What a difference 40 years makes.

“Right after I read that article, I saw a patient who was very heavy. He had a thick neck and edema,” said David H. Winslow Jr., M.D., sleep medicine physician with Norton Pulmonary Specialists and Norton Sleep Centers. “Classic signs of right-sided heart failure — I put a nasal trumpet in, and the patient felt better. That case piqued my interest.”

The rest, as they say, is history.

This year Dr. Winslow is retiring and will be succeeded as medical director of Norton Sleep Centers by Kevin K. Trice, sleep medicine physician with Norton Pulmonary Specialists and Norton Sleep Centers.

Dr. Winslow’s four-decade career started at what we might think of as the dawn of modern sleep medicine.

Starting with the heart

“I started practicing pulmonology in South Louisville. I would see referred patients who were supposed to have severe chronic obstructive pulmonary disease,” Dr. Winslow said. “Their breathing function would be OK, but they’re telling me they snore at night. They don’t wake up rested.”

Puzzle pieces began to fall into place: the article he’d read, the first patient he treated for an airway blockage and these new patients.

When Dr. Winslow’s practice group moved to what is now Norton Audubon Hospital in the late 1970s, the closest sleep clinic was in Miami, Florida.

“We started sending patients to Florida for a while, but it was pretty far away for most of them. In 1979, I went to a very small conference of people who were interested in these symptoms and what they meant for sleep and health.”

That conference was full of the forefathers of sleep medicine. That’s about the time the first sleep disorders clinic in Louisville opened on what is now Norton Audubon Hospital campus. In 1983, Dr. Winslow became medical director of what would become Norton Sleep Centers.

“We were board certified and became the 30th sleep center in the United States,” he said.  

Waking up to a new way of treating sleep disorders

To say things have changed in 40 years would be like saying Rip van Winkle took a cat nap.

“The old polysomnography machines used ink pens,” Dr. Winslow said, noting the contrast to today’s modern electronics.

A polysomnography machine monitors various data points during sleep: heart rate, breathing and so on. Pens would trace onto large sheets of thin paper — the “old-school” way. This analog method came with its own set of problems.

“We had to change the rugs out every year or so in the labs because the ink would go everywhere,” Dr. Winslow said.

Nowadays, polysomnography uses sophisticated computers, and data is collected, recorded, analyzed and shared electronically.

Computerized machinery is just the edge of sleep medicine’s changes since the early days. Today, not all patients have to spend the night in a laboratory, away from home, to do a sleep study. There are portable, lightweight machines patients can take home and use in the comfort of their own bedrooms. When patients do require an on-site sleep study, Norton Sleep Centers have four diagnostic lab locations in the Louisville area, with a total of 24 sleep study beds available. 

“We understand so much more about sleep disorders, and not just sleep apnea,” Dr. Winslow said. “Narcolepsy, for example. Beyond sleep disorders, we know more about how the body responds to more sleep, less sleep and better sleep hygiene. We know more about how hormones and weight impact sleep.”

Even so, he said, “There’s still much more to learn and know about sleep.”

Decades of service that won’t stop with retirement

If you ask Dr. Winslow what he’s proud of in his career, he might mention the practical portion: the sleep studies and clinical trials, writing papers and presenting to symposiums. But he’s done more than that, in service to both the medical community as well as Louisville region.

“I feel fortunate to have been part of two fields from the early days,” Dr. Winslow said. “Pulmonary and sleep [medicine] were both just getting started when I joined.”

He also served as head of Norton Audubon Hospital’s Ethics Committee, which in part oversaw palliative care.

“That was a great joy for me to participate in,” Dr. Winslow said.

As he reflected on his legacy and the expertise he has passed on to colleagues, Dr. Winslow expressed confidence in his successors who will treat patients in Louisville.

What’s next for this sleep specialist? He’s looking forward to spending time with family and volunteer work.

“My wife and I will spend winters in Florida. We love to walk and ride our bicycles,” Dr. Winslow said. “I haven’t decided exactly where else I’m headed, but I’m looking forward to growing spiritually and intellectually.”

The post After 40 years of helping people sleep, this physician is ready to relax, reflect appeared first on Norton Healthcare.

Chronic fatigue treatment options focus on relieving symptoms, which can vary widely among individuals.

Potential treatments include:

• Graded exercise therapy. This is designed specifically as a treatment for chronic fatigue. The therapy is a customized plan of physical activity that starts slowly and gradually increases.
• Cognitive behavioral therapy. This treatment addresses unhelpful patterns of thinking and learned behaviors that may be exacerbating chronic fatigue.
• Various medications may be prescribed to control pain, depression and difficulty sleeping.

“Chronic fatigue often is misunderstood. While the symptoms can seem similar to less serious illnesses, chronic fatigue lasts more than six months, patients ‘crash’ after physical or emotional effort and they wake up feeling as tired as they did the night before,” said Loyal W. Walker, M.D., a family medicine physician with Norton Community Medical Associates – Taylorsville.

Those with chronic fatigue are unable to participate in routine activities such as work, school and socializing. The fatigue is not made better with rest and was a recent development.

Chronic fatigue also is characterized by an inability to concentrate or by feeling faint or lightheaded when standing.

If you suspect you have chronic fatigue syndrome, your primary care provider will look to rule out other possible causes of your fatigue. Symptoms of chronic fatigue syndrome may appear similar to many other illnesses such as anemia, an underactive thyroid, or liver and kidney conditions.

Your provider will ask about your health history, current symptoms and when you first started noticing them. Primary symptoms for chronic fatigue syndrome include:

• Six months or more of decreased activity and energy level
• “Crashing” after physical or mental activity that usually would not have exhausted you in the past
• Not feeling rested after a full night of sleep, and issues failing and staying asleep

The post Chronic fatigue treatment starts by ruling out other causes of your symptoms appeared first on Norton Healthcare.

Sleep apnea more than doubles the risk of stroke for middle-aged and older men and also increases the stroke risk in middle-aged and older women.

“Sleep apnea is a common but under recognized risk factor for stroke. If you or a loved one has issues with excessive daytime sleepiness, snores loudly or gasps for air during the night, you should be screened by a health care provider for sleep apnea,” said Danny R. Rose Jr., M.D., a neurologist with Norton Neuroscience Institute.

More than 12 million Americans have sleep apnea. Most are undiagnosed or untreated.

Snoring can be a sign your brain is not receiving enough oxygen. If you stop breathing for 10 seconds or longer while you’re sleeping, you may have obstructive sleep apnea.

The more severe your sleep apnea, the greater the risk of stroke. One study found men with moderate to severe sleep apnea were three times as likely to have a stroke as men mild sleep apnea or without sleep apnea. Men with sleep apnea may have a higher risk of stroke because they develop sleep apnea at a younger age.

Sleep apnea also is associated with heart and blood pressure issues, which increase your risk of stroke further. Sleep apnea also increases your risk for heart disease.

During obstructive sleep apnea, the body works hard to open the airway and breathe during these episodes, releasing stress hormones and increasing blood pressure. Over time, this can lead to uncontrolled high blood pressure and a heart condition called atrial fibrillation, or A-fib. High blood pressure, which is also called hypertension, and A-fib are both known risk factors for stroke.

Can you have a stroke in your sleep?

“Strokes during sleep are especially challenging because of the time-sensitive nature of stroke treatment. Our treatment options are often more limited in these situations, as many of these patients have irreversible brain damage before arriving to the hospital,” Dr. Rose said.

Not only is sleep apnea a risk factor for stroke, untreated sleep apnea is associated with poor outcomes after stroke. Stroke is the second-leading cause of death worldwide.

“The rate of sleep apnea is much higher in patients who have experienced a stroke, compared with the general population. Both stroke survivors and health care providers should be aware of this risk, and screening for symptoms of sleep apnea should be considered in any patient who has had a stroke,” Dr. Rose said.

Lifestyle changes like losing weight and quitting smoking can help with milder cases of sleep apnea. Moderate or severe sleep apnea can be treated with a continuous positive airway pressure (CPAP) machine. The CPAP machine keeps your airway passages open. This prevents snoring and apnea.

“Consistent use of CPAP is effective at treating sleep apnea and has been shown to reduce stroke risk factors. Adherence to nightly usage can be challenging for some patients, especially initially as they are acclimating to this change in their sleeping habits. I encourage patients who are having trouble with using their CPAP to speak with their doctor to ensure their equipment fits and functions correctly,” Dr. Rose said.

The post The sleep apnea and stroke connection appeared first on Norton Healthcare.

According to David H. Winslow Jr., M.D., pulmonologist and sleep medicine specialist with Norton Pulmonary Specialists, there’s even a name for it: coronavirus pandemic dreams.

“Nightmares and dreaming have increased by about 40 percent, according to recent studies, and that’s clearly because we’re all under a lot of stress,” Dr. Winslow said. “Right now, we’re dreaming a lot more about death.”

Dreaming is involved with memory, helping us remember the important things that happened during the day. Dreams also help process emotions like anxiety.

“During periods of stress, not being able to sleep as well, your patterns are off and you wake up more,” Dr. Winslow said.

Because we typically only remember the last dream we had before we wake up, waking up more during the night means we’re remembering more dreams.

According to Dr. Winslow, what you do before you go to bed affects your sleep and dreams.

“It is not healthy to watch news programming for five hours before you go to bed and be all stirred up,” he said.

Ways to improve sleep and remember fewer disturbing dreams

Dr. Winslow has these tips for improving your sleep and dreams:

• Establish a consistent bedtime and a good sleep routine.
• Avoid TV and the internet before bed.
• Meditation, breathing, and gentle stretching all can help you relax before bed.
• Don’t drink too much alcohol or coffee.
• Avoid sleeping pills, even now.

For people awakened by nightmares, Dr. Winslow recommends staying calm and trying

something called dream mastering. Before you go back to sleep, imagine whatever was

frightening about the dream as something harmless. For example, if you dream you’re being chased by a would-be attacker, visualize that person the size of an ant before you go back to sleep. You also can write down your nightmare and reconstruct it into something pleasant, according to Dr. Winslow.

What you do during the day also can help.

“Trying to be positive in the morning can be helpful throughout the day,” Dr. Winslow said. “I usually advise folks to smile and say something like, ‘I feel happy. I feel healthy. I feel terrific.’ Just that process, if you do it every day, can change brain chemistry and make you feel better and be more positive.”

Children and sleep during the pandemic

For parents, Dr. Winslow recommends establishing healthy sleep habits for their children, including sleeping in their own beds, as well as talking with them honestly about what’s happening with the coronavirus.

“You don’t want to hide this from children, because they can take it,” he said.

Because of the social isolation during the pandemic, dreams often fall back on the older, emotional parts of your life, which can be disturbing, according to Dr. Winslow.

Even sleep specialists are not immune from coronavirus pandemic-inspired dreams. To avoid waking up at night, Dr. Winslow started walking more during the day and tries to watch shows that have humor in them, instead of sticking to the news.

“It’s gotten better,” he said.

Suspect a Sleep Disorder?

The first stop should be your primary care provider before poor sleep starts affecting your health. For more information about the Norton Sleep Center, call: (502) 559-5559.

The post More crazy, scary dreams? Welcome to coronavirus pandemic dreams appeared first on Norton Healthcare.

Sold over the counter in pill and liquid forms, laboratory-made melatonin is absorbed directly into your system and can help adjust the body’s internal clock, regulating sleep-wake cycles.

However, many physicians don’t necessarily recommend melatonin to their patients with insomnia.

“Instead, I have found that good sleep hygiene, such as regularly following a scheduled bedtime and awakening time, limiting caffeine, avoiding daytime napping, and reducing TV and electronics use while in bed are all generally effective,” said William O. Lacy, M.D., pulmonology and sleep medicine specialist.

However, a person’s age can be a factor for advocating melatonin use.

“I would consider melatonin as an aid in helping remedy insomnia in older individuals. As people age, their natural levels of melatonin decrease,” said Dr. Lacy, who sees patients at two Norton Pulmonary Specialists locations in Louisville.

Even though the supplement is considered safe, its effectiveness is unknown. Melatonin users may experience side effects, including excessive sleepiness, dizziness, fatigue and headache. Long-term use may lower testosterone levels in men. Therefore, Dr. Lacy urges caution for anyone considering taking melatonin.

“I also tell patients they certainly need to avoid using it in combination with other medications, such as fluvoxamine (Luvox). Likewise, those taking medication to manage high blood pressure, diabetes, depression and blood clots should avoid using melatonin; mixing these drugs could cause adverse reactions,” Dr. Lacy said.

Before trying melatonin or prescription medication for insomnia, Dr. Lacy recommends improving sleep habits or trying cognitive behavioral therapy. Prescription sleep aids, such as Ambien or Restoril, are for short-term use, meaning for no more than one to two weeks.

The post Consider these changes before turning to melatonin appeared first on Norton Healthcare.

During the time before menopause, called perimenopause, the ovaries decrease production of estrogen and progesterone. Sleep issues can start during this phase, but generally ramp up after menopause, when a woman has gone without a period for one year.

Hot flashes and obstructed breathing are the most common causes of sleep issues for women during menopause.

“Before a hot flash, body temperature rises, which results in waking up,” said James M. Graham, M.D., OB/GYN with Women’s Care Physicians of Louisville, a Part of Norton Women’s Care. “These flashes can last around three minutes. If a woman experiences several hot flashes during the night, it can lead to low-quality sleep and next-day drowsiness.”

RELATED: Menopause and anxiety: When to talk to your gynecologist

Additionally, as a woman ages, the throat muscles lose tone, impinging on the airway during sleep. This can cause obstructive sleep apnea (OSA).

Hot flashes will go away in one to three years for most women, but because OSA has impacts on heart health, mental health and more, it requires medical attention.

Read more:  The link between heart disease and sleep apnea.

The good news is lifestyle changes may be all it takes. Losing weight, eating a balanced diet that includes soy and getting enough exercise can help.

Avoid nicotine, and keep caffeine and alcohol to a minimum. Alcohol can increase hot flashes. Sleep in lightweight clothing and avoid heavy blankets. Use a fan or air conditioner to circulate air.

Hormone or medication therapy as well as a variety of treatments for OSA also are options if lifestyle changes don’t work.

The first step is making sure your health provider is aware of your sleep issues. A good night’s sleep is too important to your overall health to not do something about.

“Life is one big adaptation. You go through puberty and motherhood. Menopause is another change that you have to adapt to,” Dr. Graham said. “And your doctor can help you find solutions.”

The post Hot flashes, sleep apnea causes of menopause-related sleep issues appeared first on Norton Healthcare.

“Sleep is incredibly important to a number of brain functions, including how neurons communicate with one another,” said Mohammad S. Alsorogi, M.D., neurologist with Norton Neuroscience Institute. “In fact, your brain stays remarkably active and does a lot of work while you sleep.”

Research shows sleep is vital to memory. The brain uses that time to consolidate and file memories, which leads to the ability to retrieve them later. Lack of sleep also impacts the brain’s ability to learn and pay attention, which often leads to reduced creativity, decision-making, problem-solving and overall work performance.

Link Between Poor Sleep and Brain Diseases

Prolonged periods of sleep deprivation can have even more serious consequences. A recent study from the National Institutes of Health revealed that just one night of sleep deprivation results in the accumulation of a protein linked to Alzheimer’s disease. Research also shows that a chronic lack of sleep is linked to neurodegenerative diseases, including Parkinson’s, and psychiatric disorders such as depression, anxiety, ADHD and overall mood.

“The space between brain cells expands during sleep, which allows the brain to flush out proteins and toxins it doesn’t need,” Dr. Alsorogi said. “This is needed on a nightly basis to keep the brain healthy.”

Studying Sleep Deprivation May Lead to Breakthroughs

While many mysteries remain, scientists continue to learn about how sleep affects brain function and the risks involved with being chronically sleep deprived. A greater understanding between the two might not only help with diagnosing but also preventing certain diseases.

“Sleep changes may eventually allow us to predict and get ahead of treating mood disorders and neurological diseases,” Dr. Alsorogi said. “At the very least, if we can improve sleep, patients should see an improvement in their mood and overall brain function.”

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Roughly 10% of U.S. adults — an estimated 22 million — have moderate to severe sleep apnea.

“As a pulmonologist in the late ’70s, primary care physicians and cardiologists were referring patients to me with what they had diagnosed as end-stage chronic obstructive pulmonary disorder (COPD), which is an umbrella that covers many breathing disorders,” said David H. Winslow, M.D., sleep medicine specialist with Norton Pulmonary Specialists. “But as I would talk with these patients, I was discovering most had an obstructed airway during sleep.”

The only treatment option at that time was a tracheotomy, which is invasive and leaves the patient with a permanently open airway. But the treatment worked, and patients who opted for it recovered from medical conditions as serious as heart failure, according to Dr. Winslow.

Sleep Apnea Can Cause Many Serious Health Issues

Physicians now know OSA has a significant impact on overall health, ranging from obesity to foggy thinking to a host of heart issues, including sudden cardiac death. About 50% of people who have a heart attack or stroke also have OSA.

“With OSA, a person stops breathing during sleep. In most cases, when someone stops breathing it shocks them back and they wake up,” he said. “But those sudden stops and starts of the cardiovascular system can lead to heart arrhythmias, atrial fibrillation, heart failure, heart attack and stroke.”

Learn the link sleep disorders have to heart disease

Innovators in Sleep Medicine

By the early 1980s sleep labs were created to conduct sleep studies. The first sleep lab in Kentucky was at what is now Norton Audubon Hospital. At that time, most referrals were from wives who couldn’t sleep because of their husbands’ snoring.

“Although statistically, OSA happens to both men and women, early on it was commonly known as a man’s disease. The loud snoring and gasping for air during the night would have wives in a panic and encouraging their husbands to have a sleep study,” Dr. Winslow said.

After a sleep study and diagnosis of OSA, patients would be sent home with a continuous positive airway pressure (CPAP) machine. The bedside machine consisted of a mask worn during sleep that increased air pressure in the throat to prevent the airway from collapsing.

Treatment for Sleep Apnea Other Than CPAP

The first masks were bulky and cumbersome; however, patients who could tolerate the awkward equipment reported much better sleep quality. Fortunately, technology advances have allowed for smaller, often more comfortable CPAP masks. A dental device can help some patients.

“The dental device helps move the lower jaw out farther when sleeping, allowing the airway to open more clearly. This is an alternative for patients with mild to moderate sleep apnea, but they have to be closely followed by their pulmonologist and dentist,” Dr. Winslow said.

In rare cases for patients who are unable to use the dental device or CPAP, Dr. Winslow offers hypoglossal nerve stimulation. This implantable device stimulates the nerves that control the airway while the patient sleeps.

Sleep Apnea Quiz

Answer each question. Your score will appear at the end of the survey, then learn more about what your score means in the scoring guide.

Sleep Apnea Quiz Scoring Guide

Use your total points out of 20, displayed at the top of the quiz when you submit your answers.

• 9 or more points — You have a high risk of developing sleep apnea or other sleep disorders. For information about testing options, seek advice from your health care provider or call a Norton Sleep Center.
• 6 to 8 points — You have a moderate risk of developing sleep apnea or other sleep disorders, and you may want to discuss your risk factors with your health care provider.
• 0 to 5 points — You have a low risk of developing sleep apnea or other sleep disorders.

Quiz developed by David H. Winslow, M.D., pulmonologist and sleep medicine specialist with Norton Pulmonary Specialists and Norton Sleep Center.

The post Sleep apnea treatment options have improved over the years appeared first on Norton Healthcare.

“This can lead to poor food choices, such as carb loading in order to get an energy fix,” said Meredith C. Sweeney, M.D., bariatric surgeon. “When that energy wears off, you’re back to feeling sluggish and looking for something to give you a boost again.”

In addition, complex changes in brain function after poor sleep make it harder to practice self-control and stimulate the brain’s reward center, making that candy bar extra enticing.

A Slippery Slope to Obesity

Add feeling too fatigued for activity and exercise, and over time poor sleep becomes a slippery slope that can lead to obesity.

“Especially if you are trying to lose weight, getting enough sleep is critical to success. There’s strong evidence that sleep is the missing ingredient with people who are having difficulty losing weight,” Dr. Sweeney said. “Weight gain also can lead to sleep apnea, which creates another factor contributing to poor sleep.”

If that’s not enough, sleep deprivation increases insulin resistance, meaning blood retains more sugar and the body produces more insulin to compensate.

“The excess insulin makes you hungrier and tells the body to store calories as fat,” Dr. Sweeney said. “This can lead to Type 2 diabetes.”

The bottom line is when you get plenty of sleep, it’s easier to make healthier food choices.

The post The link between poor sleep and weight gain appeared first on Norton Healthcare.

Creating the ideal sleeping conditions is one of the best ways to get better sleep. Making changes in your bedroom may be all it takes to relieve some sleep issues. Here are some key ways you can create your own sleep sanctuary.

Create the Right Environment

Sheets should be clean and soft. Keep bedding to a minimum and use a pillow to keep your neck in a neutral position. Block your clock or turn down brightness. Aromatherapy can help put you to sleep. Pets should have a separate sleeping area.

Try areca palm, English ivy, orchids or succulents to improve the air. Turn down the thermostat to 65 to 72 degrees. Try a noise machine to block outside noises.

Prepare

Get into a routine of spending the last hour before bed preparing for the day ahead — make lunches or meals, choose clothing, go through the next day’s to-do list — followed by washing up, changing into pajamas and then doing a calming activity, such as meditation, breathing exercises or reading a book. Power off the TV and electronic devices that emit blue light.

Ban Work From the Bedroom

Your sleep area should be free from work notes, work reading materials, calendars, bills or any potential stressors. It also shouldn’t be the space for making complicated decisions. All of these can bring on anxiety and unnecessary thinking.

Meditate

Quiet mental noise by spending a few minutes in either traditional meditation or mindful meditation, in which you become aware of your emotions, thoughts and surroundings in a positive way. This will help clear your mind for sleep.

Stretch It Out

Holding one stretch or yoga pose for about 10 minutes can relax you. This can be as simple as lying on your back on the floor with your legs flat and arms extended. Inhale for four counts, exhale for four counts. Repeat for 10 minutes.

Put the Bottle Away

While having a drink is a common way to destress and alcohol works as a sedative, it won’t provide long-lasting rest. A drink may help you fall asleep, but it will not help you stay asleep. Try chamomile tea or warm milk instead.

Make a Worry List

At least two hours before bed, take a few minutes to write down what’s on your mind. Having thoughts written down where you can address them or not forget about them will help keep the thoughts from racing when you lie down to sleep. And you know that saying about not going to bed mad? It’s a thing. If you have a conflict to resolve, make peace. Doing so will ease your mind so you can sleep better — and it actually will help you get more deep sleep.

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