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.

Conditions that disrupt the sleep such as sleep apnea or insomnia can lead to arousals (many of which are not remembered) and this in turn leads to over-stimulation which increases the firing of the sympathetic nervous system (i.e. a rush of adrenalin).  This is all a fancy way to say:  when you don’t have good sleep, your heart is not resting as it should.  You can have an increase in your blood pressure and an increase in your heart rate that over many years can increase your risk for high blood pressure, heart disease, congestive heart failure, stroke and cardiac arrhythmias such as atrial fibrillation or ventricular tachycardia (as well as many other conditions such as diabetes, obesity, dementia and impotence).

If you treat sleep disorders such as sleep apnea, it can dramatically benefit your heart. For example, I saw a patient this week, Richard,  who had an initial, diagnostic sleep study that found significant sleep apnea and showed that his maximum heart rate while asleep was 122 bpm (beats per minute) with a mean pulse rate of 80.  This was much higher than expected for this extremely fit, 69 year old man who has a resting heart rate in the daytime of 65 bpm.   When he returned to the sleep lab and was started on CPAP (Continuous Positive Airway Pressure) to treat his sleep apnea, then his maximum heart rate dropped to 67 bpm and his mean was 52 bpm!   He had a nearly 50% reduction in his heart rate because we were able to eliminate the pauses in his breathing and all the stress on the body that apnea induces.   Plus keep in mind that this was his first night on CPAP and it was in a sleep lab with wires attached to him.  It will surely be even better when he is sleeping in his own bed and he becomes more accustomed to CPAP.

Sleep disorders are still one of the most overlooked causes of cardio-vascular disease.  Yet, there are more and more sleep centers and sleep physicians who can work with your internist and cardiologist to help find the optimal treatment plan.  To find the best sleep center near you, go the American Academy of Sleep Medicine’s website (aasmnet.org).   They list all accredited sleep centers in the US.  Be sure to ask if they are a comprehensive sleep center that has a board-certified sleep specialist and which treats all sleep disorders because your problem may involve more than one sleep disorder.

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.

The authors suggest that pediatricians be “particularly diligent about screening all children with asthma for Sleep Disordered Breathing (Sleep Apnea) and also consider sleep disorders as a possible risk factor for behavior problems.”

There is a growing body of evidence that sleep disturbances can cause and exacerbate behavior and learning problems and may mimic the symptoms of Attention Deficit Hyperactivity Disorder (ADHD).  It is important for pediatricians, psychiatrists and psychologists to consider sleep disorders early in the work up of ADHD (or other learning or psychiatric problems).  Indeed, I maintain that no child should receive a diagnosis of ADHD without having an overnight sleep study to rule out sleep apnea.

Parents with children diagnosed with ADHD can think that their children “sleep just fine” because they go to bed and seem to sleep for 10 hours before emerging from their bedrooms, but few parents sit and watch their children sleep for hours so they don’t really know about their quality of sleep.  Too many children are being put on stimulates, and many at such a young age. 

These drugs were never tested in children and this usage is a recent enough phenomenon that we are only starting to see how people fare who have been taking stimulants (e.g. methylphenidate (Ritalin or Concerta); dextroamphetamine + amphetamine (Adderall);  lisdexamfetamine (Vyvance)  for many years.  I know that I see teens and young adults  every day in my sleep practice who suffer from intractable insomnia likely connected to lifelong use of prescription stimulants.

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.

There is a growing body of research that shows that people who sleep too little or who have poor quality of sleep are more likely to be over-weight or obese.  The new research from the University of Chicago (www.uchospitals.edu) has a new and interesting implication:  that you might be able to lose weight if you are sleep deprived, but it might not be fat that you are losing. The study is limited by small sample size, but it indicates that weight loss during periods of sleep restriction may be due more to loss of lean body mass than to loss of fat. Fat represented 57% of the weight loss when the nine subjects slept 8.5 hours on average in a 2 week period , but only represented 26% of the weight loss when they slept 5.5 hours during another 2 week period.  The total amount of weight they lost in each period was practically the same.

The other study mentioned in this article showed what many population studies have showed:  Those people who sleep less, gain more weight.  There are numerous population studies that show that people who sleep fewer than 6 hours or have sleep that is disrupted by disorders such as sleep apnea are much more likely to be over-weight or obese. 

Laboratory research, much of which was done at University of Chicago, points to the explanation for this. When your sleep is disrupted or restricted, then your metabolic rate is slowed, your appetite hormones are not functioning properly(making you hungrier) and your ability to regulate your glucose and insulin is impaired, not to mention that you just have no energy to exercise or take the time to prepare nutritious food.