Sleeping: we all do it. On average a third of our lives. For most people this works without any problems, but a small proportion spend hours awake every night. The most problematic sleepers end up in the sleep wake center in the Tjongerschans hospital in Heerenveen.
Almost everyone has a period of poor sleep at some point: from falling asleep late or not being able to sleep through to waking up too early. Due to stress, for example tension at work or in the relationship, or a toddler who keeps his parents awake. This usually goes away on its own. But if such a period lasts too long, you have to do something about it.
“Our criterion for a sleep problem is if you sleep poorly at least three days a week for three months,” says Caroline Blankvoort, one of the three somnologists at Tjongerschans, or sleep expert.
Together with pulmonologist Charlotte Seijger, she talks in her office about the work they do. Behind Blankvoort, next to a stack of professional literature, is the framed certificate from the Sleep Medicine Association of the Netherlands (SVNL): Tjongerschans hospital has recently become the first certified sleep wake center in the Northern Netherlands.
A nice boost for Tjongerschans, which has been working on sleep medicine since 2016 and thus care for patients who struggle with sleep disorders and other related health problems.
Tip of the iceberg
Blankvoort, Seijger and their colleagues have seen around 2,300 unique patients so far this year, as well as fifty children, and this number is growing. “The tip of the iceberg,” says the pulmonologist. “There are many people with sleep apnea who do not know it, but are walking around with all kinds of complaints because they do not get enough sleep.”
Those who do manage to find the sleep wake center usually come there after a referral from their GP. Blankvoort: “A very large number with complaints about fatigue, poor concentration, never waking up fit, difficulty falling asleep and staying asleep.”
The sleep problem has often been going on for a long time; Sometimes people take sleeping medication for years before they sound the alarm. Blankvoort: “Sleeping tablets are very addictive and they do not improve your sleep.” Seijger: “I recently had an eighty-year-old woman who had had complaints for thirty years. She turned out to have sleep apnea and was so sorry she hadn’t come sooner. I promptly received her daughter and granddaughter for the consultation, and they turned out to have it too.”
Sleep test
In the sleep wake center, various specializations work together to detect, diagnose and treat all common sleep disorders.
This process starts with an extensive intake, after which a sleep test takes place depending on the complaints. Previously standard in the hospital, nowadays usually at home. It often turns out that there is sleep apnea, in which a person stops breathing several times an hour (see boxes, IJ). Blankvoort: “But insomnia is also very common, insomnia: difficulty falling asleep, difficulty sleeping through the night, waking up early.” The latter often has to do with someone’s ‘sleep-wake hygiene’, or behavior that contributes to a good night’s sleep.
In that case, cognitive behavioral therapy can offer a solution. “We try to break the vicious circle of poor sleep. Educate patients about what good sleep actually means: regular bedtimes, no daytime naps. Sometimes people lie in bed for far too long hoping to get some rest; we impose sleep restrictions on them. We will work on thoughts: what do you do when you are worrying, how can you convert this into helpful thoughts?”
Sitting on your phone for hours
“Everything you do during the day and in the evening affects your sleep, such as sitting on your phone for hours,” Seijger adds to her colleague.
In five group meetings – over three months – an attempt is made to improve sleep hygiene. Participants are given homework and must keep track of their sleeping times. Blankvoort: “Many patients first start to feel worse, for example because they spend less time in bed. But if you cram the bedtime hours together, the quality will eventually improve. After about six to eight weeks we see improvement.”
The somnologist acts as the ‘spider in the web’ in the multidisciplinary team, which also consists of specialists from neurology, ENT, oral surgery, pediatrics and medical psychology. A wonderful profession, says Blankvoort.
More likely to be overweight
“I find it fascinating that you are so awake during the day, sleep takes over at night and then you are completely gone. It is very nice to be able to solve sleeping problems, I see people really improving here.”
In our hectic society, the importance of good sleep is sometimes underestimated, the two specialists believe. Blankvoort: “Sleep is not an emergency. But it is essential for all facets of life. If you don’t sleep well, you are more likely to be overweight, recovery from illness is more difficult, and you cannot do your job properly. In short, it affects everything.”
Youandi Mazeland from Lemmer: I could sleep every second of the day
It was in 2015 that Youandi Mazeland visited the pulmonologist in the Tjongerschans. “I was always so tired, I could sleep every second of the day,” says the 47-year-old woman from Lemmer. A home sleep test revealed that she had sleep apnea. “My breathing stopped an average of thirty times an hour, so I couldn’t get into my REM sleep and then you don’t rest properly.”
Mazeland was known to have sleep apnea through her family. The average sleep apnea patient is over 50 and often obese, not the build that Mazeland himself had. She received a so-called CPAP mask, a kind of oxygen pump that ensures that air is continuously blown into the body. This prevents breathing from stopping, so that people fall asleep more deeply.
Snoring mouthpiece
In general this has a positive effect, but with Mazeland it was disappointing. She was then given a snoring mouthpiece, but that also did not seem to help sufficiently. The Lemster woman came to the somnologist’s office in 2021 Caroline Blankvoort who took an extensive sleep test. This showed that Mazeland’s oxygen level was too low, something that also affects the quality of sleep. She was put on an overnight oxygen machine, which improved her oxygen levels, but her sleep apnea remained.
Gradually Mazeland came close to despair; would a solution ever be found for her sleeping problem? Blankvoort called together the multidisciplinary team of the sleep wake center: the neurologist, dental surgeon, pulmonologist, ENT doctor, medical psychologist and herself. Eventually they came up with a solution: the tonsils would be removed, the uvula halved and the position of the tongue adjusted.
Much stress
Discussions also followed about ‘sleep-wake hygiene’, because there were also some things wrong with that. “My sleep rhythm was not good. I was going through a divorce and just had a baby.” These circumstances caused a lot of stress, which is also not conducive to good sleep.
In February 2022, her tonsils were removed, a fairly major operation for an adult. This intervention, in combination with much less stress in daily life, ensures that Mazeland finally sleeps well. Still with braces, that is. “Seven hours a night. I wake up fresh and have energy all day long, which is wonderful.”
Sleep apnea webinar
Tjongerschans Hospital is organizing a Tjongertalk (webinar) about sleep apnea on November 20. One in 100 people in the Netherlands has sleep apnea. You stop breathing several times an hour. Such a breathing pause lasts 10 seconds or longer. This can startle you awake, but most people don’t notice anything. The result is that you are very tired during the day and never feel rested. The complaints worsen the longer the sleep apnea lasts. Many people do not know that their fatigue is due to sleep apnea.
Sleep apnea is treatable. The first step is to recognize the signals. During the Tjongertalk, pulmonologist Charlotte Seijger and somnologist and physician assistant from the sleep wake center Caroline Blankvoort explain how to recognize sleep apnea and what you can do about it.
November 20, 7:30 PM – 8:00 PM
To register: www.tjongerschans.nl/tjongertalk