When COVID 19 and its myriad effects gripped the nation in March, Dr. Adrian Pristas and the staff at Hackensack Meridian Health’s Sleep Center witnessed a sharp increase in sleep disorder complaints.

“Undoubtedly, coronavirus caused a lot of grief to a lot of people,” the corporate medical sleep director at Hackensack Meridian Health Center for Sleep Medicine noted. “People were obsessing about getting sick, fearing for their friends and family, and experiencing an unprecedented level of solitude because they were doing the right thing and staying home. Stress of any kind can lead to a bad night’s sleep and because stress was so magnified these past several months, we, as sleep professionals, have seen an incredible uptick in sleep disorders.”

People strayed from their healthy habits, and sleep schedules were disrupted by abnormal work from home schedules, Dr. Pristas explained, noting how diet, exercise, and routine are an important part of overall sleep health.

“Sleep is not just about putting your head down on the pillow,” said the doctor. “You have to do lot of things right so that sleep happens. And insomnia and other sleep related issues start with just a few bad nights. If you don’t undo small sleep issues from the start you could be destined for a larger problem initiating a lifetime of bad sleep.”

As a practicing pulmonologist and sleep specialist, Dr. Pristas has diagnosed and treated many COVID related illnesses since March, each of which had a significant impact on the patient’s sleep patterns.

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“COVID is no different than any other illness in that you have to sleep to recover,” he said. “Your body recovers while it’s sleeping, so it’s very important in the recovery stage of any illness to eat right, sleep right, and de stress your system to get back on track.”

Dr. Pristas should know. A pulmonary disease specialist with more than 25 years of experience, he became connected to sleep medicine early in his training, enamored by the subspecialty because it involved nearly every aspect of medicine. In addition to serving as Hackensack Meridian Health’s corporate medical sleep director, he also chairs the network’s sleep group which works collectively to diagnose and treat disorders across eight sleep labs in the system.

“We have a wonderfully refined sleep network here which is unique because of its size,” said Dr. Pristas, referring to Hackensack Meridian Health’s large sleep program which features a specialized pediatric division as well as its own fellowship program. “We are a well-seasoned team of sleep doctors with a lot of experience. We are highly tuned into academics and currently in the midst of launching a software platform which allows our labs to talk to each other, sharing research and data collection. Our goal is to give New Jersey residents the opportunity to get a better night’s sleep.”

In achieving that goal, Dr. Pristas is joined by Dr. John Villa, director of the Institute of Sleep/Wake Disorders at Hackensack University Medical Center.

“The technology involved in our sleep studies has improved dramatically over the past several years,” noted Dr. Villa. “I’m dating myself, but I can remember doctors having heated discussions about the benefits of computerized sleep studies vs. the original paper polysomnograms. Those tests were a pile of paper four or five inches thick that were scored by hand, very cumbersome. Today everything is detected and read by a computer. Our equipment is smaller and sleep studies can actually be performed in the comfort of the patient’s home. It really is a game changer for the entire division of sleep medicine.”

Similar to testing at a sleep center, at home testing devices monitor information such as your sleep patterns, blood oxygen, heart rate, chest motion, and body movement and positions. There are a number of qualifying factors for an at home study and eligibility is determined by your physician based upon your health history. The equipment is shipped directly to your home and can be disposed of after use. Dr. Villa noted it is a great resource to assess sleep patterns, especially during this current pandemic.

“Home sleep testing is cost effective and safe during COVID,” said Dr. Villa. “We embraced it years ago at Hackensack Meridian Health and while we still need the lab for complex cases, it is a wonderful way for patients to get tested from the comfort of their own homes. Patients who have significant cardiac, pulmonary, or neuromuscular disorders should be monitored in the lab and if a patient cannot perform the home sleep test because of lack of ability to apply the device, that is a reason to test in the lab as well. But for many qualified candidates, the at home sleep study is a perfect fit.”

In the future, Dr. Villa foresees studies simplifying even further, possibly monitored by smart phones and watches.

“Right now the Fitbits and Apple watches are decent surrogate markers of sleep habits,” said the specialist. “People are coming to us, telling us that the watch indicates a bad night of sleep, and it usually confirms symptoms that the patient is complaining about. The watches provide a small amount of information, but they are reliable. It’s pretty fascinating what technology can do.”

Treating disorders such as sleep apnea, chronic insomnia, and narcolepsy which can cause serious health effects and interfere with your daily activities Hackensack Meridian Health’s Sleep Center also specializes in treating pediatric sleep disorders which can present as obstructive sleep apnea, restless leg syndrome, or difficulty falling or staying asleep. Dr. Pakkay Ngai, the medical director at Palisades Sleep Wake Center, says those disturbances are extremely treatable once they are diagnosed.

“Predominantly, my patients are children who have medical and behavioral sleep problems,” noted Dr. Ngai. “I see my share of infants who are having trouble sleeping enough hours, and there’s also a good number of snoring children who potentially need surgeries to remove their tonsils and adenoids. Most recently our team has been diagnosing and treating a subset of teenagers who are having difficulty sleeping because as they gain more independence there is less regulation of their sleep patterns and more usage of devices and social media.”

Referencing the National Sleep Foundation’s guidelines, Dr. Ngai said teens should achieve eight to ten hours of sleep each night but with the advent of electronics and their disruption of melatonin production that is not always the case.

“Diagnosis and treatment of the teen patient population starts with a review of their sleep hygiene and environment. The bedroom should be cool, dark, and absent of electronics. Even a clock radio can cause a disturbance. Ideally the last caffeinated beverage should be taken no later than 3 p.m. and the temptation to go to sleep and wake up later on the weekends should be avoided. At any age, it’s very important to be regular and consistent with sleep.”

It’s those types of statistics that are being studied and applied at Hackensack Meridian Health’s sleep medicine fellowship.

“We have a very vibrant and dynamic learning environment here in which we offer treatment, research, and education regarding sleep disorders. The field of sleep disorders, I believe, is the best kept secret in medicine,” noted Dr. Divya Gupta, director of the Sleep Center at JFK Medical Center and head of the Sleep Medicine Fellowship Training Program at Hackensack Meridian Health. “The diagnosis and treatment of sleep disorders results in a significant improvement in the patients’ quality of life and reduces their risk for cardiovascular diseases such as heart attack and arrhythmias. It is so gratifying to help someone overcome this type of problem.”
Approved by the Accreditation Council of Graduate Medical Education and the American Academy of Sleep Medicine, Hackensack Meridian Health’s Sleep Medicine Fellowship Program at JFK Medical Center offers two positions per year. Multi-disciplinary board certified faculty provide training in respiratory, neurological, and behavioral disorders of adult sleep medicine with exposure to pediatric sleep medicine during the one year fellowship.

“Our students are able to see to a wide variety of cases everything from sleep apnea and movement disorders to narcolepsy and behavioral sleep issues,” said Dr. Gupta. “Our fellows learn in a state of the art digital sleep lab and learn about the latest treatment advances such as implantable devices for sleep disordered breathing that are available within the HMH network. They discuss their clinical approach on how they would develop testing and treatment plans for the patient. They are able to refer patients to experts in the community when needed for dental appliances or insomnia therapies.”

Fellows also sit in on lectures on a weekly basis that prepare them for their sleep medicine board exams.

“It’s a comprehensive training program that really sets our sleep center apart from others,” explained Dr. Gupta. “Not only do we offer a strong academic environment, we also are preparing a new generation of doctors who can practice sleep medicine in the community, assuring the continued improvement of sleep health in our population.”

Hackensack Meridian Health Center for Sleep Medicine
30 Prospect Aveune / hackensackmeridianhealth.org