Dr. Sharma examining Bernard
Bernard Riddick doesn’t sleep much. As a driver for a company that delivers food to schools in Pennsylvania and New Jersey, he is often awake at 4 a.m. or 5 a.m. to start the day’s deliveries by 6 a.m.
About six months ago, however, sleep became a medical problem for the 30-year-old South Philly resident.
That’s when Bernard began having difficulty breathing while lying down. As the problem became worse, he would often wake up in the middle of the night gasping for air. He tried sleeping upright until that stopped helping.
It got so bad that one night Bernard was afraid to go to sleep. Afraid, that if he fell asleep, he might never wake up. He headed to the Emergency Room at Jefferson.
“We don’t often see many cases of sleep apnea or related issues in the ER, so when I saw that he had been kept for observation, I made my way over to see the patient that afternoon,” says Sunil Sharma, MD, director of Pulmonary Sleep Medicine at Jefferson and associate director of The Jefferson Sleep Disorders Center.
Bernard was treated with non-invasive ventilation followed by a sleep study that confirmed the diagnosis of severe sleep apnea. This astute response by the Emergency Department and specialists in respiratory and sleep medicine may have saved his life.
Bernard’s case highlights a novel, multi-specialty, patient-focused collaboration at Jefferson between Pulmonary Sleep Medicine and various other services at the Hospitals including the Emergency Department. This collaboration ensures that a sleep specialist sees patients within 24 hours whether a sleep disorder is a primary or secondary condition.
“This collaboration allows us to see patients with diabetes, heart failure and severe sleep apnea immediately,” says Dr. Sharma. “Lack of oxygen during sleep can worsen an already existing condition.”
In fact, sleep disordered breathing including obstructive sleep apnea has significant cardiovascular implications and is often under-recognized in hospitalized patients, Dr. Sharma notes.
A sleep study that same evening revealed that Bernard actually stopped breathing 78 times in 60 minutes and that the level of oxygen in his blood – his pulse oxygen – dipped to below 50 percent; a normal level is 90 and above.
“It was scary to find out how little oxygen I was getting, but I’m glad I now have a diagnosis,” Bernard says.
For Dr. Sharma, the results were also alarming.
“It is extremely rare for a patient in his 30s to have such severe oxygen desaturations in absence of underlying lung or heart disease,” he says. “Had he gone much longer without medical attention, the results may not have been good.”
In fact, the fear that drove Bernard to the hospital – that he might fall asleep and never wake up – may have occurred if his oxygen levels fell to low levels and remained low for an extended period.
Bernard now sleeps with a CPAP machine that pumps oxygen into his airway to keep it open as he sleeps. CPAP is the gold standard treatment for sleep apnea.
The treatment has had a dramatic impact. He is now sleeping better and feeling more rested. And he is no longer afraid to go to sleep.
Dr. Sharma keeps in close contact with Bernard and monitors his condition closely.
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