SLEEP APNEA Juan A. Albino, MD, FCCP Village Sleep Lab October, 2007

Thank You !!! Debbie Hurtt, Rotary Club Debbie Hurtt, Rotary Club Phillip Ratliff, AWAKE Group ( ) Phillip Ratliff, AWAKE Group ( ) Heather Ellington, Office Manager Heather Ellington, Office Manager John Crawford, Technical Director John Crawford, Technical Director Thomas Chaput, Sleep Technologist Thomas Chaput, Sleep Technologist Miyoshi Scott, Nurse Miyoshi Scott, Nurse Brigette Hayes, Receptionist Brigette Hayes, Receptionist

Common Sleep Disorders Insomnia: wants to sleep but cannot Insomnia: wants to sleep but cannot Sleep Deprivation: does not want to sleep but can; problem of sleep quantity Sleep Deprivation: does not want to sleep but can; problem of sleep quantity SLEEP APNEA: during day, snores at night because of obstruction in throat; problem of sleep quality SLEEP APNEA: sleepy during day, snores at night because of obstruction in throat; problem of sleep quality Restless Legs Syndrome: leg discomfort, relieved by movement that hinders sleep Restless Legs Syndrome: leg discomfort, relieved by movement that hinders sleep

Good Sleep Hygiene: Basics Regular times for sleeping and awakening Regular times for sleeping and awakening Maintain bedroom dark, quiet, cool Maintain bedroom dark, quiet, cool Use bed only for sleep and sex Use bed only for sleep and sex Avoid late daytime naps Avoid late daytime naps Avoid at night: alcohol, caffeine, nicotine Avoid at night: alcohol, caffeine, nicotine Sleep around 7 to 8 hours every night Sleep around 7 to 8 hours every night Prudent exercise and eating Prudent exercise and eating Avoid stressful situations at bednight Avoid stressful situations at bednight

Restless Legs Syndrome Leg discomfort, worse at night, relieved by movement, affects 5-10% of population Leg discomfort, worse at night, relieved by movement, affects 5-10% of population Familial, begins in childhood Familial, begins in childhood Associated with iron deficiency, drugs, Periodic Limb Movements of Sleep Associated with iron deficiency, drugs, Periodic Limb Movements of Sleep Easily treatable with medicines Easily treatable with medicines Restless Legs Syndrome Foundation, June K. Wharton ( ) Restless Legs Syndrome Foundation, June K. Wharton ( )

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

Insomnia: Acute or Chronic Insomnia: inability to get to sleep, stay asleep, wakes up early, with daytime impairment Insomnia: inability to get to sleep, stay asleep, wakes up early, with daytime impairment Acute Insomnia (<4 weeks): stress, illness Acute Insomnia (<4 weeks): stress, illness Sleep medicines work well in acute stage Sleep medicines work well in acute stage Chronic Insomnia: >4 weeks, often years Chronic Insomnia: >4 weeks, often years Treat basic problem: >60% psychological Treat basic problem: >60% psychological Psychotherapy and behavioral therapy better than medicines, not easy to treat Psychotherapy and behavioral therapy better than medicines, not easy to treat Psychologists, Psychiatrists, PCP Psychologists, Psychiatrists, PCP

Sleep Apnea: Risk Factors Affects: 4 to 5% of population: common Affects: 4 to 5% of population: common Family history, Sleep maintenance insomnia Family history, Sleep maintenance insomnia Obesity: 80 % of sleep apnea patients; central (visceral, apples) obesity Obesity: 80 % of sleep apnea patients; central (visceral, apples) obesity Increasing age, Male gender Increasing age, Male gender Large tonsils / adenoids in children Large tonsils / adenoids in children Small mandible, large neck Small mandible, large neck Smoking, alcohol, sedatives, nasal allergies Smoking, alcohol, sedatives, nasal allergies

Sleep Apnea: Consequences During night: snoring, snorting, gasping, difficult or stops breathing, wife worries During night: snoring, snorting, gasping, difficult or stops breathing, wife worries During day: sleepy, tired, depressed, irritabile, impotent, forgets, sometimes few complaints During day: sleepy, tired, depressed, irritabile, impotent, forgets, sometimes few complaints More accidents: work, home, motor vehicle More accidents: work, home, motor vehicle Higher death rates with severe sleep apnea Higher death rates with severe sleep apnea Hypertension, Congestive Heart Failure Hypertension, Congestive Heart Failure Heart Attacks, Strokes, Atrial Fibrillation Heart Attacks, Strokes, Atrial Fibrillation Promotes Obesity and Diabetes Promotes Obesity and Diabetes Problems: at night, during day, risk factor Problems: at night, during day, risk factor

What is OSA? Cessation of airflow with ongoing respiratory effort NORMALSNORINGSLEEP APNEA Obstructive Sleep Apnea

Sleep Apnea: Treatment Behavioral: Weight Loss, Sleep Position (Sleep on side, head raised), Oxygen, Avoid sedatives Behavioral: Weight Loss, Sleep Position (Sleep on side, head raised), Oxygen, Avoid sedatives CPAP: proven therapy, needs motivation: widely available, 70%: patients adapt well CPAP: proven therapy, needs motivation: widely available, 70%: patients adapt well Surgery: tracheostomy, tonsillectomy, pull forth mandible or tongue Surgery: tracheostomy, tonsillectomy, pull forth mandible or tongue Bariatric Surgery: banding, bypass (Bob Eisenhauer ; Lewis Jones ) Bariatric Surgery: banding, bypass (Bob Eisenhauer ; Lewis Jones ) Dental appliances: also pull forth mandible or tongue; expertise necessary Dental appliances: also pull forth mandible or tongue; expertise necessary

Treatment -CPAP treatment –Positive pressure keeps airway open –100% effective CPAP therapy Treatment Options: CPAP

Summary: Sleep Apnea Very common and dangerous Very common and dangerous Easily diagnosed and treated Easily diagnosed and treated Benefits of treatment: sleep better at night, also Benefits of treatment: sleep better at night, also Feel better during the day: less sleepiness and fatigue, more energy, less accidents Feel better during the day: less sleepiness and fatigue, more energy, less accidents Reduce risk factor for heart disease and strokes Reduce risk factor for heart disease and strokes Control better: obesity, diabetes, hypertension Control better: obesity, diabetes, hypertension Bed partner sleeps better: less noise and less worry (but dog is scared of CPAP) Bed partner sleeps better: less noise and less worry (but dog is scared of CPAP)

Websites National Sleep Foundation: sleepfoundation.org National Sleep Foundation: sleepfoundation.org American Sleep Apnea Association: sleepapnea.org American Sleep Apnea Association: sleepapnea.org Restless Legs Syndrome Foundation: rls.org Restless Legs Syndrome Foundation: rls.org National Center on Sleep Disorders: healthfinder.gov/orgs/HR2536.htm National Center on Sleep Disorders: healthfinder.gov/orgs/HR2536.htm Commercial: MyResmed.com Commercial: MyResmed.com Commercial: Respironics.com Commercial: Respironics.com

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