We at University of Louisville Hospital use a multidisciplinary approach to treat sleep disorders, integrating sleep medicine, pulmonary medicine, psychology, neurology, otolaryngology, oral maxillofacial surgery, dental sleep medicine and bariatric surgery. Our specialists are board certified in sleep medicine by the American Academy of Sleep Medicine. We evaluate and treat a wide variety of sleep complaints and disorders, including:
- Sleep apnea
- Excessive sleepiness
- Insomnia
- Narcolepsy
- Movement disorders that affect sleep patterns
- Restless leg syndrome (RLS)
- Parasomnia
- Circadian rhythms sleep disorders
- Shift work sleep disorder
- Sleep disorders related to neuromuscular diseases with chronic respiratory failure
Diagnostic testing includes:
- Nocturnal polysomnography with end tidal CO2 monitoring
- Multiple sleep latency testing
- Maintenance of wakefulness testing
- Titration of positive airway pressure as treatment for sleep disordered breathing
- Nocturnal oxygen titration
- Actigraphy
- Initiation and titration of non-invasive mechanical ventilation for patients with chronic respiratory failure, including patients with neuromuscular disorders
Treatments we provide include:
Positive Airway Pressure (PAP)
Positive airway pressure is a mode of respiratory ventilation used in the treatment of sleep apnea. A continuous positive airway pressure (CPAP) machine initially was used mainly for patients in the treatment of sleep apnea at home, but now is in widespread use across intensive care units as a form of ventilation. Obstructive sleep apnea occurs when the upper airway becomes narrow as the muscles relax naturally during sleep. This reduces oxygen in the blood and causes arousal from sleep.
A CPAP machine stops this by delivering a stream of compressed air via a hose to a nasal pillow, nose mask, full-face mask or hybrid, splinting the airway (keeping it open under air pressure) so unobstructed breathing becomes possible, therefore reducing and/or preventing apneas and hypopneas. CPAP treatment can be highly effective in treatment of obstructive sleep apnea. For some patients, the improvement in the quality of sleep and quality of life due to CPAP treatment will be noticed after a single night's use.
 Often, the patient's sleep partner also benefits from markedly improved sleep quality due to the alleviation of the patient's loud snoring.
Alternatives to PAP therapy
- Bilevel positive airway pressure (BPAP): Unlike CPAP, which supplies steady, constant pressure to your upper airway as you breathe in and out, BPAP builds to a higher pressure when you inhale and decreases to a lower pressure when you exhale. The goal of this treatment is to assist the weak breathing pattern of central sleep apnea. Some BPAP devices can be set to automatically deliver a breath if the device detects you haven't taken one after so many seconds.
- Oral appliances: These are portable devices designed to keep your throat open. PAP is more effective than oral appliances, but oral appliances may be easier for some patients to use. Some are designed to open your throat by bringing your jaw forward, which can sometimes relieve snoring and mild obstructive sleep apnea.
- Supplemental oxygen: Using supplemental oxygen while you sleep may help if you have central sleep apnea. Various forms of oxygen are available as well as different devices to deliver oxygen to your lungs.
- Adaptive servo-ventilation (ASV): This more recently approved airflow device learns your normal breathing pattern and stores the information in a built-in computer. After you fall asleep, the machine uses pressure to normalize your breathing pattern and prevent pauses in your breathing. ASV appears to be more successful than CPAP at treating central sleep apnea in some people.
- Surgery: The goal of surgery for sleep apnea is to remove excess tissue from your nose or throat that may be vibrating and causing you to snore, or that may be blocking your upper air passages and causing sleep apnea. Our Sleep Medicine specialists can refer you to a qualified surgeon in the UofL Physicians network.
- Pharmacologic (medication) therapies
A variety of medications can be used to alleviate sleep problems. Our team performs a complete evaluation to determine if this course of treatment is best for you.
Cognitive and behavioral therapies, with a special focus on insomnia
These treatments focus on re-learning how to sleep better. The premise of cognitive behavioral therapy is that changing our thinking leads to a change in affect and behavior. CBT helps individuals replace ineffective coping skills, cognitions, emotions and behaviors with more adaptive ones by challenging an individual's way of thinking and the way he/she reacts to certain habits or behaviors.
