Participate in Sleep Apnea Research!

I hope you are enjoying this hot and crazy summer!

As you know, we in clinical sleep medicine are here for you.  Without patients in need of help for their sleeping problems, there would be no physician sleep specialists, no sleep centers, no sleep medicine.

Sleep medicine is an independent medial subspecialty, just like cardiology, pulmonology, and neurology.  Though sleep medicine remains focused on the clinical evaluation and management of sleep disorders, it also must continue to move forward in innovation and search for answers to unknowns in our field.  These essential aspects of our work can only be accomplished through research.

An organization called SAPCON (Sleep Apnea Patient Centered Outcomes Network) is dedicated to promoting sleep apnea research around the country.  Organized in conjunction with the American Sleep Apnea Association, it is one of the largest networks to advance sleep apnea research.  My friend and mentor, Dr. Vishesh Kapur (Professor of Medicine, University of Washington; Steering Committee Member, SAPCON), asked me recently to spread the word about SAPCON, which has created a website designed to develop a sleep apnea patient community that will learn about and contribute to sleep apnea research.  Sleep apnea apnea patients may now easily connect with health care providers and researchers to share ideas and needs.  As Dr. Kapur puts it, through the website “patients will be able to learn what is new in sleep apnea research, suggest new areas of focus for sleep apnea research, and participate in research if they choose to.”  The website also contains valuable online tools to help you manage your sleep apnea.

The website:  www.myapnea.org

I encourage sleep apnea patients and their loved ones to visit the site and see all that it has to offer.

Stay cool and sleep well this summer, everyone!

 

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Bus Driver Falls Asleep at the Wheel and Causes a Huge Series of Crashes

Recently a Michigan bus driver was involved in a horrendous accident, in which his bus plowed into a total of eight cars.  Take a look at this surveillance video:

You can see the driver calmly driving at the beginning, and then suddenly slamming his brakes as he sees that his vehicle is about to crash into another.  He pulls over to the shoulder and slow down, but he takes out car after car as he decelerates.  Amazingly, there was only one bus passenger onboard, and she was not injured; however, multiple people in the other vehicles were hurt.  This 65 year-old driver, who reported that he felt that he had probably fallen asleep behind the wheel, now faces charges for having caused this accident.

Unfortunately, similar accidents (though usually not this dramatic) occur on American roads every day.  It is estimated about 100,000 car accidents are reported every year in this country due to driving while drowsy or fatigued.

Why is drowsy driving so prevalent?  Well, there are several reasons:

1.  Daytime sleepiness can be a chronic issue that may not have resulted in substantial consequences for you . . . until you wreck your car.  In other words, if you have felt sleepy during the day for years, but have never been in a wreck, you may fool yourself into believing that you may never get into an accident due to falling asleep, which, of course, is completely faulty reasoning.

2.  Daytime sleepiness is not usually “painful,” per se–unless you’re in an accident because of it–and may not be viewed as an actual problem.  If you’re used to falling asleep peacefully in front of the TV every day, you may view that tendency as just a harmless “thing you do” instead of a potential concern or medical issue.

3.  Lots of people are chronically sleep-deprived, such as due to working several jobs, and so sleepiness may be viewed as just an inevitable component of everyday life.  This doesn’t make daytime sleepiness normal!

Ironically and tragically, because sleep disorders such as obstructive sleep apnea are becoming a substantially public policy issue because of their tendencies to cause fall-asleep car crashes, some professional drivers may choose to delay or even completely forego a medical evaluation for such problems for fear of losing their jobs or to spare themselves the hassle.

Bottom line:  excessive daytime sleepiness can kill you if you’re behind the wheel or operating machinery.  It’s better to pull over, rest, stop work, whatever it takes, than to keep on driving if you’re sleepy.  It’s just not worth it to keep going, man.  Imagine being the guy in the video.  And if you’re excessively sleepy during the day despite proper amounts of sleep at night, I strongly recommend seeking medical attention for this brutal problem.

 

Diabetes and Sleep Apnea–Increasing Evidence of a Link

Here’s hoping you’ve recovered from Thursdays’ turkey debauchery!

 

November is National Diabetes Month, and as we wrap up the month I want to bring to your attention an article recently published in the Huffington Post regarding diabetes and obstructive sleep apnea.  Recent published literature demonstrates that up to 7 out of 10 diabetic people have sleep apnea.  Those are astounding numbers considering how many people are diabetic in the United States.

Rather than repeat the contents of the article (written by my academy’s president, Tim Morgenthaler), I’m providing the link to it here:

http://www.huffingtonpost.com/timothy-morgenthaler-md/type-2-diabetics-get-eval_b_6214504.html?ncid=fcbklnkushpmg00000030

There are many reasons to be concerned about this connection.  First, obstructive sleep apnea is still a very under-recognized, under-diagnosed problem.  Epidemiologic studies show that out of the millions of Americans with sleep apnea, only about 15% have been diagnosed!  Second, there is increasing evidence that sleep apnea affects metabolism and weight more deeply and in more ways than originally thought.  Finally, both sleep apnea and diabetes are risk factors for the development of heart disease, such as heart failure, early heart attack, atherosclerotic disease, and rhythm abnormalities.

Diagnosing and treating sleep apnea early have the potential of making the sleep apnea patient feel MUCH BETTER and more awake and alert during the day, but among the fringe benefits are that the SNORING STOPS and hopefully there may be a REDUCTION IN RISK for cardiac disease.  I can’t underscore enough how important it is to seek medical help if you’re chronically sleepy during the day, snoring substantially at night, and having breathing pauses or choking or gasping events during your sleep.

Some of my readers may know that I’m back in school, which is why I’ve not been writing as much recently.  However, winter break will soon be here, and I will write more on the topic of sleep deprivation in the near future.  I wish you and yours’ a most peaceful (and snore-free) holiday season!

Former NFL Star Aaron Taylor Discusses the Importance of Sleep Apnea Diagnosis and Treatment

I must admit that, two months following Super Bowl XLVIII, I’m still flying high from our Seattle Seahawks’ resounding victory.  The win has also served to take some of the sting out of my Kansas Jayhawks’ second-round loss in the NCAA national basketball tournament several weeks ago.

Well, back to sleep problems.  If you’re reading this you probably have heard of a common but under-recognized, under-diagnosed sleep disorder called obstructive sleep apnea.  This is a breathing problem during sleep, in which one’s upper airway episodically collapses or closes down while asleep.  A study recently published in the Journal of Clinical Sleep Medicine has demonstrated that sleep apnea is independently associated with an increased risk of cancer, stroke and death, and that apnea sufferers are 4 times more likely to die if the sleep apnea is left untreated longterm as compared to people who do not have the problem. (1)

My wonderful and patient readers have had to put up with my many posts regarding the importance of diagnosing and treating sleep apnea.  Now it’s time to hear from another authority on the subject:  Aaron Taylor, former NFL offensive guard (Packers and Chargers) and now a sports analyst for CBS College Sports.  Recently Taylor was interviewed and featured on CNN’s The Human Factor.  Here he is, talking about his own journey through the discovery and management of his sleep apnea.

http://www.aasmnet.org/articles.aspx?id=4703&utm_source=WeeklyUpdate&utm_medium=email&utm_campaign=wu-4-18-14

All too frequently I hear from my patients about their longstanding symptoms of daytime fatigue and sleepiness, loud snoring, and gasping sensations out of sleep, and how something kept them from getting properly evaluated in a timely fashion:  lack of motivation or time, acclimatization to their symptoms, some misconception about the treatments.  However, for many sleep apnea sufferers, treatment can be a total life-changer, resulting in profound improvements in daytime energy levels and wakefulness, a resolution of snoring and breathing pauses during sleep, and, hopefully, reduced risks of developing medical problems in the future.  I appreciate Aaron Taylor’s advocacy in bringing sleep apnea awareness to the forefront.

 

Have a great weekend, everyone!

(1) http://www.aasmnet.org/jcsm/ViewAbstract.aspx?pid=29425&utm_source=WeeklyUpdate&utm_medium=email&utm_campaign=wu-4-18-14

“Why is My Mouth So Dry With CPAP Use?”

I must have struck a chord with yesterday’s post on dry mouth, given the responses I’ve received.  Dry mouth is a very common symptom associated with sleep.  So let’s continue this topic, but with a little twist.  Do you awaken with your mouth feeling dry during a night of CPAP use?

As mentioned briefly yesterday, obstructive sleep apnea (OSA) is a sleep disorder of breathing associated with episodic collapse of your upper airway while you are sleeping; sleep disruption, gasping sensations at night, witnessed breathing pauses during sleep, substantial snoring, and daytime sleepiness are common clinical features of this very prevalent but under-recognized medical illness.  CPAP (continuous positive airway pressure) is a primary form of treatment for OSA.  CPAP is an electronic device which pressurizes room air and gently sends it down the throat via a mask to keep the airway open all night.  If properly used, CPAP stops the snoring and breathing pauses, deepens your sleep dramatically, and therefore makes you feel much better and more awake and alert during the day.

 

Some still think of CPAP use as a primitive, invasive, or unavoidably uncomfortable medical therapy based on what they’ve seen or heard a decade or more ago; this is unfortunate, in part because many people end up foregoing medical evaluation and treatment for their sleep apnea for many years based on an erroneous perception of what their treatment may be like.  There are now dozens of mask interfaces available, each with different sizes; the CPAP devices themselves are much smaller and quieter than they used to be, with lots of bells and whistles to make them more comfortable and easier to use.  If used properly and if you are willing to use it, CPAP can be an absolute game-changer; untreated sleep apnea can wreck your life, and proper treatment can dramatically turn things around.

Having said that, though, there are lots of potential ways for CPAP use to go wrong, causing people to have difficulties using it or to stop using it altogether.  I will write about these problems more in later posts, but one problem some CPAP users may have is dry mouth.  The majority of CPAP users don’t have substantial problems with this, but if this is relevant to you or someone you know, read on.

Presuming that your dry mouth isn’t caused by one of the problems I wrote about in yesterday’s post, and if the dry mouth started or became much worse after having started CPAP, most likely this symptom is caused by oral leak or oral breathing.  Your jaw muscles naturally tend to relax when you fall asleep.  In some cases, the lower jaw (mandible) may then drop slightly due to gravitational forces.  If you are using a nasal mask (i.e., a mask that covers your nose but NOT your mouth) or nasal pillows (i.e., soft prongs which are placed gently at the entrance of your nostrils), and if the mouth opens a little, then air from the CPAP device may then divert and escape out of your mouth.  This is obviously a problem.  The air dries your saliva, first of all, causing you to awaken more from sleep with that uncomfortable, parched, “Sahara desert” feeling in your mouth.  Just as importantly, though, if air is leaking out of your mouth and escaping into the open space instead of going down your throat the way it should be, then you aren’t being adequately treated because your airway may again be predisposed to collapse due to insufficient air pressure.  So due to sleep disruption and inadequate treatment, oral leak can lead to a perception that CPAP doesn’t work because you may still feel sleepy during the day despite CPAP use.

Oral leak is a very fixable problem.  Don’t turn your CPAP device into a very expensive doorstop because of it.  Before reading how to repair oral leak below, though, make sure you’ve determined where the dryness is; this is particularly important because people often don’t actually feel the air coming out of their mouths, because the leak happens while they’re asleep (when you awaken your muscles abruptly regain their tone and the mouth usually closes).  If the sensation of uncomfortable dryness is in the nasal passages and/or the back of the throat, but NOT in the mouth, oral leak is probably NOT the problem; I would suggest increasing the heated humidity in your CPAP device if this is the case.  However, if the dryness is clearly localized to the mouth chamber–with a pasty sensation in the mouth, for example, a feeling of having to “peel” your tongue from the roof of your mouth, dryness of the lips and teeth–oral leak is then likely the cause.

1.  If you’re using a nasal mask or nasal pillows and you like your current setup, a chinstrap is usually effective.  When wrapped gently around the head, it mechanically keeps your mouth gently closed.  It does not need to placed tightly; it should be just secure enough to be effective, but not so tight it’s uncomfortable.  People usually become accustomed to chinstrap use pretty quickly.  Many straps are made of thin neoprene.  However, particularly for my patients who are more heavyset or who have larger neck circumferences, I prefer a “deluxe” or “heavy-duty” chinstrap, which is wider and made of less stretchy material and therefore more likely to be effective.  An added bonus:  in some cases chinstrap use can be temporary; over time you may find that tendency toward oral leak has stopped after having discontinued the use of the strap.

2.  Another way of addressing oral leak is with the use of a full face mask, which covers both the nose and the mouth.  There are now many different full face masks available on the market.  Potential issues with full face masks, however:  since they’re larger masks, they may be more prone to leak than smaller masks; also, they don’t keep the mouth from opening, so you can still have some dry mouth if air continues to go in and out of your mouth (though usually substantially better).  Try increasing the heated humidity (which usually comes standard) in your CPAP device should this be the case.  But if you’re already using a nasal mask or nasal pillows and you’re comfortable with your current setup, a chinstrap usually does the trick with relative ease.

3.  Finally, as mentioned in yesterday’s post, addressing problems causing decreased airflow through the nose (such as seasonal allergies, hay fever, sinusitis, or anatomic nasal disorders) may well reduce the tendency to open the mouth during sleep.  Consider a visit to your primary care physician or an ear, nose, and throat doctor should you have symptoms that suggest such problems.

Sleep well tonight, everyone, and stay warm!

“Why is My Mouth So Dry at Night?”

Many of us have experienced this problem at one point or another during our lives:  awakening with that nasty sensation of uncomfortable dryness in the morning.  Your saliva–or what’s left of it–feels like paste; there’s that funky, faintly cheesy taste in your mouth that you’re sure doesn’t smell good either.

 

Dry mouth, or xerostomia, can be a particular problem at night.  Saliva is necessary to protect and lubricate the structures of the mouth and throat, as well as their fragile mucosal linings, from friction, foreign particles (food), and virulent organisms (viruses and bateria).  While sleeping, your salivary glands naturally and normally slow down production of this saliva, and so in some respects it may be natural to awaken feeling like your mouth is a little dry.  In some, however, dry mouth at night or in the early morning can be a substantial problem and a source of genuine discomfort; the words “Sahara desert” and “bone dry” are often used by my patients, for example, to describe this unpleasant sensation.

There are a number of potential causes for substantial dry mouth.  Aging into your 70’s and 80’s, for example, often further slows down saliva production.  Dehydration and metabolic imbalances may cause dry mouth as well.  Certain medical disorders, such as Sjögren’s Syndrome and lupus, often are associated with dry mouth, as are a variety of different medications, such as antihistamines, certain blood pressure lowering drugs, diuretics (“water pills”), and anti-depressants.

Another important thing to think about is whether your mouth is open while you are sleeping.  For many open-mouth breathers, the lower jaw (mandible) may naturally fall a little due to a combination of gravitational effects and jaw muscle slackening while asleep; some may be predisposed to this tendency more than others, and other factors–like body weight, neck circumference, and body position(s) of sleep–may influence mouth opening during sleep as well.  However, it’s important to know if there are other problems that may cause chronic mouth opening during sleep as well, in particular things that can cause nasal congestion or other decreases in airflow through the nasal passages–such as chronic allergies, a substantially deviated nasal septum, and sinus infections.  It stands to reason that if you can’t breathe properly through your nose, your mouth may be more likely to open during sleep to maintain proper airflow.

Another problem is that obstructive sleep apnea (a breathing disorder in which the airway collapses during sleep) is commonly associated with open-mouth breathing and, hence, mouth dryness and throat and oral irritation at night or in the morning.  People with sleep apnea often snore loudly.  Now keep in mind that you can snore with your mouth or closed (try simulating snoring with your mouth open and then with your mouth closed; you’ll see what I mean), but the snoring is generally louder with your mouth open.  As a result, sleep apnea can be more noticeable to a bed partner, because the snoring is more bothersome and the loudness of the snoring provides a greater sound contrast when you sound like you stop your breathing during sleep (which is what the sleep apnea does, due to blockage of the upper airway).  So as a clinician, I actually look at the open-mouth breathing as, in a paradoxical way, a good thing:  it makes the sleep apnea more bothersome to both the patient and the bed partner, thus making it more likely to be brought to the attention of a physician (studies demonstrate that in the United States, about 85% of sleep apnea cases are still not yet diagnosed!).

So here are my first take-home points of 2014!  I recommend that you consider these possibilities if you frequently awaken with xerostomia.  Bring symptoms consistent with reduced airflow through your nose to the attention of your doctor when you speak with him/her about the dry mouth.  If your oral symptoms are accompanied by a history of substantial snoring, and certainly is someone is telling you that you sound like you’re also stopping your breathing during your sleep, I strongly urge you to discuss these important issues with your doctor and consider an evaluation by a person like me, a physician who specializes in sleep medicine.

Have a great week, everyone!

 

Are You Ready For Some Football?

Indulge me for a moment.  Walk outside, stand quietly, and take in a deep breath.  What do you smell?  What is that that you sense?  You know what it is.  It’s the coming fall.

I love autumn.  Always have.  Even though I’ve been (thankfully) out of school for many moons now, the fall season to me is still all about the start of the new school year (now for my kids), intellectual beginnings and renewals, new activities, a prelude to colder weather and the holiday season, and, of course, that great American institution, football.

 

 

Truth be told, I’ve always been more of a basketball fan than a football fan, but I thoroughly enjoy a good gridiron game now and then.  Our Seattle Seahawks are lookin’ great this year, but I have mixed feelings and loyalties regarding the upcoming preseason rematch with the Green Pay Packers, my first NFL love (having spent 5 years of my childhood in south central Wisconsin).  Admittedly, what I love more than the game itself is the feeling of football season:  those bright crisp autumn days, the stadiums, the pulse of the marching band (in which I participated all through high school), tailgating parties, communion with close friends while rooting for our team.  That nondescript but powerful feeling remains part of why autumn has always been my favorite season.

Why is football pertinent to a discussion regarding sleep, other than sleepless nights from all the excitement?  Football players–particularly defensive and offensive linemen–have a particularly high risk of having obstructive sleep apnea, a breathing disorder in which prolonged pauses in breathing–due to closure of the upper airway–are followed by brief arousals from sleep, thus leading to symptoms such as nocturnal sleep disruption and substantial daytime sleepiness and fatigue.  Unfortunately, untreated sleep apnea increases the risk for developing heart disease, high blood pressure, and sudden cardiac death during sleep.  Reggie White, for example, was a Green Bay Packer whose tragic, unexpected death at 43 years of age has been attributed to sleep apnea.

 

People often–and mistakenly–presume that you need to be obese to have sleep apnea.  Though certainly it is true that being overweight increases your risk of developing sleep apnea because of increased soft tissues surrounding your airway, you don’t need to be obese to have the problem.

Many or most college and professional football players are not necessarily obese, per se, but they tend to be big people, obviously, often with large necks due to hypertrophied neck strap muscles.  In general, having a big neck does increase your statistical risk of developing or having sleep apnea.  In a clinical setting, the magic number is 17:  adults with shirt collar sizes of 17 or higher are at increased risk.

 

Earlier this month, the American Academy of Sleep Medicine announced its campaign to raise awareness of sleep apnea in football players.  CBS Sports college football analyst Aaron Taylor (also formerly a Packers player) is helping the AASM get the word out regarding the importance of diagnosing and treating sleep apnea:  he himself has been diagnosed with this disorder, and he has enjoyed substantial clinical benefit from being treated.  I appreciate the fact that Mr. Taylor is encouraging athletes to consider sleep apnea diagnosis and management.

 

To read more of Taylor’s story, click here:

http://www.sleepeducation.com/news/2013/08/08/aaron-taylor-warns-young-football-players-to-be-aware-of-sleep-apnea-risk

The take-home point here tonight is that certain athletes are at risk of having sleep apnea–such as football players and wrestlers–in part related to increased neck size, even if not due to fat.  If you know someone who is a football player, and if that person is a loud snorer who tends to feel tired and sleepy during the day, it may well be beneficial for that person to seek medical attention.  Treating sleep apnea can result in dramatic improvements in levels of energy and wakefulness during the day, and may even improve muscular strength and athletic endurance.  Then, hopefully, everybody wins:  players, families, teams, and fans!

It should be a great football season, y’all, and not a bad prelude to Jayhawk basketball!  Cheers, everyone!