Setting the Platinum Standard in Sleep Disorders Medicine.™
Ask Our Sleep Expert
Questions and Answers About Sleep
Dr. Jerald H. Simmons, MD.: Triple-Board Certified in Neurology, Epilepsy and Sleep Disorders Medicine
A nationally recognized leader in Sleep Disorders with over 20 years of experience in academic and private settings, Dr. Simmons began his Neurology training at Washington University in St. Louis and went on to study Sleep Medicine at Stanford University, the nation’s premier program for Sleep Medicine training and where the Sleep Disorders field originated as a medical specialty. He later studied Epilepsy at the University of California–Davis, after which he was recruited by the UCLA Department of Neurology where he Co-Directed the Sleep Disorders Center for six years.
In 1999, Dr. Simmons was recruited to establish and direct the Sadler Clinic Sleep Disorders Center in The Woodlands. Seeing a greater need for treating sleep disorders throughout the metropolitan Houston area, he established Comprehensive Sleep Medicine Associates (CSMA), an outreach program with offices in the Houston Medical Center and Sugar Land. Dr. Simmons has been repeatedly recognized by H Texas Magazine as a Top Doctor for his outstanding patient care and ability to assess and help alleviate sleep disturbances.
Past Questions and Answers by Sleep Expert Dr. Simmons:
My doctor told me that I needed a sleep study. Will I be able to get a normal night’s sleep in a strange sleep lab while hooked up to all of the wires?
Most people will not have a “normal” night’s sleep when they spend a night in a sleep lab for testing. However, a sleep study provides important information about what occurs during sleep and is designed to identify factors that cause sleep disruption. Typically, a study is done to identify breathing problems or limb movement problems during sleep.Once asleep, being hooked up to the wires does not prevent these types abnormal events from occurring. However, it is important that a person falls asleep during the test. If a patient has difficulty falling asleep in my sleep centers, we give them a short-acting sleeping medication to help them sleep and ensure that we get the information needed to establish a proper diagnosis. The medications we use do not cause abnormalities during sleep. It is important to mention that a sleep study is not designed to identify causes for difficulty falling asleep. If a person’s main sleep problem is difficulty falling asleep, treatment can be initiated without a sleep study, but does require a detailed assessment by a Medical Doctor, Nurse practitioner or Physician Assistant who understands the issues of Sleep Medicine.</p>
My doctor told me that I needed a sleep study. Will I be able to get a normal night’s sleep in a strange sleep lab while hooked up to all of the wires?
Most people will not have a “normal” night’s sleep when they spend a night in a sleep lab for testing. However, a sleep study provides important information about what occurs during sleep and is designed to identify factors that cause sleep disruption. Typically, a study is done to identify breathing problems or limb movement problems during sleep. Once asleep, being hooked up to the wires does not prevent these types of abnormal events from occurring. However, a person must fall asleep during the test. If a patient has difficulty falling asleep in my sleep centers, we give them a short-acting sleeping medication to help them sleep and ensure that we get the information needed to establish a proper diagnosis. The medications we use do not cause abnormalities during sleep.
It is important to mention that a sleep study is not designed to identify causes for difficulty falling asleep. If a person’s main sleep problem is difficulty falling asleep, treatment can be initiated without a sleep study but does require a detailed assessment by a Medical Doctor, Nurse practitioner, or Physician Assistant who understands the issues of Sleep Medicine.
I have asthma, which was well-controlled until I gained 20 pounds. Since the weight gain, I find myself waking up at night with asthma attacks and frequently reaching for my inhaler. My asthma used to occur primarily when I would exercise, so why am I now having attacks while I’m sleeping?
As a result of your weight gain, excess fatty tissue is being deposited on the wall of your throat and narrowing your airway. This is likely causing Obstructive Sleep Apnea, or OSA.
I would not be surprised if you have also developed snoring or started snoring more since gaining weight. Narrowing of the throat increases airway resistance and irritates the airway which can trigger or worsen a bout of asthma. The changes in the airway from OSA can worsen all forms of allergic reactions within the airway, including nasal congestion. By treating OSA, asthma and allergic reactions can improve to a remarkable degree. We regularly treat patients with this precise problem of awakening with asthma symptoms, and they respond very well.
I frequently travel internationally for my work. Unfortunately, after returning back to Houston from a two-week trip, I have tremendous difficulty sleeping and it usually takes about a week before I return to sleeping normally and feeling like myself. I have heard of Jet Lag and I assume that is what I’m experiencing. Do you have any tips on how to cope with Jet Lag?
Yes, it is important to recognize that traveling east is completely different than traveling west. When traveling eEast, you lose hours and thus try to go to sleep before your brain is ready. When you travel West, you gain hours and your brain would like to go to sleep earlier than you typically would. It is usually harder to adjust when traveling east than west.If you have been away long enough to adjust to the time zone you have traveled to, then returning to Houston can prove troublesome, particularly if it is more than two time zones away. To get back on track, recognize that your body will adjust by sleeping. However, the timing of your sleep is extremely important and should correspond to your regular bedtime. If you are returning from the West, then you will probably get sleepy before your target bedtime.It’s advisable to stay active and prevent falling asleep too early. Stay up by walking, talking, or doing something to keep you stimulated. Sitting still can allow your sleepiness to take over. If you traveled East, your bedtime will occur probably before you are sleepy. In this case, to synchronize your sleep schedule, you may require the use of a sleeping pill – I prescribe medications that are safe, non-addicting, and can be prescribed for the specific purpose of helping to overcome jet lag.
I find myself waking up with pain in my jaw, neck, and head. Recently my doctor sent me to a dentist who diagnosed me with TMJ disorder. I do not clench my teeth during the day, but I seem to while I sleep. Do I have a sleep problem that’s causing me to wake up with this troubling pain?
Yes, TMJ – more accurately known as TMD – is caused by clenching or grinding teeth. Frequently, this occurs at night while asleep. One of its causes, which has more recently been discovered, relates to breathing problems during sleep such as snoring and sleep apnea. Clenching and grinding teeth while asleep is now recognized as an attempt to bring the jaw and tongue forward. This is to prevent the back of the tongue from blocking the airway, which is what happens in patients with Obstructive Sleep Apnea.Many people tend the airway to partially block while asleep, making it more difficult to breathe. Clenching the jaw is the brain’s way of preventing this from occurring. I suggest viewing my website and TV show for a more elaborate explanation of TMJ / TMD and sleep. I’ve recently presented research on this topic at a national sleep disorders conference. Also, dentists who treat this problem make dental splints that ease pain by keeping the jaw open and relieving pressure on the joints. This also protects tooth enamel. However, most of these appliances do not correct the breathing issues.I am working with Ronald Prehn, DDS, a facial pain and dental sleep specialist to further educate dentists on this topic. We hold an annual professional dental sleep conference in Houston on this topic, more information is available at www.dentalsleepconference.com.
For 10 years I have been struggling with pain from Fibromyalgia. I had a sleep study that was “normal.” Is there a link between sleep and Fibromyalgia, and if so what can be done about it?
Yes, there is a link between poor sleep and susceptibility to pain. People with Fibromyalgia frequently have abnormalities during sleep related to increased pain sensitivity. It is undoubtedly clear that by treating abnormalities of sleep in patients with Fibromyalgia there is almost always improvement in pain. However, sleep abnormalities are not always easily identified.Most sleep testing centers only focus on diagnosing Obstructive Sleep Apnea, and are not sophisticated enough to detect subtle abnormalities, and probably as in your case mistakenly conclude the sleep study as being normal. Some sleep centers provide a higher quality of assessment. In my centers, for example, we use state-of-the-art methods to detect subtle abnormalities. This allows us to properly identify and treat disrupted sleep in patients with Fibromyalgia and other difficult conditions associated with abnormal sleep.When properly diagnosed and treated, patients with Fibromyalgia can frequently become pain-free without the use of narcotics or other medications that cause drowsiness during the day.
I experience an uncomfortable feeling in my feet and legs lying in bed, which briefly improves when I wiggle them. This causes difficulty falling asleep. My 14-year-old daughter has a similar problem and I notice her kicking during the night. I think we have RLS. What can we do?
Your description is typical of Restless Legs Syndrome (RLS). The restless sensation (like a static feeling from the nerves) can make falling asleep difficult. The associated leg twitching during sleep can result in brief awakenings making you feel fatigued and un-rested in the morning.The most appropriate medications for treating this condition increase dopamine activity within certain parts of the central nervous system. This, in essence, filters out the static sensations. Sedating or numbing medications are not recommended as a first-line therapy in treating this condition.RLS can be passed on genetically and occur in family members, but other causes such as nerve damage can also be a factor. Iron deficiency can also cause RLS because the brain needs iron to produce dopamine. RLS can also contribute to ADHD symptoms. Properly diagnosing and treating RLS in adults or children can result in improved sleep and daytime functioning.
When I wake up, my jaw hurts. My dentist diagnosed me with TMJ disorder saying I clench my teeth while I’m asleep. Why does that happen?
TMJ is more accurately known as Temporal Mandibular Dysfunction or TMD, which is caused by clenching or grinding teeth, and frequently occurs at night while asleep. A common cause that was recently discovered relates to breathing problems during sleep such as snoring and Obstructive Sleep Apnea.My research demonstrates that clenching and grinding teeth while asleep is an attempt to bring the jaw and tongue forward. This helps prevent the back of the tongue from blocking the airway.There are many people whose airways tend to partially block during sleep, making it more difficult to breathe. Clenching the jaw is the brain’s way of preventing this blocking from occurring. Dental splints may ease the pain by relieving pressure on the jaw joint and protecting tooth enamel, but they don’t correct the breathing issues. I have successfully treated TMJ / TMD issues by treating breathing problems, (which are sometimes very subtle), during sleep.
See our bruxism page for a more comprehensive explanation of TMJ / TMD and sleep. My research has been presented at national medical conferences and I work with a large network of dentists across Houston to properly treat this problem.