Sarah Nath Zalleck, M.D., is a neurologist with Central Illinois Neurosciences in Peoria. She received her undergraduate degree from the University of California at Santa Barbara before going on to Rush Medical College in Chicago to earn her M.D.  After serving her internship at MacNeal Hospital in Berwyn, Zalleck went on to the University of Michigan for her residency and fellowship.  She came to Peoria from Michigan in July 1998.While at the University of Michigan, Zallek gave lectures on neurology and sleep medicine for the departments of neurology and internal medicine, as well as giving instruction in neurologic examination and teaching a course for medical students.Zallek is currently involved in examining the role of sleep apnea in cluster headaches.  She shared a grant that funded the research from 1996 to 1998, and works with the University of Michigan General Research Center in an ongoing clinical study in the same subject area. Zallek is currently holding active medical licenses in both Michigan and Illinois; she is a member of the National Board of Medical Examiners, the American Board of Neurology and Psychiatry, the American Board of Sleep Medicine, and the American Board of Clinical Neurophysiology.

Tell us about your background—schools attended, family, etc.

I grew up in Peoria Heights and graduated from Bergan High School in 1983.  I went to college at the University of California at Santa Barbara, and medical school at Rush Medical School in Chicago.

I completed a residency in neurology and a two-year fellowship in sleep disorders medicine at the University of Michigan in Ann Arbor.

I have one sister, Heather Nath O’Connor, an anesthesiologist in Chicago.  My mother, Sylvia Nath, lives in the Peoria area, and my father Robert Nath live sin Albuquerque, N.M.  I am married to Chris Zallek, who is also a neurologist.

Your husband is also in the same field.  What are the pros and cons of working so closely with your husband?

We met in neurology residency training in Ann Arbor, moved to Peoria last summer, and got married last fall.  We now work in the same practice.  There are mostly pros very few cons.

We understand each other’s work very well.  We rely on each other’s knowledge and clinical judgement very often.  Although most of our day is spent apart seeing patients and doing our own work, we do see each other at times during the workday.  Working long hours often limits time at home, so lunch together can be a very nice part of the day.

The disadvantage of working in the same group is that we are tow of five who rotate on call, and we can never be on call the same night.  That makes the evenings and weekends fairly busy at times.

Who or what influenced your decision to enter medical school and to specialize in neurology and sleep disorders?

I had several influences that led me to medical school.  My parents encouraged both my sister and me to go as far in school as we could.

They were very supportive of our academic pursuits.

I also liked science in school, and thought medicine would be the best way to apply this.

My influence to study neurology was primarily from a neurologist in Chicago named Mel Wichter.  He made a complicated field very interesting, understandable, and enjoyable.  He also had a terrific way of talking to patients that made them trust him and understand what he was telling them.

When I was deciding on a specialty as a medical student, I wanted to choose something that affected a lot of people, had questions that still needed to be answered with research, and had some clinical treatment that could help patients today.

Sleep disorders are very interesting and affect a large number of people of all ages.  A great deal of research lies ahead in the field, but there are many very effective treatments available now.

My decision to study sleep came from this, and from the influence of Michael Aldrich, the director of the Sleep Disorders Center at the University of Michigan, and an excellent neurologist.

Are sleep disorder problems becoming more common in today’s society?

Yes.  Insufficient sleep is a growing problem as we expect to do more during our waking hours—and compromise sleep in turn.  We sleep about one hour less now than we did at the turn of the century.  Sleep apnea (stopping breathing during sleep) is more common in overweight people, and as we continue to become less active and more overweight, this becomes more prevalent.

Sleep disorders are also recognized much more often now.  More research is published every year, and sleep disorders are becoming better understood and recognized than ever before.  As treatments are continually developed and improved, recognition of sleep disorders is becoming increasingly important.

What are the more common symptoms indicating a person should seek a sleep evaluation?

Symptoms include excessive daytime sleepiness (sleepiness or drowsiness during the intended wakeful period).  This includes drowsiness while driving, sitting at rest while reading or watching TV, or even in more active situations.

It’s important to know that boring situations and relaxation do not cause sleepiness (they cause boredom and relaxation).  Snoring (especially if it is loud or frequent) can also be sign of a sleep disorder.

Kicking of the legs during sleep, which is more often recognized by the bed partner than the patient, can disrupt sleep (without the patient even knowing it) and lead to significant daytime sleepiness.

Restlessness in the legs that is usually worse in the evening or at night when the person is at rest, and is temporarily relieved by moving the legs, is called restless leg syndrome.

It can cause significant difficulty falling asleep, but may only cause evening discomfort without insomnia.

Other sleep problems include difficulty falling asleep or difficulty staying asleep for any reason.  There are many different causes of insomnia, and it is important to determine the underlying cause before treating the symptom.

Unusual or unwanted behaviors in sleep can also reflect sleep disorders that should be evaluated.  These include sleepwalking, acting out dreams, yelling or talking in sleep, and many other behaviors.

Explain excessive daytime sleepiness.  What are its causes and effects?  Is it common in today’s workforce?

Excessive daytime sleepiness (EDS) is feeling sleepy or drowsy during the times one would expect to be awake. 

If a person’s normal bedtime is 10 p.m., and rise time is 6 a.m., that person should not feel significantly drowsy or sleepy between those times.

Some causes of EDS include insignificant sleep, sleep apnea, periodic leg movements in sleep, narcolepsy, and insomnia.  Many other  causes exist, since anything that compromises sleep quality or quantity can lead to EDS.  It is very common in today’s workforce.

Unfortunately, it’s so common that many people think it’s normal to be sleepy at work.

How much do stress and anxiety contribute to sleeping disorders?

First, they can lead directly to insomnia.  People under stress often have trouble falling asleep or staying asleep.  They may also find they awaken much earlier in the morning than they would like.

Even after the source of the stress and anxiety may be gone, some people develop “conditioned insomnia” in which they cannot sleep well and sleep becomes a primary concern.  Often these people find it easier to fall asleep on the sofa or in a hotel room than in their own beds, and they literally “learn” not to sleep well in their beds.

This is a very treatable problem with a specific type of behavioral treatment that works to condition the person to sleep well in bed.

Stress and anxiety can also exacerbate some other sleep disorders, such as sleepwalking, grinding of the teeth, restless legs syndrome, and others.

What are some common treatments for sleep disorders?

Treatment depends on the diagnosis, and is usually effective.  Sleep apnea can be treated wit continuous positive airway pressure, a mask worn during sleep that fits over the nose to deliver pressurized air to keep the airway from collapsing.

This treatment is effective in 95 percent or more of the sleep apnea cases.  Other treatments for sleep apnea include special dental devices to reposition the jaw during sleep to reduce airway collapse (effective in about 70 percent of people with sleep apnea).

Surgery on the back of the throat can sometimes treat sleep apnea, but is only effective in about 40 percent of cases.  In children with sleep apnea, unlike adults, tonsillectomy is effective in about 85 percent of cases.

Weight loss may help but is not often effective on its own.  Positional therapy (keeping off one’s back, often by sewing a tennis ball into the back of the pajama top) is also not usually effective enough (even if the person seem to snore while on his or her back).

Treatment for insomnia depends on the cause, but rarely requires medication.  Keeping a good sleep routine is important, including going to bed when one is sleepy, but not significantly earlier.  A very regular rise time in the morning, seven days a week, can help set one’s “internal clock” (circadian rhythm). 

Avoidance of caffeine (even in the morning), and alcohol can be helpful.  Not looking at the clock when one cannot fall asleep is also a good principle.  If a good sleep routine is not an effective treatment fro insomnia, other causes must be identified.

Temporary sleep restriction is often used to concentrate sleep at night.  Elimination of all activities in the bedroom besides sleep and sex is important to help re-condition one to sleep in bed.

Restless leg syndrome and periodic leg movements (kicking in sleep) are usually treated with medication.  Several medications have been used for these disorders for many years, often with modest results.

A new medication (pramipexole), in a very low dose, has been shown in controlled research studies to be extremely effective, however, I have had excellent results in treating my patients with it.

There are other medications that are still options as well.  Also, for some, stopping caffeine and/or alcohol can significantly reduce restless legs. 

Methodist has the only accredited sleep lab in central Illinois and one of the largest in the nation.  How did it come to be located in Peoria?  How widespread is the problem?

The sleep lab at Methodist was started by Dr. C. Duane Morgan about 16 years ago.  Dr. Morgan has since passed away, but the lab has developed into a busy, accredited, comprehensive center over the years.

When I arrived last July, there were six beds (in individual rooms for sleep studies) and the lab was very busy.  We now have eight beds at Methodist hospital lab and two at the Methodist MedPointe facility in Morton.

Sleep disorders are very widespread and need specialized physicians, laboratory facilities, and technologists to provide proper diagnosis and treatment services.

Many people with sleep disorders (for example, most people with insomnia) do not need sleep laboratory testing.  They may only need to be evaluated by a sleep specialist physician.

Other people (for example, those suspected of having sleep apnea), need a physician evaluation and testing in the laboratory.  Having well-trained sleep laboratory  technologists and a well-equipped lab is essential in this setting.   Few labs in the country have as many beds or well-trained technicians and see as many patients as we do.

What has surprised you most in the area of sleep disorders?

Since I started training in sleep disorders, two things have surprised me the most.  First, most people with sleep disorders can be treated, usually without medication, and their symptoms generally resolve.  It’s a wonderful thing to see patients who are badly affected by their sleep disorder get relief through treatment and function fully in their daily lives.

Second, I am constantly surprised by how different sleep disorders are in individual patients.

I am always learning about different ways people are affected by the same disorders, and how greatly they can be affected.  Seeing patients get better with treatment for such a variety of conditions and the many ways they experience those conditions has been one of the best parts of doing what I do.

It has been said that drowsy drivers are as much a road hazard as drunk drivers.  Do you agree with the concept of policing for and ticketing drowsy drivers?

Drowsy drivers are definitely a road hazard.  We can’t even be sure of the prevalence of the problem because very few states have any system in place for the police to note whether “driver fatigue” (better termed drowsiness or falling asleep at the wheel) may have been a contributor to an accident.

But, it has been well demonstrated that sleep deprivation (either from insufficient sleep or from untreated sleep disorders) can make drivers even more impaired than if they had several alcoholic beverages.

Policing of drowsy drives is appropriate, but it is even more imperative that drivers are both educated about the dangers of drowsy driving and screened for sleep disorders.  Education of professional drivers, such as long haul truck drivers, regarding alertness while driving is very important.  Screening for sleep disorders in that group is also important (and easy and inexpensive, with a simple questionnaire).

Those who have signs of possible sleep disorders should be evaluated further.

The general public should also be much better educated about drowsy driving and should have simple screening available.  If we can prevent drowsy driving, policing will become less necessary.

What are some common misconceptions regarding sleep disorders?

Common misperceptions about sleep disorders include:

• Only overweight men have sleep apnea.  Many thin people have it, both men and women are affected, and children can have sleep apnea.
• Insomnia is not a disorder.  Insomnia affects 1/3 of the population, causes significant loss of work time and productivity, and can lead to many other problems.
• Insomnia should be treated with sleeping pills.  Most people with insomnia do not require medication.  In fact it is not helpful for most people, and other therapies usually are.
• Alcohol helps you sleep.  Alcohol does make one drowsy initially, but then disturbs sleep later on in the night. 
• Coffee in the morning doesn’t affect sleep at night.  Even one cup of coffee in the morning can change one’s sleep patterns at night.  For many people, this is not noticeable or problematic.  For people with insomnia, it could be a contributor.
• It’s normal to be sleepy after lunch.  Daytime sleepiness is not normal, even after lunch.  Our circadian rhythm—internal clock—does have a natural “low point” in the early-mid afternoon, so if one has a tendency to be sleepy, that is a likely time to experience it.  However, a normal, healthy sleeper should not get sleepy in the day—or evening much before bedtime.
• Sleep apnea is an inconvenience but not a serious disorder.  Sleep apnea not only predisposes people to serious or fatal accidents due to drowsiness, but it’s associated with high blood pressure, heart attacks, and strokes.
• “I can always tell when I am too drowsy to drive.”  Several studies have shown that we are not good at predicting when we are about to fall asleep, and we very often do not perceive when we have dozed off briefly.  This makes drowsy driving especially dangerous, and accidents unpredictable.

How would you encourage a woman to enter the medical field today?

I would encourage a woman to enter the medical field today by saying it is a very

satisfying and often meaningful job.  Medicine is a varied profession full of opportunities in research, teaching, and patient care.

I started out thinking I would want to do all three (as many students do) with an emphasis on research.  I found I liked working with patients so much, and have suck an interesting field of work, that clinical work is my focus now.

A woman entering medicine today still enters a field of mostly men, but there is now opportunity for women to succeed in medicine as they choose.

Women are represented in every field, and one can make her own choice about focus on research, teaching, and patient care.  It’s a wonderful profession.

What would you like to share with our readers about sleep disorders? 

Sleep disorders are very common and very treatable.  Most of us in medicine (including myself) learned little or nothing about sleep in medical school, which makes it hard to fully evaluate and treat sleep disorders without further training.

Many patients have symptoms for decades before they find evaluation and treatment. 

The field of sleep medicine is constantly growing, with new understanding of sleep disorders and their treatment learned every year.  Evaluation by someone qualified in the field usually leads to diagnosis and effective treatment.

Some sleep disorders can have long term consequences (for example, sleep apnea is linked to high blood pressure, heart attacks, and strokes), and getting treatment can be important for daily function as well as long term health.  TPW