans with sleep apnea fail to recognize their charac-teristic snoring as symptomatic of a seri-ous disorder. Not all snoring indicates ob-structive sleep apnea (OSA) and not eve-ryone with sleep apnea snores. However, all snoring should be investigated, and so should related symptoms, particularly if they appear together:

Ö�snoring; gasping or choking noises during sleep

Ö�daytime tiredness

Ö�headache, tiredness, or dry mouth upon awakening

Ö�high blood pressure, being over-weight, or a neck size greater than 17 inches in diameter

If these symptoms sound familiar, contact SMC for an evaluation. You may also want to visit your doctor. OSA some-times accompanies other problems-such as high blood pressure and excessive body weight, which require attention from a primary doctor or other specialist. If sleep apnea is suspected, either you or your physician can request a sleep disorders evaluation. SMC will accept appointments without a referral, if allowed by insurance.

After an initial examination by a sleep disorders specialist, an overnight sleep study will be performed at one of our three sleep labs. You may be able to tour the sleep lab during your first appointment.

An overnight visit for a sleep study for sleep apnea lasts about 9 hours (from ap-

proximately 8:00 p.m. until 6:00 a.m. any night of the week). The actual study takes six hours and involves a test called poly-somnography or PSG. The PSG measures body functions during sleep, including changes associated with sleep apnea. However, don’t expect too much sleep! See article on page five. If sleep apnea is discovered during the first half of the study, you may be asked to try a C-PAP machine to aid with your breathing during the sec-ond half of the night (sometimes referred to as a split-night study). Sleep studies are the only conclusive test for sleep apnea, although other tests may be prescribed, such as imaging studies to detect struc-tural abnormalities.

Treating Sleep Apnea. Treatment depends on the underlying cause of the sleep apnea. Some structural abnormali-ties (enlarged tonsils or adenoids, jaw mal-formations, or blocked sinus cavities) may be completely or partially corrected with

surgery. Surgery for OSA is generally per-formed by an Ear, Nose and Throat Spe-cialist (ENT), or by an oral surgeon. Tonsil-lectomy, adenoidectomy, and uvuloplasty name just a few surgeries. Dental appli-ances worn in the mouth during sleep may be recommended for certain structural abnormalities of the airway.

The majority of sleep apneics require long-term therapy with a C-Pap machine to aid with their breathing during sleep. Sleeping with a mask over one’s nose, attached to a hose, that leads to a ma-chine, involves a period of adjustment! Alas, this trail of equipment forces the air-way open so oxygen can reach the lungs, and most C-Pap users not only get used to their breathing apparatus but find a dra-matic improvement in their sleep...and the sleep of those in earshot range of their snoring.

SMC staff works with respiratory therapists, who assist patients with their use of C-Pap machines. Call any SMC location for a sleep apnea evaluation at (716)92-DREAM.

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At the News & Events podium:

Sandra A. Block, M.D.

Neurologist and SMC sleep specialist Dr. Sandra Block has treated both adults and children for sleep apnea and other sleep disorders.

Q. I’ve been snoring for years. Can’t I just assume it is not a problem if I’m not falling asleep during the day?

A. No. Although snoring does not al-ways indicate sleep apnea, it should still

be investigated. Some of the long-term effects of OSA (high blood pressure, heart disease, and obesity) may not be obvious to you. High blood pressure, often referred to as the silent killer, has no symptoms. Such dangerous conse-quences may be present even though you might feel able to “manage” your tiredness. Q. Can children develop OSA? My daughter began snoring a few months ago. She also has allergies this time of year. A. Yes. Sleep apnea develops in 1-3% of children. As with adults, chronic child-hood snoring should be investigated. The most likely culprit-enlarged tonsils.

Young children’s tonsils tend to be large in comparison to their throat, peaking at around age five. For this reason, tonsil-lectomies resolve the majority of cases of childhood sleep apnea. Obesity, asthma, allergies, facial or airway deformities, and even temporary illnesses such as upper respiratory in-fections may also contribute to child-hood temporary or chronic OSA. It is always important to treat underlying problems associated with sleep apnea as well.

Our next issue will feature several arti-

cles about Pediatric Sleep Issues.

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So you've already been to the sleep center for a consultation. The staff seems nice but now they want you to have an overnight procedure called a sleep study. Relax! Sleep disorders centers and their rituals legitimately diagnose and treat more than 80 sleep disorders and many more problems that interfere with normal sleep.

Sleep Studies-FYI. A sleep study is the most reliable mechanism for identify-ing sleep disorders because it measures changes in brainwaves and other body functions specifically associated with sleep. Two main tests may comprise your sleep study:

Ö�POLYSOMNOGRAM (PSG): a measure-ment of sleep activity including brainwaves (EEG), eye movement (EOG), muscular activity (EMG), and heart rate (EKG) during the course of a night’s sleep.

Ö�MULTIPLE SLEEP LATENCY TEST

(MSLT): polysomnogram measurements during planned daytime naps, given the day after a PSG (for the diagnosis of narcolepsy and certain types of sleep disorders).

Prerequisites. Prior to the sleep study, SMC will send along a packet of information including an exact schedule, a packing list, a questionnaire about recent sleep habits, and a sleep log to record your exact sleep habits in the two weeks prior to the study. This information pro-vides a context for the sleep study, which will aid the diagnostic process.

During the Study. PSG technicians or professionals trained to conduct sleep studies will attach electrodes which meas-ure brainwaves, muscular activity, breath-ing and heart rate to the scalp, face, eyes, arms, legs, and chest. A small clip called a pulse-oximeter will then be attached to your index finger to measure blood-oxygen levels. Finally, video recordings provide a reference point for sleep move-ments. Computerized equipment trans-

lates information from the electrodes into measurable wave forms. You will be asked to sleep as normal while techni-cians quietly monitor the study in a nearby room.

Within a few weeks, a PSG techni-cian will score or interpret the results of the sleep study, which will be used by your sleep specialist to complete a diag-nosis. Sleep studies are neither invasive

nor painful. Results of the sleep study and recommenda-tions for treatment will be discussed during a follow-up visit to the sleep center or with your doctor. SMC also provides treatment services or follow-up care for some sleep disorders.

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Before A Sleep Study

Prior to the sleep study, you will likely have met your sleep specialist, toured the sleep lab, and received information from SMC. Before the study, remember to:

5�Investigate insurance coverage.

5�Complete the sleep log and ques-tionnaire sent to you by SMC.

5�Follow all directions regarding the use of medications, supplements, caffeine, and alcohol.

5�Follow directions regarding sleep for two days prior to the study.

5�Make sure hair and skin are free of hairspray and lotions.

Packing Checklist

Before heading out to the sleep center, be sure to pack accordingly:

5�lose-fitting pajamas and slippers

5�toiletries including shampoo, tooth-brush and paste, oral appliances

5�insurance cards and related paper-work

5�magazines or quiet-time activities

Also, make a list of new medications, supplements, or changes in your physi-cal health since your last visit to the sleep center.

After the Study

PSG technicians require approximately 2-3 weeks to score the sleep study. Your sleep specialist will review the re-sults and make a diagnosis. Results will then be sent to your referring physician, if a doctor other than the sleep specialist ordered the study. Be sure to contact the doctor who ordered your study for your results. Sleep Medicine Centers of WNY pro-vides maintenance care or treatment for:

5�Sleep Apnea

5�behavioral sleep problems such as Insomnia

5�chronic sleep disorders like Narco-lepsy and Restless Legs Syndrome


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Amherst Sleep Medicine Center 1120 Youngs Road

Amherst, New York 14221 Ph#: (716)92-DREAM

Buffalo Sleep Medicine Center (9th floor, Millard Fillmore Gates

Circle Hospital) 3 Gates Circle

Buffalo, New York 14206 Ph#: (716)92-DREAM

Southtowns Sleep Medicine Center 4090 Seneca Street

West Seneca, New York 14224 Ph#: (716)92-DREAM

According to the National Sleep Founda-tion:

Ö�51% of Americans admit to driving

while drowsy.

Ö�30%-40% of heavy truck accidents

result from driver fatigue.

Ö�60% of 18-29 year olds have driven

while drowsy, with 24% reporting

that they dozed off at the wheel in the

last year.

Ö�13% of young adults admit to falling

asleep at work.

Ö�Parents of young children lose an

additional hour of sleep per night—

compared to their sleep-deprived

childless counterparts!

CME: “Pediatric Sleep Apnea”; November 8, 2005 at the Marriott Ho-tel, Amherst, N.Y. Professional credit through U.B. For more informa-tion, visit the SMC web site or contact Sandra Block at 92-DREAM.

Recent: “A New Frontier in Sleep Medicine”. See page 1 for details.

Research Initiatives:

Open Studies:

• “A Randomized, Double-Blind, Placebo-Controlled Study to Assess the Subjective Response to Treatment with Ramelton (TAK-375) in Adult Subjects with Chronic Insomnia By Utilizing An Interactive Voice Response System (IVRS) For Collecting Diary Data”

• “Evaluation of the Long Term Efficacy and Safety of Zolpidem-MR 12.5mg Compared to Placebo, When Both Are Administered Over A Long Term Period "As Needed", in Patients with Chronic Primary Insomnia” ( A randomized, double-blind, placebo-controlled, parallel group, multicenter, phase IIIb clinical study)

To view abstracts or for more information,

visit our website at:

www.sleepmedicinecenters.com/research.html

or contact (716)92-DREAM for more information

Through our Sleep Education Program, SMC now offers several educational

resources for patients, lay persons, the media, and allied health professionals:

Ö�Website: A complete source of information about Sleep Medicine Centers services, sleep research and news, sleep disorders, sleep physiology, healthy sleep habits, shift-work, and children’s sleep hab-its.

Ö�Online Resources: Looking for resources to help manage a sleep disorder? Find links from our website to recommended medical and government resources for information about insurance, medication coverage, or employment/disability issues..

Ö�Support Groups: Already been diagnosed? Let us know if you are interested in peer-to-peer support services through our professionally-sponsored support groups. Meetings and new groups will be posted to this newsletter and our website.

Ö�Special Events: Our physician-researchers periodically offer Sleep information sessions, talks, and related events, which will be posted to the website and newsletter.

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State University of New York at Buffalo

School of Medicine and Biomedical Sciences

http://www.buffalo,edu http://www.smbs.buffalo.edu

The Jacobs Neurological Institute

A Research and Teaching Institute of the State University of New York

at Buffalo http://www.thejni.org

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5�Summertime, travel, and sleep: Catch some ZZZ’s before you flee!

5�Summer Solstice is June 22.

5�Dr. Sandra Block will appear on AM Buffalo (10:00am, July 12, 2005 WKBW and again in mid-August).

5�Need to schedule an appointment? Clinic services are available Mon.-Fri., 9am-4pm. Sleep studies may be scheduled any night of the week, except some holidays.

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To subscribe to Sleep Medicine Centers Of WNY News & Events,

send a written request to:

Sleep Medicine Centers of WNY

Newsletter Subscriptions

Attn: Mary Ouimette-Kinney

67 Highgate Avenue

Buffalo, NY 14214

OR call: (716)833-6260

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and the general public.

6shfldo 6ohhs ,q 6xpphu ,qyhvwljdwlqj 6ohhs … issue2.pdfsleep lab during your first appointment....

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