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.