Loud snoring, difficulty falling asleep and un-refreshing sleep were significant predictors of metabolic syndrome, a group of risk factories related to obesity. These factors increase risk for heart disease, diabetes and stroke. Snoring doubled the risk for metabolic disease, while difficulty falling asleep increased the risk by 80 percent.

The study analyzed 2,000 patients who were enrolled in an ongoing, community-based prospective heart health study. Participants ranged in age from 45 to 74 years, lived in or around Pittsburgh, and had no co-morbidity that limited life expectancy. Individuals who were either non-black or non-white, or had a diagnosis of metabolic syndrome or diabetes were excluded. The final sample consisted of 812 patients, with a group of 294 patients who agreed to undergo further evaluation at home.

Participants were evaluated for the presence or absence of metabolic syndrome at the three-year follow up. Waist circumference, fasting glucose, and lipids were measured at baseline and annually for three years.

Patients were evaluated for insomnia and sleep apnea. Researchers also documented history of smoking, alcohol consumption, physical activeness and depressive symptoms.

At the three-year follow up, 14 percent of patients had developed metabolic syndrome. After analysis, only loud snoring remained a significant predictor of the disorder.

Results of the study emphasize the importance of identifying and diagnosing sleep problems and disorders, due to their association with heart disease.

A study presented at the annual SLEEP meeting in San Antonio, Texas shows that employees who begin work between the hours of 9 a.m. and 2 p.m.  had the maximum amount of sleep before work ( eight hours), while those who begin work between 8 p.m. and midnight had the minimum amount of sleep (4.5 hours) before work.

The National Sleep Foundation states shift workers are at increased risk for a variety of chronic health problems, such as cardiovascular and gastrointestinal diseases.  New studies suggest that shift workers may also be at increased risk for developing cancer.

Researchshows that night shift work is associated with decreased work performance and alertness  and increased risk for accidents.

People who work night shifts can improve their sleep and work performance by maintaining a bedtime and wake schedule throughout the week, drinking caffeinated beverages during the shift to help maintain alertness, by working with others to increase alertness and by taking naps during breaks.  It is important that they maximize the sleep environment, for example, by using black out shades and ensuring that there will be no phone calls to disturb the sleep.  It is recommended that a Do Not Disturb sign be placed on the door to the bedroom to remind other family members, but also on the front door so that random solicitors do not ring the door bell and disrupt the shift worker’s sleep.

Experts at Northshore Sleep Medicine can help shift workers regulate their sleep patterns with bright light therapy and special sunglasses that block out blue spectrum light in the morning.

http://opinionator.blogs.nytimes.com/category/all-nighters/

http://www.webmd.com/sleep-disorders/excessive-sleepiness-10/sleep-supplements-herbs?page=2

 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