New Bridges Outpatient Rehabilitation Center
(757) 455-8283
www.newbridgesorc.com
3500 Virginia Beach Boulevard
Suite 410
Virginia Beach VA 23452

Rehabilitation Services

Primary Focus: Substance abuse treatment services
Services Provided: Substance abuse treatment
Type of Care: Outpatient
Special Programs/Groups: Adolescents

Retinoids Topical Acne Treatment

Retinoids are a group of medications that normalize the follicle cell lifecycle. There are topical retinoids such as tretinoin (brand name Retin-A), adapalene (brand name Differin) and tazarotene (brand name Tazorac). Like isotretinoin, these medications are similar to vitamin A, but they are topical treatments and generally have much milder side effects. However, they can cause significant irritation of the skin. The retinoids appear to influence the creation and death lifecycle of cells in the follicle lining. This helps prevent the hyper-keratinization of these cells that can create a blockage. Retinol, a form of vitamin A, has similar but milder effects and doctors prescribe because it also contains moisturizers. Doctors have prescribed topical retinoids for over 30 years, but are not available over the counter, so they are not as widely used as other topical treatments. Topical retinoids often cause an initial flare up of acne and facial flushing.

How Are Sleep Disorders Diagnosed?

Depending on symptoms, some doctors will gather various kinds of information and consider several possible tests when trying to determine a sleep disorder, including:
Sleep history and sleep log. A doctor will ask how many hours a person sleeps each night, how often the person wakes during the night and for how long, how long it takes to fall asleep, how rested a person feels upon waking up and how sleepy a person feels during the day. A doctor may ask subjects to keep a sleep diary for a few weeks. A doctor may also ask if there are any symptoms of sleep apnea or restless legs syndrome, such as loud snoring, snorting or gasping, morning headaches, tingling or unpleasant sensations in the limbs that moving or jerking relieves during sleep. A sleeping partner may respond to some of these questions about symptoms, as some people are not aware of them.
Sleep recording in a sleep lab (polysomnogram). A sleep recording refers to a polysomnogram or PSG test that occurs in a sleep center or sleep laboratory. Subjects will likely stay overnight in the sleep center with electrodes and other monitors placed on the scalp, face, chest, limbs and finger. While sleeping, these devices measure brain activity, eye movements, muscle activity, heart rate and rhythm, blood pressure and how much air moves in and out of the lungs. This test also checks the amount of oxygen in the blood. A PSG test is painless. In certain circumstances, people can take the PSG at home. A home monitor can record heart rate, how air moves in and out of the lungs, the amount of oxygen in the blood and the breathing effort.
Multiple Sleep Latency Test (MSLT). Particularly useful for diagnosing narcolepsy, this test measures how sleepy a person is during the day. In this test, typically conducted after an overnight sleep recording (PSG), monitors sleep stages with devices placed on the scalp and face. Subjects nap 4 or five 5 for 20 minutes every 2 hours during times in which a person would normally be awake. Technicians note how quickly a person falls asleep and how long it takes the person to reach various stages of sleep, especially REM sleep, during these naps. Normal individuals either do not fall asleep during these short designated nap times or take a long time to fall asleep. People who fall asleep in less than five minutes are likely to require treatment for a sleep disorder, as are those who quickly develop REM sleep during their naps.
It is important to have a sleep medicine specialist interpret the results of a sleep-monitoring test (PSG) or MSLT.
A number of factors can make a person susceptible to sleep apnea. These factors include:

• Throat muscles and tongue that relax more than normal while asleep
• Enlarged tonsils and adenoids
• Being overweight--the excess fat tissue around the neck makes it harder to keep the throat area open
• Head and neck shape that creates a somewhat smaller airway size in the mouth and throat area
• Congestion, due to allergies, that can also narrow the airway
• Family history of sleep apnea

Some of the ways to help diagnose sleep apnea include:

• A medical history that includes asking family members questions about the quality of sleep and how daily functioning
• Checking the mouth, nose and throat for extra or large tissues, for example tonsils, uvula (the tissue that hangs from

A Multiple Sleep Latency Test (MSLT), usually done in a sleep center, helps determine quickly a person falls asleep at times when one would normally be awake. Falling asleep in only a few minutes usually means that a person is very sleepy during the day. Being very sleepy during the day can be a sign of sleep apnea.
Once a person completes all these tests, the sleep medicine specialist will review the results and work to develop a treatment plan. Changes in daily activities or habits may help reduce symptoms:

• Instead of sleeping on the back, sleep on one side. Sleeping on one side will help reduce the amount of upper airway collapse during sleep.
• Avoid alcohol, smoking, sleeping pills, herbal supplements and any other medications that cause sleepiness. These substances make it harder for the airway to stay open while sleeping and sedatives can make breathing pauses longer and more severe. Tobacco smoke irritates the airways and can help trigger the intermittent collapse of the upper airway.
• If a person is overweight, he or she should try to lose weight. Even a little weight loss can sometimes improve symptoms.

These changes may be all that are needed to treat mild sleep apnea. However, if a person suffers from moderate or severe sleep apnea, additional, more direct treatment approaches may be helpful.