At Cape Fear Valley, they have a good night’s sleep down to a science
Amita Shetty, M.D., and Sam Fleishman, M.D., will go the extra mile for their patients. Literally.
By Kim Hasty
Photography by Cindy Burnham
As a primary care physician in Lumberton, she noticed that she had many patients with sleep disorders that were affecting their quality of life. The nearest sleep clinic was in Fayetteville. Instead of referring her patients, she decided to give up her free time and make the drive herself, travelling from Lumberton to Fayetteville to shadow Sam Fleishman, M.D., at Cape Fear Valley Medical Center and learn more about sleep medicine.
“I was not looking to get into sleep medicine,” she said. “I came here because there were no sleep specialists around, and I wanted to take something back to my patients.”
Few had more impressive credentials than Dr. Fleishman. A Fayetteville native, Fleishman is board-certified in psychiatry and neurology/sleep medicine. He developed Cape Fear Valley’s sleep medicine program, taking over as director in 1995 and growing the program to its current status as accredited by the American Academy of Sleep Medicine and The Joint Commission.
Fleishman, who is now Cape Fear Valley’s Chief Medical Officer, has long understood the importance of sleep and how it affects quality of life and health. He is a past president of the American Academy of Sleep Medicine, as well as serving as the organization’s health policy chairman, chair of its accreditation committee and on its board of trustees.
His influence had an impact on Dr. Shetty. She’s now the medical director for Cape Fear Valley Health’s Sleep Center and has been board-certified in sleep medicine since 2007.
“I still remember my first patient,” she said. “Every month, we were putting her in the hospital. We’d treat her, we’d fix her, she’d go home, and she’d come back the next month. We diagnosed her with sleep apnea and put her on a CPAP device and that was that.
“She breathed so well that she didn’t go to the hospital for years after that,” she said. “So when you see that dramatic change in someone it really impresses you. Treat the sleep apnea and the congestive heart failure improves dramatically.”
Cape Fear Valley’s Sleep Center treats a variety of sleep disorders, including sleep apnea, insomnia, narcolepsy, periodic limb movement disorder and restless legs syndrome. A sleep study sometimes can improve mood disorders, as well.
Once a patient is referred to the center, evaluated and scheduled, he or she arrives at the sleep lab in the early evening to have electrodes and other diagnostic aids attached. The six sleep lab rooms are equipped with comfortable beds that can be adjusted as the patient wishes, from firm to soft, for instance, and from elevated to flat. Patients have access to temperature and noise controls, including sound machines. Meanwhile, a sleep technician monitors the patient’s brain activity on a computer screen throughout the evening.
That process has come a long way from the days when doctors had to peruse reams of stylus etchings on paper printouts to make a diagnosis.
“When I came here, sleep medicine was a growing specialty at the time,” said Dr. Fleishman, who completed one of the specialty’s early fellowships at the Medical College of Georgia after completing his psychiatric residency there. “I was offered this opportunity to develop the program.”
At the time, Fleishman was part of a staff of two with two beds available for patients. He had someone to schedule appointments, and when patients arrived, he was the one who took their vital signs. When they were able to hire their first sleep technician, it “was a big deal,” he said.
But he was able to do things his way. “We were always patient-driven, patient-focused and believed in the long-term management of folks. That was always a big part.”
Zak Wilkerson, who serves as Director of Administration and Sleep Services, said he believes Dr. Fleishman built a solid foundation for the program.
“The standard Dr. Fleishman has set for us,” he said, “means that we’re the lab and programs other programs want to emulate.”
John Bigger, Corporate Director of Clinical Services for Cape Fear Valley Health, said Fleishman and Shetty have been leaders in the field of sleep medicine.
“They have led national organizations, implemented best practices and collaborated across a wide spectrum of care to ensure that our program maintains the excellence that it is known for,” Bigger said. “Both have been instrumental in keeping the program at the highest levels of operation and their contributions are the reason the Sleep Center is where it is today – the best program in this part of the state, and I would argue one of the best in the country.”
Sleep medicine in general also has come a long way since the days when patients who had trouble sleeping were given medication and sent on their way.
“We use medication, but first we try to work with patients’ behavior and changing their lifestyle,” Dr. Shetty said. “Screen device usage and caffeine are the two biggest problems we see.”
That can mean turning off your cellphone at bedtime and avoiding caffeine after lunchtime. Other factors that can make for a better night’s rest are avoiding nicotine and alcohol. Exercise and a healthy diet are as important for sleep as they are for many other health conditions.
Stress and a culture that often values an exaggerated work ethic can be factors as well. “We, as a culture, are a sleep-deprived society,” Dr. Fleishman said. “Sleep has lots of functions. It affects memory, judgment, cognition and your immune system.” Shetty said that it isn’t just sleep that’s important, but the “quality, quantity and
timing” of sleep. “Sleeping at night is really important,” she said.
Fleishman agreed, “Human beings are wired to be awake when it’s light. Generally speaking, anyone working at night is going against their circadian rhythms.” Dr. Shetty has learned much about her specialty from those early days when she drove from Lumberton to glean information from Dr. Fleishman. And she’s learned to follow the advice she gives others.
“I used to do four hours of sleep a night when I first did primary care,” she said. “But after I started learning about sleep, I’m the best convert there is. I disliked sleeping, once
upon a time. I still don’t like to sleep, but I do sleep because sleep touches every possible system. Improving sleep seems to improve a lot of other things, so it’s kind of pulling the