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Sleep Apnea

What is it?
Apnea means “without breath.” Sleep apnea is a sleep disorder that results in interrupted sleep and is characterized by loud snoring and instances of pauses in breathing during sleep. These pauses in breathing occur many times throughout the night and can last from 10 seconds to a minute or more.

Sleep apnea is very common, as common as adult diabetes, and affects more than 12 million Americans. Yet, because of the lack of awareness by the public and healthcare professionals, it often remains undiagnosed and therefore untreated. It affects people of all ages, but is seen more often in individuals over the age of 40. It is found more often in men – although more and more women are being treated – and in overweight individuals.

Long-term, this disorder can cause high blood pressure, cardiovascular disease, memory problems, weight gain, impotency and headaches. Short-term effects include poor job performance and accidents due to fatigue.

What are the causes?
There are two types of sleep apnea — central sleep apnea and obstructive sleep apnea.

Central sleep apnea is less common and is caused by a failure in a person’s nervous system. The muscles in the nervous system do not receive the proper signals from the brain to make breathing occur properly.

Obstructive sleep apnea is caused by a blockage in the mouth or throat and is far more common. A typical blockage may be a person’s tongue, tonsils, or fatty muscle tissues in the throat. Each time breathing is blocked, oxygen in the bloodstream falls and the heart has to work harder to circulate blood. When the brain senses the decrease of oxygen, the sleeper is partially aroused just enough to gasp for air.

What are the signs and symptoms?
Someone watching a person suffering from sleep apnea will observe a pattern of loud snoring (which indicates the airway is not fully open) interrupted by pauses in breathing and gasps for breath during sleep.

Other symptoms include sleepiness during daytime hours, trouble concentrating, forgetfulness, irritability, headaches (especially in the morning hours), decreased sexual energy and mood swings.

How is it diagnosed?
There are many types of sleep disorders that have the same signs and symptoms. A polysomnogram (sleep study) can determine if a patient has sleep apnea.

How is it treated?
The most common treatment of sleep apnea is continuous positive airway pressure (CPAP). CPAP treats obstructive sleep apnea by providing a gentle flow of positive-pressure air through a mask to splint the airway open during sleep. The result is that breathing becomes regular, snoring stops, restful sleep is restored, and quality of life is improved.

Other less common treatments include surgery and oral appliances, which may be effective in certain individuals. A surgical procedure can be done to increase the size of the airway by removing any obstruction such as enlarged tonsils, polyps or growths that may be blocking it. An unusually formed jaw may be causing the problem and can be corrected with surgery.

Some patients may benefit from an oral appliance that repositions the tongue or jaw so that airflow is not restricted.

There are some things people with sleep apnea can do to minimize the effects of the disorder:

Avoid alcohol and sleeping pills
Lose weight (if overweight)
Sleep lying on one side

Insomnia

What is it?
Insomnia is a disorder that prevents a person from falling asleep and/or staying asleep when he desires. There are two main types of insomnia:

Primary insomnia is more serious and means that a person is having sleep problems that are not caused by a health condition or other problem.

Secondary insomnia means that a person is having trouble sleeping because of something else, such as a health condition (like depression, heartburn, cancer or asthma), pain or medication being taken.

What are the causes?
Insomnia can vary in how long it lasts and to what extent it affects a person’s lifestyle:

Short-term insomnia (called “acute insomnia”) lasts a short amount of time, usually from one night to a few weeks. It usually is caused by emotional or physical discomfort — brought on by things such as environmental disturbances (noise, changes in the weather), stress, medication side effects or jet lag.

Chronic insomnia lasts a long time — three nights a week for one month or longer. It can be caused by many things, but is often caused by underlying medical conditions such as depression, chronic stress, or pain and discomfort at night.

Individuals who are female, older than age 60 and have a history of depression are more prone to have insomnia.

What are the signs and symptoms?
A main sign of insomnia is not being able to sleep at times when the body is obviously tired. A person with insomnia will be tired the next day and may have a lack of energy.

Other symptoms include waking up earlier than expected and not being able to fall back asleep when waking up through the night.

How is it diagnosed?
A routine physical and discussion with a doctor may determine a diagnosis of insomnia. The doctor may review the patient’s medical history, discuss any recent lifestyle or environmental changes with the patient, and ask questions about the quantity and quality of sleep the person is getting.

Tests conducted at Sleepcare Diagnostics, such as a polysomnogram, can be conducted to diagnose whether the insomnia is caused by an underlying sleep disorder.

How is it treated?
Short-term insomnia will eventually go away on its own. There are certain steps a patient can take in the meantime:

Avoid alcohol
Avoid caffeine
Refrain from smoking
Avoid daytime naps
Remain stress-free

In the case of chronic insomnia, the goal of treatment is to first treat the underlying medical condition causing the insomnia.

Treatment may involve:

Medication, such as sleeping pills — dosage should be as small as possible and be gradually lowered as treatment continues.

Relaxation techniques — listening to tapes or doing stretching exercises can help a person relax in order to fall asleep.

Sleep restriction and reconditioning — a bed should only be used for sleep. If a person has trouble falling asleep, he should leave his bed and return at a time when he is more tired. It may be detrimental to lie in bed thinking about falling asleep. It is important not to use the bed for other activities such as reading and watching television; the body may condition itself to stay awake, not only during those activities, but any time the person is in bed.

Excessive Daytime Sleepiness

What is it?
Excessive daytime sleepiness (EDS) is a disorder in which a person feels tired during periods when he wishes to stay awake. Individuals affected by excessive daytime sleepiness tend to doze off without warning in various situations. Examples include falling asleep while in conversation, reading or watching television, or even more seriously, while driving.
People that experience excessive daytime sleepiness suffer mostly short-term effects, such as poor self-esteem due to not being able to predict when they will get sleepy in certain social situations, and temporary poor job performance.

What are the causes?
Excessive daytime sleepiness is caused by not getting enough hours of sleep, or from a lack of enough quality hours of sleep. The average person needs eight continuous hours of sleep per day. If an individual does not stick to a normal sleep routine, he may be affected by this disorder.

Excessive daytime sleepiness may be caused by a more severe, underlying sleep disorder. These sleep disorders prevent a person from obtaining a quality night’s sleep.

What are the signs and symptoms?
The main sign that an individual has excessive daytime sleepiness is that he cannot stay awake in situations when he should — or wants to — stay awake. People with excessive daytime sleepiness show a lack of energy during periods of alertness.

How is it diagnosed?
Excessive daytime sleepiness can be diagnosed after a routine physical and discussion with a doctor. Tests can be administered to analyze whether abnormal hormone levels in the thyroid could be causing excessive daytime sleepiness.

Tests conducted at Sleepcare Diagnostics can diagnose whether EDS is caused by an underlying sleep disorder.

How is it treated?
Excessive daytime sleepiness, if not caused by another sleep disorder, is treated by regulating the sleep cycle. A patient should make sure to get enough sleep on a daily basis and stick to the same sleep routine day after day.

If EDS is caused by an underlying sleep disorder, that disorder will be treated, and EDS should be eliminated or reduced.

Narcolepsy

What is it?
Narcolepsy is a sleep disorder characterized by excessive and overwhelming daytime sleepiness. Sudden and uncontrollable, though often brief, attacks of deep sleep occur when an individual does not want to fall asleep, such as while working, eating or driving. In addition, nighttime sleep may be interrupted with frequent awakenings.

What are the causes?
There is strong evidence that narcolepsy may run in families. It appears that narcolepsy is a disorder of part of the nervous system that controls sleep and wakefulness. It is a disorder in which rapid eye movement (REM) sleep, or deep sleep, occurs at an abnormal time.

Usually, a person enters non-rapid eye movement (NREM) sleep when he first falls asleep. Brain waves during this period become slower and less regular. A couple hours later, a person enters REM sleep (deep sleep), which is when brain waves become more active and dreaming occurs.

In narcolepsy, REM sleep occurs as soon as a person falls asleep instead of after NREM sleep. As a result, sleep paralysis and hallucinations may occur while falling asleep or waking up.

What are the signs and symptoms?
Symptoms usually appear after adolescence, but may take longer to diagnose since people with this disorder often suffer for years before seeing a doctor about their problem.

An individual with narcolepsy may have one or more of these symptoms:

Excessive daytime sleepiness — when a person cannot force himself to stay awake at times of the day when he wants to be awake. This usually occurs at the same time each day.

Cataplexy — a sudden loss of the ability to control muscle movements in the body. This can be slight, such as dropping of the jaw, slurred speech, or knee buckling, or severe, such as a complete collapse of the body. Strenuous activity or intense emotion such as heavy laughter often triggers cataplexy. This symptom is unique to narcolepsy and does not appear in individuals with other sleep disorders.

Sleep paralysis — when a person cannot move or talk for a short period of time, either right before falling asleep or directly after waking up. This can last a few seconds to minutes.

Hallucinations — memorable, scary dreams that occur right before falling asleep or directly after waking up.

Automatic behavior — when a person performs a routine task but is not aware of doing it, or later has no recollection of performing the activity.

Patients with narcolepsy always have excessive daytime sleepiness, but the presence of cataplexy, sleep paralysis or hallucinations is less common.

How is it diagnosed?
There are many types of sleep disorders that have the same signs and symptoms. Tests can be conducted at Sleepcare Diagnostics to determine if a patient has narcolepsy, including a day and/or overnight polysomnogram (sleep study) and multiple sleep latency test (MSLT). Test results of a person with narcolepsy will show that he falls asleep rapidly and enters REM sleep early.

How is it treated?
Medication is the most common method of treatment. A combination of stimulants and antidepressants may be used. Stimulants often improve a person’s ability to stay alert and awake during the day, while the antidepressants tend to control the symptoms of cataplexy, sleep paralysis and hypnagogic hallucinations.

It is crucial that medications prescribed for narcolepsy do not interfere with other medications a patient might be taking. As long as the side effects of the medications can be controlled and the patient is diagnosed early enough, the disease can be managed.

There are some things an individual with narcolepsy can do to help cope with the disease:

Avoid caffeine and alcohol
Get enough exercise
Follow a proper diet
Establish a regular sleep routine (which may include regular naps)
Use bed for sleep only

Restless Legs Syndrome

What is it?
Restless legs syndrome (RLS) is a disorder in which a person has a constant need to stretch or move the legs to ease pain or discomfort. Many sufferers of the disorder claim to feel creepy, crawly sensations in their legs. These feelings tend to be stronger when an individual is lying down or at rest, and they affect the amount of sleep a person gets because of the thrashing.

It is estimated that 5-10 percent of the population may be affected by restless legs syndrome by varying degrees.

What are the causes?
The absolute cause of restless legs syndrome is unknown, but it is believed to be a genetic disorder (hereditary). Research is being done to determine which gene causes the behaviors associated with restless legs syndrome. Caffeine consumption and certain medications may be a factor in RLS. RLS may be the result of an underlying medical condition, such as:

Anemia and low levels of iron in the blood
Kidney disease
Vitamin or mineral deficiencies
Poor blood circulation in the legs
Nerve problems
Muscle disorders
Pregnancy (often occurring during the late stages)

What are the signs and symptoms?
Symptoms of restless legs syndrome tend to worsen when the body is relaxed, such as in the early evening or nighttime. They will flare up as a person sits for a long period, such as when on a plane, in a car, or when lying in bed.

An individual with restless legs syndrome may have one or both of these symptoms:

Uncontrollable urges to move body parts — when a person has a sensation that he must move body parts, such as the legs. This usually occurs at night.

Pain in the legs — this sensation can range from a shooting pain in the legs (usually in the calves), to an uncomfortable feeling of constant pressure on the leg. Other feelings can be burning, itching, aching, tingling and cramping.

How is it diagnosed?
Diagnosis of restless legs syndrome is primarily done through discussions with a physician. It is likely that restless legs syndrome is an accurate diagnosis if there is a family history of the condition.

Normally, a physical and neurological examination will be done to identify other conditions that may be associated with RLS. A polysomnogram (sleep study) at Sleepcare Diagnostics may be suggested to determine if other sleep problems are present.

How is it treated?
Because the direct cause of restless legs syndrome in unknown, only the symptoms of the disorder can be treated. Symptoms often can be temporarily relieved by stretching, moving or massaging the legs.

The goal of treatment is to ensure that the involuntary movements do not interrupt sleep patterns. Certain medications may be prescribed to reduce the urges to move. Other medications may be used to ease the pain felt in the legs during periods of rest and relaxation.

There are some things an individual with restless legs syndrome can do to help cope with the disease:

Exercise or keep active right before bed
Engage the brain in activities to take the focus away from the urges and the pain
Take a hot bath
Avoid caffeine and alcohol

Parasomnia

What is it?
Parasomnias are sleep disorders in which a person’s behavior is affected by specific sleep stages or by the transition between sleeping and waking. There are four main categories of parasomnias:

1. Arousal disorders occur when a person is in a state of partial wakefulness. The person will act out a behavior, but will not remember the activity when he is fully awake. Examples include:

Sleepwalking — moving around the house, or even outside, without being aware you are doing it

Confusion arousal — crying and thrashing around in bed, being confused and upset, and not wanting to be awakened (common in infants)

Sleep terrors — screaming and shouting, having a racing heart beat, sweating, and being extremely agitated

Sleep eating — like sleepwalking, but includes eating

2. Sleep-wake transition disorders occur when a person is either in the process of falling asleep or waking up. Examples include:

Rhythmic-movement disorder — banging the body around, especially the head

Sleep starts — the body jerks around; may be brought on by a sensation of falling caused by a vivid dream

Nocturnal leg cramps — Painful feelings in the legs or feet

Talking in one’s sleep

3. REM associated disorders occur when a person is in REM sleep (the period of deep sleep during which a person dreams). Examples include:

Nightmares — bad dreams that cause a person to wake up

Sleep paralysis — not being able to move certain parts of the body during sleep

Painful erections — sleep-related, painful erections

Behavior disorder — acting out parts of a dream

4. Other parasomnia disorders include:

Teeth grinding
Bed wetting
Seizures
Choking
Snoring
Sudden death syndrome
Breathing cessation

What are the causes?
Often, parasomnias have no explained cause, particularly when they occur in children. Other times, they can be caused by stress, lack of sleep, depression or certain medications.

What are the signs and symptoms?
A bed partner can usually tell if a person is having episodes of parasomnia behaviors. For instance, the bed partner may observe the person talking in his sleep, awakening due to nightmares, sleepwalking or having unusual body movements during sleep.

In cases of severe parasomnia, injury may occur when a person decides to act out a dream or gets out of bed and moves around.

How is it diagnosed?
A specific parasomnia can be diagnosed after a routine physical and discussion with a physician.

Tests can be conducted at Sleepcare Diagnostics to diagnose whether the parasomnia needs medical treatment.

How is it treated?
If a parasomnia behavior is present in infants or children, it will probably pass in time. In adults, medical treatment is often necessary.
Many of the behaviors can be treated with prescription drugs. Others types of treatment include behavior therapy and sleep reconditioning.

Certain precautions can be taken to reduce the risk of injury caused by a parasomnia behavior, such as:

Clearing a path in areas where a person often is found sleepwalking
Locking doors and windows
Installing alarms on doors and windows

Snoring

What is it?
Snoring is the sound made when air passes through the blocked or narrowed airway of a person who is sleeping. Almost everyone snores occasionally. However, frequent and loud snoring — especially if the person snores, stops breathing for a few seconds, and then starts again with a loud snort — can be a symptom of a sleep disorder called sleep apnea.

What are the causes?
During sleep, a person’s body naturally relaxes. The tongue and lower jaw may drop back against the back of the throat and partially block the airway. The body reacts to this by trying harder to breathe; this increased surge of air causes the soft tissues at the back of the throat to vibrate, which creates the snoring noise.

How is it diagnosed?
People who snore heavily should see a sleep specialist to find out if the snoring could be causing episodes of sleep apnea. All snorers have a partial block of the upper airway. But people with sleep apnea have episodes of upper airway obstruction where the airway is completely blocked for a period of time, usually 10 seconds or longer.

Sleep apnea can be diagnosed or ruled out with a polysomnogram (sleep study). A polysomnogram of a person who snores but does not have sleep apnea will show:

Snoring and other sounds occurring often and for long episodes during sleep
No associated abrupt arousals, lowered amount of oxygen in the blood, or cardiac disturbances
Normal sleep and respiratory patterns during sleep
No signs of other sleep disorders

How is it treated?
Doctors may recommend the following treatments for people with severe snoring:

Change sleep positions — rolling over to one side may help a person who only snores when on his back. Some doctors recommend putting a tennis ball in a sock, and pinning the sock to the back of the person's pajama top.

Wear a dental appliance to bed — some snorers may benefit from an oral appliance that repositions the tongue or the jaw so that airflow is not restricted.

Surgery — an outpatient procedure to remove or reduce excessive and or obstructive tissue in the back of the throat may be beneficial. Somnoplasty is a procedure in which radio frequency waves are used to remove excess tissue. In children, removing the tonsils and adenoids is the most common type of surgery.

Behavioral and lifestyle changes — many, but not all, cases of snoring are related to weight gain. Losing weight can be a very effective form of snoring therapy. Refraining from alcohol and sedatives also are often recommended.

Periodic Limb Movements Disorder

What is it?
Periodic limb movements disorder (PLMD) is a disorder in which a person moves or kicks his legs during sleep without an awareness of doing so. The disorder is very similar to restless legs syndrome with the exception that the kicks occur during sleep rather than before sleep.

It is estimated about 5 percent of the population may be affected by periodic limb movements disorder by varying degrees. It is much more common in older individuals over the age of 60.

What are the causes?
There are various causes.

Many cases of PLMD accompany other sleep disorders. Sleep apnea, narcolepsy and insomnia can cause PLMD to occur.
Kidney disease can cause PLMD.
The condition may be linked to a lack of Vitamin E, iron and calcium in the body.
Antidepressants tend to cause episodes of PLMD.

What are the signs and symptoms?
In addition to the jerking of the legs during sleep, an individual may suffer from excessive daytime sleepiness since the condition prevents a person from getting a good night’s sleep.

How is it diagnosed?
Diagnosis of periodic limb movements disorder is primarily made based on results of a polysomnogram (sleep study). Discussions with bed partners and a medical history may indicate a study should be done. The polysomnogram confirms the diagnosis.

How is it treated?
The goal of treatment is to ensure that the involuntary movements do not interrupt sleep patterns. Certain medications may be prescribed to limit the movement. Also, Vitamin E, iron and calcium supplements may be prescribed if it is believed that deficiencies are causing the problem.

There are some things an individual with PLMD can do to help cope with the disease:

Exercise or keep active right before bed
Engage the brain in activities to take the focus away from the urges and the pain
Take a hot bath
Avoid caffeine and alcohol

Obesity and Sleep Apnea

Obesity is a major risk factor for snoring and sleep apnea. Excess weight, or fat deposits, in the throat area and neck can narrow the airway and even periodically obstruct air passage during sleep. This can cause you to stop breathing repeatedly for brief periods.

This medical condition is called sleep apnea and can cause many negative effects on your health, such as daytime drowsiness, high blood pressure and cardiovascular disease.

It is important to note that, while obesity is a major risk factor for sleep apnea, this sleep disorder occurs among people of all weights and sizes.

Sleep Loss and Obesity: A Vicious Cycle
Obese individuals often find it difficult to sleep normally, usually because they:

Have sleep apnea
Suffer from low back pain or other pain due to the extra weight
Are depressed or worried about their weight

People who do not get enough quality sleep may be less physically active, which means weight gain is more likely. Also, some research suggests that sleep loss makes a person feel hungry even if he is full, and it may interfere with the body’s ability to metabolize carbohydrates, which increases fat storage.

Diagnosis and Treatment
The good news is that obesity-related sleep apnea can be treated. Losing weight can reduce the problem since weight reduction reduces obstructive breathing episodes during sleep. Even modest weight loss can help get the condition under control.

However, there are other medical treatments to help you if you have sleep apnea, such as nasal continuous positive airway pressure (CPAP). Sleepcare Diagnostics is experienced in the techniques required to administer sleep studies to severely overweight patients in order to diagnose sleep apnea. We are knowledgeable about medical conditions that often accompany sleep apnea in these individuals and take this information into consideration as we develop a treatment plan.

Following treatment, patients may expect to:

Have restful sleep
Stop snoring
Have improved quality of life
Have reduced risk of heart disease, stroke and high blood pressure

Part of Your Comprehensive Program
Individuals involved in a weight loss program or who undergo weight loss surgery often are referred to Sleepcare Diagnostics as part of a comprehensive plan of care. We will diagnose and treat your sleep-related breathing disorder, and, as you lose weight, we will continue to monitor and adjust your treatment plan.

Good Sleep Habits

The following guidelines were established by the American Sleep Disorders Association. The guidelines can be helpful in alleviating all types of sleep disorders and will help most people sleep well:

Get up about the same time every day.

Go to bed only when sleepy.

Establish relaxing pre-sleep rituals such as a warm bath, light bedtime snack, or 10 minutes of reading.

Exercise regularly. Confine vigorous exercise to early hours, at least six hours before bedtime, and do mild exercise—such as simple stretching or walking—at least four hours prior to bedtime.

Keep a regular schedule. Regular times for meals, medications, chores, and other activities help keep the inner clock running smoothly.

Avoid ingestion of caffeine within six hours of bedtime. Don't drink alcohol, especially when sleepy. Even a small dose of alcohol can have a potent effect when combined with tiredness.

Avoid smoking close to bedtime.

Try to avoid taking naps. However, if you absolutely must nap, do so at the same time every day; mid-afternoon is the best time for most people.

Avoid sleeping pills, or use them conservatively. Most doctors avoid prescribing sleeping pills for periods longer than three weeks. Do not drink alcohol while taking sleeping pills.

Heart Conditions and Sleep

The Link between Heart Conditions and Sleep Disorders
Experts agree that there is a direct connection among sleep, sleep apnea and heart disease.

Individuals with sleep apnea repeatedly stop breathing during sleep and must partially wake each time to gasp or snort for air. This is caused by the main breathing passage in the back of the throat closing or becoming too narrow.

The result? People who have sleep apnea often develop high blood pressure and heart disease. For individuals who already have a heart condition, sleep apnea can worsen their health.

The Connection between Sleep Disorders and Heart Disease
Sleep-related breathing disorders can directly cause certain heart conditions, or can worsen these conditions if they previously existed.

High blood pressure: Sleep apnea causes the heart rate and blood pressure to increase. These nightly increases in blood pressure eventually lead to permanent increases in blood pressure, even during the day.

Coronary artery disease: People with sleep apnea have higher rates of coronary artery disease (CAD). This is because the apnea increases the risk for high blood pressure, a main cause of CAD, and because events that occur during the apnea can put added stress on the heart and worsen existing disease.

Heart failure: Many experts believe that about 50 percent of heart failure patients suffer from sleep apnea. Disorders of sleep and breathing can both cause heart failure and develop as a result of heart failure.

Stroke: High blood pressure is the most common cause of stroke, and sleep apnea can lead to high blood pressure. Also, sleep apnea may cause strokes directly since blood flow to the brain is reduced and the level of oxygen drops during apneas.

Arrhythmias: Several studies have shown that heart failure patients with sleep apnea have a higher prevalence of atrial fibrillation and ventricular arrhythmias (irregular heartbeat). People who have ventricular tachycardia (a rapid heart rate) or a pacemaker are also more prone to have sleep apnea.

Sleep Apnea is Treatable
Disorders like sleep apnea are treatable. In fact, treating sleep apnea may actually decrease a person’s chances of developing certain cardiovascular diseases.

Sleepcare Diagnostics specializes in the care of patients with heart conditions as well as severely overweight individuals. We diagnose and treat sleep disorders, and provide therapeutic devices. Our head physician and medical director for the center, Shahrokh Javaheri, M.D., is internationally known for his research in sleep disorders and in the correlation of sleep disordered breathing to cardiovascular disease.

Our well-trained and compassionate employees are experienced in the techniques required to administer sleep studies to patients with heart disease or heart failure. They are knowledgeable about the links between sleep apnea and heart conditions and take this into consideration as they work with you to achieve success with your prescribed therapy.