When the lights go out in the UC Irvine Sleep Center, things can get a little weird. Although some of the overnight patients simply snore like lawnmowers, others sleepwalk, scream, or fulfill dreams by kicking, pedaling, and punching.
To diagnose these symptoms, technologists in the Newport Beach Laboratory’s control room observe video feeds from the clinic’s eight high-tech rooms and track more than 30 vital signs for each patient, including brain waves, heart rate, breathing and blood pressure.
“It’s like a biopsy of your sleep,” says Dr. Rami Khayat, professor of clinical medicine who leads the program. Surprisingly, despite the tangle of wires and electrodes attached to patients’ foreheads, chins, chests and limbs, “people sleep pretty well here,” he says. “We rarely get a study that’s unusable.”
The sleep center, which is billed as the only comprehensive university clinic of its kind in Orange County, also performs alertness testing for pilots, military personnel, truckers, doctors and others whose work depends on staying awake.
Not everyone with a 40-wink problem needs to spend the night in the lab.
In cases where doctors at the sleep center only suspect obstructive apnea — a condition that affects nearly 30% of American adults and about half of the clinic’s patients — an at-home monitoring kit analyzes eyes closed from the person. Likewise, insomniacs are getting medical-grade smartwatches that track their vital signs and — unlike mainstream wrist gadgets — are backed by peer-reviewed scientific studies, Khayat says.
The resulting data can span hundreds of pages and is manually reviewed to recommend the best treatment.
More than half of Americans have some kind of sleep disorder, even though they may not realize it, Khayat says. Untreated, sleep dysfunction increases the risk of heart attack, stroke, diabetes, dementia and cancer, he adds, not to mention impaired decision-making and driving.
What are the warning signs?
“How do you usually feel when you get up in the morning? asks Khayat. “If you are not refreshed, it may indicate a problem. Or if you are often very tired afterwards, this is not normal.
At any age, people should have some energy in the tank at the end of the day, he says.
For new patients, doctors at the clinic spend about an hour discussing the person’s sleep environment and routines, checking their airways, reviewing medical records, and outlining options. Overnight testing — at home or in the lab — is recommended more than half the time, Khayat says.
The center, which opened in 2018, uses state-of-the-art equipment, including technology designed by the inventors at UC Irvine. A UC Irvine wireless creation worn like a sock discreetly monitors blood pressure and can even predict which patients with apnea are most likely to develop heart problems, Khayat says.
Once diagnosed, treatments range from behavioral modifications (“Some problems are self-induced,” Khayat notes) to breathing masks or surgically implantable devices. Medications are sometimes prescribed, usually for conditions such as narcolepsy, severe insomnia, or excessive sleepiness. But the clinic prefers to avoid pills and offers one of the few behavioral sleep programs in the county.
For patients with central sleep apnea, a rarer form of apnea, UC Irvine is the only health system in Orange County to offer Remede, an FDA-approved nerve stimulator that works much like a pacemaker cardiac,” says Khayat.
In addition to treating everything from drowsy driving to excessive nightmares, the center hosts a variety of UC Irvine research projects, including studies of the relationship between sleep, dementia, and heart disease. Some of the test subjects are wearing what looks like a swimming cap covered in dozens of metal buttons. It’s actually a high-density EEG headset that can draw a 3D map of brain activity and predict cognitive impairment.
Looking to the future, Khayat hopes to expand the clinic’s staff and start a sleep medicine training program at UC Irvine. “As a society, we sleep less and disorders increase,” he says, so the demand for care increases. But with few universities in the region teaching the field, “there is a shortage of sleep doctors”.
Roy Rivenburg, UC Irvine