Pittsfield — Imagine going to bed at night and waking up hours later to find yourself behind the wheel in the middle of a big city.
Its symptoms are associated with extreme sleepwalking. But that’s just one of the problems Dr. David Allberg faces in his 21-year practice as a certified sleep specialist.
The Montreal native is now director of the Sleep Disorders Center at Berkshire Medical Center in Pittsfield, continuing work started by Jack Ringler, the former doctor who first brought sleeping pills to Berkshire in the 1990s.
We spoke to Olberg about his profession, why he does it, why it matters, and what to look for if you think you might be in it.
Eagle: What is a sleep specialist?
Elberg: I am a pulmonologist (a doctor who specializes in the respiratory system). Sleep apnea is the most common sleep disorder. This is a breathing disorder, which is why pulmonologists have become the most sought-after sleep specialists. The majority of sleep specialists in this country are pulmonologists.
Eagle: How did you become a sleep specialist?
Elberg: My interest came when I was doing breathing training at the Mass General in Fellowship. The job I was looking for in Connecticut at the time (Mr. Olberg worked at Danbury Hospital before moving to Berkshire in 2018) was looking for someone who knew a lot about sleep. So I did informal sleep training at the end of my training. This dates back to his 90s (he started his fellowship in 1994) and I literally completed it while working in Connecticut. I was trained under an expert in Connecticut, so I was able to combine that with a fellowship. Now I have to do a one-year sleeping pills specialty fellowship.
The Eagle: Why did you want to be?
Elberg: Well, sleep disorders are very common, most people have sleep problems, and many of them are treatable. I have found it very interesting and exciting to be with a group of patients who have some of the treatments I offer to improve their quality of life.
My respiratory specialty was based on a lot of physiology. I was a pulmonary specialist. When I went to apply for this job in Connecticut, I was told that there were a lot of sleep patients and that was part of the physiology. After going back and training, I became addicted to sleeping pills.
Eagle: How did you fall in love?
Elberg: Well, it’s a very diverse patient population. What you’re dealing with is a set of very common problems, we’re dealing with breathing and insomnia. We are dealing with something called parasomnia, people who have more than typical insomnia. We deal with night terrors, sleepwalking, and sometimes quite elaborate sleepwalking. Some patients wake up while driving. There was a patient who woke up in downtown New York.
Eagle: Wow. How does that happen?
Elberg: That’s a complicated explanation. They are not completely asleep, but they are close to sleep.
Then there is narcolepsy. This is a very unusual problem of excessive daytime sleepiness, and it also has some interesting symptoms. These situations went unrecognized for years, if not decades. Patients have been misdiagnosed with depression and other mental illnesses, and actually suffer from a true sleep disorder. So it has a lot of physiological functions.I have always been interested in physiology
Coming from an engineering background (Olberg majored in engineering at McGill University in Montreal before attending medical school there), physiology seemed more intuitive to me than microscopes and cells. I was always into physiology.
Eagle: How did you get into engineering and eventually into medicine?
Elberg: In high school, I was good at math and physics. Engineering was a profession with fairly stable job opportunities. But while doing engineering, part of it was biomechanical research, which sparked my interest in medicine. Then I decided that I would rather see patients than be in the lab.
So I spent all my chosen time in my last year of engineering in pre-med classes, biology, biochemistry, physiology, and then applied for medicine. I was not a medical class engineer. There were 3 other engineers. My roommate was one of three others. Engineers unite.
Eagle: How did sleeping pills start?
Elberg: It was not until the 1980s that it was introduced into the medical field. It started as a science. Most of it happened in the Stamford and San Francisco areas of California. Researchers began studying people’s sleep and began to realize that there were quite a few sleep disorders prevalent that we never knew existed. They discovered this by placing electrodes on the scalp and noticing that they could see brain waves. Then you can start measuring your sleep. From there, I learned that people were having trouble breathing. They stop breathing when they sleep, this is called sleep apnea.
Eagle: An estimated 50 to 70 million Americans have some form of sleep disorder. How common is it?
Elberg: I’d say about 5 percent of people with sleep apnea, 5 percent of adults. This value is significantly higher in a specific subset, namely those who weigh more. [body] The mass index is older and male. However, sleep apnea can also occur in children. This is across all age groups, but peaks in the 40-70 year old male category.
Eagle: So why peak?
Elberg: This could be a change in body shape, but I suspect it has a lot to do with weight. Women catch up in the postmenopausal period because hormones have a protective effect. A decrease in these hormones increases the ability to have sleep apnea. In children, tonsils, enlarged tonsils, and short jaws are the main causes, resulting in blockage over a wider area of the throat.
Eagle: How do sleep disorders centers treat people?
Elberg: We are evaluating and following up our patients. I’ll follow up with any suggestions. When we need treatment for sleep apnea, we mostly use some kind of her CPAP machine, a positive pressure machine. Its equipment has become much more sophisticated over the past two decades. The biggest change is probably Auto CPAP, where the machine measures airflow obstructions and can dial up or down pressure through an internal algorithm.
Treatment for the most common type of sleep apnea has come a long way.of [CPAP machines] Now they all have modems inside, so data is saved. It was originally meant to contain data, but now it gives us even more. They can tell how well you are using it. Whether you need to adjust your machine for mask fit or pressure range, you can troubleshoot your program. Patients can now open the app and know their sleep status. Machines did the work for them.
Eagle: So this means people shouldn’t ignore it?
Elberg: No, not just because you feel tired. Sleep apnea is associated with high blood pressure, heart disease, stroke, kidney disease, and may even be implicated in diabetes. So for your bed partner, it’s not just a symptom of fatigue or trouble breathing. Their health is more important than that.
Eagle: What advice would you give to someone who wants to become a sleep specialist?
Elberg: I may be biased, but I think this specialty is a great one that gives me the leeway to care for a wide variety of medical problems, most of which are treatable. For me, it’s just an added dimension to the other areas I specialize in.