A leader in pulmonary and critical care in central Pennsylvania for more than 40 years is now part of Penn State Health Medical Group.
The approximately 60 employees at the Lemoyne and Carlisle locations of Pulmonary & Critical Care Medicine Associates (PCCMA), including 10 physicians and nine advanced practice providers, were welcomed into Penn State Health today at events that also celebrated their new names: Penn State Health Medical Group – Lemoyne and Penn State Health Medical Group – Wilson Street.
Becoming a part of the Penn State Health network allows PCCMA to offer local residents enhanced access to complete, specialized pulmonary and critical care close to home, in coordination with the future Hampden Medical Center and Penn State Health’s flagship Milton S. Hershey Medical Center.
Since its start in 1978, PCCMA has been recognized as a leading resource for treatments for a wide range of diseases and illnesses, including COPD, asthma, lung cancer and chronic bronchitis. At their sleep laboratory in Lemoyne, they evaluate and treat disorders including insomnia, narcolepsy, REM sleep behavior disorder, snoring and sleep apnea.
PCCMA’s locations see more than 24,000 patients each year. They also provide critical care services for many community hospitals in the region, including UPMC Pinnacle locations in Harrisburg, Carlisle and the West Shore.
Autism Spectrum Disorder, also referred to as ASD or simply “autism,” is a neurodevelopment disorder that affects between one and two percent of the world’s population. Those with ASD are known to have trouble with communication and reciprocal social interactions. Research suggests that they also have a higher likelihood of suffering with a sleep disorder.
A study based on parental reports showed that 53 percent of children with ASD suffer with impaired sleep. Boys are four times more likely than girls to be diagnosed with autism. Problems include difficulty falling asleep, trouble waking up and various presentations of insomnia.
The child’s sleep problems have an impact on the entire family. Mothers are more likely to have high levels of stress and fathers are more likely to exhibit sleep disruption. The child’s daytime behaviors also become more challenging when their ASD causes them to suffer from lack of sleep.
Like children with ASD, adults with ASD are more likely to experience sleep disturbances than the general population.
One study conducted a meta-analysis of data from either objective data (i.e. actigraphy and polysomnography) or subjective data (i.e. sleep diaries and questionnaires). The analysis found that adults with ASD were more likely to lie awake in bed, have difficulty falling asleep and wake up in the middle of the night.
This study provided a good foundation of knowledge, but there is still a need for additional data. Future research will help the medical community better understand and treat sleep disturbances in adults with ASD.
Possible Causes and Solutions
Melatonin is a hormone our brains produce to help regulate our circadian rhythm. People with ASD may produce lower levels of melatonin, which leads to impaired sleep. Severe insomnia may also be linked with sensory hyper-reactivity to certain triggers, such as bright lights. For example, if a person with ASD avoids bright lights, it can affect their circadian rhythm.
Early and routine sleep assessments can help facilitate a lifetime of healthier sleep habits for those with ASD. If sleep impairments are detected, measures can be taken to remedy the problem, such as behavioral changes or medications.
Chronic lung diseases, such as COPD and emphysema, require ongoing medical attention to help manage symptoms and improve quality of life. One treatment option is pulmonary rehabilitation. Rehabilitation is uniquely tailored for each patient, aiming to improve both psychological and physical side effects of chronic lung disease.
Pulmonary rehabilitation is not a replacement for lung surgery and other medical treatments, but it can be a key component in the management of a chronic lung condition. This treatment is most effective in moderate stages of chronic lung disease, but it can also be beneficial for people in more advanced stages of disease progression. Two thirds of patients who participate in pulmonary rehabilitation report positive outcomes.
Pulmonary rehabilitation can help:
What to Expect During Treatment
Pulmonary rehabilitation is a comprehensive approach that has many layers. Your health care provider will form a treatment plan that is right for you. Your treatment plan could involve:
Education – One part of treatment is education on lung diseases and management. These classes help support lasting healthy behaviors. For example, patients learn to avoid lung irritants, use medications properly, and maintain healthy behaviors daily.
Exercise – Pulmonary rehabilitation also involves exercise training, where a patient will perform exercises appropriate to their level of physical fitness. This can improve sleep quality and circulation while increasing muscle tone for better balance. The ability to walk around is an important criterion for this type of treatment.
Breathing techniques – Respiratory therapists teach patients breathing techniques, helping them to manage shortness of breath day-to-day.
Emotional support – Group support and counseling are other important parts of pulmonary rehabilitation. Patients with a chronic lung condition can experience stress, depression and anxiety. An emotional support system can help to alleviate these conditions.
Quit smoking – For patients who smoke, part of rehabilitation therapy involves counseling to help assist in the quitting process.
Most pulmonary rehabilitation programs last only a few months. Based on progress from the beginning to the end of the treatment program, a health care provider will prescribe exercises, breathing strategies and other activities to continue doing after stopping your pulmonary rehabilitation treatment.
Those with chronic insomnia may want to add a new strategy to help supplement their existing treatment. Evidence shows that relaxation techniques can be used to effectively treat chronic insomnia.
For many people, sleep disorders are related to stress. Relaxation techniques can cause a deep psychological shift to counteract the stress response that is often responsible for sleepless nights.
Mindfulness meditation is a relaxation technique that focuses on breathing, calming the mind and being present in the moment. During mindfulness meditation, you don’t concern yourself with thoughts of the past or future. This helps break the typical thought pattern that involves regret and worry. Instead, you’re only focused on the breaths you’re taking in that moment.
It’s recommended to practice mindfulness for 20 minutes each day, according to a study published in the Journal of the American Medical Association. Sleep disturbances are more common in older adults, so the trial was conducted with two groups of middle-aged and older adults with documented sleep troubles. For six weeks, the individual groups met once a week for two hours. One group completed a mindfulness awareness program that taught meditation and other relaxation techniques. The other group completed a class that focused on sleep education. Participants from the mindfulness awareness group had less insomnia, fatigue and depression at the end of the study.
Finding What Works for You
Some people prefer to meditate while seated or lying down, but others practice mindfulness while doing another activity, such as tai chi or yoga. Another strategy is to use music-assisted relaxation or progressive relaxation to help ease nighttime anxiety. Relaxation techniques are sometimes combined with cognitive-behavioral therapy. There isn’t a one-size-fits-all strategy for treating insomnia, so work with your doctor to find the solution that works best for you.
Relaxation techniques are generally safe and side effects are rarely reported. If you have a serious underlying health problem, consult with a medical professional before using relaxation techniques as a treatment for insomnia. Also, remember that you shouldn’t discontinue any doctor-recommended treatment without first consulting your health care team.
Vaping May Increase the Risk of Chronic Respiratory Disease
Vaping has become a controversial issue in the healthcare profession. Vapes and e-cigarettes have been touted as a safer alternative to smoking and can be used as a method to help smokers quit. There has recently been an influx of cases where vaping caused short-term health impacts. New findings indicate that vaping may also be responsible for some long-term health problems, such as:
A longitudinal analysis published by the American Journal of Preventive Medicine concluded that vaping is an independent risk factor for respiratory disease.
Researchers studied data collected between 2013 and 2016 that assessed participants based on their usage of traditional cigarettes and e-cigarettes. Dual use of e-cigarettes and smoking tobacco was shown to be the most common use pattern among participants, which carries a higher risk than using either product alone.
In theory, making the switch from smoking traditional tobacco products to vaping e-cigarettes could reduce the risk of developing respiratory disease. That theory doesn’t translate to reality because of the actual patterns of e-cigarette usage. Studies show most people who vape also smoke cigarettes or other tobacco products. For most smokers, using an e-cigarette does not increase the odds of successfully quitting. Instead, it leads to dual usage, which can cause more damage than just smoking cigarettes.
In addition to nicotine, e-cigarettes contain other toxins that have been shown to impair lung function. These toxins include propylene glycol, diacetyl and heavy metals. Studies involving animal subjects found that e-cigarettes increase pulmonary inflammation, inhibit immune responses and cause oxidative stress, an imbalance of free radicals and antioxidants.
Respiratory diseases are leading causes of mortality in the United States. Vaping further exacerbates conditions for patients with lung diseases like chronic bronchitis and COPD. For someone who has never smoked, vaping may be less harmful than traditional cigarettes. However, it can take decades for the effects of smoking to cause serious and measurable damage, so future research will be needed to confirm the long-term effects.
If you’re trying to quit smoking, talk with your doctor about tools and resources. Never smoking is the best way to protect your lungs from chronic disease but stopping now can help prevent further damage.
Outdoor artificial lights are used to enhance vision for drivers and pedestrians at night and to make communities safer. For older adults who live in areas with higher levels of this outdoor light pollution, it may be harder to fall asleep and stay asleep.
A study published in the Journal of Clinical Sleep Medicine studied the correlation between exposure to bright, artificial outdoor lights at night and the use of drugs that battle sleeplessness.
About the Study
Researchers found evidence that light pollution is linked to insomnia during their study of more than 50,000 adults over the age of 60. Of the study participants, approximately 22 percent took hypnotic drugs to manage insomnia, and about 60 percent were women. People with a diagnosed sleep disorder were excluded from the study.
The participants were categorized based on the amount of light pollution they were typically exposed to during the night. This data was not self-reported. Instead, researchers utilized satellite data from the National Centers for Environmental Information to estimate the level of light pollution each participant would be exposed to regularly.
Findings indicated that the people who were exposed to greater levels of artificial outdoor lights were more likely to take the sleeping pills more often and at a higher dose. This indicates that being exposed to bright outdoor lighting at night could be a risk factor for insomnia.
How to Combat Light Pollution
In terms of environmental pollutants, light pollution has historically not been a major concern for public health officials. However, this recent scientific evidence indicates a potential connection between light pollution and a serious health condition. More studies are needed to define the prevalence of light pollution adversely affecting human health. If the prevalence is significant, changes to public policy may be initiated.
On an individual level, those with insomnia may find it helpful to limit their exposure to outdoor artificial light at night. If you need help managing your insomnia, make an appointment with your doctor.
Can Caffeine Affect Your Circadian Rhythm?
Cold winter weather can make exercise more difficult. This is especially true for people with asthma. It’s estimated that 300 million people worldwide are living with asthma, according to the World Health Organization. At least 15 to 25 percent of athletes have asthma symptoms but haven’t been diagnosed with the disorder. However, it’s not only asthmatics who have increased difficulty with winter sports.
Exercising in the Winter
Typically, people breathe through their nose, which allows the air to be warmed and humidified before reaching the lungs. When exercising, people are more likely to breathe through their mouths due to the increased need for oxygen. This means cold, dry air reaches the lungs more quickly, which can cause irritation and make it more difficult to breathe. Breat hing through the mouth also means that air isn’t filtered by cilia in the nose before reaching the lungs, so there may be a higher level of pollen or other pollutants.
Whether or not a person has a diagnosed case of exercise-induced asthma, their athletic performance may be hindered by exercise-induced bronchoconstriction (EIB). Within five to twenty minutes of exercising, people with EIB experience asthma symptoms like wheezing, chest tightness and shortness of breath.
Diagnosis and Treatment
It’s common for athletes to feel that they need to push through the pain but breathing problems can be serious. It’s best to consult a doctor as soon as symptoms present. Whether you exercise outdoors for pleasure or competition, it’s possible to keep symptoms under control so you can still enjoy your winter workouts. A medical professional can help formulate a plan to manage the symptoms. This may include the use of an inhaler.
For your own safety, here are a few steps to take during winter workouts if you’re prone to breathing difficulties:
Sleep Apnea Could Double the Risk of Drug-Resistant Hypertension in African-Americans
When a patient is diagnosed with hypertension, commonly referred to as high blood pressure, their treatment typically consists of self-care and medications to help lower their blood pressure. If blood pressure isn’t reduced to normal range after taking medication for the condition, doctors must figure out why.
For African-American adults, the answer may lie in an undiagnosed case of sleep apnea.
Findings from a 2018 Study
A study led by Harvard University researchers found that people with moderate or severe sleep apnea are twice as likely to have drug-resistant hypertension. The link between sleep apnea and high blood pressure isn’t new, but this research is different from studies in the past.
Instead of using self-reported data, this Harvard-led study detected the presence of sleep apnea via sleep studies. Of the 664 African-American participants in this study, more than a quarter had moderate or severe sleep apnea. A shocking 94 percent of the participants with sleep apnea were not previously diagnosed or treated for the disorder. The association between high blood pressure and sleep apnea was most prevalent among those with hard-to-treat hypertension.
All the participants were adults with hypertension who were also participants in the Jackson Heart Study, the largest investigation of cardiovascular disease in African Americans. Nearly half of the study’s participants had uncontrolled high blood pressure, and approximately 14 percent had high blood pressure that wouldn’t respond to medications.
While this study has provided great insight, more research is needed to establish the cause-and-effect relationship between sleep apnea and drug-resistant hypertension. If untreated sleep apnea is the reason for drug-resistant hypertension, that means both diseases could potentially be improved with routine treatment for sleep apnea, such as the use of a CPAP machine.
For now, medical professionals can help their patients by looking at undiagnosed sleep apnea as a possible cause for drug-resistant hypertension.
Compared to white adults, black adults have a 90 percent higher chance of struggling with uncontrolled high blood pressure. There is no known cause for this, but researchers hope this study will inspire health care professionals to approach treatment and research differently in the future.
Pulmonary fibrosis is a lung disease that causes scar tissue deep inside a person’s lungs. Many cases are idiopathic, meaning there is no known cause. Because the disease is progressive, symptoms worsen overtime. There is currently no cure, so starting treatment early is the best way to ensure a better quality of life.
Medical treatments for pulmonary fibrosis sometimes include corticosteroids, oxygen, antifibrotic drugs, proton pump inhibitors and immune suppressants. Some patients also opt to try experimental treatments.
Tips to Improve Daily Lung Function
In addition to medication and doctor-recommended treatments, there are certain lifestyle changes that can help improve daily lung function for people living with pulmonary fibrosis.
An at-home pulse oximeter can be used to measure your oxygen levels throughout the day. Typically, the goal is for oxygen saturation to be above 90 percent. A lack of oxygen can cause mild problems, such as headaches and shortness of breath. In severe cases, heart and brain function may suffer.
Pulmonary rehabilitation is often a staple in the treatment of pulmonary fibrosis. This treatment involves a variety of programs that aim to reduce shortness of breath while also improving daily life.
Pulmonary fibrosis patients should be vaccinated against diseases that could cause infection and further lung damage, such as the flu, pneumonia and whooping cough. Find out what vaccines are recommended for you on the Center for Disease Control’s Adult Vaccine Assessment Tool.
Being underweight or overweight can impact your ability to breathe. A registered dietitian can help determine your dietary needs so you can maintain a healthy weight.
Smoking cigarettes causes lung damage. While the habit is not healthy for anyone, it is especially harmful for patients with pulmonary fibrosis. If you smoke, quitting now can prevent further damage. SmokeFree.gov is a great free resource to get you on the path to quitting and keep you from picking the habit back up.
People with pulmonary fibrosis may notice that certain environments trigger a decline in respiratory function. For example, dust, pet dander, the smell of chemicals at a hair salon, and gasoline fumes can irritate your lungs. Wearing a face mask can help in situations where triggers are unavoidable.
It’s very important to have an emotional support system when you’re living with pulmonary fibrosis. Online communities and in-person support groups are great ways to connect with others who are struggling with your condition. The Pulmonary Fibrosis Foundation has a wonderful resource dedicated to finding local and online support groups.