Pulmonary Medicine/Sleep Center Riverside Health System
Delp Givens says he was accident prone as a kid. “From the time I was four or five, I was always in the hospital or the doctor’s office for one reason or other,” he says. “I’d run into something, break a bone or get a cut and need stitches. I developed a fascination with human physiology.”
Luckily, he grew out of his awkward stage, but he never lost the fascination. He completed his undergraduate and medical school degrees at the University of Virginia, where he was drawn to internal medicine because “I like to analyze things, and solve problems.”
Dr. Givens did his internship at Strong Memorial Hospital at the University of Rochester Medical Center. He describes his first rotation as “the intern’s nightmare. It was the Intensive Care Unit,” he says, “and almost nobody wants to do ICU first because the patients are so sick, and you’re not all that sure of yourself yet.” But he was paired with Dr. Richard Hyde, Chief of the Pulmonary Medicine unit, who Dr. Givens says “literally turned me on to lung pathophysiology and pulmonary diseases.” Despite the crushing schedule – working 18 hours a day, call every other night, sleeping maybe six out of every 48 hours, dealing with desperately ill patients and their families – he was exhilarated by the work of pulmonary and critical care medicine.
He completed a fellowship in pulmonary and critical care at Vanderbilt University Medical Center, where he trained with Dr. Brevard Haynes, one of the first wave of sleep medicine clinicians. Dr. Givens was again fascinated – “I’d do my research during the day,” he says, “and afterward, I’d go over to Dr. Haynes’ lab and work with his team. It wasn’t a formal part of the curriculum, but I was really interested in it.”
As a result of Dr. Haynes’ mentorship, Dr. Givens was able to sit for the original American Board of Sleep Medicine exam. He is also American Board of Internal Medicine certified in Pulmonary Medicine, Clinical Care Medicine and Internal Medicine.
Dr. Givens moved to Hampton Roads to begin his medical practice in 1987. “Sleep medicine was still a very young discipline in the late 1980s,” Dr. Givens explains. “There wasn’t a formal fellowship at that time. The physicians who trained in sleep usually did so as part of pulmonary or neurology fellowships, or psychiatry residencies. There weren’t that many of us.” There were so few, in fact, that his colleagues kid him about the number on his Board certificate: 214.
In 1987, the only sleep center for all of Hampton Roads was at Eastern Virginia Medical School, under the direction of the renowned Dr. Catesby Ware, so Dr. Givens established the sleep center at Riverside Regional Medical Center, eliminating travel, traffic and and tunnel for residents on the Peninsula seeking help for sleep disorders.
The most common of these disorders is sleep apnea syndrome – a disruption in breathing during sleep. It was an Australian respiratory doctor who invented the technology that remains the best method of treating severe sleep apnea syndrome: in 1980, Dr. Colin Sullivan perfected a means to apply positive pressure through the nasal airways to alleviate obstructed passageways – the Continuous Positive Applied Pressure machine, or CPAP – an effective medical treatment that obviated the need for tracheostomy surgeries in most cases.
Sleep apnea syndrome is far more common than is generally realized, Dr. Givens says: “The number quoted most recently from epidemiology studies is 15 percent of adult men have sleep apnea, and five percent of adult women, with a further increase in incidence after menopause.”
There’s also a strong link between sleep apnea and obesity, although not as great as once thought. “The data is that about 70-75 percent of people with sleep apnea syndrome are overweight or obese,” Dr. Givens notes. “For many patients, as their obesity gets worse, their sleep apnea worsens. When they lose weight, sleep apnea improves significantly for the majority of patients. And while even significant weight loss doesn’t eliminate sleep apnea entirely for a third to a half of patients, it’s definitely a step in the right direction.”
Over Dr. Givens’ career to this point, pulmonary, critical care and sleep medicine have each accounted for about a third of his practice. That will change in 2017: “The number of patients with sleep disorders has skyrocketed, and continues to,” he explains. “There are four other pulmonary and critical care physicians in our group, one of whom – Dr. Eric Weiner – also practices sleep medicine. In order to respond to our community’s growing needs, I will shift my emphasis primarily to evaluating and managing these patients.”
And he’ll have an effective new modality to offer: for a certain number of patients diagnosed with obstructive sleep apnea, he is excited about the potential for Inspire upper airway stimulation therapy approved by the FDA. “It fits in the chest wall like a pacemaker,” Dr. Givens tells them. “There’s one lead that goes to the tongue muscle and one to the diaphragm, which senses when they’re about to take a breath in. It then delivers a small amount of current so that the tongue moves forward just enough to keep the airway open so they don’t snore – but more importantly, they don’t have apnea.”