Sleep laboratory: sleep heals
The sleep laboratory at the Swiss Paraplegic Centre (SPC) in Nottwil provides help for people with sleeping disorders: people with paraplegia and people with muscle diseases or polio often suffer from sleep disorders, which can develop into serious health problems. Being unable to sleep at all or only fitfully at night can in the long run drain your reserves of strength and lead to fatigue during the day and complications. Patients receive effective help in the SPZ sleep laboratory in Nottwil.
Anyone who has suffered the cruel stroke of fate that deprives you of your ability to move in a normal way must find life in a wheelchair very hard to bear. But what happens when you add insomnia to this physical and psychological burden, and your remaining strength is being constantly undermined by terrible fatigue?
Paralysis-specific sleep disorders
People with paraplegia are much more likely to have problems sleeping than people who are able to walk. Nighttime breathing problems are a widespread phenomenon, in particular the so-called “sleep apnea syndrome.”
At the Swiss Paraplegic Center (SPZ) in Nottwil, they have been regularly measuring patients’ breathing and pulse rate for years using a cardiorespiratory polygraph. If during the night our breathing starts to ‘go to sleep’ and no air gets into the lungs, oxygen levels in the blood start to fall. This endangers organs that need a lot of oxygen and leads to complications. The risk of developing high blood pressure or even suffering a heart attack is higher among these patients. Most are not even aware that they have nighttime breathing problems. Some even believe that they sleep well, although they often complain of lapses in concentration and increased tiredness during the day.
Besides breathing problems, people with paraplegia also have a wide range of other sleeping problems, including motor function problems and pain syndromes, which must be investigated with a polysomnograph (including an EEG). In certain patients, the spasms are worse at night, which makes it impossible to get to sleep or repeatedly wakes them up. Also, patients with paraplegia have to be monitored for restless foot and leg movements, which can massively impair quality of sleep. Pain and unpleasant sensations (dysesthesia) can be a particular problem at night for patients with incomplete paraplegia. Because of the interrupted function in the spinal cord, people with paraplegia are also particularly prone to problems with temperature regulation. Nightly alternate hot and cold baths from freezing and sweating, hot head and cold feet are not uncommon. The functioning of the sweat glands below the level of the lesion is disturbed and the blood vessels of the skin (important for heat distribution) no longer obey the instructions coming from the brain. Epileptic attacks, side-effects of drugs and psychologically related problems with falling and staying asleep, can all disturb a night’s rest. It has also been shown that people with quadriplegia have a reduced or even total loss of production of the melatonin hormone.
A wide choice of treatment
To treat paralysis-specific sleep disorders effectively, the sleep laboratory has to keep meticulous data records and analyze them carefully. To enable them to do this, the Swiss Paraplegic Center in Nottwil has a wide choice of treatment options. These range from special respiratory equipment, through a choice of drugs to behavioral therapy treatments and psychological help. Thanks to all these measures, sleep patterns are soon improved. The majority of patients treated rediscover the rest and recovery they need, and their daytime sleepiness disappears.
Many questions remain unresolved, however, and require further research. In the still young discipline of sleep medicine, the problems of paralysis-related sleep disorders and their resolution present an important challenge.
What does it all mean?
Apnea: interrupted breathing that lasts at least 10 seconds.
Sleep apnea: interrupted breathing when asleep.
BiPAP: Bi-level positive airway pressure
Cardiorespiratory polygraph: recording heart and respiratory functions (without EEG)
Polysomnograph: sleep examination using constant multichannel recording with EEG, EMG (muscle tone) and EOG (eye movements) to determine sleep phases and respiratory movement, ECG (heart curve) and oximetry (oxygen saturation in the blood) to determine cardiorespiratory function and other variables such as snoring, leg movements and body temperature.
Hypnogram: chart showing the different sleep phases during the night.
Lesion level: level at which the spinal cord was damaged – with resulting paralysis.
Melatonin: hormone that promotes sleep.
Syrinx: a cavity formed in the spinal cord.
Source: Dr. med. Eve Stockhammer, Institute for Clinical Research, Sleep laboratory, SPC Nottwil, Paraplegie, Nr. 101, Paramedia