TONASKET — North Valley Hospital’s Sleep Lab took in their first two overnight patients Monday evening, Sept. 26, after opening their clinic and serving nine new patients, eight of whom would be following up with sleep studies.
The Sleep Lab is the first one to open in North Okanogan County. The clinic is staffed by Dr. Jakdej Nikomborirak (“Dr. Jak”), MD, who is certified by the American Board of Sleep Medicine, as well as board certified in internal and pulmonary medicine. The hospital contracts with Sleep Elite to provide the technology and support for the sleep studies.
“It’s so great this service came to this area,” said Sleep Technician Ashley Kent. “When the owner of Sleep Elite reached out to me, I jumped at the chance to take the job.”
Kent, who was born and raised in Tonasket, worked at Alaska Sleep Center, a private sleep lab in Fairbanks, Alaska, for two years. After being hired to work at the NVH Sleep Lab, Kent trained for a month at a Sleep Elite Clinic on the Sunnyside Community Hospital campus.
As she prepared one of the two new patients for an overnight diagnostic test, Kent explained the process of first taking measurements, including one from the bridge of the nose over the crown of the head to the base of the skull, to properly place leads in the exact area of the brain to be monitored. After gently scrubbing with a special solution to remove dead skin, the leads are glued and taped in place. Leads for a diagnostic test include 14 on the head and face, two leg leads to monitor leg restlessness, two EKG leads to monitor the heart, one on the finger to measure oxygen, one to measure pressure, one to measure temperature and two respiratory belts; one around the chest and another around the abdomen.
“A good hook-up takes about an hour to complete,” said Kent.
Last, Kent added a “snore mike” with the lead attached outside the throat. “This picks up on all vibrations, including coughing or sneezing,” said Kent.
Once the patient was attached to all the leads, they laid down in the bed and Kent plugged the leads into a bedside monitor. With a camera in the room trained on the patient and the leads feeding data into sleep software on a computer in her office, Kent said she would be watching the patients all night.
“If a lead comes unattached, the monitor will show that and I will come back in to put it back on,” Kent assured the patient. “Call me if you need anything.”
The next morning (Tuesday, Sept. 27), 6:00 a.m. found Kent watching the monitor carefully.
“She just came out of an REM (Rapid Eye Movement) cycle, so this is a good time to wake her,” said Kent.
“It went good,” said the patient, an Okanogan County resident who wished to remain anonymous. “She’s really nice, but she had to come in and wake me up a couple times because the tape came off.”
The patient reported a quiet night in a comfortable bed, otherwise. The Sleep Lab is located in the basement of the hospital which makes for a quiet environment.
Kent said the recorded data would first be reviewed by herself, then a Sleep Scoring Specialist with Sleep Elite, and finally Dr. Jak.
“That’s what makes Sleep Elite so great, is their scoring,” said Kent. “The scoring specialist, that’s all they do is score. They don’t do hook ups or anything else. The last place I worked, the nighttime sleep tech had to do everything. But with Sleep Elite, it goes through three sets of eyes.”
Kent said her overnight hourly reports included any noticed arousals or any visits to the room to reattach leads, notations which which would help when the data was scored.
“I would prefer not to have to do this again, but I would if I had to,” reported the patient from home Tuesday morning.
The patient will follow up with a visit with Dr. Jak.
“Our new Sleep Medicine Specialist and pulmonologist Dr. Jak showed that he is very knowledgeable about his area of practice and cares about his patient base,” said NVH Interim CEO Ron O’Halloran. “We’re glad to have him here in Tonasket.”
Shadowing Dr. Jak the first day of the clinic (Thursday, Sept. 22) was new Physician’s Assistant Jennifer Person who will be conducting clinic visits with sleep patients on Dr. Jak’s days off.
“North Valley Hospital is very proud to offer this service to our surrounding communities with our team of expert sleep specialists,” said Community Outreach Liaison Mikaela Marion. “We have had comment after comment from people living in areas like Chesaw, Oroville and Loomis who have expressed a great appreciation for having these services available to them. Many struggled with finding transportation or having the energy to go to the other facilities in Brewster or Wenatchee. I’m glad we are able to provide a solution.”
The Sleep Lab offers an array of studies, dependent on the patient’s symptoms, and a team of specialized staff to assist them towards a solution to their sleeping problems, according to Marion.
A Polysomnogram is a basic sleep study that simply monitors the patient in a diagnostic test. The information collected allows the physician to determine whether a specific sleep disorder can be identified.
A CPAP Titration is a therapeutic study focusing on treating sleep apnea. A technician monitors the patient sleeping while gradually increasing the level of Continuous Positive Airway Pressure (CPAP). An air splint is formed in the airway to alleviate pressure and eliminate any events of apnea (the temporary cessation of breathing) observed during the monitoring.
The Split Night Study is a diagnostic study and CPAP Titration combined in one exam. If the patient has a significant amount of apneic events, CPAP will be initiated in order to eliminate the apneas.
The Multiple Sleep Latency Test (MSLT) is a series of naps the patient takes, or attempts to take, following an overnight Narcolepsy Diagnostic Test. Upon awakening, the patient is instructed every two hours to lie down and rest. If the patient falls asleep, they are monitored for 15 minutes. Depending on the findings, the series can be repeated four to five times.
The studies involve electrodes painlessly applied to the skin which transmit and record sleep patterns and information about the patient’s physical activities, such as breathing, brain waves, heart activity and eye and muscle movements. Data from the recordings are then analyzed to determine the nature of the sleep disorder.
Sleep disorders affect over half of the United States population, with obstructive sleep apnea affecting an estimated 18 million. Not seeking the appropriate help for these disorders can lead to deeper issues including high blood pressure, chronic sleepiness, dementia and narcolepsy.
Patients are advised to speak with their regular doctor to decide if a sleep analysis is necessary. If that determination is made, they can schedule an appointment by calling 509-486-3124.