Scott Robison's List: Sleep Apnea

• Desaturation = Drop in O2 oximetry distribution saturation by 3% below average  saturation.
  
• Desaturation  = Drop in O2 oximetry distribution saturation by 3% below average   saturation. 
  
  SaO2  scale: >89%=(none); 85-89%=(mild);80-84%=(moderate); <80% (severe).
  

• Don't Assume You Have to Snore to Have Sleep Apnea

• diabetes, erectile dysfunction, and depression - not to mention daytime  drowsiness, which can be deadly for drivers, pilots, passengers and others.

• Sleep apnea
  There is also new evidence that brief pauses in breathing  (apnea) during infancy may be a cause of ADHD. Dr. Glenda Keating of Emory  University presented data at the Society for Neuroscience annual meeting in  October 2004, showing that repetitive drops in blood oxygen levels in newborn  rats similar to that caused by apnea in some human infants is followed by a  long-lasting reduction in dopamine levels, associated with ADHD. Apnea occurs in  up to 85% of prematurely born human infants. (ScienceDaily  (http://www.sciencedaily.com/releases/2004/10/041025124027.htm))
  
  
• Brain development in utero and during the first year of life, possibly related  to drug use during pregnancy or environmental toxins.
  
• is due to the casomorphins, peptides formed by incomplete digestion of the whey  protein.
  

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• May 7 -- Exercising muscles in the upper airway may help improve the symptoms of  moderate obstructive sleep apnea, a randomized trial showed.
• Exercises drawn from traditional speech therapy techniques significantly  improved the severity of sleep apnea
• oropharyngeal exercises
• oropharyngeal exercise
• the training of upper airway muscles by playing the didgeridoo
• "These data suggest that the exercises were able to promote remodeling of the  upper airways

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• Sleep disorders are  conditions characterized by abnormal sleep patterns that interfere with  physical, mental, and emotional functioning. Stress or anxiety can cause a  serious night without sleep, as do a variety of other problems. Insomnia is the  clinical term for people who have trouble falling asleep, difficulty staying  asleep, waking too early in the morning, or waking up feeling unrefreshed. Other  common sleep disorders include sleep apnea (loud snoring caused by an obstructed  airway), sleepwalking, and narcolepsy (falling asleep spontaneously). Restless  leg syndrome and bruxism (grinding of the teeth while sleeping) are conditions  that also may contribute to sleep disorders.
• Does an  anxiety disorder lead to a sleep disorder, or does a sleep disorder cause an  anxiety disorder?
  
• lack of sleep stimulates the part of the brain most closely associated with  depression, anxiety, and other psychiatric disorders.
• some antidepressants  commonly prescribed for anxiety disorders may cause sleep difficulties. The  results of a study published in the July 2007 issue of Sleep suggest  that people with chronic insomnia are at high risk of developing an anxiety  disorder. 
• Most frequently those include anxiety and mood disorders, and treating each  condition impacts the course of the other.”
• at risk for heart disease, heart failure, irregular heartbeat, heart attack,  high blood pressure, stroke, and diabetes.
• www.sleepcenters.org.)
• Meditate. Focus on  your breath
• Exercise. Regular  exercise is good for your physical and mental health
• break up large projects into smaller, more easily managed tasks.

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• • periods of not breathing (apnea)  
  • awakening not rested in the morning
• abnormal daytime sleepiness, including falling asleep at inappropriate times
• • limited attention
• • memory loss  
  • poor judgment  
  • personality changes  
  • lethargy

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• Scans reveal dwindling of brain structures that store memory
• Memory loss and difficulty focusing are also common complaints.
• When they compared the results to images of 66 control subjects matched for age  and gender, the scientists discovered that the sleep apnea patients' mammillary  bodies were nearly 20 percent smaller, particularly on the left side.
• Obstructive sleep apnea occurs when the muscles in the throat, soft palate  and tongue relax during sleep and sag, narrowing the airway. The tongue slides  to the back of the mouth, blocking the windpipe and cutting off oxygen to the  lungs.

   

   

   

  The sleeper wakes up, gasping for air, and falls back into a fitful sleep.  The cycle can repeat itself hundreds of times per night.

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• The result in both cases can be the development of very significant  respiratory instability during sleep. It is not unusual in the sleep laboratory  when recording the sleep of people with irregular sleeping hours to discover  that all of their apnea is confined to Stage 1 and/or REM sleep. In our  experience for these people correction of this problem minimally requires  stabilizing bedtime hours across the week. Sometimes, this is all that is  required.
• excessive use of caffeinated products -- all of these things can also lead to  the instability of Stage 1 and REM sleep.

• Pertinent nasal problems include allergies to air-borne particles such as  animal dander, dryness of the nose because of a wood burning stove, or a septum  (structure separating the left and right sides of the nose) so deviated it  completely blocks the flow of air through one side. Often in that case, other  structures in the nose called turbinates grow larger on the unaffected side. The  result can be almost complete blockage of nasal breathing. That, in turn,  increases the effort the sleeper must make to breathe because of increased  resistance to airflow -- and it is that increased resistance which can then  create OSA.
• childhood asthma through emphysema. Apnea can also be a symptom of diabetes or  hypothyroidism.
• The overnight study might demonstrate that OSA develops only when the person  reverts to breathing through the mouth (vs breathing through the nose),  so-called obligate mouth breathing.
• Otolaryngological evaluation (by an ear-nose-throat specialist) might  demonstrate this to be caused by allergies (which should be evaluated by an  allergist) or other causes that may restrict air flow through the nose.
• rings which are placed inside the nostrils
• Breathe-Right® "bandaids

• For unclear reasons, uncontrolled diabetes can also lead to apnea.  Control of blood sugar levels has, however, in our experience had at best a  moderate effect in controlling the diagnosed obstructive sleep apnea.
• Progesterone (often marketed as Provera in the synthetic form), a female  hormone secreted at a high rate during the third trimester of pregnancy when the  growing uterus has pushed hard against the diaphragm and decreased the space  lungs have to operate in, has been used with some degree of success in men and  women alike. For perimenopausal and postmenopausal women, addition of exogenous  progesterone might be the first treatment effort.

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• • Holk, see Medications highlighted below.
• •  
  • What is Sleep Apnoea?  
  • How do I know if I have it?   
  • Wouldn't I know it if I woke up  so often?  
  • What should I do if I think I have  apnoea?  
  • I/my bedmate snore(s). Do I have  apnoea?  
  • OK, I don't have apnoea.  What can I do about my snoring?  
  • Is it dangerous? What are the  effects?
• • Allergies and respiratory infections:
    These cause nasal  congestion, which narrows the airway and contributes to apnoea. Consult your  physician for medications to treat these which will not interfere with sleep.  
     
  • Medications:  

    Many common medications interfere with either the breathing reflex or sleep  or both. Some of the most common are "sleeping pills", tranquilizers, and  short-acting beta blockers. Consult your sleep specialist about seeking  alternative medications. A list of medications that affect breathing or sleep  can be found in "Snoring and Sleep Apnoea: Personal and Family Guide to  Diagnosis and Treatment," by Pascualy and Soest, Demos Vermande Publishing: New  York, 1995

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• benefits of a quality night’s sleep including, increased energy and lowered  blood glucose levels.”