Dr. Adam Fisch Joins JWM Neurology

Dr. Adam Fisch joined JWM Neurology and is a board certified neurologist and sleep disorders medicine physician.

He has special interests in sleep medicine/EEG/EMG. Dr. Fisch is originally from Indianapolis and received his medical degree from Indiana University School of Medicine. He completed his neurology residency and sleep medicine fellowship at Washington University School of Medicine in St. Louis, Missouri.

Dr. Fisch is an avid educator and has lectured to medical students, rehabilitation therapists and neurology residents at many different universities. He also recently authored a book titled Neuroanatomy: Draw it to Know It, published by Oxford University Press, for which he won the “2009 Washington University in St. Louis Leonard Berg Prize for Research During Residency” Award. He has since created neuroanatomy tutorials available on http://www.drawittoknowit.com/.

Dr. Fisch sees patients with general neurology problems and sleep disorders.

Free Women's Sleep Disorders Seminar

JWM Neurology & Holder Mattress Factory Present a FREE Seminar:

"Common Treatable Sleep Disorders in Women"

Having trouble sleeping? You’re not alone! In this free seminar, Meredith Cousin, MD, a neurologist and sleep disorders specialist with JWM Neurology will talk about conditions that
influence sleep patterns and keep you from waking up rested. From sleep apnea and Restless Legs Syndrome to insomnia and hormone/pregnancy-related sleep issues, you’ll learn about common sleep disorders that can be treated.

Holder Mattress experts will demonstrate the correlation between a properly constructed mattress and a good night's sleep.

• Thursday, May 21st
• 6:00 p.m.
• Holder Mattress Factory:
1422 S. Rangeline Rd., Carmel, IN
(116th St. and Rangeline Road)

Space is limited so please R.S.V.P.

• Holder Mattress 317-848-2939
• JWM Neurology 317-308-2828, ext. 1604

Refreshments will be served.

Common Questions About CPAP

If you’ve been diagnosed with sleep apnea, chances are good that you have been told to wear a CPAP mask while you sleep in order to treat the condition. CPAP is an acronym that stands for Continuous Positive Airway Pressure. Typically, a face mask is connected to a pump and forces air into the nasal passages to stimulate proper breathing.

Here are some common questions our sleep disorders physicians are asked about CPAP along with their answers. If you are having trouble with your CPAP be sure to speak to your physician. Many sleep disorders labs have regularly scheduled CPAP clinics where patients can go and get their problems worked out.

My CPAP mask is uncomfortable and does not fit properly. What should I do?
Often times, patients have to try out a few different masks before they get a proper fit. Masks can also be individually adjusted to fit comfortably. If you are having problems contact your health care provider to see what can be done.

Is there one CPAP mask that fits all people?
No, unfortunately there is not. Everyone’s facial shape and features are different, therefore there are a variety of masks available. It’s important you find the right one with the proper fit to ensure you are able to wear your CPAP consistently.

Do I need to wear my CPAP every night?
Consistency is the key in treating disorders such as sleep apnea. Therefore, it’s important to wear your mask every night. The more you wear it, the more you’ll get used to sleeping comfortably. Sleep apnea actually causes you to stop breathing several times during sleep and is therefore a very dangerous condition. It can cause stroke or heart attack if left untreated.

My throat gets dry when I use my CPAP. Is this normal?
Yes, this is a common complaint. Many CPAP machines come with a humidifier control which helps control dry mouth. If your particular model does not have this function, ask your health care provider about upgrading or trading in your machine.

How long will it take my CPAP to become effective?
Everyone is different, however, it can range from several weeks to a few months. It all depends on your diagnosis. The key is to wear your CPAP every night (or day if you are a shift worker) once you’re fitted. It will be uncomfortable and awkward at first, but once patients get into the habit, it becomes a routine part of sleep hygiene.

Pregnancy and Sleep

Pregnant and sleeping for two or more? If so, your sleep quality may change – especially by your third trimester.

Increased sleep complaints during pregnancy are often due to endocrine and physiologic changes in the body. The increase in progesterone that accompanies pregnancy naturally increases fatigue, raises body temperature, increases respiratory rate and intensifies the need for frequent urination. Physical changes such as the increase in abdominal mass and vascular load all lead to poor sleep quality.

Often during the first trimester, there is an increase in total sleep time and the need for naps; however, sleep quality can be poor due to frequent awakenings during the night.

Initial changes in sleep patterns typically occur in the first 12 weeks of pregnancy and then increase during the third trimester and early postpartum weeks. Be aware of:

• slight decreases in Rapid Eye Movement (REM) sleep
• decrease in deep sleep
• decrease in sleep efficiency
• increased awakenings after initially falling asleep

Women who have never before snored may begin to do so when pregnant. Snoring in expectant mothers is caused from inflammation in the nasal passages. This can lead to Obstructive Sleep Apnea, caused by a blockage in the airway, which is a very dangerous condition. It can cause death if not treated.

A condition known as Restless Legs (RLS) can also develop during the third trimester of pregnancy which causes an uncontrolled urge to move the legs. A contributing factor often may be iron or folic acid deficiency, so be sure to tell your doctor if you have these symptoms.

The best tips for a good night’s sleep when expecting: learn to relax utilizing breathing and other relaxation techniques. A warm shower or bath may also be helpful.

Why Do My Hands Shake?

Essential Tremor is a common neurologic disorder affecting millions of people. It is not a dangerous condition, however, while it is not life-threatening, those who have tremors may feel self-conscious, and the tremors may make it difficult to perform everyday activities. It generally affects adults over the age of 65, but there are cases of Essential Tremor in youth.

Symptoms may include any of the following:

1. Parts of your upper body, (such as the head, hands, voice, eyelids, and arms) shake uncontrollably, and worsen when performing tasks such as holding a glass, talking, eating, writing.
2. Shaking worsens with stress and caffeine intake.
3. Shaking diminishes while resting, and disappears during sleep.
4. Family members may have a history of tremor.

There is currently no test to pinpoint Essential Tremor. MRIs and other scans usually are normal. Your neurologist can rule out other possible causes of tremors, such as side effects of certain medications you may be taking or other underlying medical conditions.

Currently there is no cure, but if you find that your tremors are making your everyday tasks difficult, medications are available to alleviate the tremors. There are also techniques you can use to reduce stress – which may help lessen the severity of symptoms. Surgery is also an option for severe cases. However, if you experience other symptoms in addition to the tremors, you should contact your physician immediately.

Sleep and Menopause, An Imperfect Match

If you’re among the 40-50 million women in America going through menopause, your sleep quality may not be what it once was. At least 40% of women suffer sleep problems resulting from menopausal-related symptoms. Here are some interesting statistics that may affect you. According to the National Sleep Foundation, as many as 61% of menopausal and post-menopausal women polled reported frequent insomnia. Most women also find that the time between turning out the lights and actually falling asleep is increased during menopause. About 20% of women in menopause sleep less than 6 hours a night. These issues, along with frequent arousals throughout the night, can cause fatigue.

Why does sleep quality lessen with menopause?

Decreased production of estrogen is the culprit for many symptoms of menopause, including hot flashes. Menopausal women often have difficulty with sleep efficiency because hot flashes cause frequent awakenings during the night. Most women may experience hot flashes for about a year, but 25% can experience them for up to 5 years.

Snoring, which can lead to Obstructive Sleep Apnea (OSA), is also more prevalent and severe in post-menopausal women. With OSA, breaks occur in your breathing while you are asleep. It’s a very serious but treatable sleep disorder and one which you should speak to your physician about right away.

How can you sleep better?

There are solutions your physician can recommend to help you sleep better. Hormone Replacement Therapy (HRT) at low doses can help minimize symptoms of menopause and therefore lessen the effects on poor sleep. However, there are associated risks, and your doctor can decide if this treatment is right for you. There are other medications and supplements he/she can prescribe as well.

The best things you can do on your own to help you sleep better during menopause are:

1. exercise regularly, but never within a few hours of bedtime,
2. avoid heavy, spicy or acidic meals, alcohol, nicotine, and caffeine before bedtime,
3. wear lightweight clothes to bed, and
4. control your nighttime environment with comfortable temperatures. For example, use a fan to help circulate the air.

If your symptoms become uncomfortable, you cannot find ways to help yourself sleep better, or if you start to have feelings of depression or anxiety, contact your physician to map out a plan.

Recognize the Risk Factors for Stroke and Stroke Symptoms

There are many risk factors for stroke, including high blood pressure, cigarette smoking, age, family history of stroke, and gender. Unfortunately, strokes affect men and women at any age, not just the elderly. Although more men get strokes than women, the death rate for women is much higher than for men. Women, especially under the age of 55 can have additional risk factors for stroke that may include:

- Having migraines accompanied by flashing spots or blind spots,
- Having diabetes, lupus or other autoimmune diseases,
- Having had a miscarriage or some other clotting disorder,
- Taking birth control pills, even if the pills are low in estrogen, and
- Using hormone replacement therapy.

What symptoms do you need to recognize if you believe that a loved one may be having a stroke? To easily identify common symptoms in both men and women, ask the person to:

1. Smile. Look to see if one side of the face droops.
2. Raise both arms. Does one arm hang downward?
3. Repeat a simple sentence. Are they slurring words? Can they repeat the whole sentence?
4. Do they experience difficulty seeing in one or both of their eyes?
5. Do they experience a severe headache and not know why?
6. Do they have trouble walking or keeping their balance?

Sometimes women may have additional possible stroke symptoms which can include:
- Hiccups
- Nausea
- Face and limb pain
- Chest pain
- Shortness of breath
- Palpitations
- General overall weakness

If you suspect you or your loved one is having a stroke, call 9-1-1 immediately. Time is a critical factor. The longer you wait, the more serious the consequences.