An Exploration of the Expansive Impact of Sleep and the Benefits Improving Sleep with a Hands-On Approach to PAP Therapy
In this month’s sleep story, meet Dr. Amy Korwin, a pulmonologist from New Haven, Connecticut who provides clinical services at Connecticut Pulmonary Specialists and sleep services specifically with Sleep Associates of Connecticut (SACT). She has been practicing sleep medicine for the past decade, with a focus on both adult and pediatric sleep disorders, and a specific emphasis on breathing disorders like obstructive sleep apnea (OSA).
Getting patients on a positive treatment often can lead to immediate improvements in day-to-day life. That’s why Dr. Korwin believes it’s so important for patients to come in and see a sleep specialist about any challenges they’re experiencing.
When it comes to getting patients the care they need, several areas of focus have been successful for the SACT team, including having a dedicated PAP management team and adopting a new sleep study management solution.
The Expansive Impact of REM Sleep
One reason sleep caught Dr. Korwin’s eye while training as a fellow in Pulmonary, Critical Care, and Sleep Medicine at Yale University was its correlative impact with many disorders and disease states.
From OSA to chronic obstructive pulmonary disease (COPD) to asthma, and other breathing disorders, sleep has an immense impact on patient health. This expansive impact has fueled Dr. Korwin’s passion for sleep. When asked about the importance of sleep, she highlighted the value of the Rapid Eye Movement (REM) stage.
“Of the stages of sleep, REM may play the most important role in recovery, memory, and emotional processing,” noted Dr. Korwin.
She highlighted that people who have struggled with sleep disorders for long periods of time, and then get on a treatment like PAP (positive airway pressure), often experience REM Rebound: a phenomenon in which a person temporarily receives more REM sleep than normal.
During REM rebound, the time spent in REM may increase in overall time, frequency, and intensity. This rebound has tremendously positive ramifications for patients. Dr. Korwin highlighted the respiratory, cognitive, and other ancillary benefits of these REM Rebound stages.
“The human body craves REM sleep. When patients first get on PAP therapy, they may start experiencing long periods of REM after not having dreamed for weeks,” said Dr. Korwin.
And while REM Rebound helps patients recover and revitalize, it is just one area where PAP treatment supports positive outcomes. As folks in sleep medicine know, PAP therapy is a life changer for most patients struggling with OSA. Unfortunately, it can be challenging to get used to a CPAP machine.
PAP Nap Educational Sessions Improve OSA Adherence
For Dr. Korwin, part of the challenge in treating OSA is patience. Do patients have the patience to stick with their CPAP treatment modality? Leaving it entirely in the hands of people struggling with their CPAP devices, without any help, can lead to lower than ideal adherence rates. That’s where the SACT PAP management clinical team comes in.
“Our team supports patients with education and encouragement,” said Dr. Korwin. “All new patients come in for a PAP nap, where they have a chance to ask questions about a device that may frighten or challenge them.”
She highlighted how the team’s techs support patients and help them get acclimated with how to use their PAP machines. The techs also provide patients with the opportunity to test out different mask shapes, styles, and sizes to find one that works best for each patient.
The SACT techs and respiratory therapists provide support with comfort settings, and all new patients get a PAP nap educational session before beginning treatment on their own.
This upfront support helps patients understand the challenges of their new sleep disorder and how to best use their new personal CPAP device, giving them the patience to stick through the hardest part of CPAP therapy: the beginning.
EnsoSleep Helps Identify the Unique Cases
One way that Dr. Korwin and the team are able to prioritize PAP education and other activities in the lab stems from the time saved by EnsoSleep, both for the scoring team and the physicians signing off on reports. When it comes to reviewing and signing off on patient sleep studies, Dr. Korwin praised the ability to easily access the studies in EnsoSleep, citing the ability to directly jump to any event in the study.
“If I want to see if a patient was displaying dream enactment behaviors, I can easily and directly access that portion of the study from Enso[Sleep]’s report to see if patients are experiencing movements they shouldn’t be able to have in dreams while they physically act out their dreams,” said Dr. Korwin.
For example, Dr. Korwin might look for movement in the patient data during REM, when the body should be paralyzed. Seeing leg movements when you shouldn’t is an easy identifier in the PSG data at a baseline of small increased muscle tone and up to full movements mirroring the patient’s dreams.
Patients struggling with REM behavior disorders (RBD) aren’t only a danger to themselves, as Dr. Korwin noted: “dream enactment behaviors can be very dangerous for both patients and those around them while they’re sleeping.”
Prior to EnsoSleep, double checking for dream enactment behaviors might have required a full review of a sleep study, but with EnsoSleep study management, jumping directly to a specific epoch in the study is simple and the AI-identified examples of movements when the body should be paralyzed during REM are easily reviewed
“Having direct access to each event type, with links to those examples in the study is a huge time saver for me,” Dr. Korwin concluded.
Across all areas in healthcare, time is a precious resource. With AI saving time on their scoring and diagnosis processes, Dr. Korwin and the SACT team are able to get back to what we all got into this business for in the first place: improving the lives of patients through better sleep health. To read other sleep stories, dive in below.