Sleep News Archives - Contra Costa Sleep Center

(extracted from CHEST Magazine, 12/2014)

Patients with obstructive sleep apnea (OSA) may improve their memory by using Continuous Positive Airway Pressure(CPAP). A study published in the December issue of CHEST shows that the majority of patients with OSA, who were memory-impaired prior to treatment, demonstrated normal memory performance after 3 months of optimal CPAP use. The study also showed that memory improvement varied based on CPAP adherence. Patients who used CPAP for at least 6 hours a night were nearly eight times as likely to demonstrate normal memory abilities compared with patients who used CPAP for 2 or fewer hours a night.

“Patients with OSA often complain of daily forgetfulness, e.g., losing their keys, forgetting phone numbers, or forgetting to complete daily tasks,” said author Mark S. Aloia, PhD, National Jewish Medical and Research Center in Denver, “Where memory is concerned, we may have the ability to reverse some of the impairments by providing effective and consistent use of CPAP treatment.”

Dr. Aloia and colleagues examined the degree to which varying levels of CPAP adherence improved memory in 58 memory-impaired patients with clinically diagnosed OSA. All patients underwent cognitive evaluation involving verbal memory testing prior to initiation of CPAP and at a 3-month followup visit. Patients were prescribed CPAP machines, and adherence was monitored using internal microprocessors within each device. After treatment, patients were divided into three groups based on their 3-month CPAP adherence: (1) 14 poor users, patients who averaged fewer than 2 hours/night of CPAP use; (2) 25 moderate users, patients who averaged 2 to 6 hours/night of CPAP use; and (3) 19 optimal users, patients who averaged more than 6 hours/night of CPAP use.

At baseline, all patients were found equally impaired in verbal memory. Following 3 months of CPAP treatment, 21 percent of poor users, 44 percent of moderate users, and 68 percent of optimal users demonstrated normal memory performance. Compared with poor users, optimal users of CPAP were nearly eight times as likely to demonstrate normal memory abilities.

“Moderate use of CPAP may help, but it might not allow patients to reach their full potential recovery where memory is concerned, especially if memory is impaired at baseline. For patients with OSA, the more regularly and consistently they use CPAP, the better off they will be,” Dr. Aloia said.

SLEEP APNEA TERMS

(Courtesy of Wake Up To Sleep)

What do certain sleep apnea treatment terms mean?

What is AHI?

apnea–hypopnea index is the number of apneas and hypopneas experienced by a person per hour of sleep. An AHI of:
0–4 is normal
5–14 denotes mild sleep apnea
15–29 denotes moderate sleep apnea
30+ denotes severe sleep apnea

Types sleep apnea

Obstructive sleep apnea (OSA): Stopped airflow for at least 10 seconds due to a “mechanical” obstruction such as a tongue relaxed to the back of the throat, a semicollapsed pharynx or a large amount of tissue in the uvula area (84% of sleep apnea patients)

Central sleep apnea (CSA): Stopped airflow for at least 10 seconds due to an irregularity in the brain’s control of one’s breathing (15% of sleep apnea patients) Complex sleep apnea (CompSA): when a person’s OSA becomes CSA after they begin CPAP treatment (1% of sleep apnea patients)

Sleep Tests

Polysomnography (PSG): An overnight sleep study, with sensors placed on the body to record physiologic signals and diagnose many types of sleep disorders CPAP titration study: When a sleep technician uses a CPAP machine to find the minimum air pressure needed to help a person eliminate all apneas, hypopneas and snoring

Split-night study: A single overnight test that includes a PSG and a CPAP titration (learn more)

Home sleep test: A device to diagnose sleep apnea at home

CPAP Machines

CPAP (continuous positive airway pressure): Delivers air at a single, constant pressure that keeps your airway open

Bilevel: Delivers a higher air pressure when you inhale and a lower one when you exhale, so you can breathe out easier APAP (automated positive airway pressure): Detects and provides the minimum amount of air pressure a person needs to avoid an apneic event. This pressure changes throughout the night, based on his/her needs

ASV (adaptive servo-ventilation): Learns your normal breathing volume while you’re awake and provides the needed pressure support to maintain that pattern while you sleep. ASV has shown to be effective for CSA (central sleep apnea) patients,

Other terms

Apnea: When a person stops breathing in his/her sleep for at least 10 seconds

EEG(electroencephalogram): Measures brain activity; used during an in-lab sleep study

EKG (electrocardiograph): Measures heart activity; used during an in-lab sleep study or home sleep test

EMG (electromyogram): Measures muscle activity; used during an in-lab sleep study

EOG (electrooculogram): Measures eye movement; used during an in-lab sleep study Full face mask: A CPAP mask that covers the nose and mouth

Hypersomnia: excessive daytime sleepiness, a common symptom of sleep apnea

Hypopnea: When a person’s upper airway is reduced by 30% or more for at least 10 seconds, coupled with a 4% drop in blood oxygen.

Nasal mask: A CPAP mask that covers the nose

Nasal pillows: The smallest, lightest type of CPAP mask, which rests at the base of the nose

Oximeter: Measures the level of oxygen in a person’s blood stream, placed on the fingertip or ear

REM (rapid eye movement): A cycle of sleep staging characterized by rapid, shallow or irregular breathing, rapid eye movements and temporary muscle paralyzing when the brain waves are very active

Sleep architecture: Your entire sleep (how long it takes you to fall asleep, how long you’re in each sleep stage, when you wake up during the night and for how long, etc.), determined by analyzing a person’s EEG and EOG

Sleep stages: Wakefulness, non-REM stages 1, 2, 3 (with increasing depth), and REM (the deepest stage)

Snoring: The sound produced when air forces itself through a narrowed airway, vibrating the soft palate at the back of the throat. While not everyone who snores has sleep apnea, it is still “the most sensitive and strongest predictor of sleep apnea.”

WHY USE A CPAP
HUMIDIFIER?

(courtesy of ResMed)

What exactly does a CPAP humidifier do and how can you get the most out of it? It’s always helpful to revisit basic sleep apnea treatment questions like these to make sure we have the best information about our own treatment, and to make note of tips and tricks we haven’t tried yet.

A CPAP humidifier helps you avoid dry mouth (which nearly 40% of CPAP patients experience) along with dry nose, running nose, chapped lips, sinus-type headaches and nose bleeds – all by doing a simple job that our noses usually perform on their own. When we breathe naturally, our noses act as humidifiers, warming up the inhaled air to our bodies’ own temperature so that it’s more comfortable to breathe, won’t damage the delicate tissues of our upper airway and lungs, and won’t wake us up, as cold air might. Air coming through a CPAP machine needs its own humidification because it’s entering our upper airway faster than our noses can warm it. This is especially true for those who live in colder or drier climates and/or require high pressures.

The first CPAP machine was invented in 1980. In the late 80s, sleep specialists began humidifying CPAP air by sending it through a chamber of room-temperature water wherein it would pick up what little moisture evaporated as it entered the patient’s tubing. This method was called passive or passover humidification, and was not very effective.

The logical next step was to heat the water itself to create more vapor for the air to absorb. And so heated humidification began in the mid-1990s.

In 2001, Chest published a study that showed humidification “significantly improves patients’ CPAP compliance, and that its need may be predicted” if patients are over 60, taking oral medications that list dry mouth as a side effect, or had prior surgery to remove tissue from their throat. Of course, we now know that humidification can make sleep apnea treatment more comfortable, especially for patients on higher pressures, which is why more CPAPs come with an attached humidifier today. You can remove it if you want and insert a cap on that end of your machine. Two side effects and how to avoid them Humidification has two main side effects: One is that you may still experience dryness-related symptoms if your humidifier’s temperature is set too low.

The second, more common side effect is called rainout. It occurs when heated air cools in your tubing and reaches your mask as water, causing you to get a damp face. “Rainout” can be avoided by using a heated tube and adjusting the temperature of the tubing and/or the level of humidification that your water chamber is producing.

e-READERS MAY DISRUPT SLEEP

(extracted from HealthDay News, 1/02/15)

Light emitted by a tablet like an iPad can disrupt sleep if the device is used in the hours before bedtime, according to a new study published in the Proceedings of the National Academy of Sciences.

In the study, 12 adults read for about 4 hours before bedtime on 5 consecutive evenings, in a very dimly lit room at the hospital. Half read ebooks and the rest read printed books. After that, they spent another 5 evenings reading at the hospital, only they traded their books for printed books and vice versa/ Participants reading an e-book took longer to fall asleep than when they read a printed book. The e-readers also rated themselves as feeling less sleepy, and spent less time in rapid eye movement (REM) sleep.

Blood drawn from the participants revealed that using an e-book reader delayed the natural nightly increase in their melatonin levels by more than an hour and a half, compared with when they read a printed book.

The following day, participants who read an ebook said they woke up feeling sleepier and took longer to fully wake up and become alert, according to the researchers.

Measurements taken by the research team found that iPads emitted heavy doses of bluewavelength light, which has been shown in previous research to suppress melatonin and increase alertness. Other light-emitting e-readers also display large amounts of blue light, as do laptops, cell phones, light-emitting diode monitors and other electronic devices.

“Bright light tends to make your brain think the sun is up. When you click it [an e-reader] off to go to sleep, you will have trouble getting to sleep,” W. Christopher Winter, MD, medical director of the Jefferson Hospital Sleep Medicine Center and president of Charlottesville Neurology and Sleep Medicine, told HealthDay.

The researchers concluded: “Overall, we found that the use of portable light-emitting devices immediately before bedtime has biological effects that may perpetuate sleep deficiency and disrupt circadian rhythms, both of which can have adverse impacts on performance, health, and safety.”

DRUGS THAT NEGATIVELY AFFECT SLEEP

(Thomas L. Lenz, PharmD, MA, PAPHS, FACLM Am J Lifestyle Med. 2014;8(6):383-385).

Getting adequate sleep is a healthy lifestyle activity that is important for the body to function optimally both physically and mentally. Unfortunately, 70 million Americans suffer from chronic sleep loss or sleep disorders. Secondary causes of sleep disorders are often overlooked and can occur from the consumption of social or medicinal drugs. Common social drugs that can disrupt sleep include alcohol, caffeine, and nicotine. Certain medications can also have side effects that can induce sleep disruptions. This article briefly reviews common social drugs and prescription medications that can negatively impact sleep.

There are many reasons why 70 million Americans are not getting adequate sleep. At least 40 million are affected by a sleep disorder. The 4 most common sleep disorders are insomnia, sleep apnea, restless leg syndrome, and narcolepsy. Secondary causes of sleep disorders can be easily overlooked. Medications can be a secondary culprit for some sleep disorders and should be evaluated in patients suffering from sleep loss. The purpose of this article is to briefly discuss common drug related causes of sleep loss.

Alcohol and Sleep
Although alcohol is not classified as an medication, it is certainly classified as a social drug. In the United States, approximately 50% of adults drink alcohol on a regular basis and another 14% drink occasionally. Alcohol has been shown to have both a positive effect and a negative effect on health, depending on amount consumed and the timing of the consumption. Sleep has been shown to be negatively affected by alcohol consumption.

Consuming an alcoholic drink prior to bedtime, or “having a nightcap,” is a solution that some individuals use to solve sleep disorders. A cocktail or glass of wine may help some to relax and fall asleep more easily. However, alcohol has been shown to disrupt sleep a few hours later.

Alcohol can disrupt certain stages in the sleep cycle (specifically non–rapid eye movement [REM] Stage 3 and REM stage) that are necessary for “restorative” sleep. This often results in keeping these individuals in the “lighter” stages of sleep with more frequent awakenings during the night to urinate. Additionally, an overconsumption of alcohol prior to bedtime can result in excessive muscle relaxation, including those muscles in the pharynx. This can exacerbate snoring and increase the risk for sleep apnea. As a result, individuals who have a “nightcap” prior to bedtime generally do not wake in the morning fully rested.

Caffeine and Sleep

Caffeine acts as a stimulant that can increase heart rate, blood pressure, mental alertness, and temporarily reduce fatigue. Caffeine can be found in many items that we consume on a daily basis. Some of the most common sources of caffeine include coffee, tea, and soda. Caffeine is also commonly found in chocolate, energy drinks, herbal products, and in overthe- counter and prescription medications. People vary widely on their sensitivity to the stimulant effects of caffeine, which can begin within 15 minutes and last up to 7 hours.

The amount of caffeine in the average 8 ounce cup of coffee is about 133 mg. The caffeine content in 8 ounces of tea and 12 ounces soda can range from 40 to 120 mg and 35 to 72 mg, respectively. Chocolate can contain about 9 to 33 mg of caffeine depending on serving size and energy drinks can contain up to 300 mg of caffeine in a 20 ounce serving. Additionally, herbal products can contain varying amounts of caffeine based on the product and quantity in which it is sold.

Caffeine is also included in many over-thecounter and prescription pain relievers, especially those targeted toward headache relief. Caffeine has been shown to speed the absorption of analgesics like aspirin and as a result provide quicker headache relief. The amount of caffeine included in pain relievers can range from 16 to 65 mg per dosage form (pill). The dosing regimen for many pain relievers suggests that patients take 2 pills per episode (e.g., headache). This can result in as much as 130 mg of caffeine and, in turn, induce sleep disorders in some patients.

Nicotine and Sleep
Nicotine is a stimulant similar to caffeine. The consumption of Nicotine, regardless of route, can result in increased heart rate, blood pressure, and respiratory rate. The stimulant effects from nicotine can last for several hours and can affect an individual’s ability to fall asleep and/or stay asleep. Additionally, withdrawal symptoms from nicotine can begin within a few hours of the last cigarette. Nicotine withdrawal symptoms can include restlessness, irritability, headache, lighter sleep, and frequent nighttime awakenings. Individuals who use nicotine often experience poor sleep quality and suffer from daily fatigue.

Prescription Medications
Similar to over-the-counter medications, certain prescription pain medications can contain caffeine. Two such products, Fioricet and Fiorinal, each contain 40 mg of caffeine per tablet. Depending on patient sensitivity, this amount of caffeine may adversely affect sleep in some individuals.

There are several other common prescription medications that induce sleep disorders that are unrelated to the stimulant effects of caffeine. The specific cause(s) for this in many medications is largely unknown and the degree to which patients experience these side effects varies widely. The following is a brief list of common drug classes and their potential sleep disruptive symptoms.

SSRIs (Selective Serotonin Reuptake Inhibitors)
Studies have shown that patients taking SSRIs can experience sleep disorder symptoms such as restless leg syndrome, insomnia, nonrestorative sleep, and daytime sleepiness. Examples of medications in this drug class are citalopram (Celexa), escitalopram (Lexapro), and fluoxetine (Prozac).

Tricyclic Antidepressants
Medications in this class of drugs have shown to disrupt sleep by increasing the potential for restless leg syndrome and insomnia. They have also been shown to increase daytime sleepiness and morning grogginess, most likely due to their negative effects on restorative sleep patterns. Examples of tricyclic antidepressants include amitriptyline, amoxapine, and clomipramine.

Angiotensin-converting Enzyme (ACE) Inhibitors
A well-known class side-effect of ACE inhibitors is cough. For many patients, the “ACE cough” worsens at nighttime. This side effect can make it difficult to sleep and may also worsen sleep apnea. Examples of common ACE inhibitors include: benazepril (Lotensin), captopril (Capoten), and lisinopril (Prinivil).

Corticosteroids
Oral corticosteroids have been linked to sleep disorders such as sleep onset insomnia (difficulty falling asleep), sleep maintenance insomnia (difficulty staying asleep), and abnormal dreams. Examples include: methylprednisolone (Medrol), prednisolone, and prednisone.

Statins
The sleep disorders linked with statin medications include sleep onset insomnia, frequent awakening at night, and daytime fatigue. The muscle soreness that can occur with taking a statin medication has also been reported to disrupt sleep. Examples of statin medications include atorvastatin (Lipitor), rosuvastatin (Crestor), and simvastatin (Zocor).

Conclusion
Restorative sleep is an important lifestyle activity. Sleep loss affects many Americans and can lead to negative health consequences. Certain social and medicinal drugs have been shown to secondarily cause disruptive sleep in certain individuals. Health care providers should be advised to check for drugs that negatively affect sleep when talking with patients about sleep disorders.

WHY DOES MY AHI INDEX CHANGE?

(from “Wake Up to Sleep,” Jan 2015)

A CPAP patient told us that over the previous week her apnea–hypopnea index (AHI) had fluctuated between 1.9 and 5. She said she hadn’t had a “5” in 10 years, but now they were coming every other night even though her CPAP machine was reporting a good mask fit each morning. Concerned, she asked if it’s normal for AHI to go up and down from night to night.

The short answer is: Yes; it is normal for AHI to vary within reason. An AHI less than 5 is considered normal, and some patients with severe sleep apnea may be told by their doctor that they can accept even higher numbers so long as they’re feeling more rested each morning, experiencing fewer symptoms and their AHI is progressively decreasing.

If your AHI was stable, but is suddenly increasing over the past few days or weeks, you should report this to your sleep specialist.

Causes of rising AHI
AHIs fluctuating between 1–5 is normal and still within a safe range. If your nightly AHIs are rising above what’s considered safe, you may be experiencing:

Mask leak: If air is escaping your CPAP mask, you’re not getting all the air pressure you need to keep your airway open. The three most common causes of mask leak are a poorly fitting mask, inadequate cleaning or mouth leak (often experienced by patients on bilevel machines and mouth breathers currently using a nasal pillows or nasal mask).

Mask off events: It’s common for some people to remove their mask during the night, either consciously or unconsciously, due to the initial foreign feeling or discomfort of wearing a mask. If your CPAP machine is reporting this happening or you suspect that it is, don’t worry, but do talk to your doctor about ways to reduce these events.

Alcohol, medicine and other drugs: The periodic use of certain medication, alcohol or narcotics may cause your AHI to go up. Ask your doctor if anything you’re taking could be causing your fluctuation, and how you can compensate for it.

Central or complex sleep apnea: A rising AHI could also be a sign that while CPAP is treating your obstructive apneas, your brain might not always be telling your body to breathe. This can cause central sleep apneas, “central” because they’re caused by a dysfunction in the central nervous system, not a physical obstruction. Most newer CPAP machines will report if you’re experiencing central apneas, but it takes a specific type of machine to treat them. If your machine is reporting central apneas or you can’t identify what is causing your rising AHI and reverse the trend, talk to your doctor or equipment provider as soon as possible.

Sleep. It’s something we spend about a third of our lives doing, but do we really understand what it’s all about?

Recent research may shed new light on this question. We’ve found that sleep may actually be a kind of elegant design solution to some of the brain’s most basic needs, a unique way that the brain meets the high demands and the narrow margins that set it apart from all the other organs of the body.

The first problem that every organ must solve is a continuous supply of nutrients to fuel all those cells of the body. In the brain, that is especially critical; its intense electrical activity uses up a quarter of the body’s entire energy supply, even though the brain accounts for only about two percent of the body’s mass. So the circulatory system solves the nutrient delivery problem by sending blood vessels to supply nutrients and oxygen to every corner of our body. The blood vessels form a complex network that fills the volume. They start at the surface of the brain, and then they dive down into the tissue itself, and as they spread out, they supply nutrients and oxygen to each and every cell in the entire brain.

Just as every cell requires nutrients to fuel it, every cell also produces waste as a byproduct, and the clearance of that waste is the second basic problem that each organ has to solve. The body’s lymphatic system has evolved to meet this need. It’s a second parallel network of vessels that extends throughout the body. It takes up proteins and other waste from the spaces between the cells, it collects them, and then dumps them into the blood so they can be disposed of. But there are no lymphatic vessels in the brain!

The brain’s solution to the problem of waste clearance was ingenious. The brain has this large pool of clean, clear fluid called cerebrospinal fluid. The CSF fills the space that surrounds the brain, and wastes from inside the brain make their way out to the CSF, which gets dumped, along with the waste, into the blood. So in that way, it sounds a lot like the lymphatic system? But what’s interesting is that the fluid and the waste from inside the brain don’t just percolate their way randomly out to these pools of CSF. Instead, there is a specialized network of plumbing that organizes and facilitates this process. The CSF on the outside of the brain doesn’t stay on the outside. Instead, the CSF was pumped back into and through the brain along the outsides of the blood vessels, and as it flushed down into the brain along the outsides of these vessels, it was actually helping to clear away, to clean the waste from the spaces between the brain’s cells. This is a solution that is entirely unique to the brain.

But the most surprising finding was that with all this fluid rushing through the brain, it’s see is that when the brain goes to sleep, the brain cells themselves seem to shrink, opening up spaces in between them, allowing fluid to rush through and allowing waste to be cleared out. When the brain is awake and is at its most busy, it puts off clearing away the waste from the spaces between its cells until later, and then, when it goes to sleep and doesn’t have to be as busy, it shifts into a kind of cleaning mode to clear away the waste from the spaces between its cells, the waste that’s accumulated throughout the day.

The waste product that these recent studies focused most on is amyloid-beta, which is a protein that’s made in the brain. So we measured how fast amyloid-beta is cleared from the brain when it’s awake versus when it’s asleep. We found the clearance of amyloid-beta is much more rapid from the sleeping brain.

A series of recent clinical studies suggest that the failure of the brain to keep its house clean by clearing away waste like amyloid-beta may contribute to the development of conditions like Alzheimer’s.

So what this new research tells us, then, is that the one thing that all of you already knew about sleep is that it refreshes and clears the mind.

This may actually be a big part of what sleep is all about. While our body is still and our mind is off walking in dreams somewhere, the elegant machinery of the brain is quietly hard at work cleaning and maintaining this unimaginably complex machine. In the brain, the consequences of failing to clean house may be the very health and function of the mind.

NEW TREATMENT FOR OSA IN WOMEN

by Alison Wimms, ResMed

Women make up nearly 40 percent of patients newly diagnosed with obstructive sleep apnea, but there has never been a treatment specifically designed to treat female characteristics of sleepdisordered breathing. ResMed has now introduced “AirSense™ 10 AutoSet for Her” providing more effective treatment to women with mild to moderate OSA at lower, comfortable pressures. How it works:

Women with OSA have significantly different sleep than men. Women tend to take longer to fall asleep than men. Women also have fewer apneas than men, specifically fewer full obstructive apneas meaning their upper airways don’t collapse as often. However, they do have more flow limitation which means the upper airway narrows and less air enters the lungs. Women also tend to have clusters of events during REM (dream stage) sleep. All of these aspects of sleep apnea can cause arousal and disrupted sleep. This can lead to symptoms such as insomnia, fatigue, reduced daytime cognitive function, headaches and depression.

The “for Her” was designed to treat femalespecific OSA. For example, It contains features to ensure that females are protected against clusters of events occurring during REM sleep. In addition, when it identifies flow limitation, it responds quickly but gently to make sure patients’ lungs are getting all the oxygen they need.

Why it matters:
More than half of former CPAP female users say they quit therapy partly because it made breathing uncomfortable or otherwise disturbed their sleep. The “for Her” contains new features which are designed to keep the average CPAP pressure lower and make pressure changes more gentle, and therefore more comfortable. In addition, women take longer to fall asleep then men, so they may be disturbed by the CPAP pressure increasing before they need it. The “for Her” features AutoRamp™, which automatically detects sleep at the beginning of the night and starts increasing the pressure after sleep is detected. By delivering effective therapy at lower pressures, this “for Her” mode treats femalespecific characteristics of sleep apnea while maximizing comfort, helping patients embrace treatment faster.

How to get it:
Ask your doctor or home medical equipment (HME) provider if the AirSense 10 AutoSet for Her is the best machine for you? More Information:
www.resmed.com/us/en/consumer/products/devices/airsense-10-autoset-for-her.html

CPAP causes Dry mouth?

If you’ve ever felt dry mouth when you take your CPAP mask off in the morning, you’re not alone. Roughly 40% of patients on CPAP therapy experience dry mouth which can cause various side effects such as headaches, dizziness, bad breath, coughing and difficulty talking or eating.

Below are the three main causes of dry mouth:

Dry mouth cause #1: Medications

Before you blame your CPAP mask for your dry mouth, it’s important to rule out other culprits. The Mayo Clinic lists six potential non-CPAP causes that you should discuss with your doctor first:

  • Oral medications that list dry mouth Aging
  • Cancer drugs
  • Nerve damage
  • Tobacco use
  • Other health conditions

Dry mouth cause #2: Non-heated air

If you and your doctor determine that your CPAP machine’s air is likely causing your dry mouth, you may benefit from added moisture through a heated humidifier and/or heated tubing These devices feed moisture into the air you breathe through your CPAP machine to prevent dryness. The heat level can be easily adjusted to provide more or less moisture – too much could create condensation in your air tube, a condition called “rainout” or “washout.”

Dry mouth cause #3: Mask leak

Whether or not your CPAP machine has humidification, severe mask leak can also cause dry mouth – as well as reduce the effectiveness of your sleep apnea treatment. Mask leak is a leading reason why 45% of former CPAP users quit their therapy. It is common among patients who:

Have an ill-fitting mask. Ask your doctor or mask provider to refit you. Never overtighten a mask just to prevent leak; the resulting pressure could cause discomfort, facial marks and pressure ulcers.

Are on a bilevel machine. Ask your doctor about the benefits of switching to a full face mask that covers the nose and mouth.

Are mouth breathers who are using a nasal or nasal pillows mask. As with bilevel users, ask your doctor about the benefits of switching to a full face mask that covers the nose and mouth.

Adherence to continuous positive airway pressure (CPAP) therapy in men with obstructive sleep apnea (OSA) and erectile dysfunction (ED) significantly improves erections and sexual desire, a randomized controlled study has found. This finding should motivate men with both ED and OSA — a common co-occurrence — to use their prescribed CPAP machine nightly. Kerri Melehan, a doctoral student in Sydney, Australia’s Royal Prince Alfred Hospital and colleagues recruited 61 men with moderate or severe OSA (apneahypopnea index >20/h) and a 6-month or longer history of erectile dysfunction. They randomly assigned them to 12 weeks of treatment with CPAP. Subjects underwent polysomnography before and after treatment. The investigators measured the men’s number of sleep-related erections by recording and monitoring penile tumescence. Participants also reported subjective measures of their sexual function, relationship satisfaction, selfesteem, quality of life, sleepiness level, and satisfaction with ED treatment.

The 55 men who completed the trial had a mean age of 54 years, an average body mass and a mean serum testosterone level. They had an apneahypopnea index (AHI) of 43.9/h on average. In the CPAP vs sham-CPAP part of the study, there were 2 statistically significant findings for the entire group — those receiving actual CPAP had more erections during sleep (average of 4.1 vs 2.4) and better overall sexual satisfaction according to the study report. But the quality of erectile function did not significantly improve the findings showed.

For the subgroup of 20 CPAP recipients who adhered to at least 4 hours of treatment nightly, however, there were additional significant improvements in erectile function/quality and sexual desire as well as self-esteem, sleepiness, social function, and mental health, with reduced depression and stress.

“I can say with complete certainty that CPAP improves erectile dysfunction,” Ms Melehan said. “I think mental factors play a role because they feel more alive and awake.” In addition, she speculated that better oxygenation with CPAP may improve arterial stiffness. That is good news for men with OSA who also have ED

SUMMER VENDOR FAIR DRAWS CROWD

The Summer Support Group Meeting drew a large turnout for the annual Vendor Fair. Seven vendors showcased their latest in CPAP machines, masks, nasal pillows, oral appliances and services.

For those who missed the meeting, the following websites can bring you up to date on the latest;

Contra Costa Sleep Center: www.ccsleepcenter.com

Dental & Sleep Medicine Offices: www.drselleck.com

Fisher & Paykel: www.fphcare.com/sleep-apnea/

Respironics: www.healthcare.philips.com/us_en/homehealth/sleep/

ResMed: www.resmed.com/us/products/productspatients.html?nc=patients

N2Sleep: www.n2sleephomecare.com

Oxygen Plus: oxygenplusonline.com

THE JOURNEY THROUGH THE NIGHT

(excerpted from the Stanford Sleep Book)

Did you know just a regular night’s sleep had so many elements to it? Not many people know really about how complex sleep really is, or how many changes and events occur in just a single, ordinary night.

The following graph is a visual representations of how we generally progress through the different stages of sleep in a typical night.

The graphic representation above shows the transitions and relative amount of time spent in each stage of sleep in a typical night for a human adult. Notice that deep, slow-wave sleep is most prevalent at the start of the night, and that as the night progresses proportionally more and more time is spent in the rejuvenating REM sleep.

Sleep is entered through non-REM Stage 1, which usually persists for only a few minutes. During sleep onset Stage 1, sleep is easily interrupted by very low intensity stimuli, like a door closing or a gentle nudge.

In Stage 2 sleep the sleeper is more difficult to arouse; a stimulus that would produce wakefulness from Stage 1 will often not invoke a complete awakening. In most adults, Stage 4 of this first sleep cycle of the night is very deep sleep, and it is much harder to awaken the sleeper at this time than later in the night. Stage 4 typically continues for about 20 to 40 minutes, after which a series of body movements usually signals an “ascent” to lighter non-REM sleep stages.

A few minutes of Stage 3 may occur, or there may be a direct transition to Stage 2 sleep. After 5 or 10 minutes, the first period of REM sleep appears. This first REM episode of the night is often quite shortlived, usually lasting between 1 to 10 minutes.

The end of a REM episode and the transition to non-REM stages of sleep may be associated with some body movement, and a very brief arousal; or the transition may occur with no movements at all and no arousal. Often there is a change in body position such as a rolling over or a series of smaller adjustments. Throughout the night Non-REM and REM sleep continue to alternate.

The duration of the first sleep cycle–from sleep onset to the end of the first REM episode–is typically 60 to 90 minutes.

In the second sleep cycle, there is less Stage 4 and more Stage 2 sleep. The REM portion of the second cycle is a little longer than the first, usually around 10 to 20 minutes. The duration of the second sleep cycle, measured from the end of the first REM sleep period to the end of the second, is generally longer than the first, averaging 100 to 110 minutes.

In the third REM sleep period and beyond, Stages 3 and 4 are usually entirely absent or present in very small amounts; the non-REM portion of these cycles is almost entirely Stage 2 sleep. REM episodes tend to become longer in later cycles–the fourth or fifth REM episode typically lasts 30 to 45 minutes–leaving room for some serious dreaming time towards the end of the night.

Brief episodes of wakefulness tend to occur in later cycles, generally in association with transitions between Stage 2 and REM sleep, but these brief arousals are usually not remembered in the morning.

In summary, a night of sleep is characterized by a cyclic alternation of non-REM sleep and REM sleep. The average period of this cycle is typically 90 minutes. The first third of the night is usually considered the deepest sleep. REM sleep and Stage 2 predominate in the last third of the night.

SLEEP & FOOD CRAVING

( courtesy of United Healthcare newsletter )

A study funded by the National Institute of Health found that sleep patterns are linked to food cravings. Subjects who got only 4 hours of sleep each night reported a 23% increase in food cravings, especially for high fat, sweet and salty foods.

A “Couple” of Sleep Problems

(From the National Sleep Foundation)

By the time a couple has been together 20 years, they’ll have spent over 50,000 hours (roughly six to seven years) together in their bed. You’d think they’d have everything worked out by then . . . . Yet an estimated 23 percent of U.S. couples sleep apart, according to a survey conducted by the National Sleep Foundation. A survey of builders and architects reports an up-tick in the requests for dual master bedrooms!

For the other 77 percent of couples that do sleep together, the National Sleep Foundation survey indicates that one partner loses an average of 49 minutes of sleep per nightdue to some disruptive behavior, such as snoring, tossing and turning, watching TV, or preferring a warmer or cooler room.

Yet despite this, many psychologists warn that sleeping apart might not be a good solution to sleep issues. They believe that sleeping comfortably with your partner is an essential component of a healthy relationship. So before resorting to separate beds or bedrooms, it’s important to identify and attempt to resolve those potentially disruptive conflicts, even before they occur.

To put it in perspective, most marriages in the United States today start when the couples are in their mid to late twenties— and have therefore spent about a quarter of a century developing their own personal sleep habits and routines. There is an initial period of unlearning and relearning when it comes to sharing the bedroom, and for a while there is relative calm.

But as life progresses, our sleep patterns and habits slowly transform. We change careers, have children, gain weight, get pets. We age. And as we do, we may begin to snore, sleep warm, develop aches and pains, sleep more lightly and wake more frequently.We age at different rates, and men and women age uniquely, introducing potential conflicts in bed. The good news: most of these new “incompatibilities” are easily addressed once they are acknowledged and targeted. In the end, the real goal is simply to improve everybody’s sleep quality. Solving the “offender’s” issue will allow both partners to sleep better. If one simply traipses off to another bedroom without addressing the real problem, there could be unresolved consequences for one or both of you.

Subtle changes in sleeping habits or bedtime routines could help. Sleep accessories such as eye masks, ear plugs or sound machines have helped many. New bedding technologies can solve temperature disputes or disturbances from motion created by tossing and turning.

Finally, the solution may be something more involved. Millions of Americans have developed sleep disorders that require medical intervention. Any serious unresolved sleep issue should be discussed with your primary healthcare provider. After all, it’s about improving everyone’s sleep.

DR FORD SPEAKS ON ENT ISSUES AND SLEEP DISORDERS

Lloyd Clarke Ford MD

Dr. Ford, is board certified in Otolaryngology and has his practice with the Contra Costa Ear,Nose and Throat. He spoke at the Winter Support Group meeting on “Ear, Nose and Throat (ENT) issues and Sleep Disorders.”

There are many ENT problems that can effect sleep but Dr. Ford concentrated on those problems causing Obstructive Sleep Apneas. These range from enlarged tonsils to throat muscles that relax during sleep and cause the throat to narrow. This can cause snoring, sometimes with reduced or completely blocked airflow. A completely blocked airway without airflow is called an obstructive sleep apnea (OSA).

Many patients have OSA because of a small upper airway. As the bones of the face and skull develop, some people develop a small lower face, a small mouth, and/or a tongue too large for the mouth. These features are genetically determined, which explains why OSA tends to cluster in families. Obesity is another major factor.

Dr. Ford stressed that if you have been diagnosed with Obstructive Sleep Apnea and have been prescribed a Continuous Positive Airway Pressure (CPAP) machine stick with it. Find the right mask or nasal pillow and make it a nightly habit to use it. To have Sleep Apneas and ignore the benefits of treatment is inviting future medical problems.

 

NEW IMPLANTABLE UPPER AIRWAY STIMULATION THERAPY

Many people suffering from obstructive sleep apnea (OSA) are unable or unwilling to make CPAP therapy work. For these patients who are intolerant of CPAP, Inspire Medical Systems (info@inspiresleep.com) has developed an implantable Upper Airway Stimulation (UAS) Therapy. Inspire therapy is designed to deliver physiologically-timed, mild stimulation to the hypoglossal nerve on each breathing cycle to prevent airway obstruction during sleep. Early clinical experience suggests that significant decreases in apnea-hypopnea index (AHI) can be achieved in properly selected patients.

In contrast to other surgical procedures to treat obstructive sleep apnea, Inspire therapy does not require removing or altering a patient’s facial or airway anatomy. It is implanted in the chest wall. A clinical study closely evaluated 126 patients implanted with Inspire therapy. Complete trial results have been published in the January 9, 2014 edition of the New England Journal of Medicine (http://www.nejm.org/doi/full/10.1056/NEJMoa13 08659#t=articleTop). Over the initial 12 month follow-up period in the study, the majority of patients implanted with Inspire therapy experienced experienced significant reductions (approximately 70 percent reduction in sleep apnea severity) in sleep apnea events and improvements in quality of life measures.

Inspire Therapy is currently approved by the FDA for sale in the United States.

SLEEPING WHEN ITS BLISTERING HOT!

(courtesy of the ccsleepfoundation.org)

In just a few months it will be summer. One of our favorite times of the year. BUT sometimes it’s too hot to sleep. If you don’t have air conditioning, or a power outage knocks yours out, the heat can seem unbearable. Here are some tips to help you cool down on nights without the AC or if fans aren’t enough.

What you can do about where you sleep.

Do whatever you can to prevent excessive heat buildup in your home. During the daytime ise blinds or curtains to block sunlight and keep windows closed. At night when it is cooler outside than in, open your windows.

Remember that heat rises. The lower you are the cooler it will be.

Camp out in the backyard for a few nights. DO NOT sleep in a motor vehicle and leave the AC running. This can be dangerous because there may be s buildup of carbon monoxide in a non moving vehicle.

What you can do before going to bed

Drink lots of cool fluids and eat smaller, more frequent meals during the day.

Water is a great cooling agent. Try taking a cool shower or bath before bed and leaving your hair damp.

Spray yourself with a water mister.

Freeze a damp washcloth, or try using an icepack or a bag of frozen veggies as a compress.

What you can do to improve your sleep environment

Sleep with light bedclothes, thin pajamas or no pajamas. Consider sleeping on linins with wicking features.

If you wake up sweaty and your sheets and pillow cases are wet, consider taking a brief shower and changing the bed clothes.

Protect your health

Remember that when you sweat a great deal, you lose both water and electrolytes. This can be dangerous. Make sure that you replenish both and do not become dehydrated. Avoid excessive and unprotected sun exposure. Sunburn will add to your misery in trying to sleep when it is too hot!

SEVEN STEPS TO BETTER SLEEP

By Mayo Clinic Staff

You’re not doomed to toss and turn every night. Consider simple tips for better sleep, from setting a sleep schedule to including physical activity in your daily routine. Feeling crabby lately? Or simply worn out? Perhaps the solution is better sleep.

Think about all the factors that can interfere with a good night’s sleep — from pressure at work and family responsibilities to unexpected challenges, such as layoffs, relationship issues or illnesses. It’s no wonder that quality sleep is sometimes elusive. Although you might not be able to control all of the factors that interfere with your sleep, you can adopt habits that encourage better sleep. Start with these simple sleep tips.

No. 1: Stick to a sleep schedule

Go to bed and get up at the same time every day, even on weekends, holidays and days off. Being consistent reinforces your body’s sleep-wake cycle and helps promote better sleep at night. There’s a caveat, though. If you don’t fall asleep within about 15 minutes, get up and do something relaxing. Go back to bed when you’re tired. If you agonize over falling asleep, you might find it even tougher to nod off.

No. 2: Watch what you eat & drink

Don’t go to bed either hungry or stuffed. Your discomfort might keep you up. Also limit how much you drink before bed, to prevent disruptive middle-of-the-night trips to the toilet.

Nicotine, caffeine and alcohol deserve caution, too. The stimulating effects of nicotine and caffeine — which take hours to wear off — can wreak havoc with quality sleep. And even though alcohol might make you feel sleepy at first, it can disrupt sleep later in the night.

No. 3: Create a bedtime ritual

Do the same things each night to tell your body it’s time to wind down. This might include taking a warm bath or shower, reading a book, or listening to soothing music — preferably with the lights dimmed. Relaxing activities can promote better sleep by easing the transition between wakefulness and drowsiness. Be wary of using the TV or other electronic devices as part of your bedtime ritual. Some research suggests that screen time or other media use before bedtime interferes with sleep.

No. 4: Get comfortable

Create a room that’s ideal for sleeping. Often, this means cool, dark and quiet. Consider using room darkening shades, earplugs, a fan or other devices to create an environment that suits your needs. Your mattress and pillow can contribute to better sleep, too. Since the features of good bedding are subjective, choose what feels most comfortable to you. If you share your bed, make sure there’s enough room for two. If you have children or pets, set limits on how often they sleep with you.

No. 5:Limit daytime naps

Long daytime naps can interfere with nighttime sleep — especially if you’re struggling with insomnia or poor sleep quality at night. If you choose to nap during the day, limit yourself to about 10 to 30 minutes during the midafternoon. If you work nights, you’ll need to make an exception to the rules about daytime sleeping. In this case, keep your window coverings closed so that sunlight — which adjusts your internal clock — doesn’t interrupt your daytime sleep.

No. 6: Include physical activity in your daily
routine

Regular physical activity can promote better sleep, helping you to fall asleep faster and to enjoy deeper sleep. Timing is important, though. If you exercise too close to bedtime, you might be too energized to fall asleep.

No. 7: Manage stress

When you have too much to do — and too much to think about — your sleep is likely to suffer. To help restore peace to your life, consider healthy ways to manage stress. Start with the basics, such as getting organized, setting priorities and delegating tasks. Give yourself permission to take a break when you need one. Share a good laugh with an old friend. Before bed, jot down what’s on your mind and then set it aside for tomorrow.

Lastly, know when to contact your doctor

Nearly everyone has an occasional sleepless night — but if you often have trouble sleeping, contact your doctor. Identifying and treating any underlying causes can help you get the better sleep you deserve.

PAT McBRIDE TALKS ABOUT INSOMNIA

Pat McBride spoke to the last AWAKE meeting on Oct17th. She reviewed many of the issues surrounding insomnia. As a specialist in the dental treatment of sleep apnea, a board member of the Physicological Dentistry and Medicine Association, and Dental Sleep Medicine Consulting and Practice Management, she noted that Insomina is the most common complaint encountered in the field of sleep medicine. In any one year 1/3 of the adult population reports difficulty in sleeping and about 4% take some sort of sleep medication. Some individuals become distraught from unrealistic expectations as to how much sleep they should achieve. The patterns vary; 1) Prolonged time to fall asleep, 2)Awakening the middle of the night, and 3) early morning awakening.

There are two types of insomnia; primary and secondary.

Primary insomnia means a person is having problems that are not directly associated with any other health condition or issue.

Secondary Insomnia does have multiple causes and can be categorized as:

1. Medical conditions – pulmonary, cardiac, arthritis, gastrointestinal, nervous system
2. Psychiatric – dementia, depression, anxiety, stress
3. Sleep disorders – sleep apnea, sleep disordered breathing, periodic leg movements
4. Psychosocial – retirement, isolation, loneliness, bereavement, lack of physical activity
5. Circadian Rhythm Shifts – age related changes, shift work
6. Can result from other medications, foods, beverages
7. Environmental factors – temperature, noise, light
8. Poor sleep hygiene

Underling conditions must first be treated and stabilized, and if insomnia persists then sleep hygiene, behavioral therapy, counseling, or medications can be used. If no underling cause is identified then insomnia is described as Primary Insomnia. Insomnia is usually intermittent and unpredictable on any given night. It can be transient lasting only a few weeks or it can be chronic and go on for years.

There are daytime consequences of insomnia, such as, excessive drowsiness, impaired job performance, difficulties with concentration, memory, attention, problem solving, vitality, emotional stability, and increased reaction times, depression, absenteeism, auto accidents.

Insomnia also varies in how long it lasts and how often it occurs. It can be short-term (acute insomnia) or can last a long time (chronic insomnia). It can also come and go, with periods of time when a person has no sleep problems. Acute insomnia can last from one night to a few weeks. Insomnia is called chronic when a person has insomnia at least three nights a week for a month or longer.

*Causes of acute insomnia can include: Significant life stress, job loss or change, death of a loved one, divorce, moving) Illness, Emotional or physical discomfort, Environmental factors like noise, light, or extreme temperatures (hot or cold) that interfere with sleep. Some medications, Interferences in normal sleep schedule (jet lag or switching from a day to night shift,)

*Causes of chronic insomnia include:
• Depression and/or anxiety
• Chronic stress
• Pain or discomfort at night

Acute insomnia may not require treatment. Mild insomnia often can be prevented or cured by practicing good sleep habits If your insomnia makes it hard for you to function during the day because you are sleepy and tired, your health care provider may prescribe sleeping pills for a limited time. Rapid onset, short-acting drugs can help you avoid effects such as drowsiness the following day. Avoid using over-the-counter sleeping pills for insomnia, because they may have undesired side effects and tend to lose their effectiveness over time.

Treatment for chronic insomnia includes first treating any underlying conditions or health problems that are causing the insomnia. If insomnia continues, your health care provider may suggest behavioral therapy. Behavioral approaches help you to change behaviors that may worsen insomnia and to learn new behaviors to promote sleep. Techniques such as relaxation exercises, sleep restriction therapy, and reconditioning may be useful. Good sleep habits, also called sleep hygiene, can help you get a good night’s sleep and beat insomnia.

Here are some tips:
– Try to go to sleep at the same time each night and get up at the same time each morning.
– Try not to take naps during the day, because naps may make you less sleepy at night.
-Avoid caffeine, nicotine, and alcohol late in the day. Caffeine and nicotine are stimulants from falling asleep.
– Alcohol can cause waking in the night and interferes with sleep quality.
– Get regular exercise. Try not to exercise close to bedtime, because it may stimulate you and make it hard to fall asleep. Experts suggest not exercising for at least three to four hours before the time you go to sleep.
– Don’t eat a heavy meal late in the day. A light snack before bedtime, however, may help you sleep.
-Make your bedroom comfortable. Be sure that it is dark, quiet, and not too warm or too cold. If light is a problem, try a sleeping mask. If noise is a problem, try earplugs, a fan, or a “white noise” machine to cover up the sounds.
– Follow a routine to help you relax before sleep. Read a book, listen to music, or take a bath.
– Avoid using your bed for anything other than sleep or sex.
– If you can’t fall asleep and don’t feel that is not overly stimulating until you feel sleepy.
– If you find yourself lying awake worrying about things, try making a to-do list before you go to bed. This may help you to not focus on those worries overnight.

CPAP CAN IMPROVE YOUR LOOKS

(WebMD News, Sept. 13, 2013)

Treatment for sleep apnea may do more than improve your sleep and health: It could help you look better, according to a new study.

The study included 20 middle-aged sleep apnea patients whose facial appearance was rated before and after they started using a treatment called continuous positive airway pressure (CPAP), which helps keep the airway open by providing a stream of air through a mask that is worn during sleep.

Improvements in the patients’ faces were noted just a few months after they started using CPAP, according to the study published in the Journal of Clinical Sleep Medicine.

These changes included: looking more alert, more youthful, more attractive, having less-puffy foreheads and less-red faces.

The findings need to be confirmed in larger studies, the researchers said. They decided to conduct their study because sleep center staff often noted improvements in patients’ faces after they began using CPAP.

What Are Naps?

By Brandon Peters, M.D.

(Dr. Peters is a neurology-trained sleep medicine specialist who currently practices in Novato, CA and serves as adjunct clinical faculty at Stanford University.)

A nap is a short period of sleep that typically occurs during the day. Children may take frequent naps as their nighttime sleep is less consolidated. As we get older, we do most of our sleeping at night. Nevertheless, we typically have a strong desire to take a nap in the early afternoon.

Reasons to Nap

There are plenty of reasons to get a little extra sleep in the form of a nap. The most obvious reason for a nap is that you simply are not getting enough sleep at night. This may be a temporary inadequacy or a chronic issue. It may be helpful to determine how much sleep you need to see if this is a likely contributor.

There may be other reasons that you have excessive daytime sleepiness and need a little extra sleep in the form of a nap. This could be due to any of the sleep disorders that can cause sleepiness, including sleep apnea, narcolepsy, and insomnia.

Napping Options and Benefits

People will commonly say that they “power nap.” The implication is that a short amount of time spent sleeping (15 to 20 minutes) can revitalize and recharge. Assuming that you are able to fall asleep fairly quickly, you may be expected to enter into the lighter stages of sleep (either stage 1 or stage 2). This can be refreshing, but it may not give you the brain boost you desire.

More prolonged naps seem to have favorable consequences, improving memory and creativity. When naps last 30 to 60 minutes, you are more likely to enter into deep or slow-wave sleep. It is thought that even longer naps (up to 90 minutes or more) can enhance creative problem solving. Studies have consistently shown that naps can improve alertness and motor performance. Naps can furthermore reduce stress and even decrease your risk of heart disease.

Editors Comment

It seems that there has been a proliferation of new lightweight CPAP masks and nasal pillows – some even in shades of pastel. This is perhaps an improvement for those patients that can use them. For those of us, and I am one of them, who move about while sleeping the older more robust mask and/or nasal pillow assembly seems a necessity. To the manufacturers – don’t abandon the old standbys, to the DME providers – fit the patient with what works for them….. not necessarily the latest, and to the patient…… use what works for you!

“SOUND SLEEPER” TOPS 1,000 READERS

As its 19th year (and 76 issues) draws to a close, the SOUND SLEEPER’s combined e-mail and “snail mail” circulation now exceeds 1,000 addresses!

ANNUAL VENDOR FAIR

Six vendors were present at the annual Vendor Fair held at the summer support group meeting. If you missed it and want to see what’s new in CPAP machines, masks, nasal pillows and DME services, these vendors have websites:

Fisher & Paykel:
www.fphcare.com/sleep-apnea/

Respironics:
www.healthcare.philips.com/us_en/homehealth/sleep/

ResMed:
www.resmed.com/us/products/productspatients.html?nc=patients

LifeCare Solutions:
julinger@lifecaresoln.com

N2Sleep:
www.n2sleephomecare.com

UNTREATED SLEEP APNEA & BLOOD PRESSURE

(from the Stanford Center For Sleep Sciences and Medicine)

Poor sleep can exert its effects on nearly all medical conditions. With obstructive sleep apnea, if left untreated, you have an increased risk of developing high blood pressure, high cholesterol, diabetes, heart attack and stroke.

For centuries, sleep was thought to be a passive state, however, we now know that nothing could be farther from the truth. There is a lot going on in our bodies while we sleep — a very complex interaction of neurotransmitters, hormones and regulatory nerve traffic — resulting in dynamic physiological interactions.

Take for example, the role of the autonomic nervous system, the part of our nervous system responsible for regulating our body’s automatic functions — breathing, heart rate, blood flow, digestion, etc. The autonomic nervous system has two components: the sympathetic, or “fight or flight” component and the parasympathetic, or “rest and relaxation” component. When we fall asleep, our parasympathetic system takes over and as we progress into deeper stages of sleep, its effects become even more pronounced. Our breathing becomes more regular, our heart rate decreases and our blood pressure falls.

Then we enter rapid eye movement (REM) sleep and our sympathetic system intermittently takes over. While we dream, our blood pressure can swing dramatically and our heart rate and breathing become irregular. Those of us who can recall awakening from a particularly bad nightmare can attest to the nature of the fight-or-flight response: sweating, heart racing, we awaken with intense fear. These same physiological response would occur if we were attacked or chased by a predator. How does this all relate to high blood pressure and cardiovascular risk in untreated sleep apnea? Researchers have established that resting blood pressure typically falls by 10 to 20 percent in most individuals during sleep. This is a normal physiological response, mediated by the parasympathetic component of the autonomic nervous system. However, in some individuals, termed “non-dippers,” this does not occur. In others, so-called “reverse dippers,” blood pressure actually increases by 10 to 20 percent. Non-dippers and reverse dippers are at higher risk for stroke than dippers are. And those with obstructive sleep apnea are much more likely to be non-dippers or reverse dippers. In addition, whenever there is a sudden arousal from sleep, be it due to a nightmare or to upper airway obstruction from sleep apnea, there is a surge in sympathetic activity. As a result, there is a burst of adrenaline released into the bloodstream, blood pressure shoots up (sometimes extremely high), and — especially if there is a corresponding drop in blood-oxygen levels as frequently occurs during an apnea — heart rate can become irregular and dangerous arrhythmias, such as atrial fibrillation may develop.

Furthermore, it is thought that this apneainduced sympathetic surge carries over into the waking state. Researchers have found that patients with sleep apnea have higher daytime levels of adrenaline and higher resting blood pressure than normal controls. They were, however, able to significantly lower the levels in those treated with continuous positive airway pressure (CPAP), the most common treatment for obstructive sleep apnea. The relationship between sleep apnea and high blood pressure has now been well established in several epidemiologic studies. As with the adrenaline experiments, treatment with CPAP alone resulted in a small but significant reduction in resting blood pressure. There is also a well-established relationship between the severity of obstructive sleep apnea and the risk of developing (or worsening the risk of) diabetes, atrial fibrillation, stroke and heart attack.

Of course these risks are all related to the severity of sleep apnea — how many apneas an individual has in a given hour of sleep and how often the blood oxygenation drops throughout the night. To fully assess an individual’s risk, he or she should be evaluated by a sleep physician and most likely undergo a sleep study to evaluate for the presence and severity of OSA. If present, OSA is a very treatable condition, one that if addressed properly can help not only to improve a patient’s level of daytime alertness, but also help to reduce the risk of developing many other significant health problems down the road.

Sleep and Chronic Disease

(Materials from the Center for Disease Control)

More than one-quarter of the U.S. population report occasionally not getting enough sleep, while nearly 10% experience chronic insomnia. Fundamental to the success of all of these efforts is the recognition that sufficient sleep is not a luxury – it is a necessity – and should be thought of as a “vital sign” of good health. Understanding how lack of sleep affects your health can allow you to make healthier decisions for you and your family. While we often consider sleep to be a “passive” activity, sufficient sleep is increasingly being recognized as an essential aspect of health promotion and chronic disease prevention in the public health community. Moreover, insufficient sleep is responsible for motor vehicle and machinery-related crashes, causing substantial injury and disability each year. In short, drowsy driving can be as dangerous—and preventable—as driving while intoxicated.As chronic diseases have assumed an increasingly common role in premature death and illness, interest in the role of sleep health in the development and management of chronic diseases has grown. Notably, insufficient sleep has been linked to the development and management of a number of chronic diseases and conditions, including diabetes, cardiovascular disease, obesity, and depression.

Diabetes
Research has found that insufficient sleep is linked to an increased risk for the development of Type 2 diabetes. Specifically, sleep duration and quality have emerged as predictors of levels of Hemoglobin A1c, an important marker of blood sugar control. Recent research suggests that optimizing sleep duration and quality may be important means of improving blood sugar control in persons with Type 2 diabetes.

Cardiovascular Disease
Persons with sleep apnea have been found to be at increased risk for a number of cardiovascular diseases. Notably, hypertension, stroke, coronary heart disease and irregular heartbeats (cardiac arrhythmias) have been found to be more common among those with disordered sleep than their peers without sleep abnormalities. Likewise, sleep apnea and hardening of the arteries (atherosclerosis) appear to share some common physiological characteristics, further suggesting that sleep apnea may be an important predictor of cardiovascular disease.

Obesity
Laboratory research has found that short sleep duration results in metabolic changes that may be linked to obesity. Epidemiologic studies conducted in the community have also revealed an association between short sleep duration and excess body weight. This association has been reported in all age groups—but has been particularly pronounced in children. It is believed that sleep in childhood and adolescence is particularly important for brain development and that insufficient sleep in youngsters may adversely affect the function of a region of the brain known as the hypothalamus, which regulates appetite and the expenditure of energy.

Depression
The relationship between sleep and depression is complex. While sleep disturbance has long been held to be an important symptom of depression, recent research has indicated that depressive symptoms may decrease once sleep apnea has been effectively treated and sufficient sleep restored. The interrelatedness of sleep and depression suggests it is important that the sleep sufficiency of persons with depression be assessed and that symptoms of depression be monitored among persons with a sleep disorder.

We wish you a good night of sleep!

“Everything you need to know about CPAP – But were afraid to ask!”

Lori Ellis RCP

founders of the Sleep Apnea Patient Support Group 19 years ago), ably assisted by Bill Stoll of Timberlake Respiratory Care gave an excellent presentation to the Support Group at the spring meeting on “Everything you need to know about PAP.”

Lori traced the history of CPAP therapy from what was originally called the “Pickwickian Syndrome” (named after “Joe” in the Charles Dicken’s novel, “The Pickwick Papers” who fell asleep in almost any situation) up through the development of PAP (Positive Airway Pressure). Lori also covered the variations of PAP and their specialized uses. This was followed by an informative Q & A session.

HIGHER RISK SLEEP APNEA WITH USE OF OPIOID PAIN MEDS

(from MedicalNewsToday.com)

Opioid-based pain medications1 may cause sleep apnea, according to an article in the September issue of Pain Medicine, the journal of the American Academy of Pain Medicine.

“We found that sleep-disordered breathing was common when chronic pain patients took prescribed opioids,” explains lead author Lynn R. Webster, MD, from Lifetree Clinical Research and Pain Clinic in Salt Lake City, Utah. “We also found a direct dose-response relationship between central sleep apnea and methadone and benzodiazepines2 an association which had not been previously reported.”

Opioids, effective medications for chronic pain treatment, are often used for cancer patients, but are now gaining widespread acceptance as long-term therapy for chronic pain unrelated to cancer. An increasing number of patients with nonmalignant chronic pain are receiving around-the-clock pain relief through opioid therapy.

The researchers studied sleep lab data on 140 patients taking around-the-clock opioid therapy for chronic pain to assess the potential and prevalence sleep apnea in opioid treated pain patients. All patients were on opioid therapy for at least six months with stable dosing for at least four weeks.

The investigators say that their results show a higher than expected prevalence of sleep disordered breathing in opioid treated chronic pain patients. Obstructive and central sleep apnea syndromes occurred in the studied population at a far greater rate (75%) than is observed in the general population, where obstructive sleep apnea is known to be underdiagnosed but has been estimated at roughly 2% to 4%. Central sleep apnea is estimated at 5% in people older than 65 years and from 1.5% to 5% in men less than 65 years old. People who stop breathing during sleep because of faulty brain control have central sleep apnea as opposed to obstructive apnea, which is triggered by obesity and/or other health problems and accompanied by loud snoring.

The investigators comment that the absence of crescendo-decrescendo breath size commonly associated with central sleep apnea suggests that the central sleep apnea mechanism is different for people taking opioids than the general public. They suggest it could be related to the direct effects of opioids on the part of the brain that controls respiration.

The authors also note that if opioid medications increase sleep apnea risk as their research suggests, then chronic pain patients who are prescribed opioids have a higher risk of contracting sleep apnea.

“The challenge is to monitor and adjust medications for maximum safety, not to eliminate them at the expense of pain management,” Dr. Webster concludes.

1 The American Academy of Family Physicians notes that opioid drugs include those  produced for pharmaceutical purposes and those for recreational purposes. For example, opium and heroin are street opioid drugs. Other opioid drugs, such as codeine, fentanyl, hydrocodone, hydromorphone, methadone, morphine, oxycodone, oxycontin, oxymorphone, paregoric, sufentanil and tramadol, have medical purposes.
2 http://wikipedia.org/wiki/List_of_benzodiazepines

IMPORTANT CHANGE IN HOW YOU GET CPAP SUPPLIES

Effective July 1, 2013 Medicare has changed the manner in which those on “Original Medicare” obtain CPAP equipment and supplies if you live in certain areas, In order to receive Medicare reimbursement you need to obtain these supplies from a “Medicare – Contract Supplier.” The schedule for replacement of CPAP equipment and supplies remains unchanged only the manner in which you receive them. Information regarding this program was mailed to eligible Medicare patients. If you did not receive the material in the mail of have questions go to www.Medicare.gov/supplier and enter your ZIP code or call 1-800-633-4227.

Trauma and Sleep

(from National Sleep foundation)

Stress from a traumatic event can often lead to a variety of sleep problems. The result can be insomnia, bad dreams, and daytime fatigue caused by sleep disturbance. Some people with sleep problems and anxiety have posttraumatic stress disorder, or PTSD. PTSD is a reaction to a traumatic stressful event resulting in a feeling of a loss of control and an inability to help yourself in a bad situation. It’s often experienced by people who are in situations that range from combat to rape, but it can be caused by a variety of events.

When the body is overstimulated, the brain is flooded with neurochemicals that keep us awake, such as epinephrine and adrenaline, making it difficult to wind down at the end of the day. The neurochemicals remain present in the brain and can interrupt your normal sleep cycle. The following are common sleep problems following a trauma:

Flashbacks and troubling thoughts can make falling asleep difficult.

The victim might feel the need to maintain a high level of vigilance, which can make sleep difficult.

For those who experience violent situations, nighttime and darkness can, in and of themselves, bring about added anxiety and restlessness.

Taking naps during the day might be helpful, but, if overdone, can also interfere with your efforts to sleep through the night.

Once asleep, nightmares can frighten a survivor back to consciousness, and getting back to sleep can be very difficult.

COPING
For those who are experiencing temporary sleep problems, there are a number of things you need to know which can help with insomnia, bad dreams, and daytime fatigue. Sleep experts recommend trying to reduce feelings of stress, especially before bedtime. Don’t watch the news right before going to bed. Avoid coffee in the afternoon and evening. Take a warm bath or soak in a hot tub before bedtime. If sleep problems persist, see your doctor, who can prescribe medications that will help you sleep but won’t make you groggy in the morning. Here are some additional tips that may prove helpful:

Sleep in a location where you will feel most rested and safe. While the bedroom is optimal, it may not be possible to rest there soon after the trauma if you experienced violence in that room.

Create an environment in which you can sleep well. It should be safe, quiet, cool and comfortable. While it often helps to sleep in a dark room, if keeping a nightlight on helps bring about a more safe feeling, then consider keeping the room dimly lit.
• Engage in a relaxing, non-alerting activity at bedtime such as reading or listening to music. For some people, soaking in a warm bath or hot tub can be helpful. Avoid activities that are mentally or physically stimulating, including discussion about your violent experience, right before bedtime.
• Do not eat or drink too much before bedtime and recognize the negative role that alcohol can have on your sleep.
• Rest when you need to rest. It is common to feel exhausted after a violent trauma, so you may need more rest or to rest differently during this time. Relaxing and resting for brief times throughout the day and taking short naps (15-45 minutes) may help.
• Go to bed when you feel ready to sleep. Try not to force sleep, which can add to the pressure of wanting to get to sleep. Developing the harmful habit of lying in bed awake for long periods when you want to sleep is counter-productive.

 

Why a Sleep Apnea Diagnosis May Save Your Life

by Yoni Freedhoff, MD (assistant professor of family
medicine at the University of Ottawa) in U.S. News&
World Report – Feb 7, 2013

It’s one of the most under diagnosed conditions around, and I’d argue that, in a sense, the diagnosis of sleep apnea is more a blessing than a curse.

For those who aren’t familiar with sleep apnea, its most common form, obstructive sleep apnea (OSA), causes sufferers to stop breathing periodically throughout the night, or breathe so shallowly that the oxygenation level of their blood plummets, leaving their bodies in an almost nightlong state of metabolic panic.

In severe cases, a person may wake up dozens of times an hour, yet these micro-awakenings aren’t usually conscious ones, and so sufferers might well have no idea they’re even happening. More than just a tiring nuisance, people with OSA are at greater risk of developing a myriad of medical conditions including heart disease, heart attack, obesity, depression, and sudden death.

While weight itself is a tremendous risk factor for the development of OSA, neck architecture is also involved, consequently, simply because you might be at a lighter weight doesn’t exclude you from the possibility of having OSA.

Symptoms of sleep apnea vary, but the most common ones include never feeling well rested, even after a good night’s sleep; excessive daytime or afternoon sleepiness; and morning headaches. Partners of individuals with OSA may complain that they snore excessively; they may also note hearing pauses in their partner’sbreathing, which often resumes with grunts, gasps or snorts.

he gold standard of screening tests involves spending a night in a sleep lab hooked up to more electrodes than you can imagine. And while being hooked up to electrodes does make it more challenging to sleep, you only need to be out for an hour or so to get a definitive reading.

The reason I suggest the diagnosis is more a blessing than a curse is how incredibly effective OSA’s non-drug treatment can be, and how life changing it often is. People who’ve suffered unknowingly with OSA will sometimes report, even after a single night of treatment, that they feel more energetic than they have in years. So besides reducing the risk of sudden death, treatment markedly improves quality of life.

Treatment options vary from devices that help to keep a person off of their back (where OSA is often worst) to dental devices as well as CPAP machines, which use air to keep the airways open, and even surgeries.

If you’d like to take a simple test to determine whether or not you might want to consider testing for sleep apnea, just answer the following eight questions. If you reply with three or more yeses, I’d strongly encourage you to ask your physician to organize a night for you in the sleep lab.

1. Do you snore loudly?
2. Do you feel tired during the day?
3. Has anyone ever told you that you stop breathing during your sleep?
4. Do you have high blood pressure ?
5. Is your BMI greater than 35?
6. Are you older than age 50?
7. Is your neck size greater than 15.75″?
8. Are you male?

STUFFY NODE?

(Reprinted from the Spring 2010 Sound Sleeper)

One of the most frequent complaints of CPAP users is of nasal congestion using CPAP. An examination of this problem proved it is far more complex as to the cause and solution than first imagined.

There have been only a few studies of this specific problem but these suggest that CPAP itself is not the culprit and, in fact, CPAP results in a reduction in nasal resistance 2 to 3 hours after commencing use due to the mechanical splinting effect and/or reduction of vascular fluid in the nasal membrane. Therefore the cause of nasal congestion must be due to something else. Chief among the causes identified are; mouth breathing, the change to a more recumbent posture (i.e. lying down), nasal dryness, allergy, and/or the “rebound” caused by the use of decongestants, or Rhinitis/Sinusitis.

Examining each of these potential causes of congestion may offer a clue as to what your individual problem is and what steps can be taken to achieve relief.

Mouth breathing is known to increase nasal obstruction and can be alleviated by the use of a chin strap or switching to a full-face mask. A recumbent posture normally causes a slight increase in nasal resistance. If lying down with CPAP causes nasal congestion to the point making it difficult to breath through the nose this would tend to indicate a pre-existing nasal obstruction or structural physical problems with the nasal passages may be the cause. If the stuffiness goes away when you remove your mask and get up the problem is most likely postural. In any case an examination of your nasal passages by a physician is in order. Nose drops or nasal spray may help but rely on your doctor’s recommendation.

Nasal Dryness can be a cause of irritation and resulting swelling of the nasal passages. The solution can be as simple as squirting a saline solution (e.g. Ocean brand) into each nostril before putting on your CPAP mask and again several times during the day. If this doesn’t work than investigate the addition of a humidifier to your CPAP machine.

Allergies can cause inflammation and can cause difficulty breathing. Over-The-Counter (OTC) allergy medications treat the symptom (i.e. inflammation) not the cause (allergy) and even then only for a little while. You need to talk with the physician who is treating your allergy and they need to know that you use CPAP and the breathing problem you are having.

“Rebound” caused by the use of decongestants is perhaps one of the commonest “self-inflicted” causes of nasal inflammation. Most decongestants are designed for short-term use to decrease congestion and they will cause inflammation if used over extended periods. Beware the “OPXs” – look at the ingredients on the package and avoid those containing the following: Oxymetazoline (e.g. Afrin), Phenylephrine (e.g. Neo-Synephrine) and Xylometazoline (e.g. Sudafed or Sinex). They will all cause “rebound” nasal irritation. Your physician can prescribe one of several nose drops that can be safely used for extended periods without causing inflammation or “rebound” in the nasal passages. One of these is the antihistamine Azelastine (e.g. Astelin).

Rhinitis/Sinusitis is really a fancy name for inflammation of the nose and/or nasal passages. Anything that irritates the nose can cause rhinitis. Changes in weather, such as temperature, humidity, and sudden barometric pressure changes often aggravate an already inflamed nose. Many systemic diseases can also impact rhinitis. The most common cause is allergies, but diabetes, high blood pressure, and many medicines can be also effect rhinitis. Treatment first involves getting a diagnosis of the cause of the Rhinitis.

Treatments vary from avoidance of offending substances such as; smoking, symptomatic overthe- counter medicines known to contain an irritating decongestant and prescriptions with similar ingredients. Reducing or eliminating Rhinitis can be a difficult process to resolve alone. What may be tolerable to one not using CPAP may not be tolerable for one on CPAP. Again you need work with a physician with complete knowledge of your problem.

A stuffy nose is not caused by CPAP and abandoning CPAP will not cure a stuffy nose!

day requires adequate healthy sleep at night. It has been said that we sleep so that we will not be sleepy. At this time, we simply do not know what the sleeping brain is doing and why it is doing it, at least not the same way we know what the waking brain is doing and why. When we are awake, the major task of our brain is to orchestrate our behavior in the world. This requires learning, remembering, moving about, projecting ourselves into the future, planning – all those things that concern our interactions with our external environment in the service of our survival as individuals and as a species. Since we have no conscious awareness of what our brains are doing during sleep it is though that period of time is “shut off” and only others can report to us what are bodies were doing during our sleep.

We know that sleep is a primary function of our brains, occupying nearly a third of its activity each day and strongly affects us during the remaining, wakeful two-thirds of the day if we do not obtain optimal sleep quality and quantity. We now realize that a number of medical disorders are specifically related to the sleeping brain and not the waking brain.

Why does sleep overtake us, even under circumstances when nodding off might threaten our very lives? The reason must be that the brain has something else to do – or many things to do – that cannot be done when it is preoccupied with sensing and responding to the environment. It seems highly likely that the functions and tasks of the brain in sleep relate to maintenance of the organism in ways we do not fully understand. Furthermore, it would be absurd to hypothesize that the brain in sleep performs but a single task. We know that the brain in sleep is an active brain; it no more “shuts off” when we fall asleep than the liver, pancreas, heart or lungs do. In fact, in the mode of sleep call REM sleep, brain activity revs up to levels equal to or greater that those attained in the waking state.

Animal studies show that sleep is necessary for survival. For example, while rats normally live for two to three years, those deprived of rapid eye movement (REM) sleep survive only about five weeks on average, and rats deprived of all sleep stages live only about three weeks. Sleep-deprived rats also develop abnormally low body temperatures and sores on their tail and paws, possibly because their immune systems become impaired.

Some experts believe sleep gives neurons used while we’re awake a chance to shut down and repair themselves. Without it, these brain cells may become so depleted in energy or so polluted with byproducts that they begin to malfunction.

(Excerpts from The Sleepwathchers by William
C, Dement, M.D., 2nd ed. 1996).

DRUG MAY AID SLEEP APNEA AT ALTITUDE

(The following article may be of interest to those who have occasion to be at altitudes above 5000′)

People with sleep apnea can safely travel to high altitudes with the help of a diuretic and a commonly used breathing device, a new study from Switzerland suggests.

Researchers found acetazolamide (sold as Diamox), which is already used to treat mountain sickness, improved overnight oxygen levels among people with the sleep disorder who spent time above 5,000 feet. Because there is less oxygen in the air at high altitude, nighttime breathing symptoms may get worse far above sea level. However, there aren’t any standard recommendations for mountain travelers with sleep apnea, according to Dr. Konrad Bloch, who worked on the new study.

“Physicians had no scientific evidence to counsel the patients,” Bloch, from the University Hospital of Zurich, told Reuters Health.

To try to provide some guidance, his team sent 51 people with sleep apnea – all of whom lived at low altitude – to resorts in the Swiss Alps as high as 8,497 feet on two different trips.

Each time, the volunteers used a breathing device commonly prescribed to people with sleep apnea, called continuous positive airway pressure therapy, or CPAP, at night. On one trip, participants also took three 250- milligram doses of acetazolamide each day. On the other, they were given drug-free placebo pill.

Along with being a diuretic, acetazolamide also triggers more frequent breathing. Bloch and his colleagues found participants’ average oxygen saturation overnight – a measure of sleep apnea severity – was better among the acetazolamide group, at 91 percent versus 89 percent in the placebo group at the highest altitude. (Normal oxygen saturation is between 97 and 99 percent.)

People taking acetazolamide also stopped breathing fewer times during the night than those taking the placebo pills, the research team reported Tuesday in the Journal of the American Medical Association.

With the type of CPAP used here, called autoCPAP, a computer controls air pressure flowing through the breathing mask. For standard CPAP – which is more common in the United States – pressure is calibrated in a sleep lab and doesn’t change based on nightly variation.

Most of the study volunteers were moderately obese men. Any related conditions they had – such as diabetes or high blood pressure – were stable before the study.

WATCH OUT FOR SIDE EFFECTS
Bloch said acetazolamide, which requires a prescription, “is not a harmless drug” because it alters water and salt content in the body. Some people in the study had side effects such as burning, numbness or tingling – and others complained about the drug’s taste.

For patients with heart or kidney disease in addition to sleep apnea, acetazolamide could lead to more serious complications – by making them pee too much, said Dr. Seva Polotsky, a sleep apnea researcher from Johns Hopkins University School of Medicine in Baltimore.

“I think it’s really beneficial. Having said that, you have to be careful with this drug,” Polotsky, who wasn’t involved in the new study.

“I would definitely check with a doctor and approach it very carefully.”

The new research was partially funded by a grant from Philips Respironics, which markets sleep systems such as CPAP devices. Drs.Bloch and Polotsky both recommended anyone traveling at altitude ascend slowly and take time to acclimatize along the way. “This is a recommendation that is important for everyone, but especially those that have a breathing problem,” Bloch said.

SOURCE: Journal of the American Medical Association, online Dec 11, 2012

SHOULD YOU HAVE A BACK-UP CPAP MACHINE?

The answer is emphatically YES!

Here is why: By the time that your sleep apnea gets bad enough that you take action to correct it, you’ve probably been suffering from it for 20 or more years. Obstructive Sleep Apnea is insidiously slow. You think your are sleeping well but your bed partner can tell you different. Your friends and hunting buddies can tell you different. Snoring, not breathing for up to a minute, chocking, gasping for air, it doesn’t bother you but it bothers them. You sleep the night away but they don’t.

Even though you sleep the night away, you don’t get the rest your body needs to repair itself. CPAP therapy restores normal breathing while you sleep. It keeps your upper airway open allowing you to breath normally. It allows you to go into the deeper stages of sleep allowing your anatomical functions to slow down and do the necessary repair work. After using CPAP for a while, your system returns to it’s normal functioning. The stresses placed on the heart and lungs is eliminated. You get back to a near normal state.

Suddenly, your CPAP machine or your nasal interface quits or breaks. You can’t use your CPAP machine because it is showing SERVICE REQUIRED or and ER (error) code in the LED window. It won’t run.

Can you get along without it? Sure! All you need to do is sleep setting up. As you find out on night one, that doesn’t work out too well. The next night you sleep on your stomach. That doesn’t work out either because it is very uncomfortable.

The third night you keep jerking yourself awake because you are not breathing properly, the apnea is waking you up or your snoring is waking you up. You are not sleeping. The next day you are tired, sleepy, can’t concentrate, have a hard time staying awake while driving, watching television or trying to read the daily paper. Your apnea is back, full blown and trying to kill you. Suddenly the stresses that cause heart attacks and strokes is much higher because your system had acclimate to a near normal stress level, thanks to the CPAP therapy. With out the CPAP you are at a much If you had a back up CPAP machine setting in the closet, when the old machine quits, within 10 to 15 minutes you could be back to sleeping like a baby. You and everybody else would be happy. Get a back-up CPAP machine now. They are not that expensive. This is affordable insurance, even setting in the closet!

SOURCE: www.cpapman.com/newsletter

Alzheimerʼs Disease and Dementia

Alzheimer’s disease (AD) is a brain disorder that affects a person’s thoughts, memory, speech, and ability to carry out daily activities. There is a loss of brain tissue that leads to deterioration of mental abilities and may also disrupt the sleep/wake cycle, which may cause sleep problems, nighttime wandering, and agitation.

Symptoms of AD develop slowly, usually beginning with short term memory problems. Over time, patients gradually lose more and more of their mental capabilities. For example, they may have difficulty remembering people or events and then lose the ability to do everyday tasks such as cooking, cleaning, and bathing. Eventually, AD patients may not be able to recognize loved ones, speak, or think clearly. Additional symptoms of AD include: Incontinence; speech problems; an inability to dress, or groom oneself; wandering and getting lost; losing items; and depression.

Patients in the early stages of AD may sleep more than usual or wake up disoriented. As the disease progresses, patients may begin to sleep during the day and awaken frequently throughout the night. Patients with more advanced AD rarely sleep for long periods. Rather, they doze irregularly throughout the day and night. Because caregivers are likely to be asleep during the night when AD patients are active, sleep/wake disruptions can be a dangerous problem for AD sufferers. In addition, AD patients who do not get enough sleep are more likely to suffer from agitation.

A feature of AD is “sundowning,” a term used to describe an increase in agitated behavior that occurs in the evening. This increased agitation may be explained by sleepiness or it may be that agitated behavior is more troublesome to caregivers after sun down. Whatever their causes, agitation and sleep problems result in severe stress for caregivers and are among the top reasons AD patients are given care in nursing homes instead of at home.

Alzheimer’s disease is not a normal part of aging but the risk of developing it goes up with age. It usually begins after age 60 and the risk nearly doubles with every 5 years of age after age 60. The number of Alzheimer’s patients is expected to increase dramatically in the coming years.

There is no cure for AD, but there are behavioral and drug therapies that may slow its progression and treat its symptoms. For example, cholinesterase inhibitors are medications used to treat mild to moderate AD (Aricept). They work by blocking the action of an enzyme that breaks down acetylcholine, a chemical which is essential to brain function. In addition, a drug called memantine is used to treat moderate to severe AD (Namenda). It works by regulating glutamate, a chemical in the brain that is important to learning and memory. AD patients may also benefit from antidepressant, antipsychotic, and sedating medications.

The National Institute on Aging at the National Institutes of Health identifies many forms of dementia, all of which have many of the same effects as Alzheimer’s disease. AD is the most prevalent form of dementia, though the second leading cause of impaired cognitive function in older adults is multi-infarct dementia which is actually caused by a series of often imperceptible strokes. Some forms of dementia may be cured or managed if accurately diagnosed and treated. That is why it is important to actively seek out answers to signs of memory loss.

Coping with AD:
• Create an ideal sleep environment
• Keep a regular sleep/wake schedule
• Get into bright light soon after waking
• Keep lighting dim as bedtime approaches
• Create simple routines for accomplishing everyday tasks
• Create a safe environment – keep dangerous items out of reach
• Use labels and reminder notes to help accomplish daily tasks such as dressing and food preparations
• Get some form of exercise every day

VENDOR FAIR FEATURES NEW CPAP MASKS

Laurie Moellering of ResMed describes their new “Swift FX” CPAP
Nasal cushion mask to support group members

The July Support Group meeting hosted the annual Vendor Fair and was attended by representatives from Respironics, ResMed, the Contra Costa Sleep Center and Oxygen Plus, Inc. The manufacturers present displayed and demonstrated their new CPAP masks and existing line of CPAP machines. Doug Lockwood from Respironics presented their newest full-face mask, the Amara.

The “Amara” is smaller, lighter and quieter than traditional full-face masks. It has only four parts including a one-piece cushion. A simple full-face mask design, it requires just a single “click” to assemble the cushion to the mask frame or to detach it for cleaning, It also features: quiet micro exhalation port, fine-glide forehead adjuster, strong and easy-to-use talon clips for connecting the headgear. You can see a video review at: http://www.youtube.com/watch?v=hx8GwD4MHAE For more information about the Amara mask and Respironics “System One” line of CPAP machines see your DME or http://masks.respironics.com/

ResMed’s Laurie Moellering demonstrated their new nasal pillow mask, the “Swift FX.” The Swift FX offers minimal design, unprecedented softness, simplicity and stability.

The soft frame and nasal pillows allows for a freedom of movement without discomfort or interruption of therapy. For more information on the Swift FX or ResMed’s S9 series of CPAP machines contact your DME or www.resmed.com/us/index.html

The Contra Costa Sleep Center was on hand with information about their services for the diagnosis and treatment of sleep disorders, and informational brochures concerning Sleep Apnea, its effects and treatment. With a staff of seven physicians and 14 years experience as the only accredited, state of the art, sleep center in Contra Costa County. Contact them at (925) 935-7667 or by e-mail at: info@ccsleepcenter.com 

Oxygen Plus, Inc. was represented by Matt Chirco their owner. This Durable Medical Equipment (DME) supplier is located across the street from John Muir Medical Center and the Contra Costa Sleep Center at 130 La Casa Via in Walnut Creek. They provided a handy brochure outlining their services, the Medicare schedule guidelines for CPAP supply replacement, and the recommended Maintenance and Cleaning Schedule for CPAP equipment and masks. Contact them at (925) 363-7474 to request a copy.

Famous People With Sleep Apnea

If you have Sleep Apnea you are in the excellent company of Presidents, Kings, Queens, inventors and NFL football players. There is a very high likelihood based on written reports of their lifestyle and habits that these people had Sleep Apnea: Grover Cleveland, Johannes Brahms, Henry VIII, Queen Victoria, Theodore (Teddy) Roosevelt, Franklin D. Roosevelt, Winston Churchill, William Howard Taft, the comedian John Candy, Thomas Edison and Napoleon Bonaparte.

More recent celebrities who have had it come out in public that they have Sleep Apnea: Reggie White (NFL football player), Rosie O’Donnell (comedienne and talk show host), Jerry Garcia (Grateful Dead Guitarist), Billy Connolly (actor), Anne Rice (writer), Johnny Grunge (professional wrestler), William Shatner (actor), George Kennedy (actor), Jason Rutcofsky (musician), Hall Sutton (PGA Champion), Mark Calcavecchia (PGA Golfer), and John McEuen (founder of the Nitty Gritty Dirt Band). It is suspected that Sleep Apnea was a contributing factor in the death of actor Chris Penn; actor Sean Penn’s brother. Source: apneasupport.org, NEJM (Jan 2003) urce:cpaptalk.com, NEJM(01.03.

Taking a Nap

(Excerpted from National Sleep Foundation)

More than 85% of mammalian species sleep for short periods throughout the day. Humans are part of the 15% minority, meaning that our days are divided into two distinct periods, one for sleep and one for wakefulness. It is not clear that this is the natural sleep pattern of humans. Young children and elderly persons nap, for example, and napping is a very important aspect of many Latin cultures. As a nation, the United States appears to be becoming more and more sleep deprived. And it may be our busy lifestyle that keeps us from napping. While naps do not necessarily make up for inadequate or poor quality nighttime sleep, a short nap of 20-30 minutes can help to improve mood, alertness and performance. Nappers are in good company: Winston Churchill, John F. Kennedy, Ronald Reagan, Albert Einstein, Thomas Edison and George W. Bush are known to have valued an afternoon nap.

TYPES OF NAPS:
Planned napping (also called preparatory napping) involves taking a nap before you actually get sleepy. You may use this technique when you know that you will be up later than your normal bedtime or as a mechanism to ward off getting tired earlier. Emergency napping occurs when you are suddenly very tired and cannot continue with the activity you were originally engaged in. This type of nap can be used to combat drowsy driving or fatigue while using heavy and dangerous machinery. Habitual napping is practiced when a person takes a nap at the same time each day. Young children may fall asleep at about the same time each afternoon or an adult might take a short nap after lunch each day.

TIPS FOR NAPPING:
A short nap is usually recommended (20-30 minutes) for short-term alertness. This type of nap provides significant benefit for improved alertness and performance without leaving you feeling groggy or interfering with nighttime sleep.

Your surroundings can greatly impact your ability to fall asleep. Make sure that you have a restful place to lie down and that the temperature in the room is comfortable. Try to limit the amount of noise heard and the extent of the light filtering in. While some studies have shown that just spending time in bed can be beneficial, it is better to try to catch some zzz’s.

If you take a nap too late in the day, it might affect your nighttime sleep patterns and make it difficult to fall asleep at your regular bedtime. If you try to take it too early in the day, your body may not be ready for more sleep.

BENEFITS OF NAPPING:
Naps can restore alertness, enhance performance, and reduce mistakes and accidents.

Naps can increase alertness in the period directly following the nap and may extend alertness a few hours later in the day. Napping has psychological benefits. A nap can be a pleasant luxury, a mini-vacation. Most people are aware that driving while sleepy is extremely dangerous. Still, many drivers press on when they feel drowsy in spite of the risks, putting themselves and others in harm’s way. While getting a full night’s sleep before driving is the ideal, Sleep experts recommend that if you feel drowsy when driving, you should immediately pull over to a rest area, drink a caffeinated beverage and take a 20-minute nap.

STIGMAS TO NAPPING:
While research has shown that napping is a beneficial way to relieve tiredness, it still has stigmas associated with it; Napping indicates laziness, a lack of ambition, and low standards, Napping is only for children, the sick and the elderly. These statements are false.

A recent study in the research journal Sleep showed that a 10-minute nap produced the most benefit in terms of reduced sleepiness and improved cognitive performance. A nap lasting 30 minutes or longer is more likely to be accompanied by sleep inertia, which is the period of grogginess that sometimes follows sleep.

When fatigue sets in, a quick nap can do wonders for your mental and physical stamina.