1. Board Certified in Sleep Medicine
SLEEP APNEA The Village Sleep Lab Accredited by the American Academy of Sleep Medicine
Juan A. Albino, MD
Board Certified in Sleep Medicine
; March 25, 2015

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

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

17. 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

18. 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)

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

20. 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

21. 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)

22. 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,

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

24. Websites
National Center on Sleep Disorders:
Insomnia: Cognitive Behavioral Therapy cbtforinsomnia.com and uwhealth.org/health/topic/mini/insomnia/uh1001.html
Commercial:
Commercial:
Buyer Beware!!!

25. 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