Wednesday, June 10, 2009

Benefits of the CPAP machine - Sleep Apnea

After a diagnosis of obstructive sleep apnea, your doctor may prescribe a continuous positive airway pressure machine. The thought of using the apparatus, with all its tubes, masks, knobs, buttons, lights, humidifiers and such, every time you sleep from now till eternity can be pretty daunting. The side effects of the treatment are easy to find and your doctor will surely outline most of them to you.

However it’s worth pointing out the benefits of the CPAP machine. Here’s a list of what you can look forward to and why you have become a “hose head”

Benefits of the CPAP machine

Lower Blood Pressure – OSA causes you to stop breathing momentarily, often hundreds of time during the night. An extreme case will result in massive loss of oxygen to your body. The cardio system relies on a regular supply of oxygen from the lungs to the heart. If the heart has to work harder with less oxygen, then your blood pressure goes up.

Elevated BP is associated with a higher risk of heart disease, stroke and type 2 diabetes. It is the main reason why sufferes of OSA have such a higher rate of mortality compared with non-sufferers. The CPAP machine will deliver more air to your lungs and lead to a reduced blood pressure. It is the single most important reason for using the machine.

More alert and fewer day time naps – The interrupted sleep associated with sleep apnea obviously leads to less rest during the night. It can often feel like you get barely any shut eye at during a long night while every body else is dreaming peacefully.

Your body needs a certain amount of rest every day - the sleep apnea prevents this and you try to compensate by slowing down brain function and causing naps during the day. If you can get more sleep at night, then the reverse will occur. Brain function will improve and you may be more productive and better at your job.

Reduced or eliminate depression – More rest at night will increase your emotional stability. Life just doesn’t seem as tough when your body can use the night time for what it’s for. Time spent awake during the night can all to be easily lead to anxiety and a viscous circle of depressive thoughts. The chance to fall off quickly and regularly can break this cycle and lead to a much happier life in general.

Many surveys have confirmed that people who use CPAP state that they have a superior quality of life when compared to what they used to put up with prior to their treatment.

Lose your temper less – A well rested person will have better control over their temper. Poor sleep will leave you with elevated levels of adrenalin and a lower stress threshold.

Do you find that you get angry with workmate, your kids or spouse because you haven’t been getting enough sleep? It’s a very common complaint. More sleep will improve your relationships with those who are most important to you. As will waking up without dry, sludgy eyes or a splitting headache. Starting off the day well makes a huge difference to the outcome of the rest of your life.

More energy – Sleep is when your body concentrates on repairing itself. A restless, unproductive night will leave you physically under-prepared for the day. In addition OSA sufferers will have not absorbed oxygen in sufficient quantities to allow the body to process essential nutrients during the night.

The first response of many people on first using the CPAP machine is how much more energy they have. It’s like returning to sea level from high altitude. More oxygen in the body and hence blood stream and organs means more energy the next day. It can be a life changing difference and one that shouldn’t be avoided.

Lessen your risk of car accident – People with untreated or undiagnosed OSA have been shown by scientific studies to be at much higher risk of a car accident. The daytime sleepiness and general loss of alertness brought on by an interrupted poor night’s sleep makes you more dangerous on the road. It is estimated that sleep apnea sufferers are 15 times more likely to be involved in an accident. Passengers, other drivers and pedestrians are at the same higher risk when a sufferer is behind the wheel. CPAP treatment is one of the best methods of protecting the safety of your children is you have sleep apnea, because you are less likely to hurt them in an accident.

Better concentration during the day – The brain uses REM dreams to recharge it batteries, “file away” what happened during the previous day and prepare for the day ahead. It takes two hours of unconsciousness before it is ready to enter this phase. Apnea sufferers, who stop breathing so regularly and wake up so often may never enter this phase.

When sleep is interrupted, the brain may not get a full chance to perform these necessary functions. This is why our brains can be muddled, groggy and our ability to concentrate is poor after a restless night Allow the brain to achieve the state it needs and the symptoms will reverse.

Medical expenses – Beyond the initially appointments at the specialist and cost of the CPAP machine and finding a comfortable nasal of facial mask, the life time cost of medical care for obstructive SA treatment will be less than no treatment at all. Diagnosed sufferers go to the doctor less and will have fewer severe health problems in the long term. Your annual costs will reduce and insurance premiums may drop as your underlying health improves once treatment is well underway. So there is a financial benefit as well as a mental and physical health pluses involved in the CPAP treatment.

Less Snoring – the opened airways that the CPAP machine will force from its use will directly reduce the volume of your snoring. It can be hard to tell how loud your own snoring really is, because we are generally asleep during its worst effects.

Your sleeping partner will benefit though and leave them with a better more relaxing night. There can often be feelings of resentment brought on by the lack of sleep caused by this snoring so chances are your relationship with your significant other will improve as well! If they currently sleep somewhere else they may even return to your bed.

Sleep through the night – Possibly the greatest benefit of the CPAP machine is the relaxing feeling of sleeping through the night. For an OSA sufferer the last solid eight hours of rest that everybody else takes for granted can be a distant memory.

This continual level of unconsciousness doesn’t happen for everyone on the treatment, but most will see an almost immediate level of improvement. Many patients even get sore body parts and pins and needles in their limbs because there bodies have forgotten to naturally move and roll over during the night. The most beneficial dream state – REM doesn’t occur until 2 hours into a rest period so this is the level to aim for initially.

Tuesday, June 9, 2009

Sleeping Disorders - Causes of Sleep Apnea

Ralf Bromade's children had been laughing at his snoring for as long as he could remember. They called him "The Bear". He was a big guy and liked to eat and drink with friends and was generally pretty happy. There was one major problem in his life, he couldn't get a good night's sleep.

Ralf's wife told him his snoring was as bad as ever, and he was choking during the night. The headaches in the morning were starting to affect his job, so Ralf made an appointment with his doctor to get checked out. He was quickly diagnosed, with sleep apnea. (Some people call it sleep apnoea)

There are two types of sleep apnea, obstructive (OSA) and central (CSA)
Obstructive sleep apnea is the most common and involves a physical obstruction of the upper airways. Your tongue and soft palate block your throat while you're trying to breath.

This obstruction doesn't always cause apnea. This is the most severe result of the blockage. Often though snoring and very shallow breathing, known as hypopnea, will result.

You will be at a higher risk of OSA is you have one of several predispositions
  • A smaller than normal airway size, due to a larger tongue or soft palate, or swollen throat.
  • Weak musles in the upper throat. This may be an unavoidable characteristic, or brought on by excessive alchol intake or a neurological disorder.
  • Obstruction caused by nasal congestion. Many reasons exist for nasal congestion, but if you have a chronic complaint, like an allergic reaction that causes swelling, a side effect of a drug or a long term illness than these can all lead to the obstruction

Central sleep apnea is far less ommon and is due to neurological disorders which reduce the bodies abilities to look after itself

Symptoms to watch out for
  • Excessive daytime sleepiness and tiredness.
  • Nocturnal problems such as loud snoring, thrashing in bed, choking while asleep, making weird noises, pain reactions or mini 'seizures'
  • Headaches in the morning
  • Sexual dyfunction

Obstructive sleep apnea can be managed by your doctor but if it's undiagnosed, or left untreated, than there is a signifigantly higher risk of cardiovascular disease and motor vehicle accidents. Ralph was shocked when he saw the statistics and realized what his death would mean to his wife and kids.

You will be at a higher risk of having OSA if you're obese, unfit, keep odd sleeping hours, drink alcohol before sleeping, smoke cigarettes, take sleeping pills or have a chronicly blocked nose

Ralph's doctor put him through several steps to help with his problem.
  • He lost weight, nearly 10kg, which made a big difference in many areas of his life
  • He began to excersize and got fit for the first time since school
  • he started going to sleep at the same time each night, didn't watch TV in bed and practiced some relaxation techniques
  • He stopped taking sleeping pills to help him sleep but left him feeling drugged the next day
  • Stopped drinking during the week and has (nearly!) stopped smoking
  • Sleeping on your stomach or side may help with sleep apnea

At the moment these measures appears to be working, but Ralph still wakes up groggy and with a headache. He feels much better and can finally chase after his children. Unfortunatley his wife is still woken up by his snoring.

The next step is a few nights in a sleep clinic and using a Continuous positive airway pressure CPAP machine.

It's currently the most effective way to treat sleep apnea. You wear a mask over your nose, or face and it uses air to hold open your throat. Most patients report a big increase in sleepiness and can think better in the morning.

Monday, June 8, 2009

Cures for Hypnic Jerks

One of the most common searches that brings people here to sleep-disorders-help is for those trying to cure their hypnic jerk.

That jolt you feel just before dropping off. That startle when you’re safe in bed that feels like a falling sensation. That electric shock that wakes you from the earliest stage of sleep. Hypnic or hypnagogic jerks are a fact of life for many Americans.

They can be episodes of frighteningly vivid life-like dreams or a simple physical reaction that causes a mild surprise. Around 70% of people experience this phenomenon.

Nobody knows for sure but there are several theories as to the causes of the jolt while sleeping. It happens most often when we are stressed, in an uncomfortable position, over tired or anxious.

The viscous circle is that a hypnic jerk which wakes you up can make you anxious about falling asleep, which leads to another jerk. Anxiety leads to insomnia and the restless night and bad morning which result can all to quickly follow this cycle.

Some tips to help you minimize the effects.
  • Follow good sleep hygiene, develop a routine and follow it every night.
  • Watch what you eat before bedtime
  • A magnesium, calcium or iron deficiency may be to blame. First try to improve your diet, lots of fresh fruit and vegetables. Or try a supplement, with those minerals and vitamin C.
  • Heavy exercise too close to bedtime can have an effect. Try to limit heavy weights or cardio sessions in the evening. Conversely a gentle walk an hour before bed may help.
  • Smoking or drinking will reduce the quality of your sleep. One drink before bed may help you to fall asleep and avoid the hypnic jerk, however it will reduce the quality of your later sleep. If the jerk is severely dehabilitating then this may be a way to get things under control.
  • Meditation can help relive those negative feedback loops that will make you dread going to bed.
  • Maintain a positive outlook, and get some tips of relaxation or yoga. The techniques taught in even the most basic class may be enough to allow you to get your mind in a state where sleep comes naturally.
  • A relaxation CD played at night may be the answer. It will give your brain something to do instead of worrying and may quickly become an essential part of your sleep routine.
  • If the sleeping disorder is having a negative effect on your life then see a doctor, who may prescribe some medication to help you get that much needed sleep.
Most importantly remember that if you rarely or regularily experience a hypnic jerk you’re completely normal, take a few deep breaths and relax. The more you worry about it, the worse it will get.

Wednesday, June 3, 2009

Sleeping Disorders - Foods that Help Sleep

Sleep is as important to the human body as eating and drinking. For many people though, getting a good nights rest can feel impossible. Insomnia, the inability to go to or to stay asleep for a worthwhile length of time can be severely debilitating. A few changes to your eating habits may promote a better bedtime environment and allow you to drop off more quickly and stay in dream land once you’re there.

What should I eat to help sleep?

The first essential element is timing your meals. The body has a natural cycle during the day, called the circadian rhythm, which dictates which processes are best suited to a particular time. Sleep requires a drop in body temperature along with an associated lessening of the body’s metabolism. One of the largest processes your body undertakes is digestion. If the body is working then it’s temperature will increase. At the most basic level, digestion can negatively effect your bodies preparation for rest.

To avoid this, try not to consume a large meal before bedtime. The largest meal of the day should be at lunchtime, with a smaller, lighter choice in the evening. Consuming a snack before bed may be OK, but anything larger like a full dinner should happen at least two to three hours before bedtime.

Apart from digestive reasons, another obstacle to avoid is heartburm or acid reflux which occurs when our stomach acid, used to digest the food we’re eating, escapes from the digestive system and makes it’s way back up to the esophagus. It can escape after we lie down and gravity stops helping the cardiac sphincter muscle. Leaving a decent period between eating and rest can go some way to alleviate the symptoms. Spicy foods, fruit juice, fried foods, salty snacks, coffee, tea, onions, peppermint, and chocolate can also make things worse.

Having said that, a small snack before bedtime, can be beneficial. Going to bed hungry can cause discomfort and hunger pangs during the night may wake you up. If you do suffer from this try a snack high in carbohydrates like plain popcorn or a piece of toast, enough to take the edge off your hunger but not enough to kick the digestive system into overdrive.

Foods that help sleep

There is a complex chemical pathway in the body from the foods we eat to the effect they have on our behavior and moods. The most relevant pathway for sleep development is still being researched, but there are a number of theories that have been developed.

Tryptophan is an essential amino acid which is converted by the body to 5-HTP (5-hydroxy-tryptophan). This then aids the development of serotonin. Serotonin is associated with mood, appetite, sleep and impulse control. The pineal gland produces melatonin, the sleep-inducing hormone. Serotonin is essential for melatonin production.

Enough bio-chemistry for now! All this means is that foods rich in Tryptophan can help with sleep, if they are consumed with other appropriate nutritional elements.
To transform tryptophan into serotonin, vitamin B6 is required. Carbohydrates will assist with transporting the amino acids into the blood stream and into the important parts of the brain. Calcium will assist with the development of melatonin.

A combination of foods rich in tryptophan, 5-HT, calcium, vitamin B6 and carbohydrates is perfect for sleep promotion.

Try to avoid an excess of protein and fats (ie too much red meat!) as these will inhibit the pathway to melatonin production and obstruct the beneficial nutrients we are trying to consume

Some foods rich in tryptophan are chocolate, oats, bananas, durians, mangoes, dried dates, milk, yogurt, cottage cheese, red meat, eggs, fish, poultry, sesame, chickpeas, sunflower seeds, pumpkin seeds, spirulina, and peanuts. It is found in turkey at a level typical of poultry in general

5-HT rich food includes dried dates, figs, papaya, banana, strawberries, sweet cherries, orange, mango, pineapple, grapefruit and hazelnuts.

Vitamin B6 is found in meats, whole grain products, vegetables, and nuts however canning and freezing will eliminate the benefits of these foods.

A good source of calcium is dairy foods, if you prefer to avoid these other good choices are seaweeds such as kelp, wakame and hijiki; nuts and seeds (like almonds and sesame); blackstrap molasses; beans; oranges; figs; quinoa; amaranth; collard greens; okra; rutabaga; broccoli; dandelion leaves; kale; and fortified products such as orange juice and soy milk.

A good mix of foods from each of these segments (many are found in more than one place) will develop your chemical pathways leading to sleep hormones. If your diet currently lacks foods such as those above, experimenting foods may be exactly what you need to have a better nights sleep and avoid sleep interruptions like bad dreams, night terrors and sleep walking.

Tuesday, June 2, 2009

Sleeping Disorders - Drinks before bed

Drinks that help sleep
What you drink in the hours before heading to bed and falling asleep can have a major bearing on the quality and quantity of rest that you will experience every night. If you are having trouble falling asleep and are unable to identify or haven't been diagnosed with a sleeping disorder pay careful attention to what you're consuming during the day.

Here are a few things to consider

is great for hydration but our bodies have another response to it – the bathroom. An excess of water before bed can cause you to get up during the night so limit what you drink in the hours before your bedtime. Warm water vcan be very soothing and is a good alternative to a cup of tea or coffee.

Warm milk
is probably the most common recommendation for food before bed time. There is little evidence that it has a significant physiological effect, the amino acids and hormones present are miniscule but it may have a psychological benefit.

Drinking a warm glass of milk before bedtime is very comforting, and may take us back to relaxing safe themes of childhood and mothering. The routine can be helpful to prepare our bodies to ready for sleep

Herbal teas
such as peppermint, jasmine, spearmint and lavender can help you relax before bedtime and may aid the sleep process. Chamomile tea is especially effective. It is a calmative and works as a mild sedative It can help with the anxiety of being unable to drift off to sleep.

Alcohol will help you fall asleep, in small doses it is a sedative. However it prevents the brain from entering the deeper stages of sleep and will result in a less restive night. One or two drinks will probably not have much effect but if you regularly drink more than this it may be a leading cause of your sleeping problems. Try a few days without a drink and see what happens, it might be the best change you can make to your life.

Any more than a few drinks and the sedative effect will reverse, it becomes a stimulant. This will lead to even more troubles with sleep

Coffee and tea contain caffeine, which is a stimulant. If you’re having problems with falling asleep avoid these caffeinated drinks, and chocolate and cocoa for up to 8 hours before bedtime. The stimulant will increase the activity in our nervous systems and make the process of drifting off increasingly difficult. If you drink a lot of coffee at the moment, cut down gradually to avoid the onset of withdrawal symptoms.

Sunday, May 24, 2009

Sleeping Disorders - Apnea and Driving

A recently released study has worrying implications for obstructive sleep apnea sufferers who drive. Researchers at the University of Adelaide examined the effects of interrupted sleep and alcohol on drivers who have OSA and those who don’t. It found that there is a much higher risk of an accident with even legal amounts of alcohol in the bloodstream.

The study recruited subjects who drove on a simulator for ninety minutes. It mimicked a two lane country road with long straight stretches followed by shorter curves. Fifty-eight people participated with a range of ages and sexes, nearly two thirds had apnea, many were untreated or undiagnosed.

The people who undertook the driving test were split into several streams; uninterrupted eight hours of sleep or interrupted sleep of four hours and a moderate intake to achieve a blood alcohol level of 0.05. This is the legal level in many countries and states in the USA.

It is well known that sleepy drivers are involved in thirty percent of road traffic accidents. What was not known was how people who were suffering from OSA behaved under a sleepless night or with alcoholic intake.

The result was quite stark. The targeted group were 20 times more likely to have micro-sleeps while behind the wheel and over 7 times more likely to have their eyes closed for longer than two seconds. These are significant indicators of dangerous driving habits and crashes.

The researches recommended that people with untreated OSA not get behind the wheel of a car following a restless night of sleep or after having any alcohol

This study follows one released three years ago which showed that OSA sufferers have a much higher risk of death or heart attacks and have worse outcome following a stroke when compared with non-sufferers.

Tuesday, May 12, 2009

Sleep Disorders - 10 side effects of the CPAP Machine

Side effects of the CPAP machine
After a diagnosis of sleep apnea, a debilitating cause of sleep interruptions, one of the most effective treatments currently available is the CPAP or continuous positive airway pressure machine in conjunction with a face mask.

Many patients will notice an immediate improvement in their sleep patterns and a reduction in other symptoms after just one night of use. For others however, a little time may be required to get used to the process and to curing the sleeping disorder.Regular communication with your doctor is vital, especially to ensure the machine is set up correctly, for example he will check to see if the pressure is too high or too low

It is estimated that 60% of CPAP users are still using the machine after a few months. By addressing the most common side effects that stop the use of the machine it is hoped you will get a better nights sleep and say goodbye to sleep apnea and drastically improve your life and safety while driving etc.

Here are ten side effects or problems you may notice when using a CPAP machine

– it can take some time getting used to having a mask over your face. Start of slowly if necessary, an hour at a time and increase the duration of use every night even if it’s only a minute or two.

Try using the mask before bed for an hour or two to get used to it. Drugs can help if the anxiety gets too much but this is to be avoided if possible.

Try not to overtighten the straps on the maskThe purpose of the CPAP is to allow you to get a good night’s sleep so tell your doctor if the machine is preventing this.

Nasal irritation and congestion
– the air from the CPAP machine can dry out your nasal passages. This may irritate the area and trigger a response, often a runny nose, sneezing, congestion or a burning sensation. Nose bleeding can also be expected.

Most machines will come with a humidifier, when used properly this should alleviate your nasal irritations by moistening the airways as the pressured air passes through. A heated humidifier can make the treatment much more comfortable

Uncomfortable Mask or pressure loss
– the mask does not have to be uncomfortable. If it is causing you discomfort, tell your doctor or CPAP machine specialist as there are many mask shapes and sizes. Some fit around the nose and some include the mouth. Some are wider and some are deeper.

Try different masks until you find the one that is most comfortable. You may need to use the machine everyday for the rest of your life so a good fit is essential. Advancing technologies may require an upgrade every few years.

Beards, mustaches and other facial hair along with a dirty or oily face may prevent a proper air-tight seal. Good hygiene and facial maintenance will ensure pressure can’t escape through the mask. If the seal become worn, see you doctor.

Sleep interruption and lack of progress – The CPAP machine may be uncomfortable at first, but it relieves your symptoms of sleep apnea and will help with the sleeping disorder. Remember to accentuate the positives of the treatment, think about waking up headache free, work at sleeping through the night.

Set goals for yourself, try to wear the CPAP machine mask for a longer duration every night, even if only for a few minutes. If your health is not improving or you’re finding sleep even harder than usual, be sure to see your doctor

Difficulty breathing though the nose – CPAP is usually applied through the nose. Your sleep apnea is responds best to pressure in this area. If you find it difficult to breath through your nose than the treatment may not be particularly effective.

Try treatments for allergies or congestion initially and consult your doctor. If there are larger structural problems with your nasal passages or septum then surgery may be recommended. There are a range of full face masks that may be more suited to you

Headaches and ear pressure – The CPAP machine will increase the pressure in the airways. If your ears or sinus are blocked due to allergys or cold and flu congestion than a pressure difference can develop between your differenct body cavaties. This pressure difference will cause discomfort and even pain, similar to diving deep into a pool.

Over the counter decongestion medication may relieve the symptoms and allow the contual use of the CPAP amchine. If there is no improvement don’t use the device for a few days until the cold passes.

If there is no improvement after a prolonged period and it is preventing you from using the CPAP machine, consult with your specialist.

Air in the stomach
– Some people may find in the morning that they are experiencing gas or a bloated stomach after sleeping with the CPAP machine in place.

This suggests a poor alignment between the intake (your nose) and your respiratory system. Try not to use pillows that are too high, this can cause the chin to tilt down and block off the airways we are trying to keep open. Talk to your CPAP specialist, a lower pressure may be benefitial.

Noise – The CPAP machine can be noisy, especially older models. Try placing the machine further away from the bed, or mask the machine noise with a fan or other source of white noise. If it becomes a serious issue ask your doctor for suggestions for a newer quieter model.

Bear in mind that the machine noise is probably far quieter than your snoring!

Tube gets in the way
– Finding a position for the tube to sit so that it avoids your own arms and those of your partners as well as allowing you to make your natural shifts in bed at night.

Many people find that the CPAP tube sits bets running directly from the mask to the headboard or top of the bed and from there to the machine

Taking off the mask at night and not replacing it – Try to take the mask with you if you get up during the night. Unhook the tube at the machine and take it with you.

Keeping the mask on will greatly increase the chance that you will keep using the CPAP machine after an interruption during the night.

Sunday, May 10, 2009

Sleeping Disorders - Sleep disordered breathing.

Sleep disorders can be a killer.

A recently publish study based on the Wisconsin Sleep Cohort investigated the effects of sleep disordered breathing on sufferers compared with the general population.

Of particular concern is the effect apnea (or apnoea) has on the body. Apnea is generally defined an upset in the regular breathing pattern, so that one or more breath is missed with a gap between breaths of 10 seconds. Hypopnea is similar, but no breaths are missed. A series of shallow inefficient breaths are undertaken but breathing does not stop.

Sleep disordered breathing.
Sleep disordered breathing (SDB) is defined by the Apnea-Hypopnea Index (apneas or hypopneas per hour)– an AHI greater than 5 is considered a mild disorder, above 15 is considered moderate and above 30, is a severe case. Previous studies have shown a link between these issues and an increased mortality, but because they were based on people diagnosed as having sleeping disorders to begin with the results were incomplete.

The Wisconsin Sleep Cohort is a random sample of the total population. Over 1500 people aged 30-60 agreed to have their sleep patterns examined and regularly updated their health outcomes. It is important to emphasize that these were not just clinical patients, or those who had sought treatment for a sleep disorder or other ill health. The survey began in 1988, and the follow up study was investigated in 2006, 18 years later.

The alarming result of the study for those people with a severe sleep disorder is that there was a three-fold increase in the risk of mortality compared with the general population. For cases that were undetected or untreated there was a four-to-five fold increase.

This was taking into account other factors such as age, sex, BMI and smoking.

It was hypothesized that sleep disordered breathing was contributory to all causes of the increased mortality, from coronary heart disease, stroke and hypotension through to behavioural issues including suicide, accidents, violence and car accidents.

Previous studies have proved a conclusive link between apnea and other sleeping disorders and obesity. With the rate of obesity increasing in modern society, there appears to be a linked increase in the rates of sleep disordered breathing with worrying implication for the nations health care systems.

The study did find that patients who had access to continuous positive air pressure (CPAP) which is the preferred current treatment did have better outcomes than those who remained untreated. And patients who did not report an increase in day time sleepiness, which is not always a linked symptom, had the same negative outcomes as for those sufferers who did report the symptom.

Which makes the conclusion clear, if you suspect you may be suffering from a sleeping disorder liked to apnea or hypopnea or have been diagnosed, then obtaining treatment through a competent health care professional is essential for your long term health.

Young T et al. Sleep disordered breathing and mortality. SLEEP 2008 31(8):1071:1078

Thursday, May 7, 2009

Sleep Disorders - Sleep realated problems

Sleep disorders, including snoring, insomnia and sleep apnea (or apnoea) are one of the most common health related problems seen by medical professionals. Sleep is essential to regular human function. A disturbance to the normal wake-sleep cycle can be an extreme annoyance while a sleep disorder can be a significant contributor to illness and even death.

There is considerable variance in normal sleep requirements. Common knowledge is that 8 hours of sleep per night are required. However many people need more or less sleep time than this amount.

For a healthy fit young person the typical ideal is 7.5-8 hours per night, with the time between attempting to sleep and falling asleep of half an hour. Wakefulness during the period of sleep should be less than 5% of the time, so again less than half an hour.

Our busy modern lifestyles often don’t leave room in the schedule for sleep durations of this length. Often this is not a major problem, humans can stay awake without issue for 16-18 hours, however a feeling of sleepiness is a function of instability in the wake-sleep cycle.

Sleep experts are often questioned as to how to fall asleep quickly or how to avoid waking up during the night or how to stop snoring. These questions may indicate an underlying sleeping problem.

Alarm clocks and late nights may allow us to live our modern lives as we like, but at the risk of developing sleep debt, sleeping problems and frequently sleeping disorders.

A sleep disorder is any disorder which prevents, interrupts or disturbs sleep. They are very common, half the population report having some trouble sleeping every year while a quarter of the population report that they have trouble getting enough sleep. Snoring is perhaps the most common sleep disorder.

Before we answer the question of how to get a good nights sleep it is important to understand why sleep is important and what can cause sleep problems.

Sleep is divided into two stages. REM or rapid eye movement and non-REM sleep. REM is that period during sleep when dreaming occurs; it is also associated with physiological arousal. Physically the eyelids flicker. Typically REM sleep occurs for short durations of five minutes or so, lasting longer throughout a night of uninterrupted sleep.

Non-REM or slow wave sleep usually lasts for a much longer duration, between sixty and ninety minutes. The REM takes place in between these stages of slow wave sleep.

Slow wave sleep is associated with an increase in hormones and an increased cellular rate. It helps the body to prepare an environment that can maintain the bodies’ defenses, repair of cells and metabolism. Children, adolescents and pregnant women often require additional sleep for this reason.

Both REM and non-REM sleep is required on a regular basis as it helps to preserve recent memories, maintains and refreshes both physical and mental equilibrium and prevents neurotransmitter depletion. The benefits of a good nights rest regularly and generally uninterrupted through the night are clear. Any disturbance of this state, especially involuntarily is to be taken seriously, and medical help should be sought.

The body has a natural rhythm which is evident in the wake-sleep cycle. This cycle is part of the human function known as the circadian rhythm.

The circadian rhythm is a biological function found in humans, other animal and even plants. It is related to the 24 hour cycle of the day and is an internal clock usually governed by the natural light/dark day/night cycle. The human biological clock is located in the hypothalamus and pineal gland of the brain. These glands secrete melatonin in response to the natural rhythm of the day and to light sources which can affect these rhythms. Melatonin is an important hormone for sleep regularity, during day time there is less in the body while the dark of night time increases the production in the glands.

The production of melatonin is heavily dependant on the bodies circadian rhythm, hence a rapid change in time zone from air travel or a switch to shift work is often associated with the sleep disorder known as jet lag.

A sleep disorder often indicates other issues and can be the primary symptom for very serious problems. Depression, anxiety and stress can all manifest themselves this way. Treatment of these problems will often resolve the sleeping issue.

Medical professionals, when presented with complaints of lack of sleep will also look for signs of adverse reactions to over the counter or prescription drugs or even illegal drug abuse.

Obstructive sleep apnea is potentially the most serious cause of interrupted sleeping. Undiagnosed or treated sleep apnea is directly linked with a much higher rate of injury and death due to the lack of deep and beneficial sleep this disorder will cause.

There are a range of other sleep disorders which regularly effect the population.

-somina is the Latin root for “sleep” or “dream”.
Many of the disturbances and disorders that follow will be based on this root

Dyssomnias are a disturbance in the regular pattern of sleep.

Parasomnias are disorders which interfere with sleep due to abnormal dreams, behaviors, actions and emotion experienced while asleep.

Secondary sleep disorders are problems with sleeping associated with another underlying problem. The sleep disturbance is a symptom rather than the primary cause for concern.

Some common sleep disorders
(Source Murtagh (2003), “General Practice” McGraw Hill)

Dyssominas (problem with falling asleep)
  • Primary Insomnia
  • Nocturnal myoclonus

Excessive somnolence (excessive sleep)
  • Primary hypersomnia
  • Narcolepsy

Breathing related sleep disorder
  • Obstructive sleep apnea (or apnoea)
  • Central sleep apnea
  • Central alveolar hypoventilation syndrome

Circadian rhythm sleep disorder
  • Jet lag
  • Shift Work
  • Delayed sleep phase

  • Nightmares (dream anxiety) Disorder
  • Sleep Terror Disorder
  • Sleepwalking disorder

Secondary Sleep Disorder
  • Medical Condition disorder
  • Mental Disorder
  • Substance Abuse

Sleep specialists are a relatively new field in medicine. Certified sleep experts can be found by contacting the American Academy of Sleep Medicine or the appropriate medical directorate in your country. Observation in a sleep lab or sleep clinic is often used to diagnose sleeping disorder issues, alternatively the patient may construct their own sleep calendar to develop accurate records of the sleeping troubles.

Saturday, April 11, 2009

Sleeping Disorders - A startle or jolt before sleep - The Hypnic Jerk

One of the most common sleeping disorders, and one of the milder ones, is an involuntary muscle spasm or jolt which occurs just as we are falling asleep – a sleep start. This condition is known as a hypnic jerk or hypnagogic jerk. It is a reaction very like the “startle” response and can be accompanied by a falling sensation. It can feel like an electric shock just before dropping off.

Something around 10% of the population will experience hypnic jerks on a regular basis and 60% to 70% at some point in their lives. They often happen if we fall asleep in an uncomfortable position, are sleep deprived or over tired or are having a stressful or anxious time. A hypnic jerk is a type of myoclonic twitch and is similar to a hiccup. It’s considered to be a benign condition.

Not enough research has been done on the subject to give a definitive answer on why they occur but there are a number of theories.

One is that it is just a part of falling asleep in some people. As part of a number of stages from changing brain waves, slowing heartbeat and breathing, the bodies muscular systems transition into their “sleep” state accompanied by the jerk.

Another theory is that as the muscles relax our brain is tricked into thinking that it is falling, drowning or somehow in danger. The jerk is an attempt to turn oneself upright or catch something leading to safety.

Most people experience the hypnic jerk once or twice a night and often don’t even know they are undergoing the reaction. A more severe case can severely affect the sufferers or a bed partners sleep inviolves the twitching every 30 seconds throughout the night. This sleeping disorder is known as periodic limb movements (nocturnal myoclonus).

Generally hypnic jerk requires no treatment and is a normal part of sleep every so often. No “cure” has been developed. A return to normal sleeping patterns, retiring to bed before overtiredness or treatment for the underlying stress and anxiety will often reduce the occurrences another suggestion is to avoid caffeine and spend some time before attempting to fall asleep engaged in relaxation.

If the jolt is causing you more than a mild surpise or is preventing you from getting regular sleep than see you doctor.

Thursday, March 12, 2009

Sleeping Disorders - The Phases of Sleep

Half a century ago scientists discovered what our bodies and brains were doing when we experienced our deepest and most memorable dreams. Eugene Aserinsky and Nathaniel Kleitman with assistance from William C. Dement at the University of Chicago discovered REM sleep in 1953,

While we are asleep our brains and bodies experience two distinct phases. The most widely known is REM or rapid eye movement sleep. This is the less common one; the more regular phase is known as non-REM sleep.

Relaxation is indicated by alpha waves seen on an EEG of the brain. With our mind free of thoughts and eyes closed it is the first stage we undergo before falling asleep. Delta waves replace the alpha waves as drowsiness commences. When the mind reaches this stage itindicates we have fallen asleep and entered the slow wave or non-REM stage of sleep.

Slow wave sleep is associated with muscle rehabilitation and growth through the release of anabolic hormones and cytokines. The cells of the body are repaired and immune defenses maintained. It helps us recover from the active rigors of the day. Pregnant women and fast growing children and adolescents experience longer periods of slow-wave sleep than those off us who no are not experiencing periods of growth.

Non-REM sleep can be divided into three phases.

Stage 1 is the beginning of sleep. If you are woken at this stage it feels like you haven’t been asleep at all. You will often experience hypnic jerks which are muscular twitches, typical before the next stage of sleep.

Stage 2 is the next stage. It is still easy to be awoken from this stage though you are unconscious, this is the predecessor of Stage 3.

Stage 3 or slow wave sleep is what we call deep sleep. If you are woken during this stage of sleep then drowsiness and grogginess can be expected. This is also the stage where it is most difficult to wake a sleeping person. You will experience dreams at this stage though not nearly as memorable or vivid as those experienced during REM sleep. Nightmares, night terrors and sleepwalking is most common during this phase.

After 60-90 minutes of non-REM sleep, you will enter the first period of REM sleep. This is characterized by rapid eye movement, muscle paralysis and brain waves similar to the waking state. This first period will be short, around 5 minutes, but the cycle will continue through the night and periods of REM will get longer. The time spent in REM sleep should consist of around 20% of the total.

Dreaming and physiological arousal will be experienced while in REM sleep. Any dreams remembered the next morning will usually have occurred during this stage. It is theorized that the purpose of all this brain activity is to consolidate memories made during the day.

If you’re not getting the sleep your brain and body needs every night, which varies per person but is generally from 6-10 hours than you may not be reaching your full potential. Younger adults, teens and children need more sleep.

A simplified explanation for the purpose of sleep is that the brain needs the REM sleep to analysis and sort what happened during the day and the body needs non-REM sleep to repair the damage that happened during that same day.

Tuesday, March 10, 2009

Sleeping disorders - Why do people sleepwalk?

Sleepwalking is a type of sleeping disorder called a parasomnia. It generally occurs when you're in deep sleep, also known as slow wave sleep. This means that you wont be having vivid dreams like you experience during REM sleep so sleepwalkers aren't in the middle of a dream while they're walking around.

Sleepwalkers aren't exactly unconscious, it's more that their brains are in a very restful state and the conscious part of it is not engaged. This is why you may appear to be awake but you won't remember the sleepwalking episode occurring

We don't really know why our brains mis-function like this sometimes. We do know that it occurs more often in children and there is a genetic component, children of sleepwalkers are more likely to sleepwalk themselves.

It's possible that the chemical that stops your brains motor system from engaging while asleep isn't working properly. More research is being done

Sunday, January 11, 2009

Sleeping Disorders - Sleep Hyigene

The University of North Carolina has an excellent Sleeping Disorder resource website

Their rules for sleep hygiene

1. Never use the bedroom for anything but sleep or sex. Read, watch TV, exercise, eat or argue
someplace else.

2. Lie down intending to go to sleep only when you are sleepy.

3. If you are unable to fall asleep within twenty five minutes, get up and go to another room. Stay
up until you feel sleepy then return to bed. If you still are unable to fall asleep get up again.

4. Set your alarm to get up at the same time each day regardless of how much sleep you got
during the night.

5. Turn on the lights or walk outside in the sunlight when you wake up in the morning.

6. Do not nap during the day.

7. Exercising in the morning or late afternoon will help you sleep, but exercising in the late
evening will stimulate your body and make sleeping more difficult.

8. Eat your evening meals at least two hours prior to going to bed. Large meals or hunger can
inhibit sleep.

9. Avoid caffeine and refined sugars in the evening. Foods like chocolate, coffee, tea and soda
will inhibit sleep. Also tobacco and alcohol should be avoided since these disrupt sleep.

10. Avoid the use of over the counter sleep medicines.

11. Relax in the evening before going to bed. Try not to rehash the day's problems.


Thursday, January 1, 2009

Sleeping Disorders Introduction

Welcome to Sleeping Disorders help. This site provides tips and techniques for sleep and overcoming sleeping disorders. If you have questions not covered in Sleeping Disorders help please feel free to email your questions.