ABCs of Sleep || Gastroesophageal Reflux Disease (GERD)

Gastroesophageal Reflux Disease (GERD) is a condition in which acid rises from the stomach and breaches the valve separating the bottom of the esophagus from the top of the stomach. This valve, also known as a sphincter, is meant to keep stomach acid out. If it comes into contact with the stomach acid on a regular basis, it can become damaged and no longer prevent the "reflux" of stomach acid from rising back into the esophagus and even into the trachea and other parts of the upper airway. 

The highly corrosive nature of stomach acid means it will wreak havoc on other parts of the body outside the stomach as they are not lined with the heavy mucosal barrier like the stomach. If allowed to enter the airways, stomach acid reflux can lead to, trigger or aggravate respiratory disorders like chronic cough, wheezing and asthma. 

Other common complaints of GERD include chest pain; problems with the ears, nose and throat, such as postnasal drip, vocal cord damage, upper airway resistance and congestion; and inflammatory diseases like bronchitis and pneumonia, in which particles of stomach acid are accidentally aspirated (inhaled) into the lungs. 

Researchers are also looking into relationships between GERD and obesity as well as obstructive sleep apnea (OSA) as each of these conditions relates to physiologically challenged upper airways.

GERD can happen at any time of day and to nearly anyone at any age and of any size. But at nighttime, it can be especially troublesome. People laying completely flat (and especially while supine) are most susceptible to the creeping up of stomach acid. 

This can make bedtime frustrating because GERD leads to frequent awakening, requiring its sufferers to rise out of bed, take an antacid, and even sit in a chair in order to fall asleep again, as the gravity of a vertical position can help pull the acid back into the stomach where it belongs. 

However, sleeping is hardly easy or comfortable to achieve in an upright position. GERD may be a key reason why many older people sleep in reclining chairs, as they have the flexibility of raising and lowering the back of the chair to suit their issues with GERD. 

There are several things a person with GERD can do to help prevent their condition from interrupting with their nightly sleep. 


Elevate the head of the bed by 3 inches. This increases the angle of the bed enough to help use gravity to one's advantage without being too noticeable for people sleeping in bed. Individuals might consider sleeping in a reclining chair or using a wedge pillow that helps them sleep more upright. 

Quit smoking. Smoking exacerbates any issues with asthma or other pulmonary conditions that could develop as a result of GERD.

Dietary changes. Eating a low-fat diet, avoiding high acid foods, eating lighter meals at dinner and eating at least two hours before bedtime can help alleviate GERD and improve sleep quality.

Avoid alcohol. Alcohol relaxes the body's muscles, which increases the chance that the sphincter which serves to keep stomach acid out of the esophagus will lose its ability to seal. 

Sleep on your left side. This sleeping position is most likely to support the closure of the sphincter between the esophagus and the stomach; sleeping on the right side is more likely to break that important seal.

Treat GERD. There are a number of approaches to managing reflux disease; some are over-the-counter, while others are more aggressive prescription approaches that should be monitored by a healthcare professional.

Sleep Hygiene Tip of the Week: Humidify

You've got a fire in the stove. Maybe you've cranked up the heater. It's winter, right? And outside, the relative humidity plummets with a new high pressure zone, leading to high blue skies, but dry air. Bone dry. 

Having trouble sleeping? Even worse... have you noticed that is everyone in your house catching the same virus?

Here's why this could be.

A household humidity level of 43 percent or higher can significantly reduce the incidence of airborne viral infections, whereas a lower level of humidity leads to more disease transmission via coughing because... guess what? The air is too dry! You cough to encourage mucus flow, introducing more germs into the environment at the same time. 

Humidifying your household air can be done through a whole house system (very common in dry weather winter climates) or via tabletop humidifier units.

In either case, that added boost of moisture in the air is not only going to help keep you and your family healthier, it's also going to help you keep your upper respiratory system--the sinuses, the nasal passage, the tongue and insides of the mouth, even the vocal cords--soft, pliable, moist and comfortable. Even your eyes and skin will feel better.

The result? Less coughing, sneezing and sore throats throughout the season.

What's more, humidity can be the ticket for people who snore when the air runs dry. Add some moisture, et voila! No more snoring (or at least it won't be as loud)! Good not only for snorers but for people who have to sleep with them!

If you are using a humidifier, please remember that you need to keep it clean to avoid developing bacteria and mold.

For personal humidifiers, using distilled or demineralized water can help keep your humidifier cleaner longer and reduce the chances of bacterial growth. A weekly clean is easy and should do the trick. Also, look for filters that may need regular replacing.

Check with your owner's manual if you are using a whole-house humidifying system to determine its care schedule. This can include replacing filters.

Also, make sure you don't overhumidify. You can have too much humidity, even in the winter. This can lead to problems with condensation and mildewing.

The best way to check humidity is to use a tool called a hygrometer in the room where the personal humidifier is being used, or set your whole-house system to maintain a level between 40 and 50 percent.

Portable hygrometers are not hard to find: look at discount or hardware stores. There are also decorative "weather stations" many people hang on the walls of their homes that include a hygrometer along with a thermometer and barometer.

The Wisdom of Sleep || Anthony Burgess

"Snore" (2007) by blogger Sue Ling.

LAUGH and the world laughs with you; 

SNORE and you sleep ALONE. 

—Anthony Burgess, author (1917-1993)

JUST BREATHE: No, there are no magic pills for sleep apnea, and some magic pills just make it worse

Sorry, I cannot provide you a link to purchase these for your sleep apnea because they don't exist.
 

It would be so nice to just pop a pill and be done with sleep apnea, right? Except that because sleep apnea (the obstructive variety, anyway) is an issue of physiological mechanics, no pill can fix that.

(Not sure what sleep apnea is? Check out this great 3-minute video to learn how to differentiate snoring from sleep apnea.)

So there aren't any magic pills for OSA. Fine, you say. But wait! There are still plenty of drugs that can actually aggravate OSA (whether you have been diagnosed or not). This goes for all kinds of sleep disordered breathing, not just apnea.

Alcohol--Can't share this one enough. Alcohol may help you fall asleep, but you will always have a withdrawal effect a couple of hours later, after you metabolize your nightcap, which disrupts the remainder of your sleep all night. On top of that, it relaxes the airway structures in a way that encourages them to collapse.

Muscle relaxants--Makes sense, right? You have soft tissues in your airway but you also have muscles there, too. The muscles help keep the soft tissues from collapsing. Relax those muscles and you have more chances to develop an obstructed airway when you're asleep.

Sedatives--Sleep medications play a lot of tricks on your brain to get it to fall into a sleep-like state. One of the problems with sedatives is that they interfere with the neurochemical messages that your brain processes with relation to your blood's oxygen/carbon dioxide balance. Your brain normally startles you awake so that you take a breath when that imbalance hits a certain threshold. If you are taking sedatives, it will take longer for your brain and lungs to work together to avoid this depression of the respiratory system. The result will be more apneas; if you already have OSA, the result will be more severe apneas.

Cigarettes--So maybe a smoke relaxes you at bedtime. What's the harm? It also introduces irritants into the airway which cause the tissues there to swell in response, creating obstruction.

ABCs of Sleep---C is for CPAP

A typical CPAP machine is small
enough to put on your nightstand
and includes a humidifier and
other simple adjustments.

CPAP

Continuous Positive Airway Pressure. A device for treating obstructive sleep apnea and other sleep-related breathing disorders.

____________________

CPAP is a common therapy which involves wearing a mask hooked to a machine delivering continuous air pressure in order to "splint open" the upper airway to prevent sleep obstruction. CPAP therapy is considered the gold standard for treating apneas.

This nasal mask is light enough to be
comfortable while still being an  effective
aid for improved breathing while asleep.

CPAP machines don't actually deliver oxygen to the patient airway via the mask, they just provide the right amount of pressure through the mask to keep the patient's airway "patent" or open. This kind of therapy helps keep the patient fully oxygenated while asleep, preventing a wide array of homeostatic problems such as hypoventilation, oxidative stress on the heart and hypertension. In fact, CPAP is considered a life-saving, life-altering device. Many patients have added years to their lives after using this therapy. Most patients, once adapted and compliant to CPAP therapy, report increased energy during the day and more restful sleep at night.

There are multiple versions of PAP therapies, including Bi-Pap and AutoPap, which regulate pressures through algorithms and preset programs to make the experience of breathing simpler and more comfortable for those with additional or multiple respiratory issues.

Today's CPAP therapy uses various kinds of masks to deliver the pressure, include oral nasal masks with or without chin straps, nasal pillows and full face masks. The technology has rapidly improved in recent years so that machines are far more quiet and deliver more comfortable pressure using built-in humidifiers; the masks today are also made of ultralight hospital grade silicone which is more light and flexible than previous masks.


Links to learn more:

What is CPAP? || National Heart, Lung and Blood Institute
How CPAP controls sleep apnea || Mayo Clinic (VIDEO)
Sleep and CPAP Adherence || National Sleep Foundation
AASM Recommendations for Treatment || SleepWell Solutions

____________________

*SOURCE for DEFINITIONS:
Spriggs, WH. (2010.) Glossary. In Essentials of Polysomnography (pp585-606). Sudbury, MA: Jones and Bartlett Publishers

Sleep in the Media || Video || Suspect your snoring sleep partner might have apnea? Check these five signs

Video courtesy The Alaska Sleep Clinic's Educational Web Series 
http://www.alaskasleep.com/blog/5-signs-chronic-snoring-obstructive-sleep-apnea

New Technologies || Inspire to stimulate your airway

So you've had a sleep study, determined you have OSA, tried CPAP, but couldn't tolerate it, maybe you've even tried an oral device and didn't stick with it. What else can you do?

The FDA recently approved a new implant that stimulates the nerves in the upper airway in order to keep the tissue "patent," or firm, so that it won't collapse while you sleep.

This could be a revolutionary new treatment for stubborn OSA for those people who cannot tolerate the CPAP and upper airway devices currently on the market.

University Hospitals Case Medical Center in Ohio and WellStar Paulding Hospital in Georgia are the only hospitals in the U.S. to offer this new procedure. They hope it can successfully address the needs of moderate to severe obstructive sleep apnea patients who have not been able to adapt to traditional treatments such as CPAP.

Learn more:

From the FDA website: 
http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/DeviceApprovalsandClearances/Recently-ApprovedDevices/ucm398321.htm

From CBSNews.com: 
http://www.cbsnews.com/videos/new-sleep-apnea-device-gets-fda-approval/

From Dr. Eric J. Kezirian, USC Otolaryngology
http://www.sleep-doctor.com/surgical-treatment-overview/upper-airway-stimulation/

From the manufacturer, Inspire Medical Systems
http://www.inspiresleep.com/inspire-therapy/how-it-works/

Sleep Hygiene Tip of the Week || Forget about those nightcaps

Having trouble sleeping at night after a long, stressful day? You do yourself no favors by having that alcoholic nightcap, despite popular opinion.

Alcohol has a detrimental impact on sleep architecture, it turns out. It may help you fall asleep, which is often why people have drinks right before bed. But once your body metabolizes the alcohol in the bloodstream, which takes most of the first half of the sleep cycle, a "rebound" effect occurs in which the body shifts away from deeper sleep toward earlier stages, which is in direct opposition to the kind of sleep one should normally have in the second half of the night. In essence, your body goes into withdrawal. This is true for anyone who drinks any kind of alcohol right before sleep and is not specifically a problem falling within the realm of alcoholism.

The deeper sleep cycles, stage 3 and REM stage sleep, are critical for healing. Deep non-REM sleep helps the body to repair itself physiologically at the cellular level by introducing human growth hormone (HGH) during its first cycle; however, this cycle might very well be skipped if you are still metabolizing alcohol. In REM sleep, the brain recalibrates and compartmentalizes thoughts, memories, learned ideas and experiences from the previous day. Without adequate amounts of this stage of sleep, cognitive dysfunction can develop over time which can include fatigue, memory issues, learning disabilities and an inability to process information and multitask neurologically at your normal rate. Severe issues can lead to dementia.

In addition, research has shown the relationship between alcohol intake and diminished sleep quality to be bi-directional: disturbed nighttime sleep caused by nightcaps enjoyed prior to bed increases your chances of craving future alcohol use, and alcohol itself has the potential to influence the quality of sleep you get from one night to the next.

On top of all this, if you have a sleep-breathing disorder such as sleep apnea, you can be sure to expect it to worsen over time if you are having a regular nightcap. The muscles in the upper airway lose their patency (firmness) during episodes of sleep apnea; the muscle-relaxing qualities of alcohol will only exaggerate this problem and lead to longer, more serious episodes of obstructed breathing which, over time, can become life-threatening.

SLEEP HYGIENE TIP OF THE WEEK: No one here is saying you have to quit drinking, nor is it being suggested that you abstain completely from alcohol before bed from here on out. Special occasions in our lives mean that, from time to time, we will enjoy an alcoholic drink in the evening. Our tip is to avoid drinking right before bed as a matter of habit, or as a form of sedative use; you cannot expect to be at your 100 percent cognitive best following a late night out with drinks during special occasions. In addition, you can expect a slow degeneration of cognitive dysfunction over time if you do, in fact, make it a habit.

The main takeaway? Using alcohol every night as a bedtime sedative is going to have multiple negative impacts on your health. Try to avoid it whenever possible. If you are having trouble falling asleep at night, please talk to your doctor to determine root causes for this common condition. Insomnia is treatable and definitely worth overcoming for anyone who wants to live a rich, healthy, long life. Just don't treat it with a nightcap, okay?