SLEEP APNEA AWARENESS WEEK || Diagnosing Sleep Apnea

In case you missed it || What SleepyHeadCENTRAL has already posted about Diagnosing Sleep Apnea

• Apnea is treatable, but you need a diagnosis first
• Be on the lookout for insomnia's secret cousin: untreated OSA
• Do you have insomnia... or do you have sleep apnea?
• Suspect your snoring sleep partner might have apnea? Check these five signs (video)

SLEEP APNEA AWARENESS WEEK: OSA Basics

In case you missed it || What SleepyHeadCENTRAL has already posted about OSA Basics

• ABCs of Sleep || A is for Apnea
• Edward Grandi on Sleep Apnea: What is it and what can I do about it?
• "Heard About Sleep?" APNEA... If not, listen in here (music video)
• Hope2Sleep's "Dangers of Untreated Sleep Apnoea" (infographic)
• JUST BREATHE... it will help you stay A.W.A.K.E.
• No, there are no magic pills for sleep apnea, and some magic pills just make it worse
• Sleep Apnea and the Brains of Women
• What happens if I don't treat my sleep apnea?

October 1st launches SLEEP APNEA AWARENESS WEEK

The American Sleep Association is hosting its annual Sleep Apnea Awareness Week, an international effort to raise public awareness about Obstructive Sleep Apnea (OSA), which takes place October 1 through 7.

OSA is a sleep disorder characterized by repetitive pauses in breathing due to mechanical obstruction of the airway. Though these airway obstructions or collapses are brief and temporary, they can persist, one after the other, over the course of the entire night, leading to a multitude of problems from hypoxemia (low blood oxygen) to exacerbation of diabetes, hypertension, increased likelihood of stroke and more.

People with OSA are more likely to have motor vehicle accidents, one of the reasons why the commercial trucking industry is asked to test its drivers regularly, as drowsy driving-related accidents happen at an alarming rate in this country and often involve commercial vehicle drivers.

OSA is not rare: it's estimated that more than five percent of all adults suffer from it, with many of them undiagnosed and untreated. About one percent of children are affected as well. Most individuals affected by the disorder are still not diagnosed.

If you suspect you or a loved one may have sleep apnea, the appropriate action to take is to discuss your observations with a physician, who will likely arrange for a sleep study in order to make an accurate diagnosis.

Treatments vary widely but the most common--and most effective--is use of a Continuous Positive Airway Pressure (CPAP) machine. Treated individuals often reclaim energy and alertness, improve their hypertension and see a reduction in complications to their health caused by OSA.

For more information

Today's #Sleeptember FACT --- Sleep apnea and the brains of women

If you're hip on your sleep knowledge, then you probably already know that obstructive sleep apnea (OSA) is not just a man's disease, but rather common in women, too.

If this is new to you, listen up: For decades it's been thought that women did not normally get OSA, but recent findings and regular clinical observation in sleep labs shows that women not only suffer from OSA, but they often do not even know that they have it.

#SLEEPTEMBER

It's not just common in obese women, either (though carrying extra weight is a major risk factor). Age, physiological structure of the cranium and jaw, pharmaceutical interactions, estrogen levels, pregnancy status, and other medical conditions can all contribute to sleep apnea.

The consequences of untreated sleep apnea for women mirror those for men, as well:

• High blood pressure
• Increased risk for stroke
• Development of heart disease
• Onset of diabetes
• Depression 

However, women with untreated OSA have been shown to actually suffer higher degrees of brain damage as an outcome when compared to their male counterparts.

In a multi-year study conducted at UCLA, "Sex Differences in White Matter Alterations Accompanying Obstructive Sleep Apnea," researchers confirmed that women, in fact, not only suffer brain damage from OSA (which is true for men, as well), but that they suffer it differently than men.

The areas in the front of the brain, which are responsible for decision-making and management of mood, were shown to have more OSA-related damage than in the same brain areas in men. This damage can lead to higher levels of depression and anxiety symptoms in women who have untreated OSA.

The differences were so pronounced in the study that its chief investigator, Paul Macey, concludes that "doctors should consider that [OSA] may be more problematic [for women] and therefore need earlier treatment in women than men."

Never assume that just because you are a slim young woman, that you are less likely to have OSA. If somebody tells you that you snore loudly and gasp or stop breathing in your sleep, take their observation seriously and consult a medical professional. Earlier treatment of hidden sleep breathing disorders like apnea is not only ideal, but critical for managing your overall health. 

Source: "Sex Differences in White Matter Alterations Accompanying Obstructive Sleep Apnea." Macey PM, Kumar R, Yan-Go FL, Woo MA, Harper RM. Sleep. 2012 December 1; 35(12): 1603–1613. Published online 2012 December 1. doi: 10.5665/sleep.2228

Today's #Sleeptember FACT --- Apnea is treatable, but you need a diagnosis first

Nearly all sleep disorders are treatable or can be managed, but some are tougher to treat than others.

What's more important to consider, however, is that many people are walking around with sleep disorders they don't ever get checked out. They know they aren't sleeping well, they know they snore loudly, they know they wake up feeling terrible every single day, but for some reason they don't mention this to their doctors.

#SLEEPTEMBER

What's more, not all doctors are tuned into sleep health as an indication of general health.  They may not always ask, "How are you sleeping these days?" But times are changing and more doctors are coming on board with the idea that treating sleep health issues can also mean treating other health issues (sometimes it's even a two-for-one kind of deal).

In the meantime, patients need to speak up.

This can be particularly true for people who have obstructive sleep apnea (OSA). Chances are pretty solid that if you are a loud snorer and you are carrying around some extra weight, you have at least mild OSA. It happens to women and men, adults of all ages, children and people with other health concerns which may lead to OSA or which may even be directly caused by OSA. 

And yet, how many are actually treating their condition?

From the authors of the 2008 article, "Epidemiology of Obstructive Sleep Apnea: a Population-based Perspective": 

Evidence suggests that a large proportion of individuals with OSA remain undiagnosed. Analysis of two large population-based studies—Wisconsin Sleep Cohort and the Sleep Heart Health Study—estimated that up to 80% of individuals with moderate or severe OSA enrolled in these studies more than a decade ago had remained undiagnosed by their physicians despite adequate access to health care.

You can't treat OSA without a diagnosis. Treatment requires a physician's prescription, which is based on laboratory results after you've had at least one sleep study and other workup. 

These simple questions from the
ASAA site are designed help you
decide whether you should see a
doctor about your sleep problems.

There's no getting around it: you cannot just go to Walmart and buy a CPAP machine that's plug and play because you think you might have sleep apnea. And how will you know how to use it anyway? How will you know how to make the most of the mask, the humidification, the ramp settings? This is one for doctors to help you with, not Dr. Google or Craigslist.

Please don't self diagnose your sleep issues; the margin of error is just too great. Instead, discuss your sleep problems with your doctor. You may have few issues or you may have surprising issues you were never aware of (and how can you be? If you are sleeping and failing to breathe, for instance, how are you to know unless somebody tells you?).

The American Sleep Apnea Association is a patient-led organization which exists to help people to understand what sleep apnea is, to encourage them to seek diagnosis and treatment and to offer them opportunities within their own communities to gather with others in live settings and talk about living with OSA.

Learn more about the American Sleep Apnea Association here:

• American Sleep Apnea Association (ASAA)
• Follow the ASAA on Facebook
• Follow the ASAA on Twitter @sleepapneaorg
• Follow the ASAA on YouTube

JUST BREATHE: "Heard About Sleep?" APNEA... If not, listen in here.

Respiratory Therapist Adrian Hunter has created this catchy song and video to spread awareness about OSA.

One of the biggest challenges in healthcare is connecting providers with patients "where they are at," especially when patients aren't willing or able to go in to the clinic. Some patients learn more about their health from friends and family than they do from doctors because they feel medical practitioners are out of reach. Others consult "Dr. Google" more often than a real MD to learn about medical problems, which can actually lead to more problems. In both situations, misinformation, dangerous advice and fear can break down a stable patient-doctor relationship, which is critical for good health outcomes. Doctors are, more than ever, tasked with finding innovative ways to engage with their patients so that they can offer them the best care possible. Using creative space in the Age of Media is one such way. The multimedia arts can be a fruitful venue where patients and healthcare professionals can connect: through books, photographs, films, comedy performances, etc. --SHC

________________

We met sleep health professional Adrian Hunter, RT, at a technologist conference in October 2014. Hunter has found a unique way to spread knowledge and awareness about Obstructive Sleep Apnea (OSA) through the multimedia arts: a sleep apnea awareness song, "Heard About Sleep," which she wrote, performed, produced and which can be seen as a video here on YouTube (and yes! that's her in the pajamas!).

She couldn't wait to play the recording from her smartphone during a break between seminars and spoke tirelessly about her dreams to use her musical background shed light on the problems of untreated OSA. We could not help but be inspired by her charm, her talent, her determination and her vision. Since our meeting, Hunter has completed her production package with a video and sought copyright protections. She has approached sleep apnea and respiratory healthcare organizations for their support and has reached out to sleep technology societies to find ways to get more people on board with her novel approach to patient education.

Adrian Hunter is just one person, but her unique effort has reached people worldwide through the powerful medium of music. And while she has produced an entertaining music video--which conveys a "soft" message--she nonetheless clearly grasps the gravity of not treating sleep disordered breathing problems. The information from her video bears this out: she recognizes that OSA is not a minor health problem in the US, but one that demands attention and treatment. The statistics on this chronic sleep disorder support her concerns:

• Twenty-five million Americans suffer from OSA and many remain untreated; that's roughly 26 percent of the entire population. 
• As many as 20 percent of all children under the age of 18 also suffer from OSA. 
• Two major longitudinal studies in recent history (Wisconsin cohort and Sleep in America) estimate that up to 80 percent of study participants who had confirmed moderate or severe OSA were still not diagnosed by their physicians despite adequate access to health care.
• Insufficient sleep is considered by the Centers for Disease Control to be a public health epidemic, with OSA contributing a critical burden. 
• Untreated OSA adds as much as $3.4 billion to medical costs annually, making it a large-scale problem economically, yet another reason to make it a subject worthy of raising awareness among both physicians and the general public. 

Healthcare providers can and have tried sending out the "hard" message for years now, that OSA is real and a huge problem for Americans, but the numbers of undiagnosed and untreated sufferers are on the rise. Maybe the "hard" message is not effective; maybe it will be the "soft" message that people like Adrian Hunter has created that will sink in and inspire awareness and change.

We had an opportunity recently to ask her more about her work to spread awareness about OSA: especially how she was able to combine her skills as both a respiratory therapist and musician.

Adrian Hunter, RT and recording artist

SleepyHeadCENTRAL: What is your current job, and how long have you been working in sleep?

Adrian Hunter: I am currently working with DME companies. I’ve been a Respiratory Therapist since 2001. I began working in Sleep in 1999. I have experience working in hospitals, sleep centers, DME companies and I am currently being treated for sleep apnea.

SHC: What inspired you to write and produce this song?

AH: As I continue to work with my patients and doctors and attend sleep-related conferences, I am reminded of the millions of people unaware and untreated for sleep apnea and other sleep conditions. So I thought of the saying, “music makes the world go around.” I love music and I love to sing so I decided to write a song; this way, people can listen and learn whether in their car, home, work, shower... anywhere.

SHC: Describe the process you followed to write the lyrics.

AH: For this particular song: one evening while watching the sports channel with my husband, I began to think about my patients and how they confide in me their concerns about family and friends who refuse to get tested for sleep apnea. I thought about what I’d say to them when setting them up on PAP devices for the first time, or what I’d say when they are noncompliant. How do I help teach people about sleep apnea? I began humming the words “sleep apnea.” I then went into my bedroom, got my pen, paper and tape recorder, sat on the side of my bed, and began writing the lyrics and putting my beats and rhythms together.

I completed my song, “Heard About Sleep” aka “Sleep Apnea Awareness Song” within two hours.

SHC: What was the performing and producing experience like?

AH: The recording session was easy for me because I diligently practiced daily, practicing sounds with my voice and beats on the keyboard before I entered the studio. I couldn’t get this song out of my mind. I knew what I was looking for. I wanted a catchy beat to help draw attention to the song. The recording process went very quickly, less than a couple of hours.

SHC: How do you hope this song will raise awareness?

AH: My hope for this song is that it will propel me into a worldwide recognition as a spokesperson and advocate for sleep apnea and other related conditions and to help improve sleep hygiene, self confidence, job performance, relationships etc.

SHC: Have you ever performed, produced or recorded other original music?

AH: I have been performing as long as I can remember. My father was a lead singer and choir director. He inspired and molded me to be the singer I am today. This is my first recording of any of my original music.

SHC: What is your challenge, now that you have a song recorded and ready to share with the world?

AH: Now that I have completed ”Heard About Sleep,” my focus is to have the opportunity to continue advocating and increasing the awareness of getting tested for sleep apnea and to also continue supporting people who are receiving sleep apnea treatment.

SHC: What do you hope will happen with your song?

AH: I hope my song will be a platform to help launch me as a spokesperson for sleep apnea and any other conditions I can be supportive of.

SHC: Would you be inspired to write other sleep health-related songs?

AH: Yes, I am inspired and encouraged to write other sleep health-related songs.

SHC: What would you say to someone who works in sleep health who is also a creative or performance artist?

AH: I encourage everyone to follow their dreams and be creative. It’s not always an easy process, but it’s worth the challenge. It is important to keep moving forward, putting one foot in front of the other, until you reach your goal.

_____________

For more information about her music video or to contact Hunter, check out her *Heard About Sleep* Facebook page or email her directly at heardaboutsleep@gmail.com.

IN CASE YOU MISSED IT: March at SleepyHeadCENTRAL.con

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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?