What is Delayed Sleep Phase Syndrome?

What is Delayed Sleep Phase Syndrome?

Getting an adequate amount of sleep each night is vital to your body’s ability to function properly throughout the day. Those with Delayed Sleep Phase Syndrome (DSPS) are frequently deprived of quality rest.

DSPS is a disorder in which a person’s normal sleep is delayed by two or more hours. For example, a person with DSPS may find themselves falling asleep several hours after their desired bedtime. They may lie down before 10 p.m., but still be awake well after midnight.

DSPS affects approximately 15% of teens and adults, according to the American Sleep Association. DSPS often begins in adolescence and continues into adulthood. Genetic and environmental factors may also lead to the development of this sleep disorder.

Symptoms of DSPS include:

  • Inability to fall asleep
  • Difficulty waking up at a desired hour
  • Daytime sleepiness
  • Frequent napping to balance sleep deprivation
  • Depression and behavioral problems (especially in children and adolescents)

Another symptom is simply the lack of other sleep problems. Those with DSPS typically sleep through the night without trouble. When they can sleep freely on their delayed sleep and wake schedules, they will awake refreshed later in the day.

Most people with this disorder describe themselves as “night owls.” The problem occurs when that person lacks sleep because they must wake up early for school, work and other responsibilities.

Treating Delayed Sleep Phase Syndrome

Those who are unable to correct their sleeping pattern may need to seek the help of medical professionals who specialize in sleep disorders. There are two treatments that have been successful in treating DSPS.

  1. Bright light therapy, also known as phototherapy, is a technique that gradually shifts sleeping patterns. The patient is exposed to bright lights in the morning, shortly after they wake up, and avoids bright outdoor light in the evening. When properly executed, the treatment has been shown to normalize the patient’s circadian rhythm.
  2. Chronotherapy corrects the patient’s circadian rhythm by delaying their bedtime by two hours every few days. It is used less frequently than bright light therapy because it can disrupt their normal schedule of activity.

If you think you or a loved one are suffering from Delayed Sleep Phase Syndrome, consult your doctor for diagnosis and treatment.

Surgical Menopause May Lead to Decreased Sleep Quality

Surgical Menopause May Lead to Decreased Sleep Quality

Most women experience menopause naturally. It is the stage when a woman permanently stops having menstrual periods. The average age of menopause is 51, but it can vary.

Nearly 26 percent of postmenopausal women report severe sleep disturbances, making insomnia one of the most common symptoms of menopause. This symptom often begins during perimenopause, which is a 3- to 10-year period of time before menopause occurs.

A study published in 2018 suggests that sleep quality is often worse for women who undergo surgical menopause than for women who experience menopause naturally.

What is Surgical Menopause?

Medical procedures that interfere with ovarian function can often cause premature menopause. For example, if a premenopausal woman has one or both ovaries removed, she may experience abrupt menopause. Surgical menopause may also stem from radiation of the pelvis and ovaries during cancer treatment.

Potential Causes of Increased Sleep Issues

Menopause can be challenging for any woman, but women who undergo surgical menopause tend to have increased symptoms of menopause. This includes a decrease in sleep quality. One possible cause for the difference is that surgical menopause results in a sharper drop in estrogen levels as opposed to the more gradual hormonal changes that result from natural menopause.

In one study, women were twice as likely to suffer from insomnia if they experienced surgical menopause. They also reported worse sleep quality, especially regarding the duration of sleep.

Hot flashes and night sweats are two well-known symptoms of menopause, which only serves to worsen sleep quality. Since all menopausal symptoms tend to be more intense in women who undergo surgical menopause, these severe physiological symptoms may make it psychologically harder to fall asleep and stay asleep.

The Importance of Early Treatment

Poor sleep quality can cause daytime fatigue, lower quality of life and a higher risk for other serious health conditions if the insomnia persists. The most common treatment for menopausal symptoms is hormone replacement therapy (HRT), but treatment may vary on a case-by-case basis.

Women who are experiencing sleep problems after natural or surgical menopause should consult their doctor to determine the best course of treatment for their condition.

Pregnant? Sleep Apnea Can Affect Your Baby

Pregnant? Sleep Apnea Can Affect Your Baby

Sleep apnea can have serious health implications for anyone, but the risk is amplified for pregnant women if the disease goes untreated.

Millions of Americans live with sleep apnea, but many are never diagnosed. The disease is not only dangerous for the health of a pregnant woman, but also the health of their unborn child.

Causes and Risk Factors

Sleep disorders are fairly common during pregnancy. This is because of both hormonal and physiological changes.

Obstructive sleep apnea is more prevalent in women who were overweight before pregnancy because excess tissue in the airway can block airflow during sleep. High blood pressure and gestational diabetes are two additional risk factors for developing sleep apnea.

Physiological changes can contribute to sleep apnea during pregnancy. For example, excess hormones may cause congestion in mucous membranes, increasing the likelihood of sleep apnea. There is also a genetic component.


Pregnant women with sleep apnea are more likely to experience complications before, during and after childbirth. Examples include preeclampsia, congestive heart failure, pulmonary embolism, a longer hospital stay and an increased likelihood of admission to the intensive care unit. Sleep apnea may also increase cognitive decline over time.

Sleep apnea during pregnancy can affect the baby, as well. Serious complications may include:

  • Preterm delivery
  • Low birth weight
  • A higher likelihood of admission to the NICU (neonatal intensive care unit)
  • Low Apgar scores

Sleep apnea is also linked to impaired fetal growth, according to a 2017 study.

Luckily, early diagnosis and treatment of sleep apnea during pregnancy can mitigate these complications.

Managing Sleep Apnea During Pregnancy

Any pregnant woman who suspects a sleep disorder should consult their doctors immediately. Symptoms include snoring, pauses in breathing while asleep, and sputtering after a pause in breathing. Daytime tiredness, depression and headaches can also indicate a sleep disorder, but there are other potential causes for those symptoms. (Sleep Disorders May Affect Women Sooner than Men)

The most definitive test for sleep apnea is a sleep study. The study allows doctors to diagnose the sleep apnea and determine the best course of treatment. (5 Things to Know Before Your Sleep Study)

Most common treatments are the use of a CPAP (continuous positive airway pressure) machine or oral appliances, but surgery is sometimes necessary.

By diagnosing a maternal sleep disorder in the early stages, both mom and baby have the best chance of avoiding complications.

Patient Freedom of Choice Notification


Pulmonary & Critical Care Medicine Associates (PCCMA) Physicians will no longer be providing pulmonary and intensivist care medical services at Geisinger Holy Spirit Hospital, effective May 1, 2019.

PCCMA physicians will continue to provide pulmonary and critical care medical services at all UPMC Pinnacle facilities, including Harrisburg Hospital, West Shore Hospital, UPMC Pinnacle Carlisle Hospital, and Community General Osteopathic Hospital.

Every patient has the right under federal and state law to be treated by the physician or specialist they choose. You can exercise your right to patient freedom of choice by advising your primary care physician or specialist that you would like to be treated by our PCCMA physicians.

If you are a patient with questions, please call our office at 717–234–2561. We encourage you to exercise your legal rights to receive treatment from the physician of your choice.

PCCMA Invites Public to Learn About Common Sleep Problems at Community Event Feb. 9

80 million adults have sleep apnea; only 1 in 5 are diagnosed
Experts to lead discussion on sleep apnea, treatment options

PCCMA Invites Public to Learn About Common Sleep Problems at Community Event Feb. 9

Pulmonary & Critical Care Medicine Associates is holding a community event focusing on sleep apnea, a common condition that affects a person’s breathing during sleep. The event, free and open to the public, will be held Saturday, Feb. 9, from 10 to 11 a.m. at the PCCMA Sleep Center at 50 N. 12th St. in Lemoyne.

More than 18 million adults in the United States have sleep apnea, but only about 20 percent have been diagnosed. A person with sleep apnea has times during sleep during which air cannot flow normally into the lungs. These pauses in airflow can occur off and on during sleep, and cause a person to wake up from a sound sleep. If sleep apnea is not treated, serious health problems may develop including type 2 diabetes, high blood pressure, heart disease and depression.

Attendees will learn about sleep apnea symptoms, diagnosis and treatment options. Patients previously diagnosed with sleep apnea are also encouraged to attend to ask questions about treatment options and hear from other patients.

PCCMA Sleep Center Manager Salvatore Santelli, RPSGT, CSE and Respiratory Therapist Trevor Burns, BS, RRT will lead the discussion.

Space is limited. To register, contact Trevor at (717) 629–7168.

Circadian Rhythm: Is your ‘Body Clock’ on Schedule?

Circadian Rhythm: Is your ‘Body Clock’ on Schedule?

A circadian rhythm is your body’s daily cycle. It keeps your physical, mental and behavioral changes working like clockwork. Most living things have circadian rhythms, including plants and microorganisms.

Circadian rhythm is affected by natural factors produced by the body, but environmental factors like daylight can also have an effect.

Sleep cycles, eating habits, digestion, body temperature and hormone release are all influenced by circadian rhythm. Irregular rhythms have been linked to various health complications, including:

  • Sleep disorders
  • Depression
  • Bipolar disorder
  • Seasonal affective disorder
  • Obesity

Circadian Rhythms and Sleep

Your body’s clock controls the production of melanin, a natural hormone that makes you tired. When there is less light (at night), it is generally a signal for your body to produce more melanin. The circadian rhythm also controls when you wake up.

Resetting Your Internal Clock

Ninety percent of people in the U.S. use technological devices within an hour before bedtime. The popularity of using mobile devices, television and computers at night has led researchers to study how the light from those devices may affect circadian rhythm.

The blue light emitted by electronic devices delays the production of melanin, making it difficult to fall asleep. To minimize this effect, turn off electronic devices a couple hours before bed or whatever is realistic for you. A good substitute is reading an old-fashioned book.

Traveling between time zones can also wreak havoc on your body’s natural circadian rhythm. When your body’s existing rhythm conflicts with the normal time of your new destination, you might experience jetlag. It sometimes takes a couple days for your biological clock to reset.

People with rotating work schedules also find it difficult to maintain a regular circadian rhythm.

The best way to keep your circadian rhythm on track is by maintaining a regular schedule. If you go to sleep and wake up at roughly the same time each day, your body will adjust to give you more energy throughout the day. It may also help to go for a walk each morning to expose your body to sunlight.

If you have problems with your sleep/wake schedule or feel that your circadian rhythm is otherwise off balance, schedule an appointment with your doctor to eliminate any underlying conditions and determine a plan to help regulate your circadian rhythm.

COPD Complications in Flu Season

COPD Complications in Flu Season

Because influenza primarily affects the respiratory tract, it is especially dangerous for individuals with COPD and other preexisting respiratory conditions. The rate of unfavorable outcomes for patients with respiratory diseases – like COPD – is significantly higher than for the general population who contract the flu.

Flu season is quickly approaching, which means patients with COPD should take extra precautions to protect themselves. If you do get the flu, there are special considerations to improve your chances of a full recovery.

Fighting the Flu Before Infection

There are steps you should take to minimize your chance of contracting the flu. These steps are important for everyone, but especially the elderly and people with chronic diseases such as COPD.

  1. Avoid contact with the virus. The flu is a highly contagious disease that can spread when you’re in contact with someone carrying the flu virus. If possible, avoid encountering sick people during flu season. If you yourself are sick with the flu, minimize contact with anyone who has COPD or other respiratory problems.
  2. Hygiene. During flu season, be especially conscious of your hygiene. Wash your hands regularly with soap and warm water. This is especially important when you’ve been in a highly populated area where germs are more likely to spread from person to person.
  3. Flu shots. A yearly flu vaccine is arguably the best way to protect yourself during flu season. The Centers for Disease Control recommends that everyone over the age of 6 months get vaccinated by the end of October each year. You’re especially encouraged to receive a flu shot if you’re over the age of 65, or if you have asthma or COPD.

If You Contract the Flu

If you’re exhibiting flu symptoms, call your doctor immediately. Symptoms include fever, shivering, headache, sore throat and cough.

You may be prescribed antiviral medications within 24 hours of your symptoms starting. These medicines can shorten the duration of your illness and make your symptoms milder, preventing serious complications.

New influenza strains are constantly emerging, indicating that the flu will remain a serious problem for the foreseeable future. Being proactive and vigilant can help prevent complications from the flu in patients with COPD.

The flu could trigger exacerbations for patients with COPD, worsening symptoms beyond the expected day-to-day variation. Inhaled bronchodilators, systemic corticosteroids and antibiotics may be prescribed to manage secondary complications.

For more information about flu prevention and complications for patients with COPD, ask your primary care physician or contact Pulmonary & Critical Care Medical Associates at (717) 234-2561 weekdays from 8 a.m. to 4:30 p.m.

A New Way to Manage Your Health

RevUp Chronic Care Management Program

Pulmonary & Critical Care Medicine Associates (PCCMA) is excited to offer RevUp, a new way for patients with Medicare coverage to manage their health!

What is RevUp?

RevUp is a Chronic Care Management Program designed to help you stay connected and be supported between your PCCMA doctor visits.

You’ll be assigned a personal care team including a nutritionist, dietitian, physical therapist and nurse. The care team is available to answer your questions, provide health recommendations and coordinate with your doctor when necessary.

Think of this team as your health coaches and advocates, who can help keep you on the right track to manage your condition.

How does it work?

With RevUp, you can track your health online from home by logging your weight, blood pressure, blood sugar and more. Studies show that patients who actively track their health data see improvements in their health.

How can it help?

In many cases, RevUp has prevented health problems from progressing and even prevented visits to the hospital. Even if you’re in a good state of health now, RevUp can help you stay that way by monitoring your condition and providing suggestions about nutrition, pain management, exercise and more.

In short, RevUp will help you take charge of your health.

How do I get started?

For more information talk to your PCCMA provider or call 717-234-2561.

*Like all Medicare Part B services, a co-insurance payment is required. If you have a Medi-Gap-type supplemental medical policy, you may not be responsible for any payment. Patients who have not met their deductible for the year may be responsible for meeting their yearly deductible first, if they do not have secondary insurance or if their secondary insurance does not cover deductibles. Regardless of your insurance coverage, the front desk will be able to provide additional information regarding any billing concerns. You can call the front desk at 717-234-2561.

PCCMA Introduces COPD Video Series (Part 2 of 2)

How to use your RESPIMAT inhaler
In our last blog post, we introduced the first two segments of Pulmonary & Critical Care Medicine Associates’ five-part video series explaining the many facets of Chronic Obstructive Pulmonary Disease (COPD). The segments were “Learning You Have COPD” and “Understanding COPD.”

The remaining segments of the video series focus on how to improve your quality of life with COPD and how to use a RESPIMAT inhaler.

Living Better With COPD

At just over seven minutes in length, the third section in PCCMA’s video series provides detailed insights into ways you can live better with COPD.

Elizabeth Tuttle, PA-C, discusses how certain medication and lifestyle changes can help you feel better over time. Specifically, she talks about the benefits of exercise, proper diet and quitting smoking. PCCMA has programs to help individuals who are trying to stop smoking and those who are trying to make healthier eating choices.

Elizabeth also helps you learn more about the disease, including what COPD does to your body and what triggers COPD symptoms.

You’ll then meet Henry Ostman, MD, FCCP, who emphasizes the importance of having a support system of friends and loved ones. If you’re lacking a strong support system, PCCMA doctors and medical staff can help. Additionally, you should tell your doctor if you have feelings of depression or disappointment.

Dr. Ostman concludes the segment by discussing why it is critical to take your medication as directed, including using rescue inhalers and daily inhalers.

How to Use a RESPIMAT Inhaler

This fourth video segment offers critical information for anyone using a RESPIMAT inhaler to help treat COPD. Joshua Hoffman, MD, explains what the inhaler is and how it works.

The segment also includes step-by-step instructions on how to use an inhaler. This portion of the video is especially valuable if you have never used a RESPIMAT inhaler before.

Managing COPD

Christopher Shaffer, MD, concludes the video series by summarizing the importance of treatment for living well with COPD.

Although there is no cure for COPD, symptoms can be managed.

The doctors and staff at Pulmonary & Critical Care Medicine Associates are ready to be your COPD care team and to be part of your support system.

If you have questions about COPD, or suffer from symptoms, please make an appointment or call us at (717) 234-2561.

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