Dr. Puja Thakkar

Things That Go Bump in the Night

April 8, 2018 by Dr. Puja Thakkar Leave a Comment

Patients with parasomnias complain of unusual behaviors during sleep.
The most commonly seen parasomnia is sleep walking. In addition, parasomnias can also include: sleep related eating disorder, nightmares, sexsomnia—sometimes referred to as sleepsex—and confusional arousals. Confusional arousals include symptoms such as moving around in bed, crying during sleep, sleep moaning, or sleep talking.

Each parasomnia can last from one minute to hours. Everyone in the family is affected by these behaviors. Therefore, identifying and treating the parasomnias become vital.

What causes a parasomnia?
Parasomnias often run in families. They can also be triggered by other sleep disorders such as obstructive sleep apnea and can be brought on by various medications.

Prevalence?
Parasomnias affect about 10% of the American population. All age groups are affected, but are more common in children.
One should not attempt to wake up a patient in a parasomnia event by shaking or shouting. Commonly patients can get irritable and aggressive during the response. It is best to redirect the person back to bed gently.

If you or someone you love can identify with the above symptoms, it is important that the affected person be evaluated so that they can be helped in ways in order to get better.

Please contact me if you or someone in your family is dealing with any form of parasomnia.

Snoring and Pregnant? Time to get evaluated.

December 10, 2017 by Dr. Puja Thakkar Leave a Comment

Pregnancy is associated with sleeping disorders such as insomnia, restless legs syndrome, habitual snoring, and excessive daytime sleepiness. OSA (Obstructive Sleep Apnea) is the result of airways narrowing which leads to respiratory disruptions, intermittent hypoxia, and sleep fragmentation. It is commonly characterized by snoring, breathing cessation, and daytime sleepiness.

OSA is common in the United States and often remains undiagnosed. As pregnancy progresses, women are at risk for developing new OSA. Over 10 percent of first-trimester pregnant woman suffer from OSA, but by the third trimester, over 26 percent have been diagnosed.

Although the causes for increased occurrence of OSA during pregnancy are the result of normal physiological changes, it has also been associated with weight gain, edema, and hyperemia, all of which can cause narrowing of the upper airways. Women are therefore at risk for developing OSA prior to or during pregnancy.

In pregnant women, OSA has been associated with hypertensive disorders, gestational diabetes, and preeclampsia. Women with OSA during pregnancy have odds of in-hospital mortality five times higher than controls. These women also have a higher risk of future cardiovascular diseases. Similarly, women with preeclampsia have a significantly lower level of nighttime fetal movement. When these women use a continuous positive airway pressure (CPAP) machine to increase nighttime airflow and ease breathing, the nighttime fetal movements improved.

Child Snoring: A Serious Problem

October 12, 2017 by Dr. Puja Thakkar Leave a Comment

Does your child snore? Do they have attention and/or behavior problems? If you answered yes, we should chat.

First and foremost, I am a mother—a mother to two beautiful, very active fraternal twins. When my son was about 11 months old I noticed he snored. He snored when he took a nap and overnight. He snored and he snored. Being that I am a sleep doctor I knew what I was dealing with; but being a mother, I was scared to come to terms with it. I was so scared to diagnose my son with something. I asked family members and friends; to most, his snoring was “cute.” They all told me stories about how all the kids they knew snored. They all assured me that everything was fine. Although, deep down I knew something was wrong.

After perhaps staying up with my son for many months, listening to his snoring and making sure he continued to breath, I had him evaluated for sleep apnea. Sure enough, he had sleep apnea and we treated him. Fortunately, for my son (and my future patients) after one night of treatment he was better. As he continued treatment he continued getting better. He started feeding better, gaining weight appropriately, had decreased reflux symptoms, and his mom got more sleep as well. He was less cranky. He was a happy baby again.

Sleep Apnea symptoms in children can include snoring, daytime sleepiness (needing naps after the age of four), very restless sleep and sleeping in unusual positions, heavy breathing, weight problems (can be increased or decreased BMI), symptoms of reflux, and behavioral problems.

When a child is sleep deprived it can lead to symptoms that are identical to what is seen in ADHD. We are now seeing many children that have been misdiagnosed with ADHD when in fact they have OSA (Obstructive Sleep Apnea). Once the child’s OSA is better they are better.

Any parent who is dealing with a child who has poor sleep should seek out a sleep physician. There are multiple treatment options available that will help to get your child sleeping well and you getting the relief you need.

Get Enough Sleep: Your Life Depends on It!

August 7, 2017 by Dr. Puja Thakkar Leave a Comment

We can all remember our parents telling us how important it is to sleep. Most of us can vividly remember the cry of a cranky toddler who has not had his or her nap and lets the world know it. Unfortunately, as adults we manifest the effects of not having enough sleep a lot more dangerously then the crying toddler. As adults not getting enough sleep means having an increased risk of heart attack and stroke.

Many obstacles get in the way of us having healthy sleep. To name a few: we have deadlines that need to be met, work longer hours, have “insomnia ,” travel for a living and are constantly in different time zones, and/or we have a disorder like Obstructive Sleep Apnea. Whatever the reason, the problem of sleep deprivation must be corrected. This is exactly what sleep physicians do—they get people sleeping.

Recently the American Academy of Sleep Medicine and The Centers for Disease Control and Prevention (which help support the development of the current guidelines) have recommended that adults get at least seven hours of sleep each night. Getting only six or less has been associated with a decrease in performance, increased risk of heart attack, stroke, diabetes, and obesity.

Although there are many causes of not getting enough sleep, today we will focus on the epidemic of undiagnosed sleep apnea which accounts for anywhere 75% – 85% of cases.

What is Sleep Apnea and how many people does it effect?

Estimates suggest that sleep apnea affects more than 18 million people in the United States. Sleep apnea is when breathing partially or completely stops during sleep. The most common type of sleep apnea, Obstructive Sleep Apnea, is caused by blocked airways in the throat. A person with sleep apnea will awaken, partially or fully, when the brain doesn’t get enough oxygen. In most cases, the person is not even aware of. People with sleep apnea may be known as loud snorers and often the bed partners are the ones who bring them in to see a doctor. People with sleep apnea may have excessive daytime sleepiness, fatigue, insomnia, depression, or secondary hypertension.

What are the risk factors for Sleep Apnea?

Increased BMI>25.Around half the people with obstructive sleep apnea are overweight. Fat deposits around the upper airway can obstruct breathing.
Narrowed airway.You may have naturally narrow airways, or your tonsils or adenoids may be enlarged, which can block the airway.
High blood pressure.
Chronic nasal congestion.
People who smoke are more likely to have Obstructive Sleep Apnea.
A family history of sleep apnea.If you have family members with Obstructive Sleep Apnea, you may be at increased risk.
Recent research has found an association between asthma and the risk of Obstructive Sleep Apnea.

In addition, patients who have Atrial fibrillation (also called AFib) should be screened for sleep apnea. There are many risk factors for developing AFib. These include being age 60 years of age or older, having high blood pressure, diabetes, or existing heart disease. Another risk factor that is little known and not completely understood is sleep apnea.

How is sleep apnea diagnosed?

Sleep apnea is diagnosed by an overnight sleep test. The study measures the number of times that a person either stops breathing during sleep or breathing becomes very shallow. It also measures the level of oxygen in the blood and monitors the brain and heart rhythm during sleep.

What are treatment options for sleep apnea?

The major treatment options are as follows:

Lifestyle changes such as losing weight
CPAP or BIPAP therapy
Dental devices for sleep apnea
Nasal dilators
Surgical options of which there are many. Our patients have had a lot of success with the new Inspire therapy.

Dr. Thakkar is the founder and the medical director of Golden Gate Sleep Centers. She completed her Internal Medicine training at UCSF, Fresno, then a Sleep Medicine Fellowship at UC, Davis. She then served our Veterans at the VA in Sacramento / Mather. She remains part of the UC Davis volunteer Faculty in Sleep Medicine and has served as Medical Director of private practice Sleep Labs. Visit her website at goldengatesleepcenters.com or call (925) 820- 4472.