About Dr. Pathial

 Dr. Kishore Pathial, has been practicing Pulmonary, Critical Care and Sleep Medicine in Yamhill County for the last twenty years having moved here with his young family from Green Bay, Wisconsin.  Prior to that he had completed his fellowship training in Pulmonary and Critical Care Medicine at the Medical College of Wisconsin, Milwaukee, WI. 

 

He has been Board Certified in all these disciplines and strives to maintains his training at the highest level to provide the best possible patient care.

 

He has been recognised for his commitment to his profession by being elected as a Fellow of American College of Chest Physicians (FCCP) and as a Fellow of American Academy of Sleep Medicine (FAASM)

 

He has served in many capacities of the Medical staff of Willamette Valley Medical Center, McMinnville, including Chief of Medical Staff.  He and his family are actively involved in the local community. He strongly believes in giving back to the community as being a core of his beliefs and guiding value of his practice of medicine and life.One of his passions remains tennis and other sports and he continues to actively participate and enjoy sports very much. He loves living in this area and truly believes that this is one of the most beautiful places in the world.

 

Obstructive Sleep Apnea (OSA) and Snoring

Sleep apnea affects some 18 million people.  According to National Sleep Foundation's 2002 Sleep in America poll, about 1 in 10 adults reported experiencing some pauses in breathing during sleep.  Snoring can be a symptom of sleep apnea.  About 59% of adults said they snore, according to the same poll.  About 1/4 of those who snore do so every night or almost every night.   In sleep apnea, the airway of the snorer closes and he/she must wake up to resume breathing. This cycle may repeat hundreds of times during the night, resulting in severe daytime sleepiness.

What are the risks to my health from Sleep Apnea?

  • Diabetes
  • High Blood Pressure
  • Stroke
  • Heart Attack
  • People with untreated sleep apnea are 2-7 times more likely to have automobile crashes than the general population.

What are some of the signs of Sleep Apnea?

  • Loud Snoring
  • Snoring accompanied by snorts, gasping or choking noises
  • Snoring with pauses
  • Daytime Sleepiness
  • Changes in alertness, memory and interest in daily activities
  • Irritability and/or Depression
  • High blood pressure (when found in combination with the above symptoms)
  • Accidents or near misses related to sleepiness

Who is at risk for having Sleep Apnea?

  • Males: twice as likely as females
  • Primarily men and women in the 30-50 age bracket
  • Obese individuals or those more than 20% over their ideal weight
  • Individuals with difficulty breathing through their noses
  • Children or adults with enlarged tonsils
  • Children who are obese

Is there anything I can try to help with my snoring?

  • Lose Weight
  • Drink only in moderation and avoid alcohol within two hours of bedtime
  • Avoid sleeping pills and other medications, which make you sleepy
  • Sleep on your side
  • Treat nasal congestion. Ask your doctor or pharmacist for their recommendations
  • Avoid extreme fatigue
  • Stop smoking

How is Sleep Apnea diagnosed?

The diagnosis of this disorder requires an overnight sleep study. For more information, see our page on diagnostic testing.

How is Sleep Apnea treated?

  • CPAP (Continuous Positive Airway Pressure): In this highly effective therapy, a mask is worn over the nose during sleep. Pressure from an air compressor enters the nasal passages and airway. This gentle pressure holds the airway open and allows the person to breathe normally.
  • Oral Appliances: Devices that may help some apnea patients are designed to open the airway by bringing the jaw, tongue and soft palate forward.
  • Surgery: There are surgical procedures designed to correct abnormalities of the upper airway. These abnormalities may include enlarged tonsils or adenoids, nasal polyps or other growths, a deviated nasal septum and malformations of the jaw or soft palate. In one common procedure excess tissue at the back of the throat may be removed. An evaluation by an Ear, Nose and Throat specialist is necessary to determine if you are a candidate for any of these surgical procedures.
  • Oxygen: This is rarely needed for the treatment of Sleep Apnea alone. Oxygen, however, may be added to the nasal CPAP system to correct for low oxygen levels due to existing lung or heart disease.
  • Medication: This is generally of limited benefit for sleep apnea sufferers.
  • The suggestions above for treatment of snoring also pertain to people with Sleep Apnea.

Always follow rules of Good Sleep Hygiene.

Understanding Polysomnograms - Sleep Studies

What is a Polysomnogram, a Sleep Study, or PSG?

A Polysomnogram (PSG) is a multi-channel recording during sleep. Your doctor, physician or sleep disorder specialist may order polysomnography because of complaints about ailments like daytime fatigue or sleepiness that may be from troubled, problematic and/or interrupted sleep. Polysomnograms are ordered to diagnose, or to rule out, acute obstructive sleep apnea. PSGs can be accomplished during the day or night but most sleep studies are done at night because that's when most people normally have their sleep periods. Shift workers can be accommodated in some labs by having the test at other times - a good lab wants to ensure the testing is done during the patient's normal sleep time and not disrupt the patient's sleep periods.

 

What to expect during a Sleep Study

Normally the patient comes at a sleep lab in the early evening, and is introduced to the lab environment over a 1 or 2 hour period. Then the patient is "geared" so that multiple channels of data from the brain and body can be recorded after the patient falls asleep. To make the patient more comfortable, Yamhill Valley Pulmonary and Sleep Center is designed in an enviroment that is much like a home would be. A trained sleep technician is always in attendance and is responsible for attaching the electrodes to the patient and monitoring the patient during the study.

 

Different Types of Sleep Studies

 

Polysomnogram (overnight study).

A polysomnogram, or PSG, is the most reliable test used to diagnose certain sleep disorders. It measures abnormalities in the sleep cycle. This test can also help to rule out that the person’s symptoms stem from another medical condition. As mentioned above, the test is an overnight study that is very easy to have done; there is virtually little or no discomfort. Electrodes are placed on the skin and scalp. These electrodes are then connected to recording equipment to monitor and record the following body functions during sleep: airflow and respiratory effort, blood oxygen levels, heart rate, electrical activity in the brain, eye movement and muscle movement.

 

Multiple Sleep Latency Test (daytime study).

A multiple sleep latency test, or MSLT, is conducted, along with a polysomnogram, to confirm or rule out narcolepsy. This test is performed during the daytime and monitors a series of naps to reveal a person’s severity of sleepiness and whether REM sleep (deep sleep during which a person dreams) intrudes inappropriately throughout waking hours. This test is usually done immediately after an overnight study (PSG). You will remain wired with most of the wires from the polysomnogram done the previous night. Typically, a series of five naps are taken at two-hour intervals. The test is usually finished by late afternoon or 5:00pm There is little or no discomfort from the MSLT.

 

Positive Airway Pressure (PAP) Titration (overnight study).

A Positive Airway Pressure (PAP) titration study is an overnight sleep study that is for treatment rather than diagnosis. When you come in you are tested and fitted for a PAP mask and then hooked up to the polysomnography equipment. During the night the pressure of the air coming from the CPAP or BPAP machine is gradually increased until your breathing is normalized and your correct CPAP or BPAP pressure has been determined. You will be briefly trained that night for proper use and care of your PAP machine and for understanding how it helps you. Once patients become accustomed to the use of a CPAP/BPAP device they typically find a much better night's sleep.

 

Maintenance of Wakefulness Test (daytime study).

A Maintenance of Wakefulness Test, or MWT, is conducted along with a polysomnogram to determine your level of daytime sleepiness after treatment for narcolepsy or sleep apnea. This test is generally used for commercial drivers, pilots and people who work around heavy equipment to ascertain ability to perform their job safely. This test is normally provided immediately after an overnight study. You will remain wired with most of the wires from the polysomnogram performed the previous night. A series of four “naps” are taken at two-hour intervals. Each nap requires the patient to sit in a chair for 40 minutes and try to remain awake. The test is usually done by late afternoon, or 5:00pm, and there is little or no discomfort for the patient.    

About Dr. Pathial

 Dr. Kishore Pathial, has been practicing Pulmonary, Critical Care and Sleep Medicine in Yamhill County for the last twenty years having moved here with his young family from Green Bay, Wisconsin.  Prior to that he had completed his fellowship training in Pulmonary and Critical Care Medicine at the Medical College of Wisconsin, Milwaukee, WI. 

 

He has been Board Certified in all these disciplines and strives to maintains his training at the highest level to provide the best possible patient care.

 

He has been recognised for his commitment to his profession by being elected as a Fellow of American College of Chest Physicians (FCCP) and as a Fellow of American Academy of Sleep Medicine (FAASM)

 

He has served in many capacities of the Medical staff of Willamette Valley Medical Center, McMinnville, including Chief of Medical Staff.  He and his family are actively involved in the local community. He strongly believes in giving back to the community as being a core of his beliefs and guiding value of his practice of medicine and life.One of his passions remains tennis and other sports and he continues to actively participate and enjoy sports very much. He loves living in this area and truly believes that this is one of the most beautiful places in the world.