The science of sweet dreams

Dr. Dav­id Visco holds the mask, which is con­nec­ted to the C-PAP ma­chine, up to his face. The ma­chine blows air in­to the pa­tient’s nose so that he or she can breathe easi­er dur­ing sleep. JENNY SWI­GODA / TIMES PHOTO

Dr. Dav­id Visco has un­masked a new way to treat sleep­ing dis­orders.

Can­cer. It’s a word with so much mean­ing.

The pa­tients who hear they have it know, or come to know, it means their lives will nev­er be the same. There will be new medi­cines, new ther­apies, doc­tor vis­its, hos­pit­al stays and pain.

And one more thing — fa­tigue.

The dia­gnos­is of can­cer can cause anxi­ety, fear, grief and de­pres­sion, all of which can make sleep­ing dif­fi­cult.

Ninety per­cent of the pa­tients ex­per­i­ence “can­cer-re­lated fa­tigue,” said in­tern­ist Dr. Dav­id Visco, adding that pa­tients’ un­der­ly­ing sleep dis­orders con­trib­ute to that prob­lem.

Ac­cord­ing to the Na­tion­al Can­cer In­sti­tute, 25 per­cent of the pop­u­la­tion ex­per­i­ences ser­i­ous sleep prob­lems, but that num­ber surges to 45 per­cent for can­cer pa­tients.

Deal­ing with a sleep­ing prob­lem might not seem that ur­gent to a pa­tient who has been dia­gnosed with can­cer, Visco said.

“Everything else takes a back seat [to can­cer treat­ment],” said Visco, who is the med­ic­al dir­ect­or at the Sleep Cen­ter at Can­cer Treat­ment Cen­ters of Amer­ica on Wyom­ing Av­en­ue.

But that prob­lem of get­ting enough rest is severe, and some can­cer med­ic­a­tions and treat­ments make it even tough­er to get to sleep, so the pa­tients al­ways feel tired. So much so that fa­tigue can be­come one of the most life-chan­ging parts of can­cer.

“Pa­tients self-re­port that fa­tigue im­pacted their lives more than pain,” the doc­tor said.

Pa­tients need their rest to re­cov­er their strength to help them battle can­cer, and Visco said un­re­cog­nized sleep­ing dis­orders also present dangers to pa­tients un­der­go­ing an­es­thesia for sur­ger­ies.

And it’s not just the pa­tients who are af­fected, he ad­ded.

A can­cer pa­tient might sleep in the same bed with his or her main care­giver, whose sleep also is af­fected by the pa­tient’s dis­order.

Visco said nail­ing down ex­actly why a pa­tient is not get­ting prop­er rest is the first step to cor­rect­ing the con­di­tion.

For the doc­tor to make his dia­gnos­is, the pa­tient has to sleep at least four hours hooked up to mon­it­or­ing screens in the next room. Most pa­tients in­sist they will not fall asleep at all with wires at­tached from their heads to their chests, Visco said, but they do.

Tech­ni­cians like Car­ole Tur­chi from May­fair, mon­it­or each pa­tient’s air­flow, muscle tone, snor­ing, heart rate, arm and leg move­ment, oxy­gen levels in the blood and teeth grind­ing.

What doc­tor and ther­ap­ists are look­ing for is any­thing ab­nor­mal, but to do that they want their pa­tients’ routines to be as nor­mal as pos­sible, Visco said.

“We want them to sim­u­late ex­actly what they do at home,” the doc­tor said.

If a pa­tient’s oxy­gen levels drop, he is not breath­ing well or not breath­ing at all, and his brain awakens him, Visco said, so the pa­tient will breathe more reg­u­larly and get his oxy­gen levels up.

“Sev­er­al dis­orders can lead to a pa­tient’s rest­less­ness at night and to fa­tigue, Visco said. Since he has been work­ing at Can­cer Treat­ment Cen­ters of Amer­ica, he’s done more than 100 sleep stud­ies of can­cer pa­tients — about four a week — and he has found sleep dis­orders in all but 5 per­cent of them.

In Feb­ru­ary, colon can­cer pa­tient Christinea Fen­ster­mach­er was dia­gnosed as hav­ing sleep apnea, she said in a tele­phone in­ter­view.

“I was snor­ing, wak­ing up and keep­ing my hus­band awake,” she said, “and I had no en­ergy.”

The North Car­o­lina res­id­ent said her sleep study showed air­ways were clos­ing as she slept and she would then wake up.

“I thought I woke up four times,” she said, “but they told me I woke up more than 150 times.”

And that was in just four hours, she said.

Visco said he pre­scribed use of a small ma­chine that gently forces air in­to the pa­tient’s air pas­sages. The ma­chine, called a C-PAP (con­tinu­ous pos­it­ive air­way pres­sure), in­creases the air pres­sure as the pa­tient falls more soundly asleep.

By us­ing the C-PAP, Fen­ster­mach­er is not only get­ting her rest, some of her oth­er con­di­tions have im­proved.

“I no longer take high-blood pres­sure medi­cine,” she said, adding that her de­pres­sion is gone, so she no longer takes anti-de­pres­sion med­ic­a­tion.

Dia­gnos­ing a sleep dis­order also helps an­es­thesi­olo­gists pre­pare for deal­ing with breath­ing ir­reg­u­lar­it­ies that might be spot­ted dur­ing an op­er­a­tion and cause enough con­cerns that the sur­gery is stopped.

The C-PAP ma­chine is used to treat many pa­tients, but the doc­tor and his team em­ploy oth­er ther­apies, too, he said.

A C-PAP ma­chine is not even a cu­bic foot, so it’s small enough to sit on a night table, and it weighs less than 5 pounds. The ma­chine, which costs from $300 to $500, forces air through a pa­tient’s air­ways so the pa­tient gets the oxy­gen he needs.

“It’s just the air from the room,” Visco said, but he ad­ded that oxy­gen also can be de­livered by C-PAP, too.

Fen­ster­mach­er said her C-PAP de­liv­ers oxy­gen.

Us­ing the ma­chine re­quires pa­tients to wear a small mask that holds a tube that brings the air. A small num­ber of pa­tients — per­haps 5 per­cent, Visco said — don’t like the ma­chine or its mask and re­fuse to use it. Oth­er pa­tients need en­cour­age­ment and fol­low-up vis­its with the doc­tor be­fore they use the C-PAP, the doc­tor said.

Most pa­tients love the ma­chine be­cause they’re get­ting to sleep and stay­ing asleep. They take it with them even when they’re trav­el­ing, Visco said.

“Once they’re used to it, they nev­er leave it home,” he said. ••

For more on Dr. Dav­id Visco and the can­cer cen­ter at 1331 E. Wyom­ing Ave., vis­it www.can­cer­cen­

For more on sleep dis­orders and tips for sleep­ing well, vis­it www.can­cer­cen­­vices/sleep-prob­lems.cfm

Re­port­er John Loftus can be reached at 215-354-3110 or

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