DR. CHEUNG SPEAKS ON “SLEEP & AGING”

Dr. Karin Cheung spoke at the Fall meeting of the Support Group on the subject of “Sleep & Aging” and had the rapt attention of the group (except during the 8:16PM small earthquake). She is a specialist in Pulmonary and Sleep Medicine, is in private practice in Walnut Creek and on the medical staff of the Contra Costa Sleep Center.

Dr. Cheung opened with the remark, “We need consolidated, restorative sleep to function in a safe efficient and effective way, for cognitive social and physical performance, for emotional enhancement and relating well with others, for learning and memory consolidation, and for the prevention of health problems.”

“Sleep changes with normal aging,” she said. Insomnia can effect older people, Obstructive Sleep Apnea can occur, Restless Leg Syndrome may disrupt sleep, and medications prescribed can change sleep patterns.

The elderly typically say about their sleep;
• Time in bed increases
• Number of awakenings increase
• Total sleep time decreases
• Time to fall asleep increases
• More dissatisfaction with sleep
• More tired during the day
• More frequent napping

Dr. Cheung stressed, “Severe Daytime sleepiness at any age almost certainly indicated a sleep disorder.”

A number of factors affect sleep with aging; Circadian Rhythm disorders (i.e. effecting the biological timing of sleep) and Advanced Sleep Phase Syndrome (e.g. go to bed early in the evening 6:00–8:00 p.m. and wake up very early in the morning 1:00–3:00 a.m.), Obstructive Sleep Apnea, Medical illness, stimulants, Medications, and Dementia.

Snoring increases with age – about 40% of the U.S. adult population snores. BUT Obstructive Sleep Apnea, which in middle age affects 4% of men and 2% of women, increases for those over age 65 to 28% of men and 24% of women. This is a serious health risk!

She then expanded on the causes of Insomnia in the elderly citing; stress, depression, anxiety, physical illness, acute or chronic pain, caffeine intake, irregular schedules and poor bed habits, Circadian Rhythm disorders, and drugs, alcohol and nicotine ingestion.

“Making matters worse,” she said, “Older people may take a number of medications that may adversely affect sleep. They drink coffee too late in the day. They drink alcohol to speed sleep onset but it leads to disruption of sleep later in the night. And smoking can cause stimulation and result in insomnia and disrupted sleep.” She offered the following tips for older adults to enhance sleep:

• Exercise
• Limit naps to 1 a day for less than30 minutes
• Take a walk in the late afternoonor early evening to increase bright light exposure
• Check Medications for side effects
• Avoid alcohol, caffeine, nicotine
• Limit liquids
• Keep regular hours
• Practice good bed habits.

In summary, Dr. Cheung said, “Sleep is a basic biological need that is essential to our health, performance, safety and quality of life. Sleep deprivation has serious negative consequences. Establish healthy sleep practices prevents sleep problems from arising and promotes optimum sleep. Signs and symptoms of sleep difficulties need to be identified and discussed with your doctor.

REPLACING YOUR CPAP MASK

(based on an article in CPAPStore.com)

The silicone rubber cushion, the part that goes over your nose on a nasal or full face mask and the part that goes up the nose with a nasal pillow is replaceable without needing to replace the frame and headgear.

Some manufacturers design their mask so that you can replace about every part on the mask. The leaders in this field are ResMed followed by Philips Respironics, Fisher & Paykel, and DeVilbiss.

The most critical part of an interface is the cushion. That is the silicone rubber part that goes over the nose or over the nose and mouth in a full face mask.. Because the cushion comes in contact with the skin in order to seal, the silicone can be affected by the body oils and other skin secretions. If you wash your face and mask cushion before you put on your mask, the cushion will last eight to fourteen months, possibly even longer. The better care and maintenance you give your mask, the longer it will last.

At some point the cushion will begin to get soft and mushy. It will start being hard to keep the cushion from leaking. This is when you need to replace the cushion. You can find replacement cushions on many websites (CPAP Supplies/Mask Cushions) or from your Durable Medical Equipment (DME) supplier. You will need to know which mask you have and the size of the cushion you are using. That information is printed or embossed on your mask cushion. Different manufacturers place it in different places. Some even put the specific part number on the cushion. Just look close and you will find it. Your users manual should contain a schematic to aid you in ordering parts or you can find one on the manufacturer’s website. By replacing the cushion on your mask, it will respond like a new mask. The payoff is, you don’t have to readjust your mask and you save a lot of money. On top of that, you don’t have to have a prescription to replace mask parts.

BEWARE THE SLEEPY TRUCKER

According to Overdrive magazine (March 2010), a magazine of the trucking industry, “an estimated 28 percent of truck drivers suffer from mild to severe sleep apnea, but less than half of those with the disorder are being treated for it, experts say. Nearly 42 percent of drivers are overweight and considered prone to having the disorder.” The National Transportation Safety Board is drafting regulations that would require those diagnosed with sleep apnea on the required physical to utilize CPAP in order to retain their license.

High Altitude Issues

In California, most of the population leaves near sea level elevation so we do not experience any difficulties traveling from one point to another. However, if one goes to altitude, adjustments are needed to accommodate to the higher altitude with lower atmospheric pressures and less available oxygen. Even though there is 21% oxygen concentration in our air clear up to an altitude of 70,000 feet, the available oxygen diminishes in direct proportion to the atmospheric pressure. For example, the following elevations have the associated partial pressures of oxygen available:

Altitude	Air Pressure	Partial Pressure of Oxygen
Sea level	765 mm Hg	160 mm Hg
3,000 Feet	686	144
6,000	613	129
9,000	547	115
15,000	423	91
20,000	352	74
40,000	141	30

Donner Summit on Interstate 80 is 7058′ above sea level and therefore has 19% less available oxygen than at sea level. Most commercial airplanes pressurize their cabin pressures to the 8,000 foot level. If cabins were not pressurized, passengers could start losing consciousness at 18,000 feet.

When one travels to the mountains 8,000 feet or above quickly, they may experience acute altitude sickness, especially if they do not consume enough water, exercise too vigorously, or drink alcohol.

The mild to moderate symptoms are:
• Headache
• Fatigue
• Dizziness or light-headedness
• Difficulty sleeping
• Loss of appetite
• Nausea or vomiting
• Rapid pulse
• Shortness of breath

More serious symptoms are:
• Bluish discoloration of the skin
• Chest tightness or congestion
• Crackling breathing
• Confusion
• Coughing up blood
• Decreased consciousness
• Difficulty walking

If the serious symptoms develop then one must go down to a lower altitude by at least 1,500 feet. If one is unconscious, then one should go to the lowest altitude possible or be treated in a pressure chamber.

Prevention is the key. Drink plenty of liquids and avoid alcohol in the first two days. Avoid vigorous activities in the first two days and stay rested. Your physician may be able to prescribe a medication to reduce the chance of acute altitude sickness. Patients that use CPAP machines must also make accommodation for altitude in order to receive sufficient pressure at altitude. Most new machines have a built in altitude adjustment to 10,000 feet and will automatically adjust. Older CPAP machines must be raised to a higher treatment pressure. Ask your dealer if you are planning a vacation to high altitudes.