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The Greek word "apnea" literally means "without breath." There are three types of apnea: obstructive, central, and mixed; of the three, obstructive is the most common. Despite the difference in the root cause of each type, in all three, people with untreated sleep apnea stop breathing repeatedly during their sleep, sometimes hundreds of times during the night and often for a minute or longer.
Obstructive sleep apnea (OSA) is caused by a blockage of the airway, usually when the soft tissue in the rear of the throat collapses and closes during sleep. In central sleep apnea, the airway is not blocked but the brain fails to signal the muscles to breathe. Mixed apnea, as the name implies, is a combination of the two. With each apnea event, the brain briefly arouses people with sleep apnea in order for them to resume breathing. Consequently sleep is extremely fragmented and of poor quality. The figure shows the collapse of the airway and the blockage.
There is a characteristic snoring pattern associated with this syndrome. There are loud snores or brief gasps that alternate with episodes of silence that usually
last 20 to 30 seconds. The snoring is commonly so loud that it disturbs the sleep of bed partners or others sleeping in close proximity. The snorer occasionally will hear
the snoring, but is usually not aware of the snoring intensity.
Sleep apnea is very common, as common as adult diabetes, and affects more than twelve million Americans, according to the National Institutes of Health. Risk factors include being male, overweight, and over the age of forty, but sleep apnea can strike anyone at any age, even children. Yet still because of the lack of awareness by the public and healthcare professionals, the vast majority remain undiagnosed and therefore untreated, despite the fact that this serious disorder can have significant consequences.
Untreated, sleep apnea can cause high blood pressure and other cardiovascular disease, memory problems, weight gain, impotency, and headaches. Moreover, untreated sleep apnea may be responsible for job impairment and motor vehicle crashes. Fortunately, sleep apnea can be diagnosed and treated. Several treatment options exist, and research into additional options continues.
Why Do We Sleep?
The very first question we would like to ask about sleep is why do we need it all? Researchers in the field say this is one of the unsolved mysteries of biology. It’s been shown that sleep improves learning. During sleep the brain apparently replays some events of the day –and this helps to consolidate memories. Recently it’s been hypothesized that sleep affects the synapses in the brain – the connection between neurons. Sleep may prevent a ‘descent into chaos’. This goes along with the idea of sleep as a restorative process - that ‘knits up the ravelled sleeve of care’.
The consequence of not getting enough sleep is called sleep debt or sleep deficit, experienced as sleepiness. One of the founder’s of sleep studies, Dr. William Dement has called this ‘Nature’s Loan Shark’, suggesting that the debt is going to be repaid – or there will be serious consequences. And Nature is keeping track of the debt. Inability to focus and concentrate are obvious consequences. Falling asleep briefly is the likely cause of many car and train accidents, ships running aground and other general mayhem.
Tips for Better Sleep
Assuming there are no serious problems that require medical attention, you can help yourself sleep better in several ways:
Establish Pre-bedtime routine
- Have a consistent time for sleeping
- Avoid excitement and anxiety producing thoughts or activities. Meditation has been found to be helpful
- Do activities that you find relaxing, such as listening to music or reading
Create Suitable Environment
- Experiment with the physical setting of bed, pillows, mattress.
- Get annoying animals out of the room (the cat that walks across your face)
- Keep the room dark, cool and quiet
Control Habits
- Some people find regular exercise helps them nod off quickly
- Alcohol may help with falling asleep but reduces the quality of sleep – try to avoid drinking too close to bedtime. Dedicated drinkers may find this difficult.
- Caffeine or other stimulants will interfere with sleeping for up to 12 hours ahead.
- Smokers may find themselves waking up due to withdrawal symptoms
Many people who are on CPAP (continuous postivie airway pressure) equipment find it cumbersome and uncomfortable. The treatment does appear to work, though, if you can stick with it. There was a study reported in the June 15 issue of the Journal of Clinical Sleep Medicine. Five or more hours of CPAP per night reduced complaints of fatigue, tiredness and sleepiness compared to those who didn’t have the treatment.
Researchers at the Rensselaer Polytechnic Institute in Troy, N.Y., tested whether a device used to deliver blue light directly to the eyes would affect circadian rhythms — the body’s internal clock that regulates when and how much people sleep and other biological cycles.
“Light and dark patterns are the major synchronizer of circadian rhythms to the 24-hour solar day,” study principal investigator Mariana Figueiro said in a statement. “Light stimulus travels through the retina, the light-sensitive nerve tissue lining the back wall of the eye, to reach the master clock in the brain. However, a combination of age-related changes in the eye and a more sedentary lifestyle may reduce the amount of light stimulus reaching an older person’s retina, therefore reducing the amount of light for the circadian system.”
The study found the blue light showed a stimulation effect on the circadian system.
According to a study in the Dec 2008 issue of the journal Sleep, the use of light exposure therapy, dark sunglasses and a strict sleep schedule can help night-shift workers create a “compromise circadian phase position,” with better increased performance and alertness during night shifts. It also allows adequate nighttime sleep on days off.
“The major finding of this study was that complete physiological adaptation to a night shift and day sleep schedule does not appear necessary in order to improve night shift alertness and lengthen daytime sleep,” said lead author Mark Smith, post-doctoral fellow in the Biological Rhythms Research Laboratory at Rush University Medical Center in Chicago. “Instead, we found that partial physiological adaptation using scheduled exposure to light and darkness is sufficient to bring night shift performance back to daytime levels.”
Adolescents often struggle to obtain a sufficient amount of sleep during the school week due to a biological change that occurs during puberty, which makes falling asleep in time to obtain the required 8-10 hours of sleep for full restoration difficult. Students who use multiple forms of technology late into the night and consume caffeinated beverages subsequently may suffer from excessive daytime sleepiness. This was studied at Drexel University and the results are being presented June 8, at SLEEP 2009, the 23rd Annual Meeting of the Associated Professional Sleep Societies
A study in the April 15 issue of the Journal of Clinical Sleep Medicine determined that over-the-counter melatonin medication can shorten the length of time it takes for children with autistic spectrum disorder (ASD), Fragile X Syndrome (FXS), or both to fall asleep at the beginning of the night.
Results indicate that children who received over-the-counter melatonin treatments experienced significant improvements in total night sleep durations, sleep latency times, and sleep-onset times. Mean sleep duration was longer on melatonin than placebo by 21 minutes, sleep-onset latency was shorter by 28 minutes and sleep-onset time was earlier by 42 minutes.
Patients saw improvements in subjective sleep quality and sleep diary parameters while practicing meditation. Sleep latency, total sleep time, total wake time, wake after sleep onset, sleep efficiency, sleep quality and depression improved in patients who used meditation.
According to principal investigator Ramadevi Gourineni, MD, director of the insomnia program at Northwestern Memorial Hospital in Evanston, Ill., insomnia is believed to be a 24-hour problem of hyperarousal, and elevated measures of arousals are seen throughout the day.
“Results of the study show that teaching deep relaxation techniques during the daytime can help improve sleep at night,” said Gourineni.
The research abstract will be presented on Tuesday, June 9, at SLEEP 2009, the 23rd Annual Meeting of the Associated Professional Sleep Societies
118 adults with chronic insomnia participated in a 5-week, online treatment for insomnia. Treatment consisted of psychoeducation, sleep hygiene, and stimulus control instruction, sleep restriction treatment, relaxation training, cognitive therapy, and help with medication tapering. There were statistically significant improvements in sleep quality, insomnia severity, and daytime fatigue. The study is reported in the journal Sleep.
In sleep apnea, the upper airway becomes blocked, and people stop breathing during sleep, usually in 10- to 20-second bouts that can occur 30 or more times an hour. The problem is usually treated with a device that increases air pressure in the throat, keeping the airway open. Called continuous positive airway pressure, or CPAP, the therapy involves wearing a mask attached to a machine.
The success rate of CPAP therapy is more than 90%. Though effective, many people find it uncomfortable and cannot tolerate the appliance.
A surgery, called transpalatal advancement pharyngoplasty, enlarges the space behind the roof of the mouth. The lead author of a study that tested this treatment, Dr. Neville Patrick Shine, of St. Johns Hospital in Edinburgh, Scotland, found better than 60% success with this procedure .
Another alternative is an appliance called a mandibular advancement device, designed to prevent the airway obstruction of sleep apnea. It does this by moving the lower jaw forward. A research team led by Dr. Chul Hee Lee, from Seoul National University Bundang Hospital and Seoul National University College of Medicine, evaluated 50 people with sleep apnea who used the device. Based on reductions in shallow or stopped breathing, the device worked in 37 of the participants, including a mix of people with mild, moderate and severe sleep apnea, the researchers found.
However, Dr. Shirin Shafazand, an assistant professor of medicine in the Division of Pulmonary and Critical Care Medicine at the University of Miami Miller School of Medicine, said that devices such as the one tested in the Korean study, are really for people with mild sleep apnea and should be prescribed only after people have undergone sleep studies to determine the severity of their condition.
SOURCES: Neville Patrick Shine, F.R.C.S., St. Johns Hospital, Edinburgh, Scotland; Shirin Shafazand, M.D., assistant professor, medicine, Division of Pulmonary and Critical Care Medicine, University of Miami Miller School of Medicine, Miami; Jose W. Ruiz, M.D., assistant professor, otolaryngology, University of Miami Miller School of Medicine, Miami; May 2009, Archives of Otolaryngology, Head & Neck Surgery.
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