 Welcome to our discussion today on sleep disorders. With me today are Dr. Leonard Suraj, ENT surgeon, and Dr. Jacqueline Bird, pediatrician. Welcome to the Government Information Service. Thank you. Thanks for having us. Most welcome. So we start out today by looking at your diagnostic sleep center, which was established last year in November. Can you just, first of all, write off the bad, give us an understanding of why a diagnostic sleep center, first of all, any one of you? Well, the idea came in a few years prior to that, when I was getting so many complaints from people who are sleeping disorders and difficulty falling asleep, those who fall asleep and wake up quickly and can't sleep again, those who get into road traffic accidents because of sleep deprivation. And many of those who had the necessary contacts would have gone overseas to Miami to train that to look to do a test to find out how bad they sleep in disorder is and how it can be corrected. And having, and I subsequently, attended a course on sleep disorders. And of course, it dwell on me that really we should be offering a service like this in St. Lucia, because nobody else in the OECS was actually involved in that. So Dr. Suraj, you speak as a specialist in nose and throat surgeon. But Dr. Bird, apparently sleep disorders are also a problem for children. They're little people as well. So your perspective and your involvement in the center. And we have two pediatricians associated with the center, Dr. Martin Plummer and myself. And then two physicians, Dr. Leonard Suraj, who is a surgeon and Dr. Martin Didier, who is an internist. It's well recognized that sleep is one of your most important functions, perhaps as important as eating and drinking. And especially in children, we recognize when sleep deprivation affects children. There are many children who have sleep disorders for many problems, for many reasons. But the problems manifest a lot in their behavior. So we have children with disordered behavior in classroom settings, hyperactivity, poor attention, restlessness, somnolence. A lot of children fall asleep during a boring class. And that's when we recognize that this perhaps was a service that would not only help Dr. Suraj's patients with their airway obstructions and Dr. Didier's patients with their metabolic problems, but children as well. So in terms of the numbers of persons that you're seeing, and just to paint it in the local context, so the average, on average, how many persons, or what percentage of solutions, if you have any statistics on that, would you say, go out elsewhere to get further treatment of these sleep disorders? Well, what I can say is that about between 10 and 20 percent of the population, any given population, would have had some sleeping disorders. And sadly enough, of that 20 percent, only about 5 percent of that 20 would have actually gotten any redress to their problem, meaning that a vast majority remain undiagnosed. And even in more developed countries like the United States, and most of the figures are coming from there, we have not done any local figures because we are very early, we are fledglings in that profession. And so we have not developed data for that, but we know that as your society gets more affluent, and as people get more obese, have more weight issue and sleeping disorders, then the figure ranges from about as low as 4 percent to about 20 percent of people having problems. And before we had this sleep test, those who could afford would have gone overseas and get the treatment. And I don't want to lose track of that. When we, in the formation of that particular sleep diagnostic sleep center, we looked for expertise that would have been blending with the challenges we would have in sleep studies. And that is, pediatrics are very high proportion of children if, I don't know, a tonsill problem, end up having sleep apnea, falling asleep. I noticed with Dr. Didi as a cardiology editor in Thurdis as well with the heart and these other things. So the composition was well thought out to bring in two pediatrics, one internal medicine and a head and neck person. So in the last six months, what have you been doing? Oh, well before you launch that program, there's a tremendous amount of training from overseas because we have two technicians who have been trained to conduct, to actually do the mortages and do the tests itself. So these people have to be trained from overseas. And we had, for about almost a year, we had overseas experts come into St. Lucia to conduct the training. So we had been busy doing that kind of thing. Since November, we've been doing tests and seeing patients who have sleeping disorders. But let's us look at what exactly is a sleep disorder. I know it's somewhat associated with breathing and even manifests itself to most of us in hearing somebody snore. What exactly is a sleep disorder? Well, the slide shows us the spectrum of sleep disorders ranging from mild occasional snoring all the way up to what we call severe obstructive sleep apnea, which is really a death knell for persons who are not recognizing that they have a problem. So there's normal breathing and then there's the other end of the spectrum, severe obstructive sleep apnea. And in between, you have mild snoring, regular snoring, and the increasing upper airway obstructions. Now these manifest in patients in a wide variety of ways. Some people may not even recognize that they have this disorder, but they do recognize daytime sleepiness, falling asleep in unusual places. The children, restlessness and hyperactivity, attention deficit hyperactivity disorder has been diagnosed in a lot of children, and often it points back to their inadequate sleep at night. So then I guess the person who has a sleep disorder, are they aware that they have it or is it that a relative or parent that gives them the heads up and then in terms of your interrogation with them, your interaction with them, that is when you discover how exactly do you get to know that somebody has a sleep disorder? Most times the patient or the person may complain of being tired in the morning. Despite a long sleep rest while sleeping at night, they still feel as though they are tired in the morning. Sometimes they feel that the throat is so dry, the more they drink water, the more dry it is throughout the day. Others may have headaches and others may know that they have snoring and some of them would recall waking up as if there is something choking them and they wake up and sleep again and breathe again and fall back asleep. So these are what they would account, but the real evidence comes from the spouse or whoever is watching them and would see a drama that you only have to see it on video to understand it. So there is snoring and then there is this complete disruption in sleep that is actually very scary to watch, especially in a young child. Some of the milder clues that children take of odd sleeping positions. So if you have a baby who will not sleep well unless the head is extended over the edge of the bed so that the neck is extended, that's a very good clue. If you have children that sit bolt upright after an hour of sleeping and look around as if frightened, children that have other displays of night terrors, children that have started wetting their bed again when they used to be dry at night. That's called secondary bed wetting. Those are some of the clues other than the daytime sleepiness and the failure to be easily roused when it's time to get up in children. That's right. And of course in adults there is a tremendous amount of accidents that have been documented by patients who fall asleep. And for example, why would a 20, 25, 30 year old person, male, sleeping all night, goes, drives from view for two castries and halfway falls asleep. And if you happen to be somebody who has the lives of other people in your hands, say you are a public bus driver, you have, it's not only you and your vehicle, you have passengers and therefore it calls for understanding that if you do have a sleeping deficit to actually address it. I'm big on statistics but in terms of the numbers of accidents reported or, you know, that get referred to you, get referred to the public hospitals, do you gather any statistics on it? No, the statistics maybe gotten mostly from the traffic department. And then of course if you really have to look at the information, they would ask you how the person been convicted of that. So it gets very hazy if you're looking purely at diagnosing whoever had sleep disorders. Now that we have the sleep lab, I think we're going to be able to shed some light on that. Now that we are beginning to diagnose people and their sleep problems. But you know, there's evidence for sleep disturbance as well in doctors' offices looking after adults, especially with metabolic problems, but we haven't yet begun to make that connection. Not sleeping properly adversely affects management of high blood pressure, diabetes, weight control. There is a definite link between disordered sleep and its associated lack of oxygen and your ability to control your weight gain in your efforts. So people need to start paying attention and recognizing that if you're diabetic and you can't really understand why it's becoming so difficult to control your diabetes or your hypertension or your heart disease, the link may be poor sleep. This is very serious because it sounds like it's more than just a new sense of somebody snoring. Absolutely. But there are some very serious secondary health consequences. And indicators as well. What causes this then? The sleeping disorders are caused by many, many things. For one thing, your size, your weight for height can be an issue. The size of your neck can be an issue because when you store fat, usually you store it all over your body. But the neck is particularly prone to cause problems because as the neck expands, it narrows the inside passage for breathing. And also, strange enough, experiments have shown that when you store weight, you store fat. You also store it in the tongue. So the tongue gets big and fat. And therefore, if you're lying on your back, the tongue falls back. Also, as you age, the muscle tone is reduced. And as a result, it causes the pharyngeal muscle, the upper throat muscle. That's relaxed to make the throat blocked and the tongue falls back. Also, you have people whose chin is shorter. And as a result, the tongue is further back and causes the obstruction. And of course, people may have nasal problems. As an ENT person, I remember that one first. The nasal issue, bent nose, swollen sinus issues. So that as soon as they fall asleep, the natural thing is that the air will pass through the path of least resistance. So the nose has too much resistance, the mouth just opens and you breathe through your mouth. And you dry up your throat and you start snoring. But while on that, I want to say that snoring itself is not the culprit as much as it is the forerunner to other things. The flag, the red flag. So because if I am snoring, then it is somebody who is listening to me that I have the problem. But it's a spectrum of problems from snoring to mild obstruction, moderate obstruction, severe obstruction. And when the breathing cuts off completely, you get apnea. But smoking would contribute to that as well? Unless it's associated with some allergy, hardly smoking is an issue. Smoking has other health problems, but not tremendously related to sleep apnea. What about drinking? Drinking, yes. Because with drinking comes, apart from you being more sedated after drinking, your muscles are more relaxed and therefore you're more likely to have snoring. More importantly, because you sleep so heavy, you tend to sleep in one position for longer. Because your muscles are more relaxed and you are uptended. So as a result, you do not turn and switch position because sleep is very dynamic. You don't stay in one place like a log. You keep on turning all the time. And when you are alcoholically infused, then you do not change position and you tend to snore more. In the children, enlarged tonsils and adenoids are a fact of life, especially in very young children. Because the tonsils and adenoids are the tissues that respond to external allergies. So they are usually larger than average in many children. And those are frequently the cause of an obstructed airway and the cause of obstructive sleep apnea. And removing the tonsils and adenoids is often curative. While on the children's side, I just want to add one thing. Sleep is extremely important for children's growth. Because as we go further in the program, we may get into the stages of sleep. Stage one, stage two, stage three, stage four, in terms of depth of sleep. And the children must achieve a certain amount of depth of sleep. If they are missing that because of adenoids and tonsil enlargement and sleep apnea, you find that their growth is tunted. It is dramatic after you move the tonsils and adenoids. They just start growing like magic. Very interesting conversation with Dr. Jacqueline Byrd and Dr. Leonhard Suraj on sleep disorders. We'll be back in a moment to continue the conversation. When you're out at sea, there are no service stations along the way or supermarkets for a quick stop if you need something. It is essential that everything you would need while at sea is on the boat before you leave. That's why pre-sea checks are so important. Checks should be carried out by more than one person to ensure that all essentials are on board. Pre-sea checks should include food stores, extra water and fuel, navigational equipment, safety gear and communication equipment. Before heading out to sea, always ensure that all equipment is in working order. You are stocked up on food and also extra fuel. Call the lighthouse to inform them of your voyage plan and inform someone responsible of your departure time and estimate the time of arrival back on shore. For more information on obtaining a license to fish, contact the Department of Fisheries at 468-4143. Welcome back. Today we're discussing sleep disorders and in studio I have with me from the Diagnostic Sleep Center, Dr. Leonard Sarange and Dr. Jacqueline Byrd. We will discuss what are sleep disorders and some of the causes. Right now we will move into some of the effects of them. What would you say are some of the effects of those sleep disorders? Okay. For one thing, the lack of sleep causes initially hyperactivity. Especially children. Yeah, children. And it causes, in adults, it causes lack, apart from wanting to sleep at maybe critical times when you are operating a machinery, whether it is a vehicle or whether it is a power tool that you are operating. There is a chance that you may just fall asleep. Also, from a medical point of view, lack of sleep leads to high blood pressure, diabetes, heart failure. And people who are untreated sleep disorders give you a five, four times higher chance to have a stroke. And three times higher chance of having heart disease. And twice the normal person of getting high blood pressure. These are factual stuff. It's related, I think, just to put it simply for the lay person to understand, when your airway is obstructed, you therefore have less oxygen circulating to the areas that need it. And the most important area that needs oxygen is your brain. And certainly in the children, what happens with obstructive sleep apnea is actually a physical disruption, not only of the healing processes that sleep normally affords you, but to the actual content and structure of your brain, especially your frontal brain, your frontal cortex. Now, that's a part of your brain that allows you to be sensible and to exhibit what we call executive functioning. When we wonder why society and the world is full of such poorly executive functioning individuals, it may be related to their sleep. Executive functioning from the frontal cortex is responsible for decision-making, impulse control, shifting ideas, delaying, delayed gratification. A lot of things that we often blame youngsters and blame on youth that we can see in adults in our society. And a lot of it can come back to disordered sleeping and the poor restorative functioning of poor sleep. So you actually see that, Dr. Bullard, in your practice with children that you currently see, because I would expect that this would affect their learning. Oh, certainly. And as you alluded to, their behavior. Certainly. We are doing a lot of investigation of children that have poor academic functioning in school in St. Lucia. We have a multidisciplinary team that looks into that. And we're only now, with this new interest in sleep, beginning to recognize the impacts of poor sleep on some of what we have been dealing with. These are children who have been diagnosed with attention deficit hyperactivity disorder. These are children that have poor impulse control. These are children that have to be sent to anger management and impulse control management. And a lot of it, I believe, we're going to see now that we are exploring this new area, is related to poor sleep and the effects of not having proper oxygenation and the sleep cycle that Dr. Suraj was speaking about. It has been well recognized that when you have low oxygenation of the brain, it does affect your cognitive function, your intellectual function, your judgment. How do you place things in terms of your decision-making process? And it is well established that these things suffer when you have low oxygen, because every time you have a sleep apnea and by definition apnea means cessation of breathing, the breathing cuts off, no air is passing up and down. So whenever you have breathing, a sleep apnea, the oxygen that is normally present in your blood begins gradually to go down. So maybe if it starts at 99% oxygen, it goes 98, 97, 94, 93, 92. And then your brain says, wake up, idiot. Yes, and then about 80, it tells you wake up. And you wake up, you take a few gas, and then you fall asleep again. Sometimes you may remember, sometimes you may not. But this is the pattern, and more importantly, when the oxygen begins to go lower, it begins to cause all other problems, like the heart begins to behave funny. And it has been said that many people who die in their sleep may have done so because at low oxygen, the heart begins to get arrhythmia. So you can actually die in your sleep because of it. A very extreme sleep apnea. And depending on how dicey the heart is, when you have these apnexpels. Does it depend on age? Age-related is health-related as well. And the genetics are not very strong on that, but generally it has to do with your other comorbidities or other medical conditions that you may have. Like everything else. Let's take this moment to just have a look at a video with somebody in that state right now. It might be graphic to some of you, but it's something that we believe that we should have a look at to actually have an understanding of what the state is. We go to the video. Wow, so that's what somebody who is in sleep apnea looks like. So Dr. Suraj, can you just give us a little explanation of what exactly we were viewing just this moment? Yes, sure. What you saw there was a patient who went through a sleep study, an overnight sleep study. You may or may not have seen that there were leads on the forehead to monitor the brain activity. And a band around him? Yeah, before we get there they would run on the eyes to look at eye movement. There's a little piezoelectric sensor in the nose to monitor airflow. There is one just on the voice box to monitor snoring. There are some ECG leads for the heart testing rhythm. There are a few leads on the chest and abdomen, two bands that have sensors when they stretch to monitor how much effort you are actually making in order to try to breathe. And of course there are others in the legs, et cetera, which does not show on that one. But essentially what you saw there is somebody who was sleeping, and you can see that person has some weight. Yes, quite some weight. Who was sleeping and the breathing cuts off and a lot of abdominal movement, but very little airway because you know because there is no, you're not hearing the snoring. But of course the monitor will pick up the airflow. And when the oxygen, so as soon as this happens, the oxygen you normally have in your body, 98%, will gradually go down. And at a certain stage, say 80%, you will find that the brain triggers waking up and you wake up, take a few gas. Now when you wake up you may not be alert to show that you're woken up because you may not remember that. So really you cannot go by what the person actually remembers. They may not even recognize that their sleep has been disturbed 300 times through the night. In fact they might actually fall back into another sleep again. Yes, it's a cycle. And they measure, so this is a polysomnograph. Polysomnograph? Polysomnograph, poly means many, some don't mean sleeping and a graph is tracing. So polysomnograph is PSG, they call it. And that's what we offer you at the diagnostic center. Common spender night with us. It's a very comfortable night in an air conditioned, very seductive environment. You may get put off a little bit by the wiring, but it's not invasive. Oh yes, it's not invasive, it's not painful. The same wiring that it's done for an electrocardiogram when we do your heart testing and there's no pain at all involved. And then you're relaxed on a comfortable bed by yourself in a private room and you're invited to put yourself to sleep. So we encourage people to come along with their iPad or a good book and just settle down and sleep the way you think you sleep at home. And then we are recording you actively. So we will save you from any disorders. There's a video element to it. As well as the electronic monitoring. The video one is to look at the position because sometimes if a lead falls off, we can see it on the video. Apart from the tracing. I'm also curious, what are your clients, a patient's reaction to seeing themselves? No, they never come to them. No, the patients relax. Not first, but are they surprised at how they behave in terms of in that state? Well, actually, we do not... The video is... It's not... Sure, it's not recorded. It just goes... It just goes ad hoc. So you just see the position, the movement but we do not use the video as a tracing. So we don't have a live video going on. We're not capturing you in your sleep. So what we use the video for is to check the positioning and whether a lead falls off or whether you change position, et cetera. But we are monitoring about 24 different gadgets, different leads in all different parts of your body. We are monitoring that and to see the tracing as to how you behave. More importantly, for example, with him, you are looking at the depth of sleep. As soon as you close your eyes, you put out the light, we monitor your wakefulness. At what point you fall asleep and the sleeping at three stages, stage one, stage two, stage three and how long you spend in itch and then rapid eye movement sleep which is when you dream and when you benefit maximally from the sleep. And then after a cycle of what, this entire cycle takes about 90 minutes and then you go back to stage one and then you go stage two, stage three, barium sleep and so you go throughout the night. So this is really the best way to test and diagnose sleep orders. You really kind of do it like with a blood test or other man. No, no, no. You really have to monitor the function of the brain, the depth of sleep and the movement of the muscles of sleep while you are sleeping. So I would expect that you would need to do some level of public awareness then because at least for me in terms of what I would look for you check your eyes, you check your blood pressure, you do your animal physical but to do a polysomnograph is definitely something that wouldn't come on my radar. What would you say to solutions in terms of really looking in this direction to possibly diagnose some behavioral issues, etc.? Well, that is why we're here actually and we just thank you for this opportunity because we're really just emerging now with our public awareness to get some solutions and the wider OECS Caribbean especially to recognize that this service is available and how important sleep is to the brain and the functions of all of your body's organs. The patients that we are seeing being referred initially are patients with severe disorders from physicians who have been aware that their patients have a problem but the service has not been available before but we want to open the door wider to the average Joe and Jane to recognize that you can do a lot for yourself by improving the efficiency of your sleep but you can't do that until you diagnose that you don't have efficient sleep and so we're inviting people to come in to help the sleep questionnaire have a tour of the diagnostic sleep center and just become more aware of the functions of sleep and what happens when you don't sleep well. Thank you very much. We'll discuss a little more on that questionnaire as well as preventative measures when we come back. Thank you. Stay tuned. My 14-year-old child, she's driving me crazy. I just don't know what to do. All our child needs is some good legs to wake up. Alice, ignore the counseling pension given. Government employees have free access to professional counseling services under the Employee Assistance Program known as EAP. EAP? EAP? What's that? Not me that telling people my business. Listen to me, Alice. I was struggling with my child. I made an appointment to see an EAP counselor and I was very satisfied with the service that I received. And you know what? Up to a day like today my information remains confidential. Cox, how come nobody in the office knew anything about your counseling? Ah, that's because EAP counselors they work under strict clauses of confidentiality. I know you know what confidential means. EAP providing professional counseling services? How much is it? Girl, the counseling is free. Free for you, free for your child. And you know what? Your information remains confidential. Call the EAP unit at the ministry of the public service. Telephone number 468-2269 for more information. EAP Works, let it work for you. Welcome back. We're still discussing sleep disorders with Dr. Jacqueline Bird and Dr. Leonard Siraj from the Diagnostic Sleep Center. So we've now recognized some of the symptoms, how dangerous it is with sleep disorders. Sleep apnea can even cause death in certain instances. How do I go about... I've decided now that I want to be treated. Deciding, can you walk us through the steps of how you go about counseling people and treating them? Before you get treated, you have to be treatable. How do I know if I'm treatable? That's what I'm getting into. There is a questionnaire that is put out by... and it is accepted by the American Academy for sleep studies. Okay, so there's a standard... There's a standard form. And it is called Apley's... sorry, app of skill of sleep disturbances. Basically, it asks you to grade yourself based on your level of sleepiness for different regular activities. Regular activities mean sitting there watching TV or just reading a book or sitting in the back of a car that is driving or stopping by the stop sign. And after lunch or after a meal, do you fall asleep? In a meeting, if you are conducting a meeting and you are passive or turned into the meeting, are you falling asleep? So it goes through a few and it grades it between zero and three. Three being really bad, zero means you're fine. It also asks you to take into consideration if you have other comorbid situations like high blood pressure, diabetes, obesity. And the next circumference is a very good index of whether you really will have sleep apnea. And in men, anything above 17 is considered... Inches? Yeah, seven inches. And in women, 16 inches. Wow. The question that Leonard is speaking about is administered when you come in for investing just to get information to the sleep center. So it was just about to ask, is it something I can go out online? You can get it online and you can get it at our sleep center. It's something that's available up with sleep scoring. And if you score, after you've scored yourself, that's to determine whether you are a candidate that may require a sleep study. And if you score at a certain level more than three, then the recommendation then is to proceed and do a sleep study. And there are two sets of sleep studies you can do. Either a less intricate one where you take the gadget home and then you can do it at home. But you can do it at home. There is one you can do at home. And there is another one where you have to come to the lab because the things they are monitoring would have been more critical that you cannot be monitoring it on your own at home. When you say you can do it at home, what exactly is the equipment like or the process like? It's like a headband. It's a headband that has a few leads on it. And it measures your forehead blood flow. It measures, and there's a little thing that goes on your finger. Oxygenation. It measures the oxygen. So it does some basic... It's a screen. It's essentially a screen that highlights and flags you as a candidate for the proper overnight sleep study. And if it is a limited number of things you're looking for, then you can get by with that home sleep study. In this day and age, I'm wondering if there's an app for that. Nowadays, you have various smart watches that can trace everything while you exercise, maybe even while you sleep. Yeah, this is actually like that. Yeah, this was designed like that, as an app for that kind of thing. And the person puts it just before they go to sleep? Yeah, we would... You come in the lab, we would tell you how to put it on. It's a disposable one, so after we use it, you can use it for a second person. Okay, so would coming out of that home test, there be indication to do a deeper test there? Yeah, if it is showing that there are parameters that have been measured that is of concern to us, whereby we want to monitor you in a much more elaborate setup and observe you while you are sleeping, then we would need to recommend the sleep. But most people would prefer just to do the sleep test, the in-hospital sleep one, because you know you can get all the information you require. Okay, in terms of preventative measures, as we always talk about, what can you do to the best of your ability unless you are just susceptible to that, either through family history or other causes? But what can you do to minimize your risk of sleep apnea, sleep disorders? There are some things that you are born with. If you're born with a partition of your nose that is bent, you've got to straighten that out. If you have large tonsils and adenotes, you've got to straighten that out. If you have any other medical conditions, you'd better straighten that out. Or surgical things. And the real challenge sometimes is when you have people who are short chin, a lot of work has been done on that to find the best answer for that. It still remains a challenge. However, these conditions I mentioned so far are things that are beyond your control, you just have to be that way. There are things that are under your control and their lifestyle changes that directly impact sleep for the better. Weight loss, healthy diet, reduction in your amount of alcohol and smoking, and of course exercise. Nothing improves sleep like efficient exercise. And we recommend that a lot for children to improve their sleep patterns as well. Get your children outdoors and moving. Get your children not to be overweight. Get your children on a healthy diet. Okay. Let's again look at some of the problems associated with those sleep orders. Some of them in terms of hypertension, obesity. Everything that can go wrong with you medically can be worsened by poor sleep. So we're talking about all the metabolic conditions like diabetes, hypertension, stroke, cardiac disease. It is worsened by poor sleep through the mechanism of the cardiac arrhythmias. Mental function, intellectual function, cognitive functioning in children, academic performance in schools, attention. All of these things are negatively impacted by poor sleep. So the answer to it is you must sleep well to live well. Okay. When do you see the sleep sensor go in from here now? Very good question. Not because I don't answer, but it is still a good question. Of course it is with the sleep technology comes a lot of other things that can happen. And that is investigation for other neurological conditions like epilepsy, like dizziness, like brain tumors. All these can be because the guy who did the conduct of trading with us told us that our setup is good enough for us to expand tremendously on it. And he thinks that we should do that as a matter of urgency. When you say expansion, do you also see clients from around the region, the sub-region? Yes. We see who is here. Yes, we're the only sleep center in the OECS. Trinidad is our nearest neighbor that has an established sleep center. Both Trinidad and Barbados have sleep centers, but they are like standalone. What a guy was telling us from the state, he said that our unit attached to a hospital with the affiliation of specialists that we have, we have a tremendous, we have a far better arrangement than most places because most of the other places are standalone. One person decided to do a sleep study, but we attached to a hospital with all the importance of that. One of the most positive spin-offs that we see for the future is the ability to trap people with seizures, to investigate persons with epilepsy and other forms of abnormal movement disorders. Because the recording during the overnight sleep study also picks up abnormal brainwave activity or seizures. We don't have that service available in St. Lucia at the moment to diagnose epilepsy, and our sleep study will be able to assist patients in this regard, even if they don't have a sleep disorder. How do I find you? How do we find you? How do you find treatment? We're easy to find. We're a tapion hospital. It's not within the hospital itself. It's an adjacent building in the car park. So if people have a negative feeling about being admitted to hospital, you're not being admitted to hospital. The sleep center is a standalone center, and it's very calming and very attractive. You can call 459-2216 or 459-2034 and just ask for information, ask for a tour, and speak to one of the specialists. And we also have, we are affiliated with ISDSleepcenter.com, sleeptest.com. And this website actually has the question that you can download from there, and the website will direct those who are coming from St. Lucia to us. So we can get feedback from that. Well, thank you very much Dr. Burd and Dr. Suraj on joining us to discuss sleep disorders, sleep apnea, and ways of getting treatment. Definitely it's heartening to hear that we at least have a way to address this. And hopefully as you compile your statistics and your findings, you will come back to share it with us. We wish you all the best in your endeavor. Thank you very much. Thank you for this opportunity. Thanks GIS for allowing us to share our experiences with them and so forth. You're most welcome. Thank you very much for joining us in this discussion again. And we ask that you stay tuned with us as we bring you more information for your insight and edification. Thank you and until next time, I'm Richmond Felix, saying goodbye.