Exploring Sleep Apnea with Dr. Anthony Ackerman

According to the American Academy of Sleep Medicine, 26% of adults between the ages of 30 and 70 have sleep apnea. We talked to SIMEDHealth Neurologist and Sleep Physician Anthony Ackerman, MD, about sleep apnea and what is involved in diagnosing someone.

1. We hear the term "sleep apnea" a lot, but what exactly is sleep apnea?

Dr. Ackerman responded, "Sleep apnea is a sleep breathing disorder. There are three different types. The first and most common is Obstructive Sleep Apnea. In this type, the airway is blocked or partially blocked by the relaxed tongue and soft tissues of the pharynx. The obstruction commonly results in snoring or causing the person to wake up gasping or choking during sleep. The next type is Central Sleep Apnea which occurs when there is temporary slowing or stopping of the brain's breathing drive. Central Sleep Apnea is seen in neurologic brain disorders and is no associated with snoring. There's also something called Complex Sleep Apnea which is a combination of both Central and Obstructive Sleep Apnea. All of these types can lead to decreased oxygen delivered to the heart and brain, which cause disruptions of sleep from arousals or micro-arousals, of which the person may or may not be aware. They prevent the brain from going into the deeper, more restorative stages of sleep, such as REM (Rapid Eye Movement Sleep) and Delta sleep. It is during these deeper, restorative sleep in which the brain removes plaques and tangles debris in the brain associated with Alzheimer's type dementia."

2. What symptoms does someone suffering from sleep apnea experience?

"The person can have snoring, wake up gasping or choking, long pauses with little or no air moving during sleep," Dr. Ackerman explained. "There can be frequent nighttime arousals, and trips to the bathroom to urinate occur more often. They wake up unrefreshed and often with a dry mouth and/or morning headaches. They can have daytime sleepiness, increased irritability, and worse control of their chronic health conditions such as diabetes, congestive heart disease, heart arrhythmias, and pain syndromes. It also commonly indirectly disrupts the bed partner's sleep due to loud snoring and frequent moving around in the bed."

3. What causes or contributes to the occurrence of sleep apnea?

"The most common cause is being overweight, although being is not a requirement. Physical conditions associated with sleep apnea include having a narrow airway, a large tongue, uvula, or tonsils, having a large neck, taking certain drugs or medications such as alcohol or opiates. Neurologic diseases such as neuromuscular or motor neuron disease have a high risk, including ALS or Lou Gehrig's disease. And also, the aging process can contribute to the risk for sleep apnea", according to Dr. Ackerman.

4. What are the steps to determine if someone has sleep apnea?

Dr. Ackerman advises, "You'll want to discuss your sleep concerns with your Primary Care Physician and request a referral or call the SIMEDHealth Sleep Center directly to schedule an appointment for an evaluation. During the initial sleep clinic office visit, you'll relay your sleep symptoms and concerns to your doctor, who may end up ordering a sleep study. The study would consist of an in-lab overnight study or possibly a home study. If you're diagnosed with sleep apnea, you would likely be started on something called positive airway pressure or PAP therapy. It consists of a mask that fits under or over the nose or even over the nose and mouth. It delivers a mild air pressure that maintains the open airway. You will then follow up with the Sleep Center clinic approximately one month later to discuss your response to the therapy and address any developed issues. For some, it can take a little while to sleep undisturbed by PAP therapy. If needed, mask and PAP desensitization can be arranged through the Sleep Center. The desensitization is quite successful with many patients."


To schedule an appointment with Dr. Ackerman or any of our Sleep Center physicians, click here. To learn more about the SIMEDHealth Sleep Center, click here.

National Sleep Awareness Week

Everyone needs sleep. Humans spend roughly 33 years of their lives sleeping. Without sleep, we can’t function and without quality sleep, we can’t function to the best of our abilities. March 11th through the 15th is National Sleep Awareness Week and we sat down with Dr. Galina to discuss why sleep is so important and she gave us some easy, simple things we can do to get better sleep.


According to Dr. Galina Bogorodskaya, lack of sleep or sleep deprivation can increase anxiety. An average of 7-9 hours of sleep for an adult is essential for overall health. Inadequate sleep is associated with several health problems leading to chronic diseases such as high blood pressure, heart disease, obesity, and diabetes. Other potential problems from lack of include depression and lower sex drive which can significantly affect your personal as well as your social life.


You tend to have a poor quality of sleep if you take more than 30 minutes to fall asleep, you regularly wake up more than once per night, and you find yourself staying awake for more than 20 minutes before falling back to sleep after waking up in the middle of the night. Other factors can be noticed best by your bed partner such as you snore loudly, you make gasping and choking sounds during your sleep and you act out in your sleep or dream.


It’s good to start with a good quantity of sleep, 7-9 hours for adults where children and young adults need more. The most important factor in quality sleep, however, is how fresh you feel the next day. If you still feel tired, fatigue, yawning and depressed after good hours of sleep, it is time to see a sleep specialist and discuss your problems.


Use your bed for only 3 things, Sleep, Sickness and Sex. Avoid watching television or using electronic devices in bed. Stop such devices at least 30 minutes before bedtime. Follow a consistent sleep schedule. Try to keep your bedroom clean and avoid any distractions such as posters, to do lists, deadlines to stop you from falling asleep.  Eat your meal at least 3 hours prior to your bedtime.  Stop drinking caffeine after noon time and limit alcohol consumption to 1 or 2 drinks per day.


In the sleep center, we start with extensive consultation and evaluation of your sleep problems and concerns with our Board Certified sleep specialists. Based on the consultation, we perform a sleep study, if needed, to diagnose and treat your sleep problems. Such problems include but not limited to Obstructive sleep apnea (snoring, stopping breathing), Periodic limb movements (kicking legs at night), Insomnia, Narcolepsy, Bruxism, and many more. For more information or to schedule an appointment click here.

The Relationship Between Heart Disease and Sleep

According to the Centers for Disease Control and Prevention, about 610,000 people die of heart disease in the United States every year. Since February is National Heart Disease Awareness month, we sat down with Dr. Anthony Ackerman of SIMEDHealth’s Sleep Center to discuss the relationship between sleep, untreated sleep apnea, and heart disease.


If you suffer from untreated sleep apnea, heart disease could be in your future. Sleep apnea is a common yet severe disorder that causes patients to briefly and repeatedly stop breathing while they are asleep. Dr. Ackerman explained that untreated sleep apnea can lead to abnormal heart rhythms, clogged arteries, and high blood pressure which all down the road can cause heart disease.


He explained further that during sleep, when you stop breathing, the oxygen levels in your body go down. This causes a signal to be sent to your blood vessels to constrict causing an increase in blood pressure.  In a lot of instances this increase in blood pressure during apnea events, result in consistently high blood pressure. Dr. Ackerman said “What’s good for the heart is often good for the brain” so sleep apnea can also increase your risk of stroke and dementia.


Common symptoms include:

  • Snoring
  • Day time sleepiness
  • Pauses in breathing
  • Waking up gasping or choking during the night
  • Waking up feeling unrefreshed
  • Difficulty controlling blood pressure
  • Gastric reflux
  • Morning headaches
  • Frequent nighttime urination
  • Waking up with dry mouth


Dr. Ackerman encourages you to talk to your primary care physician about it. It is also important to get your blood pressure, blood sugar, and cholesterol checked and make sure they are under control. Talk to your doctor about visiting our sleep clinic to discuss treatment plans such as sleep tests and positional therapy.   

Why Your Phone May Be The Reason You Can't Sleep

According to the National Sleep Foundation, at least 95 percent of people use some kind of electronic device — TV, a computer, a phone or a tablet — within an hour of bedtime. 

Watching Netflix, checking emails or scrolling through social media before bed might seem harmless, and at times, necessary, however, it's the complete opposite. We spoke with Dr. Larissa Lim of SIMEDHealth’s Sleep Center to ask her a few questions about screen time and the importance of sleep.

Why is sleep so important?

“Sleep is what allows our bodies to rest and recuperate from the day. When we sleep we dream and process all the information we’ve received throughout the day,” she said.

Not getting enough sleep can mean decreased attention, slower processing speeds, general fatigue, and weight gain.

“People who are chronically sleep deprived are also more prone to depression and increased pain. If you get only 5 hours of sleep, you’ll feel it the next day,” Dr. Lim said.

Those of us who spend more time on screens before bed are more prone to these symptoms.

Why are screens bad for sleep?

The Pineal gland makes melatonin, which is the main hormone that sets our circadian clock (our internal sleep timer). Blue light from screens is meant to mimic the sun. This suppresses melatonin production and tells our brains that it’s daytime, keeping us awake longer.


How to detox from screen time:

Dr. Lim says that breaking the habit of constantly using our phones is a hard but important habit to break.

“A lot of us are mindlessly picking up our phones all the time, constantly checking texts, emails, or Facebook. We need to limit ourselves,” she said.

Here are a few techniques you can use to decrease your screen time:

1. On the iPhone’s latest operating system update, there’s a feature called “Screen Time.” This allows you to see exactly how much time you spend on your phone and on specific apps. You can also set screen time limits and limit notifications on certain apps. 

2. If you don’t have an iPhone, feel free to check out these free apps to monitor and limit your screen usage:

  •  BreakFree App
  •  Unglue
  •  AppDetox
  • Moment
  •  bSocial

3. Dr. Lim says using “Night Mode” on your cell phone before bed, might decrease the risk of exposure to blue light.

“If it’s not blue light, it may be useful in improving sleep,” she said.

4. Avoid “phubbing”, or using our phones in social situations. 

5. Dr. Lim’s top recommendation to limit screen time: Try turning off cellphone alerts during certain times of your day and give yourself a daily allowance of screen time.

If you find that it is not screen time that is keeping you from getting enough sleep, you may need to assess your sleep hygiene.

When should you see a doctor about sleep?

If you experience difficulty with falling or staying asleep for more than 3-6 months, or if lack of good sleep is beginning to affect your daily life, you should schedule an appointment with your provider, said Dr. Lim.

Sometimes the cause of your sleep concerns may be an underlying condition such as sleep apnea or seizures. This is why SIMEDHealth’s Sleep Center treats sleep disorders and evaluates multiple conditions. Dr. Lim goes on to express just how imperative it is that we limit phone use, for the sake of our sleep.

“We as a country are becoming addicted to smartphones. Each person needs to assess their phone use and minimize use before sleep.” 

Sleep Troubles? It May Be Your Sleep Hygiene

We all know what it feels like when you don’t get enough sleep. You’re sluggish, yawning, drowsy and reaching for an extra cup of coffee throughout the day. Although for some of us, the sleep troubles don’t stop there.

According to SIMEDHealth’s medical director for sleep medicine, Dr. Galina Bogorodskaya, it may not be that you’re not getting enough sleep, but rather you’re not getting enough good sleep.

Have you or your partner noticed any of these symptoms?

  • Loud or frequent snoring
  • Not breathing during sleep
  • Choking or gasps sounds
  • Kicking during sleep
  • Violent behavior during sleep
  • Walking or talking during sleep
  • Morning headaches
  • Daytime sleepiness or fatigue
  • Awakening with dry mouth and sore throat

Not only do these symptoms indicate a possible sleep condition, they can prevent you from feeling refreshed and prepared for your day. You may even find you’re more irritable than usual when you aren’t getting proper sleep, Dr. Bogorodskaya said.

 “Most people think you need 8 hours of sleep a night, and while that is the average, some people need 5 [hours], some people need 9. This all depends on your sleep hygiene,” Dr. Bogorodskaya said.

Sleep hygiene refers to personal habits and practices which allow you to sleep well on a regular basis. According to Dr. Bogorodskaya, to have proper sleep hygiene you should avoid:

  • Using alcohol before sleep
  • Eating 2-3 hours before sleep
  • Using stimulants or taking any medications with caffeine before sleep
  • Exercising before sleep
  • Sleeping with pets
  • Exposure to bright light before sleep
  • Watching TV or using social media before sleep

As you make adjustments to your sleep routine, Dr. Bogorodskaya said it’s important to make sure your bedroom has enough cool air and very little to no light, and most importantly, to be self-aware.

“Just pay attention to not only how you’re sleeping, but ask yourself how you feel throughout the day. Do you feel refreshed, satisfied, and ready for the day? Are you at your full activity level? Sometimes people think their drowsiness is a lack of vitamins, exercise, or something else, but can be related to sleep,” she said.

Memory and concentration problems may also be aided by improving sleep hygiene and taking power naps, said Dr. Bogorodskaya. A 20-30 minute power nap can leave you feeling refreshed and ready to take on the remainder of your day.

When we sleep, our brains reset, our tissue is repaired, our appetite is regulated and we, in turn, are prepared to take on life to the fullest. If you feel you aren’t getting proper rest, speak with your primary care doctor about a referral to the SIMEDHealth Sleep Center, so that you can get back to feeling like you.


Sleep Tips for a Better Night's Slumber

Woman sleeping peacefully in her bed while smiling

November is National Sleep Comfort Month, and sleep comfort has become more important than ever as many people today struggle with sleep related issues.

But how can you get a more restful sleep or recognize the signs of a sleep problem? We talked with SIMED Neurology and Sleep Center Dr. Kraiyuth Vongxaiburana (Vong) to find out everything you need to know to get a better night’s sleep!

How to Recognize if You Have a Sleeping Problem

A common symptom of most sleeping problem is waking up and not feeling refreshed or feeling tired. If you feel tired, something might have gone amiss while you slept. Not sleeping well could mean you have insomnia or other issues like sleep apnea.

Another indicator is if you have trouble falling asleep or wake up in the middle of the night and can’t get back to sleep. Sometimes, people might wake up often to use the restroom and think they have a urinary problem, but they really have sleep apnea. Snoring also might indicate that you have sleep apnea.

What is Sleep Apnea?

Sleep apnea is very common. More than 18 million people in the United States have sleep apnea. 

If you wake up and feel tired, if you snore loudly, or if your partner notices that you stop breathing at night or snore very loudly, you could have sleep apnea. Overweight people are more likely to have sleep apnea because when you’re overweight, your airway can relax and close, obstructing your breathing. The obstruction can cause you to snore loudly and stop breathing or not get a full breath of air.

When you have sleep apnea, your oxygen levels drop and you can wake up for short periods during the night without realizing. Waking up from sleep apnea can leave you unrefreshed in the morning and make your sleep fragmented. Even when you do get sleep, you might still feel lousy and like you haven’t slept. You can have trouble getting out of bed.

How Do You Diagnose and Treat Sleep Apnea?a man sleeping on a sofa with information about sleep apnea and the symptoms

You can participate in an overnight sleep study to find out if you have sleep apnea. SIMED performs overnight sleep studies which allow physicians to monitor your sleep patterns and determine your problem.

If you were diagnosed with sleep apnea, you might be prescribed a breathing machine called a CPAP. CPAPs have a mask that goes over your face and blows continuous air pressure into your airway to keep it open for more oxygen. Using a CPAP generally leads to decreased arousal, and people with sleep apnea feel more refreshed.

Why Should You Get Treated for Sleep Apnea?

Feeling more awake in the morning isn’t the only reason you should get treated. If left untreated, sleep apnea can lead to increased risk of high blood pressure, stroke, heart attack, and cardiac arrhythmias. Waking up throughout the night ramps up adrenaline and increases risk of many dangerous medical problems. It can even cause insomnia.

What is Insomnia?

Insomnia is another very common problem. About 30 to 40% of people have insomnia, and women tend to be more affected than men. Insomnia is when people have difficulty falling asleep or staying asleep.

People can have insomnia due to many different reasons. They might be uncomfortable or anxious and unable to sleep. Their circadian or sleep rhythm might be off. Patients might also have psychophysiological insomnia, meaning they are anxious about getting to sleep so they worry about sleeping and stare at the clock which makes sleeping even more difficult and creates a cycle where they’re more and more anxious and have increased difficulty sleeping. Breaking the cycle can be difficult, but working on good sleep hygiene can help.

10 Ways to Get a Better Night’s Sleep

If you have insomnia or trouble falling asleep, here are 10 tips for improving your sleep comfort.

1. If you have anxiety, write down everything that worries you. You don’t need to write everything down right before bedtime, but if you make a list a few hours earlier, you can get your worries out of your mind and into a journal.

2. Avoid stimulants like caffeine too close to bedtime. Don’t drink coffee or other caffeinated drinks past midafternoon.

3. Don’t constantly check the time. If you don’t fall asleep or have trouble falling asleep, after 30 minutes of trying, don’t stare at the clock. Instead, get up and do something calming for 10 minutes. For example, you could drink a glass of milk or read a book. Then try to go back to bed.

4. When in bed, try not to do other activities than sleep. If you’re working in bed or watching TV in bed, you train your mind to do other things than sleep in bed which can lead to your brain being more active at bed time.

infographic with 10 tips for a better night's sleep to help with sleeping problems

5. With smartphones, avoid screen time. You can easily answer your phone or check emails at night, but when you do, you train your mind to do other things at night besides sleeping and can end up resetting your sleep clock. The bright light can reset your circadian rhythm and make getting to sleep more difficult.

6. Avoid sunlight in the evenings. Especially in the summertime, try to get bright sunlight in the morning instead of the evening because it will make you feel more awake.

7. Exercise. Exercise in general has been shown to help people get to sleep and stay asleep. Some people find that exercising before bedtime can make sleeping more difficult, so exercise earlier in the day or whenever works best for you.

8. Set a good sleep schedule. Go to sleep at the same time every night and wake up at the same time every day. You should get 7 to 8 hours of sleep, and some people may even need 9 hours of sleep. Try not to take naps during the day to avoid throwing off your schedule. Create a good bedtime routine (like you might for your children) that includes turning off the TV, dimming the lights, and avoiding stimulation a couple of hours before bedtime. Some people might even take a warm bath.

9. In the bedroom, keep everything cool and comfortable. Keep the room as dark as possible, and keep noise to the minimum.

10. Use a mattress that works for you. Some people like more firm mattresses, and some people prefer softer mattresses. Experiment to find what works for you, and if you have sleep apnea, elevating the front of your bed can help because gravity won’t be working as much against you. If someone is sleeping flat, their airway can close. Sleeping on your side or elevating your bed can help open it. You can get a wedge to put under your mattress or get a mattress that elevates the head.

What about Sleep Aid Medications? Are They More Harmful or Helpful?

Over-the-Counter Medications

It’s okay to use sleep medications once in a while. A lot of over-the-counter antihistamines can help people get to sleep and feel better in the morning, but some can end up blocking acetylcholine which can affect memory. Older people should try to avoid antihistamine sleep medications and instead try medications containing melatonin. While some people can get addicted to sleep medications like Benadryl, most people won’t be addicted to over-the-counter medications.

Prescription Medications

Try to avoid prescription medications, specifically the addictive ones like ambien and restoril. For some, they are needed, but for others, the medication can work for a while, but when people get used to it, they build up a tolerance. Non-addictive medications like trazodone should be tried first to help with sleep before something with more potential tolerance for addiction.


If you use sleep aids, you can also practice good sleep hygiene and try out cognitive behavioral therapy with a therapist or psychologist. We can have difficulty sleeping because we’re anxious and set up a cycle where we worry about things which can make it more difficult to sleep. A psychologist would help tease out abnormal thoughts

Also, a psychologist could help people in a cycle of bad sleep realize getting a bad night’s sleep would not be the worst thing in the world. Those people might not worry so much about it and get a better night’s sleep.


If you have trouble sleeping, talk to your doctor about getting a sleep study done or contact SIMED’s sleep center at 352-224-2338. To schedule an appointment with Dr. Vong or another SIMED neurologist, call 352-374-2222 or request an appointment online.