Board Certified in Sleep Medicine SLEEP APNEA The Village Sleep Lab Accredited by the American Academy of Sleep Medicine www.VillageSleepLab.com Juan A. Albino, MD Board Certified in Sleep Medicine 751-4955; March 25, 2015

Facts on Sleep Disorders 12 to 18 Million people have Sleep Apnea 1/3 of Americans sleep less than 7 hrs/nite 1/3 are sleepy during the day 70% of high school students are not getting enough sleep 5,000 to 6,000 fatal crashes each year caused by drowsy drivers Women suffer more from insomnia

Sleep Disorders: Major Problem Very common but easily missed Can be disabling but develop slowly Worsen or lead to other diseases Can lead to much suffering, even fatal But easy to diagnose and treat Biggest problem: keep them in mind New field in medicine: last 25 years Need to raise awareness in the community

Good Sleep Habits: Basics Regular times for sleeping and awakening Maintain bedroom dark, quiet, cool Use bed only for sleep and sex Avoid late daytime naps Avoid at night: alcohol, caffeine, nicotine Sleep around 7 to 8 hours every night Prudent exercise and eating Beware of sleep debt: lack of sleep builds up

Common Sleep Disorders Insomnia: wants to sleep but cannot Sleep Deprivation: does not want to sleep but can; problem of sleep quantity Sleep Apnea: sleepy during day, snores (throat obstruction) problem of sleep quality Restless Legs Syndrome: legs discomfort, relieved by movement, more at night Parasomnias: abnormal sleep behaviors Circadian Rhythm Disorders: sleep time or clock not in harmony with the environment

Insomnia: Acute or Chronic Insomnia: inability to fall asleep, stay asleep, or wakes up early, with daytime impairment Acute Insomnia (<4 weeks): stress, illness Sleep medicines work well in acute stage Chronic Insomnia: >4 weeks, often years Treat basic problem: >60% psychological Psychotherapy better than medicines, beware of caffeine, smoking, alcohol, poor sleep habits Stimulus control, restriction therapy, sleep habits

Sleep Deprivation Involved in Disasters: Exxon Valdez, Challenger Space Shuttle, Chernobyl Nuclear Plant, Commuter plane crash in Kentucky 33% of fatal truck accidents 10% of fatal car accidents Impairment the same whether: drunk, sleep deprived (<4-6hrs.), sleep apnea Must be taken seriously: sleep 7-8 hours Leads to obesity, diabetes, hormonal imbalance

Restless Legs Syndrome Leg discomfort, worse at night, relieved by movement, affects 5-10% of population Discomfort difficult to describe, usually not pain Irresistible urge to move, walk, strike, or rub legs, leads to insomnia, restlessness Often familial, begins in childhood Associated with iron deficiency, drugs, Periodic Limb Movement Disorder of Sleep Easily treatable with medicines, usually mild Restless Legs Syndrome Foundation is active

Parasomnias Abnormal behaviors while asleep Common in childhood: sleep walking, night terrors, nightmares, teeth grinding, talking or shouting (outgrow them) Adults: REM Behavior Disorder, violent behavior, threat to self & others Distinguish from seizures, awake problem Sleeping pills can worsen sleep walking Controlled with medicines

Circadian Rhythm Disorders The body’s natural clock is not in harmony with the light dark cycle or with the sleep wake social cycle External disorders: shift work, jet lag Internal disorders: Advanced Sleep Phase Disorder (older), Delayed Sleep Phase Disorder (teenagers), Irregular Sleep Phases (Alzheimer’s, Liver Cirrhosis) Main problem: diagnosis, treatment varies

Important Links Obesity, sleep, stress, diet, and exercise One study: if not enough sleep, wake up with greater hunger Proper amounts of sleep and exercise decrease appetite and obesity Much easier to obtain proper sleep and treat sleep apnea than to diet

Sleep Apnea Worsens Other Conditions Diabetes & Obesity Hypertension & Atrial Fibrillation Fibromyalgia & Migraine Headaches Depression & Anxiety & Confusion GERD & Asthma & COPD Control of Sleep Apnea leads to better control of all these conditions Often medications can be stopped Cancer recently linked to sleep problems

Obesity Obesity, Sleep Apnea promote each other Hormonal links: leptin decreases hunger and increases sleep, while ghrelin has opposite effects Obesity & Sleep Apnea lower leptin levels and increase ghrelin levels Body is programmed: if not sleeping then eat more, in particular CHO and fat

Sleep Apnea: Risk Factors Affects: 4 to 5% of population: common Family history, Sleep maintenance insomnia Obesity: 80 % of sleep apnea patients; central (visceral, apples) obesity (increasing problem) Increasing age, Male gender Large tonsils / adenoids in children Small mandible, high narrow arch, large neck Elderly & women: little snoring & not obese

Sleep Apnea: Consequences Night: snoring, stops breathing, snorting, gasping, bed partner worries, GERD, restless, headaches Day: sleepy, tired, depressed, irritable, impotent, forgets, confused, ? few complaints Accidents: work, home, motor vehicle Higher death rates with severe sleep apnea Hypertension, Heart Failure, Heart Attacks Strokes, Atrial Fibrillation Promotes Obesity , Diabetes, Impotence

Obstructive Sleep Apnea What is OSA? NO AIRFLOW DESPITE RESPIRATORY EFFORT NORMAL SNORING SLEEP APNEA

Sleep Apnea: Diagnosis History: snoring, snorting, gasping for air, fatigue, excessive daytime sleepiness Associated conditions: Heart Disease, Obesity, Hypertension, Depression, Strokes, Impotence, Migraine, Confusion Sleep Study: Polysomnogram in the lab or home sleep testing in some patients

Sleep Apnea: Treatment Behavioral: Weight Loss, Sleep Position (Sleep on side, head raised), Oxygen, Avoid sedatives CPAP: proven therapy, needs motivation: widely available, 70% of patients adapt well Oral or Dental appliances: pull forth mandible or tongue; expertise necessary Surgery: tonsillectomy (children), tracheotomy, pull forth mandible or tongue Bariatric Surgery: banding, bypass Tongue Pacemaker (nerve pacing)

Treatment Options: CPAP Continuous Positive Airway Pressure: CPAP Keeps airway open 100% effective, simple CPAP therapy

Summary: Sleep Apnea Very common and dangerous illness But easily diagnosed and treated Benefits of treatment: sleep better at night, also Feel better during the day: less sleepiness and fatigue, more energy, less accidents

Summary: Sleep Apnea Reduce risk factor for heart disease and strokes, cost effective care Control better: obesity, diabetes, hypertension, depression, impotence, memory problems, headache, pain Bed partner sleeps better: less noise and less worry (but dogs and cats are scared of CPAP)

Local Organization Villages Sleep Apnea Support Group Meets 2nd Monday of the Month (except June, July, August) Cape Hatteras Room, Bridgeport Recreation Center; 6:30pm Coordinators: Phil and Linda Ratliff, 753-8773

Websites The Village Sleep Lab: (our website) www.VillageSleepLab.com National Sleep Foundation: www.sleepfoundation.org American Sleep Apnea Association: www.sleepapnea.org Restless Legs Syndrome Foundation: www.rls.org American Academy of Sleep Medicine: www.sleepeducation.com

Websites National Center on Sleep Disorders: www.nhlbi.nih.gov/health/resources/sleep/ Insomnia: Cognitive Behavioral Therapy cbtforinsomnia.com and uwhealth.org/health/topic/mini/insomnia/uh1001.html Commercial: www.MyResmed.com Commercial: www.Respironics.com Buyer Beware!!!

Books The Promise of Sleep by William Dement Sleeping Well by Michael Thorpy No More Sleepless Nights by Peter Hauri A Woman’s Guide to Sleep Disorders by Meir H. Kryger Restless Legs Syndrome by Robert H. Yoakum Say Good Night to Insomnia by Gregg D. Jacobs