SLEEP APNEASLEEP APNEA

Juan A. Albino, MD, FCCPJuan A. Albino, MD, FCCP

Village Sleep Lab 751-4955Village Sleep Lab 751-4955

October, 2007October, 2007

Thank You !!!Thank You !!!Debbie Hurtt, Rotary ClubDebbie Hurtt, Rotary ClubPhillip Ratliff, AWAKE Group (753-Phillip Ratliff, AWAKE Group (753-

8773)8773)Heather Ellington, Office Manager Heather Ellington, Office Manager John Crawford, Technical DirectorJohn Crawford, Technical DirectorThomas Chaput, Sleep TechnologistThomas Chaput, Sleep TechnologistMiyoshi Scott, NurseMiyoshi Scott, NurseBrigette Hayes, ReceptionistBrigette Hayes, Receptionist

Common Sleep DisordersCommon Sleep Disorders

Insomnia: wants to sleep but cannot Insomnia: wants to sleep but cannot Sleep Deprivation: does Sleep Deprivation: does notnot want to want to

sleep but can; problem of sleep sleep but can; problem of sleep quantityquantity

SLEEP APNEA: SLEEP APNEA: sleepy during day, during day, snoressnores at night because of obstruction in throat; at night because of obstruction in throat; problem of sleep problem of sleep qualityquality

Restless Legs Syndrome: leg discomfort, Restless Legs Syndrome: leg discomfort, relieved by movement that hinders sleep relieved by movement that hinders sleep

Good Sleep Hygiene: BasicsGood Sleep Hygiene: Basics

Regular times for sleeping and Regular times for sleeping and awakeningawakening

Maintain bedroom dark, quiet, coolMaintain bedroom dark, quiet, coolUse bed only for sleep and sexUse bed only for sleep and sexAvoid late daytime napsAvoid late daytime napsAvoid at night: alcohol, caffeine, nicotineAvoid at night: alcohol, caffeine, nicotineSleep around 7 to 8 hours every nightSleep around 7 to 8 hours every nightPrudent exercise and eating Prudent exercise and eating Avoid stressful situations at bednightAvoid stressful situations at bednight

Restless Legs SyndromeRestless Legs Syndrome

Leg discomfort, worse at night, relieved Leg discomfort, worse at night, relieved by movement, affects 5-10% of by movement, affects 5-10% of populationpopulation

Familial, begins in childhoodFamilial, begins in childhoodAssociated with iron deficiency, drugs, Associated with iron deficiency, drugs,

Periodic Limb Movements of SleepPeriodic Limb Movements of SleepEasily treatable with medicinesEasily treatable with medicinesRestless Legs Syndrome Foundation, Restless Legs Syndrome Foundation,

June K. Wharton (259-0979)June K. Wharton (259-0979)

Sleep DeprivationSleep Deprivation

Disasters: Exxon Valdez, Challenger Disasters: Exxon Valdez, Challenger Space Shuttle, Chernoble Nuclear Plant, Space Shuttle, Chernoble Nuclear Plant, Commuter plane crash in KentuckyCommuter plane crash in Kentucky

33% of fatal truck accidents 33% of fatal truck accidents 10% of fatal car accidents10% of fatal car accidents Impairment the same whether: drunk, Impairment the same whether: drunk,

sleep deprived (<4-6hrs.), sleep apneasleep deprived (<4-6hrs.), sleep apneaMust be taken seriously: sleep 8 hoursMust be taken seriously: sleep 8 hoursLeads to obesity and diabetesLeads to obesity and diabetes

Insomnia: Acute or ChronicInsomnia: Acute or Chronic

Insomnia: inability to get to sleep, stay Insomnia: inability to get to sleep, stay asleep, wakes up early, with daytime asleep, wakes up early, with daytime impairmentimpairment

Acute Insomnia (<4 weeks): stress, illnessAcute Insomnia (<4 weeks): stress, illness Sleep medicines work well in acute stageSleep medicines work well in acute stage Chronic Insomnia: >4 weeks, often yearsChronic Insomnia: >4 weeks, often years Treat basic problem: >60% psychologicalTreat basic problem: >60% psychological Psychotherapy and behavioral therapy Psychotherapy and behavioral therapy

better than medicines, not easy to treat better than medicines, not easy to treat Psychologists, Psychiatrists, PCPPsychologists, Psychiatrists, PCP

Sleep Apnea: Risk FactorsSleep Apnea: Risk Factors

Affects: 4 to 5% of population: commonAffects: 4 to 5% of population: common Family history, Sleep maintenance insomniaFamily history, Sleep maintenance insomnia Obesity: 80 % of sleep apnea patients; Obesity: 80 % of sleep apnea patients;

central (visceral, apples) obesitycentral (visceral, apples) obesity Increasing age, Male genderIncreasing age, Male gender Large tonsils / adenoids in childrenLarge tonsils / adenoids in children Small mandible, large neckSmall mandible, large neck Smoking, alcohol, sedatives, nasal allergiesSmoking, alcohol, sedatives, nasal allergies

Sleep Apnea: ConsequencesSleep Apnea: Consequences During During nightnight: snoring, snorting, gasping, : snoring, snorting, gasping,

difficult or stops breathing, wife worriesdifficult or stops breathing, wife worries During During dayday: sleepy, tired, depressed, : sleepy, tired, depressed,

irritabile, impotent, forgets, sometimes few irritabile, impotent, forgets, sometimes few complaintscomplaints

More More accidentsaccidents: work, home, motor vehicle: work, home, motor vehicle Higher death rates with severe sleep apneaHigher death rates with severe sleep apnea Hypertension, Congestive Heart FailureHypertension, Congestive Heart Failure Heart Attacks, Strokes, Atrial FibrillationHeart Attacks, Strokes, Atrial Fibrillation Promotes Promotes ObesityObesity and and DiabetesDiabetes Problems: at night, during day, risk factorProblems: at night, during day, risk factor

What is OSA?•Cessation of airflow with ongoing respiratory effort•NORMAL SNORING SLEEP APNEA

Obstructive Sleep Apnea

Sleep Apnea: Treatment Sleep Apnea: Treatment

Behavioral: Weight Loss, Sleep Position Behavioral: Weight Loss, Sleep Position (Sleep on side, head raised), Oxygen, Avoid (Sleep on side, head raised), Oxygen, Avoid sedatives sedatives

CPAPCPAP: proven therapy, needs motivation: : proven therapy, needs motivation: widely available, 70%: patients adapt wellwidely available, 70%: patients adapt well

Surgery: tracheostomy, tonsillectomy, pull Surgery: tracheostomy, tonsillectomy, pull forth mandible or tongueforth mandible or tongue

Bariatric Surgery: banding, bypass (Bob Bariatric Surgery: banding, bypass (Bob Eisenhauer 259-1485; Lewis Jones 753-3459)Eisenhauer 259-1485; Lewis Jones 753-3459)

Dental appliances: also pull forth mandible Dental appliances: also pull forth mandible or tongue; expertise necessaryor tongue; expertise necessary

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

CPAP therapy

Treatment Options: CPAP

Summary: Sleep ApneaSummary: Sleep Apnea Very common and dangerousVery common and dangerous Easily diagnosed and treatedEasily diagnosed and treated Benefits of treatment:Benefits of treatment: sleep better at sleep better at

nightnight, also, also Feel better during the dayFeel better during the day: less sleepiness : less sleepiness

and fatigue, more energy, less accidentsand fatigue, more energy, less accidents Reduce risk factorReduce risk factor for heart disease and for heart disease and

strokesstrokes Control betterControl better: obesity, diabetes, : obesity, diabetes,

hypertensionhypertension Bed partner sleeps betterBed partner sleeps better: less noise and : less noise and

less worry (but dog is scared of CPAP)less worry (but dog is scared of CPAP)

WebsitesWebsites

National Sleep Foundation: National Sleep Foundation: sleepfoundation.orgsleepfoundation.org

American Sleep Apnea Association: American Sleep Apnea Association: sleepapnea.orgsleepapnea.org

Restless Legs Syndrome Foundation: rls.orgRestless Legs Syndrome Foundation: rls.org National Center on Sleep Disorders: National Center on Sleep Disorders:

healthfinder.gov/orgs/HR2536.htmhealthfinder.gov/orgs/HR2536.htm Commercial: MyResmed.comCommercial: MyResmed.com Commercial: Respironics.comCommercial: Respironics.com

BooksBooks

The Promise of SleepThe Promise of Sleep by William Dement by William Dement Sleeping WellSleeping Well by Michael Thorpy by Michael Thorpy No More Sleepless NightsNo More Sleepless Nights by Peter Hauri by Peter Hauri A Woman’s Guide to Sleep DisordersA Woman’s Guide to Sleep Disorders by by

Meir H. Kryger Meir H. Kryger Restless LegsRestless Legs SyndromeSyndrome by Robert H. by Robert H.

YoakumYoakum Say Good Night to InsomniaSay Good Night to Insomnia by Gregg D. by Gregg D.

JacobsJacobs