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Dr. David Cunnington |
Dr. David Cunnington is a specialist in sleep medicine, experienced in diagnosing and treating a broad range of sleep disorders including sleep apnea, narcolepsy, insomnia, parasomnias and restless legs syndrome. He is Director of Melbourne Sleep Disorders Centre and Acting Director of the Department of Respiratory & Sleep Medicine at Western Hospital.
In addition to holding the highest qualification in sleep medicine awarded in Australia, Dr. Cunnington is a Fellow of the American Academy of Sleep Medicine (AASM), and is certified by the AASM as an International Sleep Specialist and International Behavioral Sleep Medicine Specialist. He is a regular invited speaker at national and international meetings, and is actively involved sleep-related research, education and training.
Visit the website for Melbourne Sleep Disorders Centre www.msdc.com.au |
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Seeking help for sleep problems |
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Tried all the tips and tricks for a better night’s sleep and still having problems? If sleep problems do not settle despite establishing good sleep habits, allowing enough time for sleep, and/or paying attention to your bedroom environment, you should discuss your sleep problems with your doctor.
For many people, sleep problems are a manifestation of an underlying medical problem. This can either be a physical or mental illness, and unless addressed the sleep problems will persist, and may progressively worsen.
What will happen when I see the doctor?
As many different medical conditions can impact on sleep, your doctor will need to make a careful and thorough evaluation including a physical examination. While this seems unusual for a sleep-related problem, sometimes sleep symptoms can be the first sign of other significant illnesses.
If your doctor suspects an underlying medical illness, they will arrange further tests or treatment. However, if nothing is found after a careful clinical evaluation, your doctor may refer you on to a sleep specialist for further investigation.
What is a sleep specialist?
A sleep specialist is a doctor who is an expert in diagnosing and treating sleep problems. As they are familiar with the full range of sleep problems, they may be able to make a diagnosis based on symptoms and a physical examination. If further testing is required, a sleep specialist can arrange tests such as an overnight sleep study.
Commonly used tests to investigate sleep problems
Sleep diary: Keeping a diary outlining your sleep patterns can be helpful in finding the cause of sleep difficulties. This is a relatively simple test and sleep diaries can be easily downloaded from the internet and completed even before you see the doctor. Click here to download a sleep diary by the American Academy of Sleep Medicine.
Overnight sleep study: An overnight sleep study, or polysomnography, is a very helpful test to look at what is happening during sleep. This test most commonly requires spending the night in a sleep laboratory while breathing, heart rate and brain wave activity are measured. If there are abnormal behaviors or movements during sleep, then video is also recorded. The data recorded during sleep is analyzed by sleep technologists and a sleep specialist and is used to make treatment recommendations.
Lab versus home studies: Sleep studies are usually performed in a laboratory, but it is possible to do sleep studies at home in select cases. Sleep studies performed at home are usually simpler than laboratory-based studies and mainly measure breathing and heart rate to look specifically for sleep apnea (a condition where breathing repeatedly stops and starts). Although home sleep studies
allow you to sleep in your own usual environment, they do not give as much information as a laboratory study. Conditions that are more complex, or where the diagnosis is not clear, require a laboratory sleep study.
What treatments are likely to be recommended?
Treatments vary greatly depending upon the cause of sleep problems. Some common conditions and their treatments include:
Obstructive sleep apnea: Severe obstructive sleep apnea (OSA) is treated by wearing a mask at night, which uses air pressure to keep the airway open and stop snoring and episodes of choking during sleep. Less severe cases can be treated using dental appliances. Weight loss is important in obstructive sleep apnea, both to reduce the severity of OSA and improve overall health, as OSA can increase the risk of high blood pressure and other heart problems.
Insomnia: The mainstay of insomnia treatment is good sleep habits and use of behavioral psychology. If insomnia persists,
then sleeping tablets may be required. It is preferable for sleeping tablets to be used for as short a period of time as possible, and it is important that anyone taking sleeping tablets on an ongoing basis remains under the close supervision of their doctor.
Depression and disturbed sleep: Disturbed sleep is a common symptom of depression and can occur long before depression symptoms are apparent. Depression is treated with psychological techniques such as cognitive behavioral therapy, or, if more severe, with anti-depressant medication. For some people sleep returns to normal once depression has been treated, but for many patients disturbed sleep can persist and need specific treatment such as seeing a psychologist or short-term use of sleeping tablets.
Sleep problems are a common part of most physical or mental illnesses and you’ll often need to address the latter in order to fix the former. If your sleep problems don’t settle despite trying good sleep habits and ensuring a good sleeping environment, then it’s time to make an appointment with your doctor to see if there is an underlying medical condition. |
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