http://www.webmd.com/sleep-disorders/excessive-sleepiness-10/myths-facts?src=RSS_PUBLIC

Today’s Tuesday Tip is to find a comprehensive sleep center that handles their own CPAP machines and masks because that way you have medical professionals working together to treat your sleep apnea and help solve the problems that you are having with the CPAP therapy.  Employees of medical supply companies who, by the way,  are usually not health professionals, simply cannot deliver the same quality of care.  Such a sleep center should do what we do at Northshore Sleep Medicine:  we let you take home and try many different masks without repeatedly billing you or your insurance company.  We guide you toward the best masks and then let you take home as many as you need until you find the perfect fit and comfort for your face and your sleeping patterns.

And remember CPAP is the gold standard therapy for obstructive sleep apnea and the only proven first-line therapy for severe sleep apnea.  It is in your own best interest to make a good effort to use the CPAP if that is what your doctor prescribes.  So don’t be fooled by the advertisements from dentists who encourage you to “hate CPAP” and to give up on it and switch to their expensive oral appliances that often do not adequately treat the sleep apnea.  There is an appropriate use for the oral appliances, but only a physician should be making that recommendation, not a dentist.

Sleep apnea is a serious medical disorder that,  if left untreated,  increases your risk for high blood pressure, heart disease, stroke, diabetes, obesity and dementia.  It goes without saying that the treatment is best guided by a sleep physician.  If you snore, have excessive daytime sleepiness or for some other reason suspect that you have sleep apnea, do not start by going to a dentist who advertises that he treats snoring.  Start by going to a reputable sleep doctor, preferabably at a comprehensive sleep center, who will then refer you to a trustworthy, experienced dentist if the oral appliance ( AKA:  mandibular advancing device)  is an appropriate therapy for you.

Most Rabbis agree that it is alright to use medical equipment such as CPAP (Continuous Positive Airway Pressure) that your doctor has determined is medically necessary for treatment of your obstructive sleep apnea.  By using your CPAP every night, you are lowering your risk of developing hypertension (high blood pressure), heart disease, cardiac arrhythmias, stroke, obesity, diabetes and dementia.

Many CPAP machines now turn on automatically when you put on the mask and turn off when you take it off so there are no on/off switches to use.  One example is manufactured by Res Med.  Ask your sleep doctor about prescribing this type of CPAP machine if that makes you feel better.

Also, another way to be observant is to use a timer such as the type people use to  turn lamps on and off- when they are away from home.  Rabbi Kreisman of Skokie, Illinois recommends this to members of his temple.

One of our staff sleep physicians at Northshore Sleep Medicine, Dr Irina Trosman, is Jewish and she feels strongly that her Jewish patients should feel comfortable using their CPAPs on the sabbath and high holidays and that they should not feel that they have gone against their traditional religious beliefs.

Mazel tov!

Studies have shown that 80% of patients with atrial fibrillation have obstructive sleep apnea and a growing body of observational studies show that treating the sleep apnea with either CPAP or the oral appliance can keep the a.fib (atrial fibrillation) under control.  Many electro-physiologists (the cardiologists who do cardio-ablations) will not do the ablation until a patient has a sleep study to investigate the presence of sleep apnea.

Sleep center interest surges both on and off campus, Health Facilities Management

I feel very strongly that school bus drivers should be screened for sleep apnea.  I know of no initiatives aimed at such a measure and would appreciate any information about this topic.

They are making recommendations that all pilots be screened for sleep disorders, especially for sleep apnea, which can make people profoundly sleep deprived and make it very difficult for them to stay awake during any sedentary activity. The repeated collapse of the throat while sleeping leads to repeated micro-arousals because the brain senses the falling oxygen levels and rising CO2 and knows that something is wrong. During the brief awakenings  (so brief that a person doesn’t usually remember), the person gasps for air and then falls back into sleep only to start the whole disruptive process all over again.

There are now several airplane crashes that are thought to have occured because of pilot fatigue and the associated poor judgement and slowed reflexes.  There are many large industrial disasters that were ruled in the end to have happened because someone fell asleep on the job, e.g.  the Three Mile Island nuclear accident and the Exon Valdex oil spill.

There is an increasing awareness and concern among sleep specialists and highway safety experts about the prevalence of drowsy driving among all drivers, but especially commerical divers.  The National Highway Traffic Safety Administration (www.nhtsa.gov) estimates that 100,000 crashes occur each year due to drowsey driving involving 76,000 injuries and 1,500 deaths.  This is just an estimate because most crashes are single driver accidents.  The tell-tale signs, which unfortuneately most police are not taught to look for, are:  (1) Single Driver; (2) Time of accident is either very late at night or during the circadian dip that occurs in the afternoon; (3) No attempt to avoid the crash (which makes drowsy driving very deadly).  In April 2009, the National Highway Traffic Safety issued its review of a  prototype for a Drowsy Driver Warning System to be used by commercial drivers.  The report concluded that this is promising technology and more development in this area is likely to occur over the next few years. See the full report at ( http://www.nhtsa.gov/portal/site/nhtsa/menuitem.54757ba83ef160af9a7ccf10dba046a0/

 Auto manufacturers are looking into offering such devices for passenger vehicles.  But we don’t want millions of sleepy people relying on such devices in order to continue to drive drowsy.  I encourage my readers to see a sleep specialist if they have problems sleeping at night or are unusually sleepy in the daytime for unknown reasons. I urge people to take drowsy driving as seriously as they do drunk driving:  It can be just as deadly.

A high percentage of adolescents becomes evening types and a significant  number of them become true night owls who can’t go to sleep before 1 or 2 in the morning.  When this sleep pattern interferes with a person’s work, school or social life, we then classify it as a sleep disorder, specifically, it is a circadian rhythm sleep disorder called Delayed Sleep Phase Disorder. 

The exact prevalence in the population is unknown, but it is much more common in adolescents and young adults with an estimated prevalence of 15%.  I am starting to see alot of teenagers in my clinic who have this disorder and for some it can have devastating scholastic consequences.  One junior in high school had to drop out of her high school and start an on-line high school curriculum because she could not get up and go to school.  She started failing classes even though she had been a straight-A student.   Her grades picked up again once she could sleep in and do her studying later in the day, but I doubt that anyone would think that it is an optimal situation to have a teen staying home all day alone learning on a computer.

It has been a mission among many sleep physicians to try to convince school administrators that they would have a healthier, happier and smarter student body if they would start the teens at a later time.  I hope to reach out to both parents and educators in the next school year either via lectures or webinars in order to inform them about the importance of sleep.

I think that many people say that they know sleep is important, but then they organize their lives such that sleep has very little priority.  There is also a lack of knowledge about how much sleep children and teens need in order to function at their very best. For example, most people don’t realize that teens need an average of 9-9.5 hours of sleep per night.

Not only does research show that 50% of snorers have sleep apnea, but the latest studies presented at the annual meeting of American Academy of Sleep Medicine in June 2009 (www.aasmnet.com)  indicate that “benign snoring”  increases your risk of high blood pressure, heart disease and stroke.  What does “benign snoring” mean?  It means that during the sleep study we did not find significant apnea. We define sleep apnea as 5 apneas per hour or more.  Perhaps the new research is demonstrating that even 3 apneas per hour can have long term consequences.  But my point is really that it is irresponsible or just ignorant to report on snoring as an annoyance or family joke without one sentence about sleep apnea and the importance of a sleep study and having an evaluation by a sleep specialist.

In all fairness to NPR, on the website report on this topic, they do talk about sleep apnea. But if you only heard the piece on the air, then you would have been misinformed about the health risks associated with snoring.

What really added insult to injury here is that I and and the American Academy of Sleep Medicine (for which I am an official spokesperson) tried to contact Alison Aubrey and tried to find her producer, but everyone was so unhelpful and uninterested in what we had to say. Now, we are the experts:  Why did they not want their listeners to hear what the experts had to add this discussion?  It baffles me.  They had a doctor in their piece who was identified as an ENT (Ears, Nose and Throat) doctor, not a sleep specialist, so why would they think they had an authoritative source of information about sleep medicine?

Here is a good analogy: NPR does a story about smoking. Smoking is very annoying to non-smokers. When you are out in public, you are embarrassed by the stench of your smoke. A new solution has been found to help you smokers contain your smelly smoke which disturbs everyone around you  . . . You see where I am going.  Would anyone report on smoking without talking about lung cancer, emphysema, heart disease?  The field of sleep medicine has worked for 20 years to have people understand that sleep apnea poses a serious threat to public health  and  to see these efforts undermined by such irresponsible reportage is very frustrating.

Message of the day is:  Snoring is no laughing matter!

The reporter, Robert Mitchum (rmitchum@tribune.com) brings up concerns that are shared by many sleep physicians, namely that hospitals and businessmen are opening sleep apnea mills.  Sleep Medicine just became a bonified sub-specialty in 2006 and the first official board exam, overseen by the American Board of Medical Specialities (www.abms.org), was given in 2007.  Until recently, any doctor could claim to be a sleep specialist.  It is important to go to a board-certified sleep specialist who treats all sleep disorders, not just sleep apnea, because people often have more than one problem with their sleep. It is also very important to go to a sleep center that is accredited by the American Academy of Sleep Medicine (www.aasmnet.org). If you go to their website, it is very easy to find an accredited center near you.

Now I know that I have a bias since I am a physician who owns and operates her own comprehensive sleep center, but I do feel strongly that this is the best way to do sleep medicine. When businessmen own the sleep lab and hire the doctor, you are not going to get the same level of care. The other week, a patient called my cell phone on a Saturday morning to say that his wife’s CPAP broke the night before and because she had one stroke already, she is afraid to sleep without it. I met them at my sleep center an hour later to give her a new CPAP. Only when a sleep center is being run like a doctor’s practice are you going to get that kind of service.

As for home sleep tests, I do some work with a company called Snap Diagnostics that provides a user-friendly, fairly reliable home sleep test that you pick up in a doctor’s office. Usually a sleep technician or nurse shows you in the office how to hook yourself to the few wires involved and then you bring the kit back the next day.

(CPAP is an acronym for Continuous Positive Airway Pressure and is the gold standard treatment for obstructive sleep apnea AKA OSA)