Say Farewell to Daytime Fatigue with Surgery for Sleep Apnea

Treatment for obstructive sleep apnea can greatly improve your quality of life, the Sleep Education Blog often reports. A new study from researchers at Henry Ford Hospital shows surgery, like CPAP, can make you feel less sleepy during the daytime.

The study examined the effectiveness of three surgical interventions for sleep disordered breathing – removing excess tissue in the back of the throat, removing the tonsils and using radiofrequency waves to destroy tissue at the base of the tongue.

A group of 40 patients with mild to severe obstructive sleep apnea participated in the study. Before surgery, the patients completed the Epworth Sleepiness Test, a questionnaire that measures daytime sleepiness during various activities. All of the patients had an Epworth Sleepiness Score (ESS) of 10 or higher, meaning they were very sleepy during the day.

After surgery was completed, the patients’ average ESS dropped to 5.5. Nearly all of the patients posted dramatic improvements. Only one patient had no change in score, while two had an increase. Researchers also noted the patients had half as many pauses in breathing while they slept.

Never leave obstructive sleep apnea untreated. It can ruin your quality of life and make you feel constantly tired. Untreated OSA can also lead to other serious health problems, like heart disease or stroke.

Surgery is only one of the effective treatment options for OSA. CPAP, or continuous positive airway pressure, is the mainline treatment for the disorder, however severe. People with less severe OSA cases can also use an oral appliance to prevent the symptoms of OSA.

Photo by Julia Manzerova

Sleep & Epilepsy

A new study evaluated daytime sleepiness in people with epilepsy.

The study involved 83 people who have epilepsy. They were compared with 80 healthy controls. Participants completed the Epworth Sleepiness Scale and an overnight sleep study.

Results show that people with epilepsy had a much higher level of daytime sleepiness than controls. They also spent less time in the stages of deep, slow-wave sleep and REM sleep. These changes were unrelated to the use of antiepileptic medications.

Epilepsy is a condition that involves recurrent seizures. A seizure is a temporary disturbance in brain function. It occurs when groups of nerve cells in the brain produce abnormal and excessive electrical impulses.

The AASM reports that stress and sleep deprivation are two factors that may trigger seizures. Some types of epilepsy tend to occur only or mainly during sleep. This may cause severe sleep disruption. As a result poor sleep quality and daytime sleepiness may occur.

Sleep disorders also may worsen seizures and complicate their treatment. A study in the journal Sleep found that daytime sleepiness in people with epilepsy may be related to obstructive sleep apnea and restless legs syndrome. Treating OSA with CPAP therapy may improve seizure control.

The CDC estimates that more than two million people in the U.S. have epilepsy. New cases are most common among children and older adults.

Conditions that may lead to epilepsy include oxygen deprivation and stroke. But a specific underlying cause is unidentified in about two-thirds of cases.

A recent journal article provided an overview of sleep and epilepsy. Learn more about sleep disorders at Sleep Education.com.

Use Bedtime Routines and Relaxation Techniques to Sleep Better

A new study in the Journal of Clinical Sleep Medicine examines the strategies people use to reduce daytime sleepiness.

Taking a bath was the most common sleep management practice for both men and women; 59 percent of men and 64.4 percent of women used it. Keeping a regular sleep schedule was the second most popular tactic.

People also wound down for the night by listening to music, snacking and exercising.

The results show that taking a bath and going to bed at the same time every night were the best ways to decrease daytime sleepiness. Snacking at night made people feel sleepier the next day.

One of the study’s authors said that culture influences the way people manage their sleep.

The study, conducted in Japan, includes data from 24,686 adults who completed a national health survey.

Don’t worry if you have a few sleepless nights. It is common to suffer from occasional bouts of insomnia. Stress, irregular sleep patterns and pain can cause you to lose sleep for short periods of time. This is known as adjustment insomnia. Once the problem is resolved sleep usually returns to normal.

What are some healthy ways to get better sleep?

The AASM recommends:

• Go to bed at a regular time each night.


• Wake up at the same time each night, even on weekends.


• Avoid naps if you can during the day.


• Don’t drink caffeine in the afternoon.

Find more tips about good sleep hygiene at Sleep Education.com.

Contact an AASM-accredited sleep disorders center if you have an ongoing sleep problem.

Image by Laura Taylor

Race & Daytime Sleepiness

Are African-Americans sleepier than whites?

Both a 2003 study and a 2006 study reported that African-Americans have higher scores than whites on the Epworth Sleepiness Scale. The ESS measures how likely you are to fall asleep in eight common situations.

Why might African-Americans score higher on the ESS? It could be that they are more sleep deprived than whites; or perhaps they are more likely to suffer from sleep-disrupting disorders such as obstructive sleep apnea.

Or maybe there is another explanation. A study in the Aug. 15 issue of the Journal of Clinical Sleep Medicine investigated.

The study analyzed the ESS scores of 687 patients who were referred to a hospital-based sleep clinic; 52 percent were African-American. The results were validated in a second group of 712 adults; 57 percent of these people were African-American.

Results show that in both groups, African-Americans had higher average ESS scores than whites. Statistical adjustments were made for factors such as sleep duration, body mass index and sleep apnea severity; they had little effect on the difference.

Further analysis showed that the difference in scores may be explained by two of the ESS questions: African-Americans in both groups were more likely than whites to report excessive sleepiness on questions six and seven.

Question six of the ESS asks how likely you are to fall asleep while “sitting and talking to someone.” Question seven measures sleepiness while “sitting quietly after lunch without alcohol.”

The authors suggest that the ESS is not measuring sleepiness consistently between African-Americans and whites. If one group really were sleepier than another, then their scores should be higher on all eight questions.

So what is it that causes the difference in scores for these two questions? The authors are unsure.

They speculate that there may be cultural differences in how the wording is interpreted. Or different life experiences may cause responses to differ. They cite a 2002 study, which found that culture can affect response patterns.

The ESS was developed in Australia and published in the journal Sleep in 1991. Since then it has been translated into other languages such as Spanish, Chinese, Greek and Turkish. But the authors report that it has never been validated in an African-American population.

So does an ethnic difference in daytime sleepiness really exist? It remains unclear. But the authors conclude that studies using an objective measure such as the multiple sleep latency test could shed light on the answer.

Daytime Sleepiness Can Be a Pain

A study in the Aug. 1 issue of the journal Sleep reports that healthy people may be more sensitive to pain if they are sleepy.

The study involved 27 healthy, pain-free adults between 18 and 35 years of age. A physical exam, drug screening and lab tests confirmed that they were in good health. An overnight sleep study verified that they didn’t have a sleep disorder such as obstructive sleep apnea.

Participants were grouped as “sleepy” or “non-sleepy” based on the results of a multiple sleep latency test (MSLT). The 14 people in the sleepy group fell asleep after an average of less than five minutes during the four daytime nap sessions; it took an average of about 13 minutes for the 13 non-sleepy people to fall asleep.

All participants then spent eight hours in bed during a night at a sleep center. The following day another MSLT was conducted. Results show that the healthy, sleepy people remained sleepy even after spending eight hours in bed. They still fell asleep in less than five minutes during MSLT nap sessions.

The day after the eight-hour night in bed also involved two tests for pain sensitivity; tests were conducted at 10:30 a.m. and again at 2:30 p.m. Participants placed their index finger on a radiant heat source; then they withdrew their finger when they felt pain.

For each person a pain threshold was determined; this was the heat intensity that produced a finger withdrawal in less than 21 seconds. Then both index fingers were tested at five different heat intensities.

Sleepy people showed increased pain sensitivity – or “hyperalgesia.” At all five heat intensities they withdrew their finger faster than non-sleepy people. They also had a lower pain threshold than non-sleepy people: 83 degrees versus 90 degrees. People in both groups were more sensitive to pain in the afternoon than in the morning.

Previous studies also have linked sleep and pain sensitivity. A 2007 study in the journal Sleep found that disrupted sleep increases spontaneous pain. A 2006 study in the journal Sleep showed that the loss of four hours of sleep promotes hyperalgesia. In 2000 a study reported that 40 hours of total sleep deprivation increased pain sensitivity.

The authors state that the solution can be simple for healthy, sleepy people: Spend more time in bed each night to get more sleep. But managing sleep can be more complex in people with chronic medical problems. In this case the authors suggest that a medication or cognitive behavioral therapy (CBT) may be needed to increase sleep time.

Insomnia, Sleepiness & Quality of Life in Older Adults

A study in the Aug. 1 issue of the journal Sleep linked insomnia symptoms and daytime sleepiness with quality of life in older adults.

The study involved 3,078 adults over the age of 40. Their mean age was 62 years at baseline and 67 years at follow-up.

Results show that self-reported sleep problems were related to quality of life. An increase in insomnia symptoms was associated with a decrease in mental quality of life. Both mental and physical quality of life dropped as symptoms of excessive daytime sleepiness increased.

The study also tracked the severity of obstructive sleep apnea. It was measured objectively by overnight sleep study. OSA severity increased slightly over the five years of the study; but this change did not affect quality of life.

“Only subjective measures of sleep were associated with quality of life,” lead author Graciela Silva, PhD, told the AASM. “These findings signal to the importance of perception of quality of sleep on quality of life.”

Scores for mental and physical quality of life were lower in women. The score for physical quality of life was lower in people who were obese.

The authors report that insomnia due to medical condition is common in older adults. Treating other medical problems often will improve sleep quality.

The AASM offers these sleep tips for older adults on SleepEducation.com.

Tired & Fatigued: CPAP Improves Daytime Symptoms of Sleep Apnea

Excessive daytime sleepiness is a common symptom of obstructive sleep apnea.

But a new study in the Journal of Clinical Sleep Medicine shows that many people with sleep apnea have other complaints: fatigue, tiredness or a lack of energy. The study also shows that treating sleep apnea with CPAP therapy can help reduce all of these symptoms.

The study involved 313 people with sleep apnea. They had an average age of 55 years.

Before treatment more than half of participants complained of a lack of energy or tiredness. About 46 percent complained of fatigue; a little less than 40 percent complained of sleepiness. Women were more likely than men to report having a lack of energy.

Results show that these daytime symptoms improved in participants who reported using CPAP for five or more hours per night. The change was statistically significant for every complaint except lack of energy.

“We found that sleep apnea patients who used their CPAP regularly…had much greater success in reducing their fatigue, tiredness and sleepiness,” study author Dr. Ronald Chervin told the AASM. “This suggests that sleep apnea may be the cause of these symptoms, as it is a cause of sleepiness.”

Learn more about the warning signs for obstructive sleep apnea. Answer these questions on SleepEducation.com to learn more about your risk for sleep apnea.

Get help for sleep apnea at an AASM-accredited sleep center near you.

Obstructive Sleep Apnea & Daytime Sleepiness

Excessive daytime sleepiness is a common warning sign for obstructive sleep apnea. But not everyone with sleep apnea feels sleepy during the day.

Sleep apnea involves a wide range of severity levels. A person with mild sleep apnea may stop breathing five or ten times an hour during sleep. In contrast a person with severe sleep apnea may stop breathing 30 or more times per hour.

Each breathing pause ends when the body briefly wakes up to take a breath. The more times this occurs, the more fragmented and disrupted your sleep will be.

Mild sleep apnea should be taken seriously even if you don’t have daytime sleepiness. It can increase your risk of other health problems such as high blood pressure. It also can progress to more severe sleep apnea over time.

Answer these questions on SleepEducation.com to learn more about your risk for obstructive sleep apnea.

Get help for sleep apnea at an AASM-accredited sleep center near you.

Are “Smart Drugs” a Smart Choice for a Brain Boost?

Early results from a new study in JAMA show that it may not be smart to take modafinil as a “brain booster.” The drug may have a greater risk of addiction than it was first thought to have.

The small pilot study involved 10 healthy men. Taking modafinil increased the dopamine in their brains. Dopamine is a neurotransmitter that plays a major role in addiction.

The brand name for modafinil is Provigil. It was approved by the FDA in 1998. It is a safe and effective treatment for three sleep disorders. It improves alertness in people who have excessive daytime sleepiness from narcolepsy or shift work disorder.

Modafinil also is approved for people with sleep apnea. Some people remain sleepy during the day even while treating their sleep apnea with CPAP therapy. These people may benefit from taking modafinil along with using CPAP.

But USA Today reports that there is concern that many other healthy people are taking modafinil as a “smart drug.” Students hope it will improve their performance on an exam. Professionals may take it hoping to stay sharp on a long business trip.

Doctors can prescribe the drug for “off-label” use. Or people may buy it over the Internet.

An article in The Times of London shows that this trend is not isolated to the U.S. The New York Times also has reported on the debate in academic circles over the ethics of taking smart drugs.

In 2008 a scientific review analyzed all of the modafinil research. It reports that modafinil can improve mood, fatigue, sleepiness and cognition in sleep-deprived people. The benefit is similar to that of caffeine. But the effect may last longer.

One of the most recent studies was published in the February issue of the journal Sleep. After 44 hours awake each participant was given modafinil, caffeine or dextroamphetamine.

Each stimulant provided a cognitive boost. But the advantages differed according to the type of task being tested.

But does modafinil give healthy people who are not sleep deprived a cognitive edge? The 2008 review states that this evidence is “controversial.”

In November another journal article indicated that there is little evidence to support the use of drugs to improve learning and memory. It reports that, “So far, all clinical trials of neuroenhancing drugs have either failed or demonstrated only very limited efficacy.”

Dr. Nora Volkow agrees. She is the director of the National Institute on Drug Abuse and the lead author of the JAMA study.

"It would be wonderful if one could take a drug and be smarter, faster or have more energy," Volkow told the AP. "But that is like fairy tales. We currently have nothing that has those benefits without side effects."

Possible side effects of modafinil include headache, nausea, anxiety and sleep problems. It also can cause a skin rash or other allergic reaction.

Of course one of the best ways to give your brain a boost is to get more sleep. You don’t need to take a pill, and the only cost is your time. It may be the smartest choice of all.

Is Daytime Sleepiness an Excessive Risk for Older Adults?

Excessive daytime sleepiness is common in older adults. But is it anything to be worried about?

A new study from France may raise a few eyebrows. It links EDS in older adults with an increased risk of death.

The study involved 8,269 adults with an average age of 74 years. All of them were living in the community rather than in a nursing home. None of them had dementia when the study began.

At the start of the study almost 19 percent of participants reported having regular or frequent EDS. The study group was followed for six years.

During this time 762 people died. Of these deaths, 196 were caused by heart disease.

Results show that the older adults with EDS had a much worse survival rate. There was a 33 percent increase in their risk of death. There also was a 49 percent increase in their risk of death from heart disease.

So is EDS a symptom of heart disease? The relationship may not be so simple.

The study measured the resting heart rates of participants. Ultrasound also was used to examine the carotid artery of two-thirds of the study group. There were no differences between those with and without EDS.

Does this mean that EDS in some way triggers heart disease? The authors aren’t sure. But they suggest that EDS in older adults may not be as harmless as some might think.

They recommend that doctors should routinely screen older adults for EDS. Those who have EDS then should undergo a sleep study to look for any underlying sleep problems.

Get Sleep Tips for Older Adults from the AASM.

Sleep, Caffeine & the Starbucks Effect

Bloomberg.com reports that Starbucks stores are going to stop the continuous brewing of decaf coffee after 12 p.m. The move is part of an effort to save $400 million by September.

You’ll still be able to request a decaf coffee in the afternoon. But you’ll have to wait about four minutes for brewing time. The company reports that demand for decaf coffee in some of its stores tends to drop after noon.

This is likely due to the timing of the body’s sleep-wake pattern. A natural “dip” in alertness tends to occur in the afternoon. So it is tempting to rely on caffeine in the afternoon to fight off sleepiness.

Caffeine is a drug that is a quick-acting stimulant. It reaches a peak level in your blood in 30 to 60 minutes. But it also can stay in your system for hours. This may cause problems when you try to go to sleep at night.

A new review looked at studies of how caffeine affects your sleep. One study shows that people who don’t consume caffeine may sleep longer and have a better quality of sleep. Another study found that people may have less trouble falling asleep on days when they drink decaf coffee.

Choosing decaf is still likely to give you a small dose of caffeine. A study found that a Starbucks decaf espresso may have 3 mg to 15.8 mg of caffeine. A 16-ounce serving of a Starbucks decaf brewed coffee may have 12 mg to 13.4 mg of caffeine.

In contrast, Starbucks reports that a regular espresso may have about 75 mg of caffeine. But it’s the 16-ounce, “grande”-size Starbucks coffee that really tips the scales. It may have 330 mg of caffeine. Another study shows that this is the same caffeine content as six, 12-ounce cans of Mountain Dew. It’s also the same as two cans of an energy drink like No Fear.

Starbucks also reports that actual caffeine content can vary greatly. That’s exactly what another study found. Researchers bought a 16-oz cup of the same type of coffee from one coffee shop for six straight days. They found that the caffeine levels ranged widely from 259 mg to 564 mg.

So in the afternoon you may want to skip the coffee and choose a drink with a lower caffeine level instead. Try a soda or a cup of brewed tea. Better yet, avoid caffeine and take a quick 20-minute nap; a study shows this may be your best option for an afternoon boost.

Sleeping on the Job Proves Costly

ABC News reports that a nuclear power plant was fined $65,000 because security workers were caught sleeping on the job.

Video images of sleeping guards were recorded by a fellow guard at different times of day. A federal investigator also discovered a guard sleeping at his post.

The incidents occurred at the Peach Bottom Nuclear Plant just outside of Philadelphia. The guards are responsible for protecting the plant from a terrorist attack.

Falling asleep on the job is a clear sign of severe sleep deprivation. This is common when security guards work more than one job.

Excessive daytime sleepiness can be a sign of another sleep disorder. These include obstructive sleep apnea, restless legs syndrome and narcolepsy.

Sleepiness on the job also is a common sign of shift work disorder. The problem can be severe for people who work rotating shifts or night shifts. This forces them to be alert at a time when the body is normally asleep.

Then they have to try to sleep during the day. Daytime distractions can make this difficult. In a recent study of 163 nurses, more than 70 percent of the nurses report that they are unable to get enough sleep.

A recent study in the journal Sleep reports that night-shift workers can benefit from a realistic but strict sleep schedule. It helps them remain alert during the night shift and allows them to stay awake during the day on days off.

Subjects slept in dark bedrooms at scheduled times: 8:30 a.m. to 3:30 p.m. after the first two night shifts. From 8:30 a.m. to 1:30 p.m. after the third night shift. From 3 a.m. to 12 p.m. on the two weekend days off. And again from 8:30 a.m. to 3:30 p.m. after the final four night shifts.

They also were exposed to five, 15-minute sessions of bright light therapy each night shift. Within two hours after waking up, they went outside for at least 15 minutes of natural light exposure. But they wore dark sunglasses whenever they were outside.

The schedule enabled them to perform well at work and sleep well at home. Contact an AASM-accredited sleep center if you are sleeping on the job or struggling with a shift-work schedule.