Behind the Headlines a Unique Sleep Clinic in Israel

The calm of a sleeping child is a reassuring sight. But the inner turmoil, the terror of a nightmare, is not always apparent, except to Dr. Naomi Amir and her staff in the unique Sleep Clinic of Bikur Holim Hospital in downtown Jerusalem.

A section of the pediatric neurology department of the hospital, the Sleep Clinic is the latest innovation in the 150-year-old institution housed in a group of aging buildings. Amir heads the department in which the clinic was established only little more than a year ago, thanks largely to a sophisticated sleep monitoring machine recently acquired by the department.

Parents often experience the signs of nighttime problems of their children, through the evidence of bedwetting and fitful sleep, as well as awakening nightmares. Some children walk in their sleep, emit cries, pick imagined creatures from their pajamas.

Common among children between the ages of 4 and 10, according to Amir, these often are manifestations of terror resulting from bad dreams and not serious disorders. But the clinic, through extensive research, often relates these signs to serious neurologic, psychiatric, physiologic and other maladies. The exact nature of the problem is carefully analyzed from the acute monitoring of sleep patterns.

CLINIC FOCUSES ENTIRELY ON CHILDREN

Amir, one of Israel’s leading pediatric neurologists, believes the Sleep Clinic at her hospital to be one of the very few focusing entirely on children. “The still developing nervous system,” says Amir, “differs in many ways from that of an adult.”

She cited as one such example the case of a child known to have epilepsy, and who is a sonambulist, or sleepwalker. Increasing the epilepsy medication to alleviate the sleep walking is an error, because the clinical research will show the unrelated nature of the two problems.

Two of the currently growing fields of medical research are endicronology (or the way the body produces and uses hormones) and the study of 24-hour body rhythms. Both are greatly aided by sleep study.

Approaching patients in their early years, and getting them to sleep, is no easy task. Typically, a child coming to the clinic for sleep monitoring would have wasted most of the night ridding himself of anxiety of strange surroundings and all the electrodes attached to the body. At Bikur Holim the child’s mother sleeps alongside, with a doctor simultaneously on duty through the night.

To further ease the tensions, the monitoring machine and technician are in an adjoining room, out of sight, monitoring the child, and guarding via a video screen. Within two to three nights, a child’s true sleep pattern appears and the clues to the disturbance are revealed.

The reams of data recorded by the monitor’s six channels of brain wave readings, as well as recording REM (rapid eye movement while dreaming), muscle tone, body temperature, chest expansion, breath expiration and more, are a wealth of information to the medical staff. Additionally, sleep apnea, a condition in which breathing stops for a few seconds during sleep, is carefully monitored.

Amir’s clinic was the natural outgrowth of another pioneering effort, Bikur Holim’s Day-Hosital for children with neurological problems. In operation since 1979, over 1,000 children from throughout Israel have been screened in this unique daytime hospital.

Children check in early in the day, and are home by late afternoon. The burden of a hospital stay, on both the parent and the nation’s hospital system, is considerably lessened, to say nothing of the relief of this hospital’s methodology on the patient. But it does require exceptionally tight scheduling and advance preparation to maximize useful time for the patients and the staff.

The Day-Hospital has grown to be the largest pediatric neurology unit in Israel, and is now staffed by four full-time senior physicians, each a top specialist in their discipline. Additionally, other medical experts including a cardiologist, psychologists and physiotherapists ensure the best multi-disciplinary evaluation for each child.

A MOVING FORCE IN THE CLINIC

A moving force in this unique facility for the children of Israel is Amir, a former American. A serious physician attracted to the then unique concept of a woman physician who could be both pediatrician and neurologist, Amir has practiced at Bikur Holim for more than 20 years.

It all started by Amir’s meeting at that time with Dr. Helena Kagan, who was head of Bikur Holim’s pediatric department. Like the magic meeting of two souls whose vision and goals synched, Kagan offered Amir the job she had dreamt of, and Amir stepped on board. This led her to further study at Columbia University, under one of the fathers of pediatric neurology, Dr. Sidney Carter.

This modest, unassuming woman who grew up in Brooklyn, proceeded to help Israel take the lead in innovative medical research and practice. And Amir’s dream, which built a clinic studying children’s dreams, is only the beginning of the bigger dream: spreading advanced medical care to the children at peace in the entire Middle East.

While so much of Israel’s attention is devoted to preventing war and destruction, those like Amir in Israel work to build the instruments of a better society at peace. These should, according to Amir, be the real headlines in the world’s daily press, for these are the really significant happenings in that spot in the Middle East called Israel.