The Insomnia Blog - Sleep Doctor Michael Breus, PhD

Insomnia may triple risk of heart failure

There is an abundant—and ever-growing—body of evidence that indicates sleep plays an important role in cardiovascular health. Poor sleep is associated with a range of heart problems, including high blood pressure and increased risk of heart attack. Now, new research shows a link between insomnia and heart failure. Nearly 6 million adults in the United States suffer from heart failure, according to the Centers for Disease Control. Heart failure is directly responsible for more than 55,000 deaths every year, and is a contributing factor to hundreds of thousands more deaths in the U.S. annually. 

Researchers in Norway conducted a large-scale study of the relationship between insomnia and heart failure, and found that the presence of several symptoms of insomnia is associated with a dramatically elevated risk of developing heart failure. The investigation included more than 54,000 men and women between the ages 20-89. All were participants in a large-scale public health study in Norway. At the study’s outset, none of the men and women included had known symptoms or evidence of heart failure.

Researchers collected data on participants’ sleep, including detailed information on three common symptoms of insomnia:

• Difficulty falling asleep
• Difficulty staying asleep
• Waking feeling un-refreshed—a sign of non-restorative sleep

Researchers also gathered information on other aspects of health, including risk factors for cardiovascular disease. Participants were then monitored over a period of more than 11 years. Over that period of time, slightly more than 1,400 people developed heart failure. Researchers analyzed data to identify a possible relationship between the incidence of heart failure and insomnia symptoms, while controlling for other factors that could influence the risk of heart disease, including age, cholesterol and high blood pressure, body mass index, history of heart problems, and alcohol and tobacco use. They found that insomnia was associated with a higher risk of heart failure: 

• People who experienced insomnia symptoms had a higher risk of developing heart failure than those who did not experience insomnia symptoms.
• The risk increased for people who had multiple symptoms of insomnia.
• People who experienced all three insomnia symptoms—difficulty falling asleep, difficulty staying asleep, and non-restorative sleep—had more than triple the risk of developing heart failure than those with no insomnia symptoms. People with all three insomnia symptoms also had significantly higher risk of heart failure than those with one or two symptoms of insomnia.  

The study results show a strong association between insomnia and heart failure. But they do not provide any evidence to answer the question of whether—or how—insomnia might directly cause heart failure. Additional research is necessary to determine if disrupted sleep plays a causal role in the development of heart failure.  

Heart failure occurs when the heart is unable to pump blood effectively at levels that meet the body’s constant needs. This is a serious cardiovascular disease that has no cure. Other research has shown evidence of a link between sleep problems and heart failure, including studies that indicate an increased risk for heart failure among patients with obstructive sleep apnea.  

There is also a great deal of evidence that sleep is critically important to heart health, and that disrupted, poor, and insufficient sleep is associated with elevated risk of cardiovascular disease:

• This large-scale investigation, conducted by members of the Norwegian research team responsible for the current study, found people with insomnia at elevated risk for heart attacks. People with insomnia had a 27-45% greater risk of heart attack than those without insomnia symptoms.
• This study showed people who slept fewer than 6 hours a night had a 48% higher risk of heart attack, as well as a 15% increased risk of stroke.
• Sleep disordered breathing—which commonly manifests as snoring, or in obstructive sleep apnea—is associated with higher risk of heart failure, stroke, and coronary heart disease, according to this research.
• Poor sleep is also linked to elevated rates of high blood pressure, an important risk factor for heart attack and heart failure.  

Science is still working to get to the root of the relationship between sleep problems and cardiovascular disease. Lack of sleep has been associated with calcium build-up in the arteries, as well as with inflammation and dysfunction of the central nervous system. Definitive answers to the role that sleep plays in cardiovascular disease may well lie in these areas. But the mechanisms by which sleep may influence—or cause—diseases of the heart are not yet well understood. Still, there is little question that maintaining healthy sleep habits, and addressing sleep problems promptly with your physician, is beneficial to your overall health and to heart health in particular.

 

Sweet Dreams,

 

Michael J. Breus, PhD 

The Sleep Doctor™ 

www.thesleepdoctor.com

The Sleep Doctor’s Diet Plan:  Lose Weight Through Better Sleep

Everything you do, you do better with a good night’s sleep™ 

twitter: @thesleepdoctor 

Facebook: www.facebook.com/thesleepdoctor

ADHD or sleep disorder: are we getting it wrong?

Millions of children and adults struggle with symptoms of Attention Deficit Hyperactivity Disorder (A.D.H.D.), a condition marked by problems with concentration, impulse control, organization, and memory. It can be a frustrating and difficult condition, stigmatizing and often isolating for those who suffer from it.  

But what if some of those who’ve been diagnosed with A.D.H.D. are, in fact, suffering from another disorder altogether—a sleep disorder? That’s the provocative and important question posed in this commentary by a practicing psychiatrist with extensive experience treating patients with A.D.H.D.  Dr. Vatsal Thakkar, who is also a clinical assistant professor of psychiatry at NYU Langone Medical Center, makes a powerful argument for the need to consider sleep problems as a possible cause when evaluating patients for A.D.H.D.  

As Dr. Thakkar points out, many of the symptoms of A.D.H.D. are very often similar to symptoms of insufficient and disordered sleep, for both children and adults. In children, the symptoms of A.D.H.D. and sleep deprivation can be indistinguishable. A diagnosis of A.D.H.D. in children frequently comes about after a child exhibits some or all of behavioral symptoms such as these:

Lack of focus: difficulty paying attention, problems listening, forgetfulness, disorganization

Agitated, excitable, impulsive behavior: excessive talking, inability to sit still, difficulty playing quietly, tendency to interrupt, difficulty sharing or waiting for one’s turn

These behaviors associated with A.D.H.D. interfere with a child’s social and intellectual development, causing problems with relationships with peers and adults, at school and at home. But what if A.D.H.D. isn’t always the underlying cause of these symptoms? Signs of poor quality and insufficient sleep in children can look remarkably like symptoms of A.D.H.D., as a number of recent studies show. There’s particularly strong evidence that children with sleep-disordered breathing exhibit many of the same symptoms—and suffer many of the same behavioral problems—as children who’ve been diagnosed with A.D.H.D.  

Sleep-disordered breathing in children has been an area of growing interest among sleep scientists—with good reason. I’ve written about the dangers of sleep-disordered breathing in children, which is linked to a range of developmental and behavioral problems—problems that often mirror those associated with A.D.H.D:  

• This study found that children with obstructive sleep apnea had higher rates of behavioral problems including difficulty paying attention, hyperactivity, communication problems, and aggressiveness. These children were also more likely to have learning difficulties and low academic performance than those without sleep-disordered breathing.  

• This large-scale study of more than 11,000 children found that those with sleep-disordered breathing were significantly more likely to show signs of hyperactivity, trouble interacting with peers, and conduct issues including aggressiveness and inability to follow rules. The study examined the effects of sleep-disordered breathing on children as young as 6 months. Researchers found that very young children who experienced some form of sleep-disordered breathing were, by the age of 7, 40-100% more likely to have behavioral problems similar to those used to diagnose A.D.H.D.  

Many adults being treated for A.D.H.D. have symptoms that are difficult to distinguish from the effects of poor quality and insufficient sleep. Difficulty concentrating, trouble completing tasks, problems with organization, and memory lapses are all common struggles for adults who’ve received an A.D.H.D. diagnosis. These are also some of the most common problems for adults with sleep problems. I’ve written about the challenges that lack of sleep and disrupted sleep pose to cognitive function in adults, including problems with memory, learning and focus.  

Given the similarities of symptoms between A.D.H.D. and poor sleep in children and adults, it’s not hard to see how misdiagnosis is possible, even likely. That risk increases when we consider the lack of regular screening that exists for sleep problems. We’ve made great scientific strides in our understanding of sleep in recent years. But we still struggle with a lack of attention paid to sleep problems by both physicians and patients. For both children and adults, sleep problems continue to be significantly under-diagnosed. This study of members of the American Academy of Pediatrics evaluated sleep-screening practices among pediatricians. Researchers found that fewer than 1 in 5 pediatricians surveyed had received any training in sleep disorders, and fewer than 1 in 6 felt confident about their ability to offer guidance to parents about children’s sleep. The study also revealed serious knowledge gaps among pediatricians about sleep, with most unable to answer correctly questions about sleep disorders in children.  

The news isn’t any better for adults. An analysis of data from the 2005-2006 National Health and Nutrition Examination Survey found that sleep disorders such as insomnia and sleep apnea remain drastically under-diagnosed. What’s more, though nearly all of the more than 2,000 adults surveyed reported at least one complaint about their sleep, fewer than 1 in 4 of them had talked with physicians about their sleep problems.  

More rigorous and effective screening for sleep problems starts with better training for physicians and medical professionals who must make diagnoses every day. As patients and as parents, we also need to be attentive to symptoms of poor sleep in ourselves and in our children. And we need to take these concerns—however mild they may appear—to our physicians. 

Another thing we can do? Protect our sleep, and our children’s sleep, by setting sleep-friendly limits against the nonstop, perpetually wired, always “on” culture we live in today. As Dr. Thakkar points out, the escalation of A.D.H.D. cases in the 1990s and 2000s coincided with the rise of the digital age, and the widespread use of personal technology that now pervades our daily lives. These devices—our laptops and tablets and cell phones—that enable so much convenience and connection, also threaten the quality and quantity of sleep. The nighttime exposure to light they emit interferes with the body’s release of melatonin, disrupting sleep cycles and diminishing time spent in the deepest, most restorative phases of sleep.  More than ever before in history, we must work to create the darkness that is so essential to sleep. Keeping our bedrooms, and our children’s bedrooms, gadget-free sanctuaries for sleep is one important way to guard against chronic sleep deprivation.  

To raise the possibility that some cases of A.D.H.D. in children and adults may actually be un-diagnosed sleep disorders does not call into question the seriousness of A.D.H.D., the difficulties it poses, and the importance of effective treatment for this very real disorder. Additional research is critical to determine whether, and how often, sleep disorders are being misdiagnosed as A.D.H.D. The goal is to make the right diagnosis—whether A.D.H.D. or sleep problems—and pursue the most effective treatment. All patients, whatever their condition, deserve no less.  Pursuing the question of a link between disrupted sleep and symptoms of A.D.H.D. is a matter of public health, one that deserves prompt and sustained attention.

 

Sweet Dreams,

 

Michael J. Breus, PhD 

The Sleep Doctor™ 

www.thesleepdoctor.com

The Sleep Doctor’s Diet Plan:  Lose Weight Through Better Sleep

Everything you do, you do better with a good night’s sleep™ 

twitter: @thesleepdoctor 

Facebook: www.facebook.com/thesleepdoctor

Snoring may be a warning of serious health risk

All too often, snoring is regarded as a nuisance rather than a real health problem. People who snore—and the partners who must listen to their snoring at night—usually have no problem acknowledging that snoring is disruptive and uncomfortable. But most don’t look for actual treatment for their snoring, particularly if it is not accompanied by obstructive sleep apnea, a serious sleep disorder that is characterized by interruptions to breathing during sleep. 

Snoring—with or without sleep apnea—is a very real health concern. Snoring is a sign of disrupted sleep, which can lead to many health problems. And new research suggests that snoring itself may increase the risk of cardiovascular disease.  

Researchers at Detroit’s Henry Ford Hospital investigated the possible effects of snoring on the cardiovascular system. They found that snoring is associated with a thickening of the inner walls of the carotid arteries. The carotid arteries are responsible for carrying blood to the brain. This thickening of the arterial wall is an early sign of carotid artery disease, a narrowing or blocking of the arteries that increases the risk of stroke. Researchers also found that people who snore were more likely to suffer from this arterial thickening than others with more widely known risk factors for cardiovascular disease, including smokers, people who are overweight, and those with high blood pressure and high cholesterol.  

Researchers examined data from 913 patients who sought treatment at Henry Ford Hospital’s sleep clinic. All the participants were between the ages of 18-50, and none of them had obstructive sleep apnea. Of this group, 54 men and women completed a survey about their snoring histories. They also received ultrasounds to measure the thickness of the intima-media of the carotid artery wall. Intima-media thickness is a measurement of the two innermost layers of the carotid artery wall. Thickening of the intima-media layers is considered a sign of elevated risk for cardiovascular disease.

People who snored had greater levels of intima-media thickness than those who did not snore, according to the study results. Snoring was alone among risk factors that associated with this abnormality to the carotid arteries. Researchers found no increase in intima-media thickness among people with other standard risk factors for cardiovascular risk factors, including obesity, smoking, diabetes, high blood pressure and high cholesterol.  

This study is one of the first to show evidence of an increased risk to cardiovascular health from snoring. There is abundant evidence that obstructive sleep apnea is associated with increased risk of cardiovascular disease. Obstructive sleep apnea is also associated with a growing array of other health problems, including diabetes, cancer and sexual dysfunction in both men and women. Snoring is a frequent symptom of obstructive sleep apnea—but not everyone who snores has sleep apnea. Overall, much less attention has been paid to the possible health problems of snoring when it is not accompanied by sleep apnea. The research that has been done in this area has returned conflicting evidence regarding the health risks associated with snoring. 

• A limited amount of research has indicated that snoring does not pose risk to cardiovascular health. Australian researchers conducted a long-term study of nearly 400 adults and found no increased risk of cardiovascular disease or death from snoring.  

• Other studies have suggested that snoring is associated with other risk factors for cardiovascular disease, but that there is no direct relationship between snoring and cardiovascular problems. Among these risk factors are obesity, smoking, and alcohol consumption.  

• Still other research indicates a more direct link between snoring and cardiovascular disease. This study conducted in Hungary found increased risk of cardiovascular disorders among men and women who snore. Researchers in this study adjusted for other common risk factors, such as obesity, in order to isolate the effect of snoring on cardiovascular health.  

The latest research appears to offer new evidence of a direct connection between snoring and the development of cardiovascular problems. Researchers indicate that they intend to follow this work with another study to investigate a possible association between snoring and cardiovascular events, such as heart attack and stroke.  

It is important to take snoring seriously as a health problem. While we wait for science to develop a greater understanding of the ways that snoring may negatively affect health, there are things we all can do to diminish the risk of snoring: 

Maintain a healthy weight. Snoring appears to be closely associated with excess weight. Keeping your weight in check through regular exercise and healthy diet is one way to prevent, reduce and even eliminate snoring.  

Drink moderately. Alcohol relaxes the muscles in the throat, and makes snoring more likely. Keep your alcohol consumption moderate, and drink no closer than 3 hours before bedtime, to avoid having alcohol interfere with your sleep and increase your risk of snoring. 

Don’t smoke. Smoking irritates and inflames the tissues of the upper airway, and increases the likelihood of snoring. Improving your sleep and reducing your snoring is another very good reason to quit.  

Talk to your doctor. It is important to let your physician know if you snore, no matter how mild you believe your snoring to be. Your doctor can advise you on the best strategies for treatment, including mouth guards and dental devices that can help keep your airway open during sleep. Your doctor can also monitor your condition in the event it progresses to obstructive sleep apnea. 

Just because snoring is common doesn’t mean it’s harmless. Protect your health and take your snoring seriously.

Sweet Dreams,

Michael J. Breus, PhD 

The Sleep Doctor™ 

www.thesleepdoctor.com

The Sleep Doctor’s Diet Plan:  Lose Weight Through Better Sleep

Everything you do, you do better with a good night’s sleep™ 

twitter: @thesleepdoctor 

Facebook: www.facebook.com/thesleepdoctor

The risks of sleep-disordered breathing in children

Does your child snore? Does he breathe through his mouth when he sleeps? Do you ever notice pauses in your child’s breathing while she’s asleep? If you’ve answered yes to any of these questions, your child may be suffering from sleep-disordered breathing.  

Sleep-disordered breathing in children is disruptive to their nightly rest, which can result in other health problems. Scientists are still working to get a sense of how prevalent the disorder is among children. We’re also still learning about the risk factors that contribute to sleep-disordered breathing in children, as well as the health consequences for kids who suffer from it. Increasingly, it appears that both the risks and the health effects of sleep-disordered breathing are different in children than they are in adults. A new study examines both the prevalence of sleep disordered breathing in children, and the particular risk factors they face.  

Researchers in Finland examined sleep-disordered breathing in 491 children ages 6-8. Their study, which was part of a larger research project on child health, analyzed the prevalence of sleep-disordered breathing among the children. The study also examined risk factors that might contribute to the sleep disorder, including tonsil size, jaw position, and facial proportions. For the purpose of this study, sleep-disordered breathing was defined as frequent or loud snoring, mouth breathing during sleep, and sleep apnea.

Here are some important highlights of their results:

• 9.9% of children had some type of sleep-disordered breathing. This rate was the same for both boys and girls in the study
• Average body-fat percentage was 20.6 for girls and 15.0 for boys
• 11.4% of boys and 15.6% of girls were overweight or obese
• Body fat was not associated with an increased risk of sleep-disordered breathing. Sleep-disordered breathing was no more frequent among obese and overweight children in this study than among children at normal weight 

Several craniofacial features were associated with elevated risk for sleep-disordered breathing:

• Children with enlarged tonsils were 3.7 times as likely to experience symptoms of sleep-disordered breathing
• Children with cross bite were 3.3 times a likely to have sleep-disordered breathing. Cross bite is a dental condition where teeth are out of alignment with corresponding teeth above or below.
• Children with convex facial profiles were 2.6 times as likely to suffer from sleep-disordered breathing as children with other facial types. Convex facial features include prominent forehead and brow line and receding chin.  

These results suggest that the risk factors for sleep-disordered breathing in children may be very different than those for adults. The most significant risk factor of sleep-disordered breathing in adults is excess body weight. Research indicates that 70% of people who are morbidly obese have obstructive sleep apnea. This study indicates that excess weight may not be a risk factor for children. For them, features of the head, neck and throat, as well as certain dental conditions, may be more significant indicators of risk for sleep-disordered breathing.  

The health problems for children who develop sleep-disordered breathing also appear to be different than those for adults. A growing body of research indicates that children who experience sleep-disordered breathing are at greater risk for problems with behavioral, emotional, and cognitive development:

• This large-scale study of more than 11,000 children found that kids with sleep-disordered breathing were significantly more likely to exhibit behavioral and emotional problems, including hyperactivity, anxiety, depression, social issues with peers, and conduct problems including aggressiveness.
• Children who exhibit aggressive and bullying behavior in school were twice as likely to have some form of sleep-disordered breathing, according to this research
• Children with sleep-disordered breathing demonstrated lower intellectual abilities than those without, in this study. This cognitive impairment existed regardless of the degree of severity of the sleep disorder. Even children with mild forms of sleep-disordered breathing experienced cognitive difficulties.  

A recent large-scale study in the United States examined the prevalence for sleep disordered breathing among children. Researchers evaluated more than 12,000 children between the ages 6 months and 6.75 years, and found:

• 1-2% of children across all ages suffer from chronic sleep apnea
• As many as 21% of children in this age range snore habitually
• Children ages 1.5-2.5 years are especially vulnerable to snoring: researchers found a significant increase in rates of snoring among children at this age
• By the age of six, 25% of children are mouth breathing during sleep  

These latest results from Finnish scientists add to the body of research that indicates how significant an issue sleep-disordered breathing is for children. We need to know more about the prevalence of the disorder among children, as well as the risk factors and health consequences. We also need to further explore how the risks to children may differ from adults.  

To avoid the behavioral, cognitive and emotional problems associated with sleep-disordered breathing, we also need to get better at identifying the problem. Early intervention can help avoid more serious problems that can occur if the disorder is left untreated. The most effective treatment strategy will involve the cooperation among doctors and dentists. But the process starts with parents. Paying attention to your child’s breathing during sleep, and bringing attention to any signs of irregular breathing, is the first and critical step.

 

Sweet Dreams,

Michael J. Breus, PhD 

The Sleep Doctor™ 

www.thesleepdoctor.com

The Sleep Doctor’s Diet Plan:  Lose Weight Through Better Sleep

Everything you do, you do better with a good night’s sleep™ 

twitter: @thesleepdoctor 

Facebook: www.facebook.com/thesleepdoctor

Chronic Fatigue Syndrome: how does it affect sleep?

For people with chronic fatigue syndrome, sleep problems are common. Sleep disorders, disruptive and non-refreshing sleep are some of the most frequent complaints from people suffering from chronic fatigue. Chronic fatigue syndrome is a debilitating medical condition. It’s also a mysterious—and historically controversial—illness.  

The basic characteristics of chronic fatigue syndrome include ongoing fatigue that interferes with daily activities, problems with memory and concentration, muscle pain and headaches, and other physical
symptoms such as sore throat and tender lymph nodes. People with chronic fatigue also experience feelings of malaise after periods of mental and physical exertion. 

The causes of chronic fatigue are unknown. There is no test to determine the presence of the illness. Physicians make a diagnosis based on the presence of a cluster of symptoms over an extended period of time, at least 6 months, and by ruling out other conditions. For many years chronic fatigue was considered with skepticism by some in the medical community. There were those who questioned whether chronic fatigue was an illness at all, rather than the consequence of a sleep disorder or a mental health issue. Over the past two decades, chronic fatigue syndrome has won acceptance by the medical establishment. But much about the disorder—its causes, its mechanisms in the body—remain largely unknown.  

Disrupted sleep is a hallmark of chronic fatigue syndrome. Chronic fatigue is associated with a range of sleep problems, including:

• Excessive daytime sleepiness
• Non-restorative sleep (waking feeling tired even after sufficient or prolonged periods of rest)
• Difficulty falling asleep and staying asleep
• Sleep disorders such as obstructive sleep apnea, insomnia, and narcolepsy  

Despite the frequency with which people with chronic fatigue syndrome experience sleep disturbances, the connection between sleep and chronic fatigue—like so much else about the disorder—is not well understood.  

Researchers at Australia’s Victoria University have conducted a review of research related to sleep and chronic fatigue. Their analysis sheds some light on possible reasons for poor sleep among patients with chronic fatigue.  

Sleep complaints are common among chronic fatigue patients, but there is no single or typical sleep experience for people with this disorder. For the past two decades, research has shown high levels of sleep disorders among adults with this condition:

• Several studies, including this one, have found that more than half of chronic fatigue patients have some type of sleep disorder
• This study showed chronic fatigue patients experience greater levels of disrupted sleep than  patients with multiple sclerosis
• More than 50% of chronic fatigue patients in this study had obstructive sleep apnea or sleep-related movement disorders, such as restless leg syndrome
• A similar study showed 46% of chronic fatigue patients suffering from obstructive sleep apnea
• This large, population-based study showed nearly 80% of chronic fatigue patients experienced un-refreshing sleep, and 20% had obstructive sleep apnea or narcolepsy 

An important area of research into the connection between sleep and chronic fatigue looks at the role of pain. The physical pain associated with chronic fatigue may be a significant factor in the sleep problems
experienced by people with chronic fatigue. We know that pain and sleep influence each other in multiple ways. Pain can make sleep difficult to achieve and sustain. Lack of sleep, in turn, can make us more sensitive to pain. Studies like this one have shown that pain causes chronic fatigue patients to wake more often throughout the night than either healthy people or those with depression.  And this study found that disruption to slow wave sleep in healthy people triggered physical pain and fatigue similar to people with chronic fatigue syndrome. As researchers themselves note, the role of muscle pain in sleep disorders among chronic fatigue sufferers is an area of research that warrants more attention and further study. 

There’s another body of research that suggests that people with chronic fatigue experience changes to their sleep cycles that could result in less restorative sleep. Studies have shown that people with chronic fatigue may spend less time in slow wave sleep than healthy people. Slow wave sleep occurs during the sleep stages 3 and 4, and is the most restorative sleep we can experience. Studies have shown that chronic fatigue patients spend a reduced amount of time in slow wave sleep and in REM sleep than healthy people. To date, there is less evidence for the reduction in REM sleep than in slow wave sleep. The cause of this disturbance to sleep cycles is unclear. However, there is evidence of a possible link between systematic inflammation and disruptions to sleep cycles, particularly to time spent in slow wave sleep. Systemic inflammation in the body is common among chronic fatigue patients, and may play a role in the persistent problem of non-refreshing sleep. 

Still another area of study suggests that changes to the body’s nervous system activity may play a role in the sleep disruptions experienced by people with chronic fatigue. Chronic fatigue patients experience
alterations to the functioning of their nervous systems during waking hours, and these can continue during sleep. Several studies have shown that chronic fatigue patients are more likely to experience disruptions to normal nervous system activity during sleep, and this may be affecting the quality of sleep they experience. 

There are so many questions that remain unanswered about the relationship between sleep and chronic fatigue syndrome. Why and how does non-restorative sleep occur so frequently? What is the cause—or effect—of sleep disorders such as obstructive sleep apnea and restless leg syndrome among people with chronic fatigue? Do the standard measurements of sleep quality work accurately for this group of people?  

Here’s one thing we do know: sleep disruptions are a critical component of chronic fatigue syndrome. Answering these and other questions about the role that sleep plays in chronic fatigue could provide some much needed insight into this debilitating illness. 

Sweet Dreams,

Michael J. Breus, PhD 

The Sleep Doctor™ 

www.thesleepdoctor.com

The Sleep Doctor’s Diet Plan:  Lose Weight Through Better Sleep

Everything you do, you do better with a good night’s sleep™ 

twitter: @thesleepdoctor 

Facebook: www.facebook.com/thesleepdoctor

Sleep apnea in women: more common than we thought?

Sleep apnea has traditionally—and erroneously—been seen as a “men’s disorder.” The truth is, obstructive sleep apnea is a common sleep disorder among women. And a new study indicates that the frequency of sleep apnea among women may be higher than we previously believed.

Obstructive sleep apnea occurs when breathing is interrupted during sleep, because of the closing of the upper airway. These pauses in breathing can occur anywhere from a few times a night to hundreds of times in the course of a sleep period. People who suffer from sleep apnea often snore, and frequently experience daytime sleepiness. Obesity is a primary risk factor for obstructive sleep apnea. Current estimates generally put the frequency of obstructive sleep apnea at somewhere in the range of 3 to 7 percent of the population, as many as 20 million American adults. Like many sleep disorders, obstructive sleep apnea is generally thought to be under-diagnosed, which means the actual number of sufferers is likely to be even higher than these numbers suggest. Men are typically regarded as being at higher risk for sleep apnea, and as a result more attention has been paid to identifying and treating sleep apnea in men than women.

Researchers in Sweden investigated the frequency of sleep apnea among 400 women between the ages of 20-70. The participants were selected from a population-based sample of 10,000 women. Researchers collected information on evidence of sleep apnea using both a questionnaire and overnight sleep monitoring. They found rates of sleep apnea among women to be substantially higher than they expected:

• 50% of women in the study were found to have some degree of sleep apnea
• 20% were found to have moderate sleep apnea
• 6% were experiencing sleep apnea that qualified as severe

The researchers found a strong association between sleep apnea in women and the risk factors of age, obesity, and hypertension:

• Among older women, severe sleep apnea was more common: 14% of women ages 55-70 had severe obstructive sleep apnea
• 80% of women who were considered obese—with a body mass index of 30 or higher—had     some degree of sleep apnea. Again, older women were more at risk: 31% of women ages 55-70, who also had a BMI of 30 or higher, had severe sleep apnea
• 84% of women with high blood pressure also had sleep apnea

Obstructive sleep apnea, in addition to being disruptive to daily (and nightly) life, can also cause serious health problems. Complications of sleep apnea include increased risk of stroke and cardiovascular disease, as well as diabetes. Sleep apnea’s link to sexual dysfunction in men is well established. But sleep apnea often leads to sexual problems in women, as well.

As with many aspects of sleep apnea, more attention has been paid to its health and quality-of-life effects on men than on women, and that needs to change. Women and men have different experiences of sleep—different challenges, and different responses to sleep disorders and sleeplessness. We’re continually learning more about how sleep disorders and their health consequences affect women differently from men:

• This study indicates women may be more at risk for cardiovascular problems than men.     Researchers found that biological markers for heart disease are more significantly affected by sleeplessness in women than in men.  

• Women with sleep difficulties appear to be more susceptible to weight problems than men. This study found that low sleep in women is more closely linked to higher BMI than men. And this study found that in women, sleep apnea is closely linked to metabolic syndrome. Metabolic syndrome is a cluster of medical conditions, including excess weight around the torso, insulin resistance, and a sedentary lifestyle, that together indicate an elevated risk for diabetes and cardiovascular disease.  

• Women also experience particular hormonal shifts throughout their lives, associated with menstruation, pregnancy, and menopause, that can pose for them specific challenges to sleep, especially with age.

Because women’s sleep is different than men’s, women’s symptoms related to sleep apnea might also be different. Loud snoring and daytime sleepiness may not be as strongly present. Women—especially older women—who have risk factors associated with sleep apnea, factors including hypertension and obesity, should talk with their doctors about their sleep, and the possible presence of sleep apnea and other sleep disorders.

It’s high time we let go of the idea of sleep apnea as a men’s problem. We need to be equally aggressive in learning about, treating, and preventing sleep apnea in women.

 

Sweet Dreams,

Michael J. Breus, PhD 

The Sleep Doctor™ 

www.thesleepdoctor.com

The Sleep Doctor’s Diet Plan:  Lose Weight Through Better Sleep

Everything you do, you do better with a good night’s sleep™ 

twitter: @thesleepdoctor 

Facebook: www.facebook.com/thesleepdoctor

Silent Stroke and Sleep Apnea

Silent Stroke and Sleep Apnea

Here is yet another health risk associated with sleep apnea: stroke. The news that sleep apnea is a risk factor for stroke isn’t new. We’ve known for some time that sleep apnea is associated with elevated risk of stroke. But this new research shows just how common sleep apnea is among stroke sufferers. In particular, these results reveal how frequently sleep apnea is present in patients who suffer silent strokes.  

What is a silent stroke?

• Silent strokes have no visible or outwardly identifiable symptoms.
• In most cases, people who suffer a silent stroke don’t even know they’ve had a stroke.
• Silent strokes are referred to as “silent” because they do not present the outward physical symptoms that are typically associated with stroke, including slurred speech, paralysis, and severe pain.
• Silent strokes are a serious health concern, however—they cause permanent damage to the brain, most often in the regions of the brain that govern mood, thought, cognition and memory.
• Silent strokes are themselves a risk factor for other types of stroke, including major stroke.

Researchers from the University of Alabama, Birmingham and from Germany’s University of Technology Dresden teamed up to investigate the frequency and severity of obstructive sleep apnea as risk factors for silent stroke. The results of their research revealed high rates of sleep apnea among patients with silent stroke. Over a period of 18 months, researchers evaluated 56 people who had been identified as having suffered acute cerebral ischemia, a type of stoke that interrupts the flow of blood to the brain. Within 5 days of stroke symptoms, patients were evaluated using MRI and CT scan to identify specific details of stroke effects in the brain, and were also assessed for the presence and severity of sleep apnea. Researchers found:

•  Sleep apnea was present in 51 of 56 stroke patients evaluated—that’s 91%
• Of these 51 patients, 29% had severe sleep apnea and 30% had moderate sleep apnea
• Severe sleep apnea was present in 58% of patients who had suffered a clinically silent infarct, commonly known as a silent stroke
• Severe sleep apnea was present in 38% of patients with chronic microvascular changes—these are tiny lesions to white matter in the brain that are associated with silent stroke
• Sleep apnea—and the degree of its severity—was found to be a strong predictor for silent stroke
• Patients with severe sleep apnea progressed more slowly and less successfully in the early stages of recovery than those patients without sleep apnea

What we don’t know from these results is whether sleep apnea is a factor in causing stroke, or whether people who suffer strokes are then more likely to develop sleep apnea. When a person suffers from sleep apnea, their airway collapses during sleep. This airway collapse temporarily cuts off breathing and diminishes the levels of oxygen in the bloodstream. People who suffer from moderate to severe sleep apnea have episodes of disrupted breathing dozens, even hundreds, of times per night. (In this most recent study, researchers defined severe sleep apnea as 30 or more episodes of disrupted breathing per hour of sleep). Learning more about how disordered breathing affects the brain and may contribute to stroke risk is a critical avenue for additional research.

We do know this: sleep apnea is associated with elevated risk for a range of serious and chronic illnesses. Obstructive sleep apnea has been linked to:

1.  Cardiovascular problems. In addition to being a risk factor for stroke, sleep apnea is also associated with hypertension, heart disease, and heart failure. This study found that obstructive sleep apnea increased a person’s risk of heart attack by 30% over a 4-5 year period.
2. Diabetes. There’s increasing evidence of a link between diabetes and sleep apnea. This study found high rates of obstructive sleep apnea among men with Type 2 diabetes. Even worse news: most of these sleep apnea cases were undiagnosed before the study.
3. Sexual dysfunction. Sleep apnea has been shown to cause sexual problems in both men and women. This study showed women with sleep apnea had significantly higher rates of sexual problems, both with sexual performance and satisfaction. This research revealed that men with erectile dysfunction were more than twice as likely to also suffer from obstructive sleep apnea.

We’ve got a great deal more to learn about how sleep apnea may contribute to these conditions, as well as to its role as a risk factor for stroke. What’s already clear is that sleep apnea is a red flag for stroke and other serious health problems. Screening for sleep apnea—and assessing sleep health in general—needs to be part of the diagnostic and risk assessment process for patients. If sleep apnea and other sleep disorders are ignored, we ignore an opportunity to identify at-risk patients before the worst occurs.

Sweet Dreams,

Michael J. Breus, PhD 
The Sleep Doctor™ 
www.thesleepdoctor.com

The Sleep Doctor’s Diet Plan:  Lose Weight Through Better Sleep

Everything you do, you do better with a good night’s sleep™ 
twitter: @thesleepdoctor 
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Police don’t get enough sleep

This news concerns me both as a health issue and an issue of public safety: a survey of nearly 5,000 police officers in the United States and Canada revealed that these law enforcement professionals are frequently suffering from sleep problems—and this lack of sleep is negatively affecting both their health and their performance on the job.

Researchers at Harvard Medical School and Brigham and Women’s Hospital screened 4957 police officers for sleep disorders, beginning with an initial screening and following with check-in screenings every six months for the next two years. Their results showed a significant portion of police officers grappling with sleep disorders, weight problems, and complications from lack of sleep. Among the 5,000 police officers who were screened: 

• 40.0% had some type of sleep disorder
• 6.5%  suffered from moderate to severe insomnia
• 33.0% had obstructive sleep apnea

 The link between obstructive sleep apnea and obesity is clear: being overweight or obese is the single greatest risk factor for sleep apnea. In this study:

• 4 out of 5 police officers were overweight or obese

 Not surprisingly, officers who screened positive for obstructive sleep apnea were more likely to have other health problems as well. Those officers who suffered from obstructive sleep apnea were also:

• 61% more likely to have diabetes
• 148% more likely to report a diagnosis of depression 
• 22% more likely to have an injury while on the job

 These findings echo an earlier, similar study, also conducted at Harvard Medical School. The results also point to the sleep hazards associated with shift work, and the difficulty of these workers in protecting the quality and quantity of their sleep while working frequently changing schedules that often span both day and night shifts. Shift workers generally get about 2 hours less sleep than other types of workers, and as a result are at greater risk for a range of health problems, including cardiovascular disease, diabetes, weight problems, and psychological problems.

 It so happens that these workers are often in high-stress jobs where public health and safety are at stake. In addition to law enforcement officers, health-care workers, members of the military, airline pilots and air-traffic controllers are all frequently working day and night shifts, with changing schedules that make it difficult to establish and sustain a sleep routine. Their health and well being is more than a private matter: it is a matter of concern for all of us, a public safety issue as well as a personal health issue.

 This most recent study indicates that police officers who are suffering from sleep problems are at higher risk for errors on the job. The officers who screened positive for sleep problems had higher rates of several job performance issues than their better-sleeping counterparts. They were more likely to:

• Commit a serious administrative error
• Fall asleep while driving on a shift
• Make an error or commit a violation that was attributed to fatigue
• Demonstrate poor behavior, including uncontrolled anger

There was one group of police officers included in this study that did not conform to the study’s overall results. Members of the Massachusetts State Police had significantly lower rates of obstructive sleep apnea than the general study populations. Not surprisingly, the Massachusetts officers also had much lower rates of obesity.

What made the Massachusetts State Police so different from the overall group? In discussing the study results, researchers point to the agency’s emphasis and encouragement of exercise and physical fitness.

•  Massachusetts requires its state police officers to pass a fitness test
• All state police barracks are equipped with physical fitness centers on the premises
• The agency requires that all its officers spend 60 minutes exercising on each of their shifts. This is paid work time, within a shift, not an extra or unpaid hour of work

This is a great example of how investing in employee health pays great dividends for everyone involved. In this case, that means healthier, more capable officers with fewer health issues—and less risk of workplace accidents, errors or incidents. This is a sleep issue that should matter to all of us, whether we personally know and love someone who works shifts or not. Our law enforcement officers—like our doctors, nurses, soldiers, firefighters and pilots—are people we entrust with our safety and security, and our health. It’s in everyone’s best interest for these people to be well rested and healthy themselves.

Sweet Dreams,

Michael J. Breus, PhD 
The Sleep Doctor™ 
www.thesleepdoctor.com

The Sleep Doctor’s Diet Plan:  Lose Weight Through Better Sleep

 Everything you do, you do better with a good night’s sleep™ 
twitter: @thesleepdoctor 
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Another benefit of CPAP: a reduction in pain?

I wrote recently about the relationship between sleep and fibromyalgia, a chronic pain syndrome, and the about important—and complicated—relationship between sleep and pain. Now there’s news that one of the most effective remedies for sleep apnea—CPAP therapy—may also have the benefit of reducing sensitivity to pain. A recent study found consistent use of the CPAP could reduce pain sensitivity in patients with severe OSA. The study tested 12 patients—7 men and 5 women—with severe obstructive sleep apnea. They found that six to eight weeks of regular CPAP use led to significantly reduced pain sensitivity and also to improved continuity of sleep.

The relationship between sleep and pain is one we don’t yet fully understand. What we do know—and what anyone who suffers from chronic pain can attest to—is that each can have a significant effect on the other. The presence of pain can make it hard to fall asleep and stay asleep, and being sleep deprived can make a person feel more sensitive to aches and pains. Studies that have examined the relationship between sleep and pain found these links to be true—and also found that it doesn’t take a lot of lost or disrupted sleep to have an effect on how we experience pain:

• One study showed 12 women who were deprived of sleep for only 3 consecutive nights experienced increased sensitivity to pain. Pain sensitivity began to increase after a single night of disrupted sleep and grew worse each night.
• Another study tested healthy men for pain sensitivity after a short period of total sleep deprivation. Researchers found that total sleep deprivation dramatically decreased the men’s threshold for pain. A recovery sleep period after sleep deprivation restored the men’s pain threshold.
• Recent research info fibromyalgia showed that women who were sleep deprived had as much as 5 times higher a risk of developing the chronic pain syndrome, over a 10-year period, as women who were not sleep deprived.
• A sleep-pain study performed on rats showed that when deprived of REM sleep, the rats experienced a significant increase in sensitivity to several types of pain stimuli.

 The type of sleep we get—or don’t get—may be significant when it comes to pain. Researchers are increasingly focusing on stages of sleep that occur in the later stages of the sleep cycle--REM sleep and delta, or slow wave, sleep—as being critical in protecting pain thresholds. Throughout the night, your sleep unfolds in a recurring and progressive cycle. Over the course of a night, the cycle shifts so that you spend more time in REM sleep and in the later sleep stages that are considered slow wave sleep. If you are sleep deprived, or your sleep is constantly being interrupted, your body does not reach the REM and slow wave-rich sleep that occurs in these later periods.

Here’s where the CPAP may be playing its role in helping reduce pain sensitivity. CPAP works by pushing a constant stream of air through the sleeper’s airway, to keep it from closing. Sleep apnea occurs when muscles in the back of the throat collapse, closing off the airway. This causes a person to stop breathing. It also interrupts a person’s sleep cycle, since those who suffer from sleep apnea are awakened, however briefly, often many times throughout the night by their breathing problem.

It’s possible that the CPAP allows a person to sleep through their full sleep cycle, achieving those later stages of sleep that are so restorative, and also appear to help decrease our sensitivity to pain. This study is just a beginning—we don’t yet know why CPAP might be effective in reducing pain sensitivity. But these results are promising and intriguing, and this is a topic that deserves additional inquiry.

For millions of people who suffer from obstructive sleep apnea, and perhaps other independent conditions that bring about chronic or intermittent pain, the possibility that CPAP could help reduce sensitivity to pain is welcome and important news. It’s also another reason to make sure that patients who have been prescribed CPAP as a treatment actually follow through with the therapy. The CPAP can work very effectively, but only if it’s actually used! This latest research provides yet another very good reason for people with OSA to make sure that the CPAP is part of their nightly routine—every night. The benefits may be even broader than we previously thought.

Sweet Dreams,

Michael J. Breus, PhD

The Sleep Doctor™

www.thesleepdoctor.com

 

 

 

 

Team up for CPAP success

Listen up, partners and spouses of people with sleep apnea: Treating obstructive sleep apnea with CPAP works best when it’s a team effort. That’s the takeaway from a recent research review, which examined dozens of studies in an effort to identify the most effective ways to help patients comply with their CPAP regimen. What they found was that having a partner involved and engaged with CPAP treatment increases the likelihood that the patient will stick with their treatment plan.

More than 18 million Americans suffer from obstructive sleep apnea (OSA). It is among the most common sleep disorders. And CPAP—continuous positive airway pressure—is the most commonly prescribed treatment for OSA. Obstructive sleep apnea occurs when the muscles in the back of the throat collapse, blocking the airway. People with OSA stop breathing briefly, anywhere from a handful of times to hundreds of times in a night in severe cases. The health risks associated with sleep apnea are serious: in addition to disrupting sleep and lowering blood oxygen levels, OSA is associated with higher risks of high blood pressure, heart disease, and diabetes, in addition to mood and memory problems. CPAP works by pushing air constantly through the airway, keeping it open and allowing un-interrupted breathing through a night’s sleep. It’s a safe, effective, well-tested treatment for OSA that has proven results. The biggest challenge to CPAP success? Getting patients to use the device consistently.

The CPAP machine delivers the air pressure that keeps the airway open by a face mask that covers the nose, which must be worn by the patient during sleep. Sleeping with the CPAP mask can be a daunting prospect for newly diagnosed OSA sufferers. Some people may find it embarrassing to wear in front of a partner. Others may find wearing it feels uncomfortable or odd at first. As effective as CPAP can be if its used consistently and correctly, there are real risks of patients abandoning the treatment, especially in the very early stages, because they feel it’s too intrusive, disruptive or uncomfortable. Finding the best ways to encourage continued use of the device is a critical area of research.

A group of researchers at Penn State reviewed 80 CPAP-related studies, searching for evidence of the most important factors in successful CPAP therapy. They found that social support increases the likelihood that a CPAP user will continue to use the device. Spouses and partners who provide active support for the CPAP can help a patient feel more relaxed and comfortable with, and also more accountable to, following through with the treatment night after night. And it’s this follow through that makes all the difference in whether or not the CPAP treatment is allowed to work as successfully as it can.

This finding echoes other research that shows CPAP works best when couples work together in support of the treatment, and that—rather than drive partners away from sex and intimacy, CPAP can actually lead to improved intimacy between partners:

•  One study indicated that men whose wives continue to sleep in the same bed with them when using the CPAP are 60% more likely to continue with the treatment than if they are sleeping alone.
• Another study examined sexual and intimate relationships in men with obstructive sleep apnea, and found then whereas OSA had a negative impact on men’s sex lives, regular use of CPAP for three months resulted in improvement in their sexual and intimate relationships. And the more serious the OSA to begin with, the greater the improvement was after using the CPAP.

It’s very common for the snoring that can accompany obstructive sleep apnea to drive partners to sleep in separate beds. So often, when the CPAP treatment begins, couples are already sleeping apart. The initial reluctance to return to the same bed is understandable—both partners may feel self-conscious. There’s no question that it takes work: trust, open communication, perhaps a decision to plan for sex and intimacy in different ways. But this is work that is worth doing—not only for the health of the person with OSA, but also for the health of your relationship.

There is no single right way to approach integrating the CPAP into your life. Researchers in the current review found that CPAP success is best promoted on a case-by-case basis, with individualized treatment regimens that take into account a patient’s life circumstances, the particulars of their disease, as well as their psychological and social circumstances. For example, for patients without partners, telecommunications strategies such as regular phone calls and wireless telemonitoring may be able to provide the social support and connection that appears to be so effective.

The bottom line? CPAP treatment not only can help alleviate OSA, and improve a patient’s health, it can also bring couples back into the same bed—if both patient and partner are willing to accept the device, and not let short-term, initial discomfort or awkwardness become entrenched. The discomfort is fleeting, but the benefits—including renewed intimacy in the bedroom—are long-term.

Sweet Dreams,

Michael J. Breus, PhD 
The Sleep Doctor™ 

www.thesleepdoctor.com

The Sleep Doctor’s Diet Plan:  Lose Weight Through Better Sleep

Everything you do, you do better with a good night’s sleep™ 
twitter: @thesleepdoctor 
Facebook: www.facebook.com/thesleepdoctor