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Post #2: The Sleep Doctor

I just moved to a new neighborhood, and while running my daily errands, I noticed a sleep medicine practice. What serendipity! I called the office and the receptionist kindly scheduled a meeting for me to chat with the doctor.

Dr. Ahmed Fadil of Northeast Insomnia and Sleep Medicine is board-certified in Internal Medicine, Pulmonology, Critical Care, and Sleep Medicine. After his residency in Internal Medicine at Penn State, he took on a fellowship in Pulmonary-Critical Care and Sleep Medicine at University of Texas. According to Dr. Fadil, about 90% of sleep medicine practitioners have a background in pulmonology. He bemoaned the “appalling” lack of education about sleep in medical school and in residency.

I asked him some questions about his practice. He sees mostly adults, but a good number of children too; most children are referred by an ENT or pediatrician because they are snoring. Dr. Fadil said that many pediatricians don’t look into snoring as a symptom of sleep apnea – parents are frequently told that the snoring is a phase that the child will outgrow. Referrals to an ENT or sleep study aren’t done until behavioral and developmental issues emerge. He asserted that sleep apnea needs to be ruled out – guilty until proven innocent! – because it is an easy diagnosis to make and an easy treatment to prescribe.

Dr Fadil laid out a few of the major ramifications of a chronic lack of sleep.

  1. The release of growth hormone peaks while we are in deep sleep – lack of sleep can lead to stunted growth. Sleep apnea can also contribute to failure-to-thrive diagnoses.
  2. The release of the hormone prolactin, which stimulates the production of breast milk, i enhanced by getting adequate amounts of sleep. (see this study for further detail)
  3. 50% of sleep apnea patients have type 2 diabetes. Our body adjusts insulin levels and circulates glucose while we sleep – those who are not getting adequate sleep get diabetes at an “astounding rate”. Not to mention that we choose sugary, carby foods when we’re tired, and then we overeat!
  4. Many developmental disorders such as ADD, ADHD, and Down’s Syndrome also come with apneas. Recent studies suggest that up to 25% of children diagnosed with ADHD may actually have obstructive sleep apnea, which would be the true cause of their learning and behavior difficulties. Overtiredness affects our executive functioning skills such as flexibility, self-monitoring, planning, organization, and mood regulation – difficulties with these skills are usually linked to ADHD. (I used this page to add some extra detail to this point.)

We also chatted about common behavioral issues I see when working with clients. Dr. Fadil said that it is normal for kids to have parasomnias like sleep walking, sleep talking, and night terrors up until age 15. Age fifteen is also when the number of apneas and the degree of severity start being measured on the adult scale. He sees a lot of too-late bedtimes and poor sleep hygiene, especially using electronics in our bedroom or right before sleep (guilty!). I asked him about sleep associations, like feeding or rocking a baby to sleep. Dr. Fadil said, and I quote, “Waking up to go to your children, or them waking you up, IS THE WORST THING FOR YOUR SLEEP AND THEIRS.”

Now, I’m a parent of a crappy sleeper too, so I know we can never be fully free of bedtime battles, night wakings, and early risings. There will always be developmental changes that require re-training, or illnesses, or nightmares, or a hundred other scenarios kids cook up. But together we can change your family’s sleep behavior and get you all the rest that you deserve!

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