When one talks about sleeping disorder they usually refer to the lack of proper sleep due to a myriad of reasons. What we often ignore is that there are a lot of other sleeping disorders, which are due to lifestyle and other similar causes, to which we are ignorant.
Sleeping is a pervasive activity, something which involves an all-round healthy existence. We shouldn’t ignore signs of any sort of sleeping disorders which we may encounter and be aware of our needs and wants when it comes to ensuring a healthy sleep pattern.
Our next influencer is Terry Penner from Sleepwerx.
Hailing from Arizona, Sleepwerx believes in a ‘sleeping experience’. They provide their clients with services which are best suited to their needs and cater to their individual concerns. They intend to provide their service to every veteran, first responder and law enforcer in the state of Arizona. With a highly qualified board of sleep specialists they work towards educating the masses about sleep and sleep disorders.
Could you throw some light on the journey of SleepWerx? What was the driving force behind this initiative?
Raising awareness of anonymous and unforeseen health problems provides powerful knowledge. So many people suffer with undiagnosed sleep disorders, and one of the bigger forces is wanting to help people in ways that they want to be helped. People want eye contact, time to ask questions, time to voice fears and concerns, expert care, and SleepWerx does just that.
As time has gone on, it became clear to me that I really enjoyed interacting with people, hearing their stories and how their stories affected their lives. Private practice became a ‘natural fit’ where I knew that I could provide high quality, service driven care. It’s a process to get to where you want to, and the way for me to achieve this type of care for my patients was to open SleepWerx.
Having worked in the community area for over 30 years, I have built strong and stable relationships with local primary care, cardiology, and endocrinology practices. I believe that these relationships are the cornerstone of any specialty practice, and that the patients they refer to me are relationships of great value. I can provide the personalized care that people need when they are seen in specialty practice.
Some people adjust to lifestyle changes quicker than others, some people are quite intolerant of treatments in the beginning and they need some one on one help. I can provide this in my own practice and patients can reach me anytime.
I have always said that I would never have a desk between a patient and myself: in my own practice, I don’t!
Having said ‘take the time that it takes and it takes less time,’ assess, don’t assume, and when in doubt don’t – I can actually practice this way in my own practice without the fiscal pressures of high volume larger practices.
There is a gap in services in this area for people with sleep disorders. Larger centers have longer wait times; anywhere from 2 to 6 weeks, where I can often see patients the same or next day (depending on insurance issues). I have their sleep test results within 24-48 hours; thus, completing their initial services within a week – while others are still waiting for initial consultation.
I like that SleepWerx is truly a community practice serving the needs of this community closer to home and is independent from the larger organizations.
I am able to have a peaceful, comfortable office environment which we have decorated with 70’s music lyrics that engages patients and their families as they remember songs from their younger years. I can offer fresh hot coffee and healthy snacks In my own practice, I can provide a sense of confidence and support as people adjust to lifestyle and/or medication changes, in our peaceful, comfortable environment.
I can provide a sense of confidence, competence and trust in my own practice, that is not always possible in larger practices. Patients feel very comfortable at SleepWerx. Our team feels deeply appreciative and respectful of every patient that comes to us.
OSA or Obstructive Sleep Apnea seems to be the major issue that you help resolve. What are the effects of OSA on a person and how serious is this problem?
Data previously published in the American Journal of Epidemiology estimated that 26 percent of American adults between the ages of 30 and 70 years have sleep apnea, which now afflicts at least 25 million adults in the U.S., according to the National Healthy Sleep Awareness Project. That makes Obstructive Sleep Apnea very serious, as 80% of people afflicted remain undiagnosed. Obstructive sleep apnea is a chronic disease that increases the risk of high blood pressure, heart disease, Type 2 diabetes, stroke and depression.
I think Obstructive Sleep Apnea is the most prevalent and most well known sleep disorder. When we don’t get good oxygen supply during sleep, the brain stays awake trying to get us to breathe. When we don’t respond, the brain sends messages to the blood vessels to constrict, thus raising blood pressure during sleep. When BP spikes, the heart rate picks up and when both elevate quickly, the body believes that it is stress and releases stress hormones. High blood pressure causes heart disease, kidney disease, and is a causal factor for stroke. Sleep apnea prevalence is estimated at more than 70 million Americans, and most are undiagnosed.
Drowsy driving: AAA estimates that 1/6 deadly traffic accidents and 1/8 crashes requiring hospitalization is due to drowsy driving. Sleepiness and fatigue decrease vigilance, reaction times, memory, psychomotor coordination, decision making, all of which are needed for safe driving.
Workplace fatigue: Costs organizations billions in lost productivity, and workplace accidents. Sleep insufficiency, defined as sleeping less than seven hours a night, can be the result of mild sleeping challenges or disorders such as insomnia, narcolepsy, apnea, and restless legs syndrome. Several issues stem from sleep insufficiency.
We all know caffeinated and careworn people who, after hours of wakeful slumber, struggle to recall simple facts, seem disengaged and uninspired, lack patience with others, and can’t think through problems or reach clear-cut decisions.
Sleep insufficiency causes immediate health and performance problems, such as impaired cognitive performance, chronic health effects, including an increased risk of certain conditions—for example, high blood pressure, lost productivity, given higher levels of employee absenteeism or “presenteeism” (when people show up to work ill or too drowsy to function).
Sleep deprivation impairs this ability to focus attention selectively. Research shows that after roughly 17 to 19 hours of wakefulness (let’s say at 11 PM or 1 AM for someone who got up at 6 AM), individual performance on a range of tasks is equivalent to that of a person with a blood-alcohol level of 0.05 percent. After roughly 20 hours of wakefulness (2 AM), this same person’s performance equals that of someone with a blood-alcohol level of 0.1 percent, which meets the legal definition of drunkenness in the United States.
Sleep consultants usually focus on sleep deprivation and how to counter that, but your website also talks about excessive sleep. How do you deal with the problem of excessive sleeping in people?
Excessive daytime sleepiness (EDS) significantly impacts personal safety, and work-life function; thus, EDS affects quality of life to a great degree. Sleepiness is an important public health issue among individuals who work in fields where the lack of attention can result in injury to self or others.
Hypersomnia is a category of disorders in which daytime sleepiness is the is the primary complaint, but the cause of this symptom is not due to interrupted night-time sleep or altered circadian rhythms (such as jet lag, sleep shift disorder, delayed or advanced sleep phase syndrome). Prior to committing to long-term medication therapy for hypersomnia, an accurate diagnosis is important along with appropriate therapy.
Many other conditions produce such sleepiness and can mimic or coexist with hypersomnia. These include sleep apnea syndromes, periodic limb movements/RLS, insufficient sleep, psychiatric disorders, medications, and circadian rhythm disorders. These disorders need to be considered in the differential diagnosis as causing or contributing to excessive sleepiness in a patient with hypersomnia.
Management of these primary or concomitant disorders requires specific interventions apart from and/or in conjunction with the use of CNS alerting medications. In some instances, certain behavioral changes may be all that is needed. Behavioral changes may include avoiding naps, and avoiding caffeine a few hours before bed. Adjusting exposure to light may also help.
For example, in delayed sleep phase disorder, avoiding light exposure in the evening including light from cell phones and computers may help. Maintaining consistent bedtimes even on the weekends can also be helpful.
Light therapy may be beneficial for people with excessive daytime sleep (that is not attributed to other conditions mentioned above). This involves sitting in front of a bright light box for a certain amount of time. The treatment is intended to readjust your body clock by delaying or advancing bedtime. The timing of the light therapy is based on the disorder.
If other treatments are ineffective, medication may be an option to treat hypersomnia/excessive daytime sleepiness disorder. Different classifications of medications may be used, including CNS alerting medications.
Who have been your major collaborators through this venture and how has it helped you in collaborating with the other experts?
We have the most amazing broad network of professional and personal people, from so many backgrounds and levels of experience, and each person continues to be of great value to us in terms of brutal honesty. In addition to that network, I have the most wonderful husband who is my biggest cheerleader and my biggest critic. He pushed me to do it, he supported me through all the steps, and he is there for me every second of every day. I feel blessed with all the support that we have around us.
I’ve become comfortable to reach out to people who started out just like us with an idea, motivation, and courage. We have a terrific Chamber of Commerce, and they have been great. My NP and MD colleagues believe in one another, we are all there for one another in any way that we can. There are plenty of patients for all of us, and that is reinforced almost every day as we see new referrals, and we see our competitors also growing.
I don’t really see the other sleep practices and sleep experts as competitors: we may all see people with the same types of disorders but we offer different therapies, and we have very different methods and strategies. I admire other sleep practices: you don’t get where they are without good, honest, hard work, stressors, and goals.
My practice is not a threat to local experts, we will all grow by encouraging one another. When you have people who are experts, and working with novices, both the expert and novice grow in different ways. At the end of the day, patients benefit and that’s what we are all about.
Could you share with us your personal journey through SleepWerx, and how has it helped you as an individual?
My journey was quite complicated starting out. We worked hard to meet regulatory requirements, establish credibility, and set up an office without having much experience. I’ve been a clinician all of my career, and it’s been a great experience. You sometimes learn by doing, so that’s just what we did. Marketing was a real challenge for us: nobody can describe what you do as well as you describe your services yourself. Once we had that figured out, COVID hit and marketing came to a halt in terms of visiting practices and discussing what we have to offer.
I had to “multitask” if you will, write policies, do credentialing, order supplies, and stop to run to the office to sign forms or accept deliveries. That growth as an individual has been very humbling and I think growth is only accomplished through learning and just doing it. You never know what you can and cannot do until you just do it.
COVID almost closed our doors and exhausted our fiscal resources. Slowly we started seeing more people toward mid-April but then I had developed worsening heart failure with shortness of breath and edema, due to a congenital bicuspid aortic valve that was critically deteriorated. I had open heart surgery at the end of May, 2020 and that in and of itself was a new experience. I had never been hospitalized prior to that surgery! I came home on post-op day 4, and was back in the office at 3 weeks post-op. What seemed like an uncomplicated speedy recovery was actually unusual, so I found that I was stronger than I thought.
I adjusted my schedule to attend cardiac rehab 3 times a week and 3 weeks into cardiac rehab. I had a collision with a bike pedal and had to have repair. At 5 weeks into cardiac rehab or 10 weeks post-op I had to have skin grafting done on the leg wounds! I was grounded to pure telemedicine for 5 weeks and I had to depend on my office to run things from there.
Now that I am back to normal, COVID is increasing again in our state and we may experience another period where sleep is not a priority in many peoples’ lives. I sincerely hope that is not the case, that people see how important sleep is, and that they continue to seek our care.
All of the above scenarios are growth opportunities if you persevere, and that’s just what we did. All of the scenarios have helped me to be a better person, a more patient person, and I’ve learned where to focus my energies, when to delegate, and how to reach out for help. That’s big.
Through your considerable experience and expertise, do you have any suggestions for the up and coming sleep consultants?
Covid-19 has changed the way we practice. We are seeing higher volumes of patients with anxieties and fears over the unknown. We have to acknowledge the fears, listen to the patient’s story and work with them from their reality.
Eye contact is big for patients. Don’t lock yourself down behind a computer and fail to engage with your patient. Listening is big for patients. Let them tell their story! Do not interrupt the patient and assume that you know what they are experiencing. It’s ok to redirect when they lose the topic but interrupting someone and putting your story on their page is not a way to practice.
We all know that this virus has brought lockdown, economic stasis, depression, and fear among people for themselves and their loved ones. It is necessary to acknowledge the importance of sleep in effective function of the immune system foremost. Without adequate sleep, people tend to get sick more often and have difficulty recovering. The importance of sleep may not be at the front of the gate, but focusing on sleeping well offers great benefits.
Sleep is imperative for emotional wellness and mental health and helps battle stress, depression, and anxiety. Explore how the sleep disorder affects your patient: let them tell you their story.
Millions of people struggled with the insomnias before the virus, and the pandemic has created new problems and challenges to sleep for people who never struggled with sleep before. Listen to the patient, acknowledge their feelings and fears without speaking. Let them tell their story. Sometimes hearing yourself talk solves part of the problem.
Being stuck at home, especially if it has low levels of natural light may reduce cues for wakefulness and sleep. People who are out of work may tend to oversleep. Sleeping more than 7-8 hours per night can make waking more difficult. Sleeping too much may make people feel foggy and irritable and people may have trouble concentrating during the day. Let the patient tell their story. Reassure patients that you understand, and that you are there to help.
Anxiety and Worry:
People fear catching the virus, worry about friends and family in the at-risk groups, and economic concerns are affecting nearly everyone. Many of us know people who have been infected and people who have lost their lives. There is still much unknown about the virus, and that uncertainty can bring anxiety that disrupts sleep
That was a refreshing pillow talk with Terry Penner from Sleepwerx. If you are having any trouble in following a proper sleeping pattern or struggle with a sleeping disorder, then do check them and get in touch with their specialists. You can reach them on their website for a free sleep screening or through Instagram!
Featured Photo from mysleepwerx.com
Written by Abhinav Goel
This post is by Abhinav Goel. A law student, he loves to read, write, and watch movies. He believes that a good book and a movie can be the perfect antidote to all of your worries. You can connect with him on Instagram to know more ways of escapism.