According to the American Academy of Sleep Medicine, CPAP is used to keep your airway open as you sleep by providing you with a steady stream of air pressure.  It keeps your tissues in your throat from collapsing and thereby ensures that you get the oxygen you need.

Results of the study show that while weight loss and surgery to remove tissue in the throat  may sometimes effectively treat sleep apnea, the evidence behind these treatments isn’t as strong as that which supports the usage of CPAP, according to the team from the Tufts Medical Center Evidence-Based Practice Center, which prepared the report.

About 12 million Americans are known to have obstructive sleep apnea, and it’s likely that millions more are undiagnosed, according to the AHRQ. The condition, caused by the repeated collapse and blockage of the upper airway during sleep, leads to a cessation in breathing that usually occurs many times through the night typically 5-100 times per hour!

The main symptoms of sleep apnea are loud snoring and feeling very sleepy during the day. Although, many patients, even those with severe OSA, can deny daytime sleepiness. Your bed partner may notice periods when you stop breathing during sleep. Other symptoms may include tossing and turning during sleep, frequent awakenings during the night, waking up with a headache, and feeling irritated and unrested.

According to the Center for Disease Control (CDC) Obstructive sleep apnea can lead to high blood pressure, heart disease, diabetes and increased risk of accidents because of daytime fatigue.

Anyone from age 2 to 92 can suffer from obstructive sleep apnea. It was commonly thought to be a disorder of over-weight, middle-aged men, but sleep specialists are revising their opinion. Thin people often have a long narrow pharynx and that predisposes them to sleep apnea. Children have tonsils that are large relative to their small throats and they can have sleep apnea that leads to symptoms of ADHD, learning difficulties and psychiatric problems such as depression. Pregnant women often develop snoring and sleep apnea and there is ongoing research into the dangers this might pose to mothers and their unborn children.  Post-menopausal women have the same risk as men.

If you are sleepy during the day despite adequate sleep time, then sleep apnea should be investigated, especially if you’re told that you snore or stop breathing at night. Studies report that anywhere from 4 percent-24 percent of men suffer from OSA, and 2–15 percent of women. Both sexes over the age of 65 have a rate of 20–25 percent.

Only a sleep specialist can determine if you are suffering from OSA, and what the best method of treatment is for you.  Contact Northshore Sleep Medicine at 847.674.3600 if you believe you or your bed partner are suffering from Obstructive Sleep

During my lecture I will discuss the association of sleep disorders with impaired glucose tolerance, changes in appetite hormones, diabetes and weight gain/obesity.  There is a growing body of literature that shows a strong  association between short sleep durations and weight gain/obesity.

Research shows that sleep deprivation increases your risk for weight gain and obesity. The Huffington Posts reportsthat sleep restriction has been shown to increase levels of the hormone ghrelin, which makes you feel hungry while also slowing your metabolism. A new area of research focuses on how specific sleep disorders such as Obstructive Sleep Apnea, Insomnia, Restless Leg syndrome may lead to weight gain, either through the short sleep mechanism or other physiologic pathways.

The American Academy of Sleep Medicine claims that at least 40 million Americans have chronic sleep problems, and an additional 20 million experience occasional sleep disturbances. As many as 47 million Americans have metabolic syndrome, which is a group of conditions that are shown to increase the risk of heart disease and stroke and is usually associated with overweight/obesity.

According to the National Sleep Foundation, a study published in the International Journal Obesity found that middle-aged women who suffer from sleep disorders are more likely to have problems with their weight than their peers who get eight hours of sleep per night. Results were unique, in that they demonstrated that sleep problems precede weight gain.

A study published in the May 2010 edition of the journal Sleep found that people who fail to get an adequate amount of sleep (less than six hours per night) tended to weigh more and exercise less. This group was also more likely to prefer fatty foods, snack frequently and eat out more often.

It is important to recognize the relationship between sleep and weight gain, in order to address the epidemic of obesity. Many people do not realize that sleep is as important to good health as exercise and diet. By obtaining seven to eight hours of sleep per night, you are helping your body stay strong, both mentally and physically.

Soy contains isoflavones (estrogen-like compounds), which may be beneficial for postmenopausal women who are struggling to get the sleep they need.

According to the American Academy of Sleep Medicine, biological changes in women who are approaching menopause often cause sleep problems.  I see many such women in my sleep clinic.  Women often experience a decline in sleep quality and increase in sleep disturbances as they go through menopause.  For most of these women, the sleep problems persist long after menopause.  Sleep Apneaalso becomes more common when women approach menopause and worsens as they continue tp age.

Participants of the study were divided into two groups; 38 postmenopausal women with insomnia were given 80 milligrams of isoflavones while the other 38 received a placebo for four months. All of the study participants underwent polysomnography.

Results of the study show that sleep efficiency in women who received isoflavone increased from 78 percent at the beginning of the study to 84 percent at the end. Ninety percent of women in this group reported moderate to intense insomnia issues at the beginning of the study; only 37 percent reported similar problems after four months of treatment.

Many people are under the misconception that poor sleep is a part of normal aging. Although sleep patterns change as we age, older adults still require seven to eight hours of sleep each night. According to the National Sleep Foundation, many older adults show an increase in the amount of time needed to fall asleep, a decline in deep, slow wave sleep and an increase in sleep fragmentation (waking up during the night). Physical and mental illnesses, as well the medications used to treat them can also disrupt the sleep of older adults.

Due to the fact that the cause of postmenopausal insomnia is not known, researchers involved in the study say that consuming soy may not help every woman. If you are experiencing symptoms of insomnia for an extended amount of time (longer than three months) you should consult a sleep expert to determine if you have an undiagnosed sleep disorder.  Also, there have been some reports of increase in breast cancer and breast cancer recurrence with women consuming soy. Therefore, it is best to discuss with your doctor before using  a lot of soy product.

Symptoms of insomnia include difficulty falling asleep or staying asleep, poor quality of sleep and early awakening. In this study, symptoms of insomnia were considered chronic if they persisted for more than a year.

The study, conducted at Pennsylvania State University College of Medicine, was led by Dr. Alexandros Vgontzas. Vgontzas believes the study is unique in that it differentiated the subjective symptoms of insomnia from the objective duration of sleep, which was measured through a sleep test (polysomnogram) in a sleep laboratory.

The study included 1,000 women with an average age of 47 years, and 741 men with an average age of 50 years. Participants provided a comprehensive sleep history, completed a physical exam and slept one night in a sleep laboratory.

Women who participated in the study were followed for approximately 10 years and men involved in the study were observed for 14 years. During the follow-up period, 248 (or 14 percent) of all participants died; 145 (21 percent) were men and 103 (five percent) were women. Mortality rate for men was 9.1 percent for those without chronic insomnia who slept for at least six hours a night, and 51.1 percent for those with chronic insomnia who slept for less than six hours per night.  No association between mortality and insomnia with short sleep duration existed among the female participants.

According to Medical News Today, additional studies using this data found that chronic insomnia with short sleep duration are linked to higher risk of type 2 diabetes and hypertension.

Researchers involved in the study hope that findings will highlight the importance of identifying and diagnosing insomnia during the early onset of the condition.  it also offers new evidence that sleep physicians need to get objective data about the sleep of patients who complain of persistant insomnia.  To that end,  I will start using an actigraph to measure the sleep if patients with insomnia who are not appropriate candidates for a sleep study.

Keep in mind that many patients think they have insomnia but in fact they have another sleep disorder such as obstructive sleep apnea or periodic limb movement disorder that is waking them up repeatedly and disturbing their sleep.  This study shows the importance of finding out exactly what is the problem that prevents a patient from getting those badly needed 6 hours (minimum) of sleep.

Principal investigator Alexandros N. Vgontzas, MD, will discuss the study “Insomnia with short sleep duration and mortality: the Penn State Cohort” on the Sept. 3, 2010, radio broadcast of “Science Friday” on NPR.  You can listen live online from 2 p.m. to 4 p.m. EDT

While OSA can occur in men and women of any age, it is commonly found in middle-aged, overweight men. Symptoms of the disorder include snoring, excessive daytime sleepiness, un-refreshing sleep, unintentionally falling asleep and insomnia. People with untreated OSA also often experience decreased awareness during the day and lower productivity.

Web-MD reports that results of the study show that patients with OSA had reductions in gray matter volume and a decrease in neuropscyhologic performance. After receiving CPAP therapy for three-months, these patients had a significant increase in both gray matter volume and great improvement in their scores on neuropsychologic testing.

No further improvement in gray matter volume was seen when patients were re-evaluated after one year of receiving CPAP therapy.

Findings of this study highlight the importance of adherence to CPAP therapy, as use results in significant improvements in patients’ overall well-being and contributes to the restoration of brain areas that are adversely affected by OSA.

The most common signs or symptoms of Sleep Apnea are snoring and excessive daytime sleepiness.

The study included 163 children and adolescents between the ages of 10 and 17 years of age. Results indicate that moderate to severe OSA is linked to both lower academic grades and behavioral problems observed by both parents and teachers.  Students who had OSA averaged a half-letter grade lower than those without the condition.

The American Academy of Sleep Medicine states that other problems associated with untreated OSA in children include aggressive behavior, attention-deficit/hyperactivity disorder (ADHD) and delays in development.  If left untreated, OSA can negatively affect a child for the rest of his or her life.

The good news is that sleep apnea in kids is easily diagnosed by a sleep test and is easily treated,   often by tonsillectomy/adenoidectomy, or is that is not successful, we do CPAP (continuous Positive Airway Pressure).  Believe it or not, children often take to it easier than adults.  Be sure that you seek out a sleep medicine specialist that has significant experience testing and treating children.  There is an extra monitor that we put on children (CO2 monitor) that is not part of the standard polysomnography (sleep test) but which is essential in detecting if the child is hypoventilating.

OSA, a sleep disorder that disrupts night time breathing, is often recognized by its’ most common symptoms; snoring and daytime sleepiness/fatigue.   While OSA is more frequently found in men, the disease also affects women, and after menopause, they are just as likely as men to develop it.   Results of this large study which included both men and women show that both genders are equally affected by stroke associated with sleep apnea. The increased risk is independent of other predictors of stroke, such as obesity, high blood pressure and smoking.

Previous studies have found that OSA is associated with diabetes, hypertension, obesity, heart disease, cardiac arrythmias,  fatigue,  dementia,  extreme daytime sleepiness and even premature death.

OSA can be treated with the use of CPAP  (continuous positive airway pressure) or an oral appliance that is prescribed by a physician and fitted by a dentist.  Proper treatment of sleep apnea can reduce or eliminate symptoms and improve overall health and future health risks as well as daytime functioning.

Only a sleep physician can determine if you are suffering from OSA. If you think you or someone you know may be suffering from sleep apnea, please contact us to make an appointment for a consultation.

A new study published in Kidney International found that sleep apnea is an independent predictor of increased all-cause mortality in patients receiving peritoneal dialysis independent of age, male gender and diabetic status. Risk increases with the severity of the patient’s sleep apnea.

The study, which began in 2001, studied 93 Chinese patients who were receiving peritoneal dialysis. Participants underwent at least one overnight polysomnography (sleep study) at the beginning of their dialysis treatment. After a median follow-up of 41 months, 53 patients (56.9 percent) developed one or more cardiovascular events. Thirty (32.2 percent) of the patients had died. Among the patients who had died, 17 (56.6 percent) were due to cardiovascular events.

While the study was unable to determine the cardiovascular outcome for all patients included in the study, sleep apnea is known to increase the risk for cardiovascular disease, stroke and death in the general population.

Sleep apnea is typically treated with continuous positive airway pressure (CPAP), which has been shown to reduce the risk of cardiovascular events.  The most common symptoms of obstructive sleep apnea (OSA) are snoring and daytime sleepiness.

As for whether physicians should do more screening for sleep apnea, there is a resounding yes from many arenas.  Primary care doctors (including pediatricians), cardiologists, pulmonologists, endocrinologists, neurologists are examples of doctors who deal every day with the diseases associated with sleep apnea.  Diseases such as high blood pressure, heart disease, stroke, cardiac arrhythmias, diabetes, weight gain, obesity,dementia. In children, it can lead to ADHD symptoms, diagnoses of psychiatric and learning problems; it can lead to stunted growth, obesity and bed wetting. There are many simple screening questionaires that could help physcians decide who should be referred to a sleep specialist, but they are not often used. Sleep specialists hope to help educate other physicians and the public about how beneficial it can be for patients to have their sleep disorders treated.

Sleep Medicine is Preventive Medicine.

http://opinionator.blogs.nytimes.com/2010/03/18/at-midnight-all-the-doctors/