WHAT'S HAPPENING: CHRONIC ILLNESS & SLEEP

After a brief hiatus, SleepyHeadCENTRAL's popular feature, This Week in Sleep News, returns today with a curation of news stories appearing since June 1 which highlight the relationship between sleep and chronic illness.

Sleep Health Related Awareness Events in June

Mens Health Month puts out the call that men need to address their medical issues, including those that cause problems with sleep health, such as smoking and drinking, overeating, and medical conditions such as Obstructive Sleep Apnea (OSA), which leads to heart disease, stroke, depression, hypertension, and diabetes if not treated; and REM Behavior Disorder (RBD), which is a potentially dangerous parasomnia which also be an early warning sign of Parkinson's Disease.

Great Outdoors Month celebrates America's natural spaces in a way that can be very good for sleep health. Human circadian rhythms are set by the seasons and the cycles of day and night, and our ability to function requires adequate exposure to natural sunlight during the day, followed by quality darkness at night as we sleep. If your sleep patterns are out of whack, one of the most pleasant ways to help reset them is to go camping for a couple of nights.

PTSD Awareness Month helps bring awareness to those who have suffered from trauma during childhood, in violent situations like car accidents or crimes, or while serving in military or service roles where traumatic events have occurred. Learn how PTSD can seriously disrupt sleep health here.

Migraine and Headache Awareness Month strives to help people understand how migraines and other forms of chronic headache can be potentially disabling. Research shows that migraines may be caused by sleep problems or sleep medications, and those who suffer from sleep-breathing disorders often encounter daily headaches upon awakening every morning. Sleep deprivation and insomnia are also conditions which lead to chronic and often debilitating headaches.

Health Awareness Campaigns for May

May is...

National Mental Health Month - Because sleep and mental health go hand in hand

National Asthma and Allergy Awareness Month - It's hard to sleep if you can't breathe

American Stroke Month  - Untreated sleep apnea can lead to this

Older Americans Month  - Our sleep needs change as we age

May 3-9: Children's Mental Health Awareness Week
Bad sleep habits start at a young age; so do sleep-related mental health problems

May 10-16: National Womens Health Week  - Women need more sleep than men

JUST BREATHE: What happens if I don't treat my sleep apnea?

This is a common question asked by patients in the sleep lab who learn they have been diagnosed with obstructive sleep apnea (OSA).

They discover that they must commit to lifestyle changes and therapies in order to overcome their disorder. This is not easy news to take in a world where we expect to fix everything with a pill or a shot. 

It may seem that wearing a therapeutic PAP mask or oral device to bed at night, or opting for an invasive surgical procedure, or embarking upon a major weight loss kick or a challenging new exercise regimen are extreme solutions for a problem they don't think of as dangerous. These patients may even equate sleep apnea with snoring. 

Snoring is annoying, sure, embarrassing, but could it really be that bad? 

Snoring, itself, may or may not be all that bad. But obstructive sleep apnea, which may also (and usually does) include snoring, is not merely a bad case of snoring. It is a dangerous condition that, left untreated, will lead to a lifetime of health woes and a shorter life span.

When you lie down to sleep, your upper airway requires enough space for your body to inhale and exhale air. This air, introduced as oxygen (O2) molecules into the lungs through the tiny air sacs called the alveoli, brings much needed oxygenation to your red blood cells. These little rafts whisk oxygen molecules away to every nook and cranny in the body in order to help maintain important chemical balances, heal wounds, nourish tissues and cleanse your body at the cellular level. You need every last one of those O2 molecules for the body to work in tip-top shape. 

If you go without adequate oxygen during the day, you simply take a breath and balance is restored. However, at night, while sleeping, your body is essentially working in autopilot. If your upper airway collapses while you sleep, it blocks that important inhalation (or exhalation) of air, and your blood cells cannot do their job. You really can't expect to stay healthy if, night after night, you are not getting adequate oxygen to your bloodstream. Eventually, the body will begin to break down, fail to heal, and fall into disease or dysfunction.

When you have sleep apnea, systemic inflammatory responses take place throughout the body (pain, swelling) and several body systems suffer the impact of the loss in blood oxygenation caused by this simple mechanical failure of the upper airway to allow air into the lungs while you sleep. 

This is what COULD happen if you don't treat your sleep apnea. 

The cardiovascular system: When your blood loses oxygen repeatedly over the course of the night, this creates oxidative stress on the heart and leads to sustained elevations in blood pressure (hypertension). Heart attacks, atrial fibrillation, other heart arrhythmias, congestive heart failure, atherosclerosis ("hardening of the arteries") and chronic vascular disease are all potential hazards of leaving OSA untreated. Stroke is also one of the greatest potential risks that a person with sleep apnea faces if they ignore this condition.

The endocrine system: When it comes to metabolism, obstructive sleep apnea can lead to many different problems. Obesity is perhaps the most notable health condition linked to OSA, but many don't realize that Type 2 diabetes mellitus has a confirmed relationship to untreated sleep apnea. When the blood's oxygen levels dip dangerously below normal, this creates a sympathetic response in the body that leads to the maintenance of higher-than-usual levels of adrenaline in the blood over several hours every night. This shift in blood chemistry leads to problems with insulin sensitivity and/or resistance and with glucose tolerance. Polycystic ovary disease is related to the higher insulin resistance that occurs in women who have untreated OSA. Middle-aged adults with this sleep breathing disorder also risk developing acromegaly, a condition in which too many growth hormones are released into the bloodstream, leading to excessive growth in the soft tissues in the upper airway. Chronic edema (swelling) can also occur as a result of chemical imbalances in the body, which then can serve to further perpetuate the mechanical disruptions caused by sleep apnea, as the body's fluids are redistributed across the body while supine, leading to additional swelling in the soft tissues of the upper airway which cause its mechanical collapse. Finally, hypothyroidism has also been linked to obstructive sleep apnea.

The brain: The repeated drops in blood oxygen saturation overnight have been shown to cause damage to the mammillary bodies in the brain, which leads to the same short-term memory loss and daytime confusion that plagues chronic alcoholics and those suffering from Alzheimers. It can also lead to significant reduction to both the brain's white and gray matter, resulting in measurable impairments in cognition, mood and alertness. Emotional imbalances are also a side effect of obstructive sleep apnea: irritability, secondary depression and the worsening of preexisting mood disorders can result.

The respiratory system: Smokers, you are probably not breathing well even while you sleep if you have apnea; chronic obstructive pulmonary disease (COPD) is positively linked to untreated OSA. So is pulmonary hypertension. OSA has also been shown to be an independent risk factor for worsening preexisting asthma.

The reproductive system: Women with untreated sleep apnea have been shown to suffer from impaired ovarian function; men with untreated sleep apnea may suffer from "low T," or reductions in testosterone, as well as low sperm counts.

The urinary system: For some, the failure to treat OSA may increase the frequency of overnight urination, not necessarily due to overactive bladder but to the stress response that corresponds with the frequent awakenings caused by apneic episodes. Many people who wake up feeling the need to use the bathroom may not actually have full bladders, but their body chemistry has been forced into a wakefulness that signals for the body to void the bladder. Sleep apnea also occurs at a significantly higher rate in people with chronic kidney disease (between 50 to 90 percent). 

If you have been diagnosed with sleep apnea, please take your doctor's orders seriously and seek out treatment. There are numerous treatments available; if you fail at one, try another. Your body will thank you later, and so will your loved ones, and you will feel better and live longer.

SOURCES

American Academy of Sleep Medicine || Brain damage caused by severe sleep apnea is reversible
Endocrine Society || Endocrine Aspects of Obstructive Sleep Apnea
Health.com || Sleep Apnea May Damage Brain Cells Associated With Memory 
Healthday || Sleep Apnea Linked to Kidney Disease Progression in Diabetics
Huffington Post & The Stanford Center for Sleep Sciences and Medicine || What Untreated Sleep Apnea Means for your Blood Pressure 
Journal of Clinical Sleep Medicine || Obstructive Sleep Apnea and Asthma: What are the links?
Lung || Chronic lung disease in the sleep apnea syndrome
Mayo Clinic || Sleep apnea complications
Renal Support Network || Sleep Apnea and Kidney Disease
SCOPE/Stanford Medicine || Sleep apnea linked with male infertility
SLEEP || Obstructive Sleep Apnea Syndrome is Associated with Overactive Bladder and Urgency Incontinence in Men
Sleep Better, Live Better Blog || How Does Sleep Apnea impact the brain?