Sleep Apnea Relief

Obstructive Sleep Apnea adversely affects glucose control in patients with type 2 diabetes, according to a study conducted by researchers at the University of Chicago.

The study “demonstrates for the first time that there is a clear, graded, inverse relationship between OSA severity and glucose control in patients with type 2 diabetes,” wrote lead author, Renee S. Aronsohn, MD, instructor of medicine at the University of Chicago.

The researchers said the study also confirmed other reports that undiagnosed OSA is very common among patients with type 2 diabetes, indicating that it is largely unrecognized additional medical risk factor in these patients.

The findings have been published online ahead of print publication in the American Thoracic Soceity’s American Journal of Respiratory and Critical Care Medicine.

Aronsohn and colleagues consecutively recruited patients with type 2 diabetes from outpatient clinics to participate in the study. The participants were interviewed to assess their diabetes history, medical history and medications, and level of physical activity. Height and weight measurements were also taken, and each participant’s sleep/wake cycles were monitored for five days using wrist actigraphy and self-reported sleep logs. Finally, participants underwent an overnight polysomnography test for OSA , and glucose control was assessed by obtaining a blood sample for hemoglobin A1c (HbA1c) measurement, the main clinical marker of glycemic control in diabetes

In total, 60 patients were included in the study’s final analysis. More than three-quarters (77%) of participants had OSA, but only five had been previously evaluated for the disease, and none were undergoing treatment. Of the study sample, 38% (23) were classified as having mild OSA, 25 percent (15) had moderate OSA and the 13% (8) had severe OSA.

The researchers found that more severe OSA was associated with poorer glucose control, implying a role more severe diabetes with potentially more complications. Relative to patients without OSA, the presence of mild, moderate or severe OSA significantly increased mean adjusted HbA1c values by 1.49%, 1.93%, and 3.69% respectively. These effect sizes are comparable to those of widely used hypoglycemic medications, meaning that having OSA may negate the beneficial effects of anti-diabetic drugs.

“Our findings have important clinical implications as they support the hypothesis that reducing the severity of OSA may improve glycemic control,” said Aronsohn. “Thus effective treatment of OSA may represent a novel and non-pharmacologic intervention in the management of type 2 diabetes.”

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Sleep apnea is characterized by repeated episodes of breathing cessation (apnea) during sleep. These episodes last from 10 seconds to nearly a minute, ending with a brief partial arousal. This can occur and disrupt sleep hundreds of times throughout one night.

An estimated 18 million Americans have obstructive sleep apnea, yet 95% of them are undiagnosed and untreated. Sleep apnea is about twice as common among men as among women.

Now sobering findings from a study reported in the journal Sleep (volume 31, page 1071) suggest that people with sleep apnea are three times as likely to die of any cause as people without sleep-disordered breathing. And the risk for people with untreated sleep apnea is even higher.

The researchers studied 1,522 generally healthy men and women for 18 years, after testing them for sleep apnea with an overnight sleep test. Those with severe sleep apnea were three times more likely to die during the study period than those without it.

People whose sleep apnea was not treated with continuous positive airway pressure (CPAP) were nearly four times more likely to die of any cause and more than five times more likely to die of heart disease. The risk was the same for people with sleep apnea regardless of whether they were sleepy during the day, a common sign of sleep apnea.

While many previous studies have linked sleep apnea with a variety of health problems, including heart disease and stroke, until now scientists have not had definitive evidence of an increased risk of death from sleep apnea.

Take home message: If you’re in doubt about whether your snoring is a sign of sleep apnea or if you have been prescribed CPAP but haven’t been sticking with it, these study findings should help convince you of the value of having your sleep apnea diagnosed and treated.

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We all have an uncle Joe. His real name could be Fred, Richard, Ben, and Jose, even Elvis. He’s the guy who just devoured a plateful of your turkey and trimmings the size of a small Buick and is now snoring away in your Barcalounger, while his stomach is creating room for dessert. You know… that uncle Joe.

Don’t blame him for crashing after a heavy meal. Be thankful. For if everyone reacted to your cooking that way, there would be no one awake to help with the cleanup.

Packing away a big meal, especially one with turkey, mash potatoes, stuffing, gravy, bread, butter… is the equivalent of hitting some of them with a tranquilizing dart big enough to bring a rhino to its knees. (Rhino’s have knees. Right?)

The Mystery Ingredient

It’s not your secret stuffing recipe handed down through the ages that dropped uncle Joe. And it’s not something the growers plunged into the backside of your Butterball before shipment. Relax; you do not have to check your homeowner’s policy to see if it covers these things. It is partly the turkey’s fault.

Turkey is loaded with tryptophan, an amino acid that promotes the production of serotonin in your brain. This brain chemical has both a calming effect as well as being involved in REM sleep. But tryptophan is not absorbed easily.

Tryptophan is an essential amino acid, meaning that the body cannot manufacture it. The body has to get tryptophan and other essential amino acids from food. Tryptophan helps the body produce the B-vitamin niacin, which, in turn, helps the body produce serotonin, a remarkable chemical that acts as a calming agent in the brain and plays a key role in sleep.

A study published last month in the Canadian Journal of Physiology and Pharmacology asserts that, in order for tryptophan to be absorbed most effectively from the blood stream into the central nervous system, it must be combined with a high-glycemic carbohydrate (all of the trimmings like mashed potatoes, sweet potatoes, stuffing, bread) thereby allowing more tryptophan to reach the brain. In other words, if you ate only turkey, that might not help you sleep.

Thanksgiving is the first time some of us get a chance to relax. It’s amazing what few days off can mean to someone needing to replenish their “sleep debt.”

“Thanksgiving and sleepiness go together like turkey and pumpkin pie,” says Dr. Ralph Downey III, chief of sleep medicine at the Sleep Disorders Center at California’s Loma Linda University Medical Center, in a release from the American Academy of Sleep Medicine. “We nap or feel drowsy because we are in a relaxed state. When we finally relax, our brain is primed for sleep from all the days when it has not had as much.”

Your place might look like a ‘60’s crash pad with all of the guests snoozing. Just make sure that the dedicated driver gets a nap before hitting the road.

Happy Thanksgiving.

Dr. Hilton

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Press Release
Date: November 2, 2009
National Sleep Foundation Launches Annual Drowsy Driving Prevention Week® to Prevent Fall-Asleep Crashes with Tips and Countermeasures

WASHINGTON, DC, November 2, 2009 – Sleepiness is often overlooked as a major contributor to vehicle crashes. The National Sleep Foundation’s 2009 Sleep in America poll shows that 1% or as many as 1.9 million drivers have had a car crash or a near miss due to drowsiness in the past year. Even more surprising, 54% of drivers (105 million) have driven while drowsy at least once in the past year, and 28% (54 million) do so at least once per month.

“People underestimate how tired they are and think that they can stay awake by sheer force of will,” said Thomas Balkin, Ph.D., Chairman of the National Sleep Foundation. “This is a risky misconception. Would there be 1.9 million fatigue-related crashes or near misses if people were good at assessing their own ability to drive when fatigued?”

“The problem,” says Balkin, “is that although we are pretty good at recognizing when we feel sleepy, we do not recognize the process of actually falling asleep as it is happening. The process robs us of both self-awareness and awareness of our environment. All it takes is a moment of reduced awareness to cause a crash.”

Studies show that being awake for more than 20 hours results in an impairment equal to a blood alcohol concentration of 0.08%, the legal limit in all states. Like alcohol, fatigue slows reaction time, decreases awareness and impairs judgment. But unlike an awake driver impaired by alcohol, a sleeping driver is unable to take any action to avoid a crash.

“Too many Americans are exhausted when they get behind the wheel, and they may not fully understand how dangerous it is to drive while drowsy,” says David M. Cloud, the National Sleep Foundation’s Chief Executive Officer. “The National Sleep Foundation recommends that drivers take practical measures when they feel that sleepiness is impairing their driving. Unfortunately, many drivers are misinformed on what to do in this situation. Understanding crucial warning signs and countermeasures is key to preventing fatigue-related crashes.”

Feeling Sleepy? Stop driving if you exhibit these warning signs!

The following warning signs indicate that it’s time to stop driving and find a safe place to pull over and address your condition:

Difficulty focusing, frequent blinking and/or heavy eyelids
Difficulty keeping reveries or daydreams at bay
Trouble keeping your head up
Drifting from your lane, swerving, tailgating and/or hitting rumble strips
Unable to clearly remember the last few miles driven
Missing exits or traffic signs
Yawning repeatedly
Feeling restless, irritable, or aggressive
Countermeasures – National Sleep Foundation’s Tips for Drowsy-free Driving:

Get a good night’s sleep before you hit the road. Most adults need 7 – 9 hours of sleep to maintain proper alertness.
Don’t be too rushed to arrive at your destination. Many drivers try to maximize their time by driving at night or not stopping for breaks. However, crashes caused by sleepiness are among the most deadly. It’s worth extra time and money to arrive at your destination safely.
Use the buddy system. Just as you should not swim alone, avoid driving alone for long distances. A buddy who remains awake for the journey can take a turn behind the wheel and help identify the warning signs of fatigue.
Take a break every 100 miles or 2 hours.
Avoid alcohol and sedating medications check your labels or ask your doctor or pharmacist about side-effects.
Avoid driving at times when you would normally be sleeping.
Take a nap; if you feel that you are in danger of falling asleep find a safe place to take a 15 to 20-minute nap.
Pack a cooler with caffeinated beverages or keep caffeinated gum and mints in the glove compartment. The equivalent of two cups of coffee can increase alertness for several hours. Since caffeine in liquid form takes about 20 to 30 minutes to take effect, consume caffeine before taking a short nap to get the benefits of both. However, it should be remembered that caffeine does not replace sleep, it only delays its onset temporarily.
Adequate sleep remains the best countermeasure for sleepiness!
For more information about drowsy driving, visit sleepfoundation.org.

Drowsy Driving Prevention Week®

In an effort to reduce the number of fatigue-related crashes and to save lives, the National Sleep Foundation is declaring November 2-8, 2009 Drowsy Driving Prevention Week®. This annual campaign provides public education about the under-reported risks of driving while drowsy and countermeasures to improve safety on the road.

About the National Sleep Foundation

The National Sleep Foundation is dedicated to improving sleep health and safety through education, public awareness, and advocacy. It is well-known for its annual Sleep in AmericaTM poll. The Foundation is a charitable, educational and scientific not-for-profit organization located in Washington, DC. Its membership includes researchers and clinicians focused on sleep medicine, professionals in the health, medical and science fields, individuals, patients, people affected by drowsy driving and more than 900 healthcare facilities throughout North America. For more information about the National Sleep Foundation and a directory of its sleep center members, please visit www.sleepfoundation.org.

Sponsors for Drowsy Driving Prevention Week® 2009

Mercedes-Benz
Mercedes-Benz continues to be a leader in developing technologies to help keep drivers safe and alert. The ATTENTION ASSIST drowsiness-detection system, an innovation released on the all-new 2010 E-Class sedan, is equipped with sophisticated sensors that monitor the driver’s operation of the vehicle across 70 parameters that have proven to be strong indicators of alertness levels. Mercedes-Benz is a proud sponsor of Drowsy Driving Prevention Week® (Nov. 2-8). For more information, visit http://www.mbusa.com/mercedes/#/whatsnew/.

National Sleep Awareness Roundtable
The National Sleep Awareness Roundtable (NSART) is a national coalition of governmental, professional, voluntary, and other organizations whose mission is to raise awareness about the public health and safety impact of sleep deprivation and sleep disorders by improving communication and collaboration among local, state and federal agencies; professional organizations; and the public.

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The Federal government says it is getting serious about screening truck and bus drivers, pilots, train engineers and merchant sailors for obstructive sleep apnea. The National Transportation Safety Board has just sent letters to the federal agency that regulates bus and truck safety and the U.S. Coast Guard citing accidents in which sleep apnea was a factor. The sleep disorder that causes pauses in breathing, which can interrupt sleep and increase daytime fatigue.

As long as I can remember, the NTSB has reporting auto related deaths from sleep related issues.  The only reason sleep apnea and accidents has become news again is due to the recent number of incidents reported in the press:

_ In January 2008, a motor coach with passengers returning from a weekend ski trip went tumbling down a mountainside, killing nine people and injuring 43 others. It was discovered that the driver had sleep apnea but did not use his CPAP.  (Many people hate their CPAP so much that no matter what the potential consequences are to themselves or to others, just will not use it.)

_ The same month, two GO! airlines pilots conked out during a midmorning flight from Honolulu to Hilo, Hawaii, as their plane continued to cruise past its destination and out to sea. Air traffic controllers were finally able to raise the pilots, who turned the plane around with its 40 passengers and landed it safely. The captain was later diagnosed with sleep apnea.

_ A trolley train that crashed into another train in May 2008 in Newton, Mass. Investigators said the driver likely fell asleep because she suffered from sleep apnea, but it could not be proved because she died.

_ In November 2001, a train engineer who drove through a stop warning in Clarkston, Mich., striking another train and killing two crew members. He was found to be a high risk for sleep apnea, but had not been diagnosed or treated.

_ In June 1995, a cruise ship maneuvering through Alaska’s Inside Passage was grounded on a submerged, but charted and marked rock by a pilot later diagnosed with sleep apnea. The ship was carrying about 2,200 people.

It is estimated that 18-million people in the United States suffer from obstructive sleep apnea, but up to 90% of those people have never even had a diagnosis.

Mark Rosenker, a former NTSB acting chairman, said the issue has long been a concern of the board, but the go! airlines incident jarred board members.  “Obviously when two pilots fall asleep in the cockpit and they miss their stop that triggers a lot of interest at NTSB,” Rosenker said.  Yeah, right!

Do you know that the first airplane hijacking in which someone was killed was on 5 July 1972; Pacific Southwest 737-200; San Francisco, CA.  In 1992, the film “Passenger 57” involved a hijacking of a plane.  Yet it took September 11, 2001 to finally get governments around the world to mandate the installation of bulletproof cockpit doors.

Don’t place any bets on this happening soon.

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We all have a bout of insomnia every now and then. It’s normal. We worry about losing our job, our home, a sick kid or an ailing parent. Sometimes we worry for no reason at all. If you suffer from symptoms of insomnia, you will find the information in this video helpful.

Sleep well…

Dr. Hilton

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