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!