Sleep Apnea and Sleepiness Raises Older Adults’ Death Risk

A study in the latest issue of the journal SLEEP provides further evidence that sleep apnea should never be left untreated. Older adults have twice the death risk when excessive daytime sleepiness is paired with obstructive sleep apnea.

The study involved 289 participants at least 65 years old and with no clear signs of dementia or depression. The average age at the start of the study was about 78 years old. About three-quarters of the patients were female.

An overnight sleep study at the beginning of the study was used to diagnose participants with obstructive sleep apnea. Subjects who indicated that they felt sleepy or struggled to stay awake during the daytime at least three to four times a week had excessive daytime sleepiness.

Social security death index records indicate after 14 years nearly 55 percent of the participants died. Results show that participants with excessive daytime sleepiness combined with sleep apnea were more than twice as likely to have died. Being sleepy in and of itself did not lead to an increased mortality risk.

The lead author of the study says it’s still unclear exactly why sleep apnea and excessive daytime sleepiness increase the risk of death in older adults, but he suspects it may be related to inflammation. Cases of inflammation may increase the risk of other medical problems such as hypertension.

Obstructive sleep apnea affects nearly 20 percent of older adults. It occurs when the soft tissue in the back of the throat collapses and blocks the upper airway during sleep, causing pauses in breathing.

The study was unable to demonstrate whether treatment for sleep apnea reduced the risk of death. The Sleep Education Blog strongly recommends that anyone with moderate to severe sleep apnea seek treatment immediately.

CPAP therapy is the first-line treatment for obstructive sleep apnea, especially in more severe cases. Surgery and oral appliance therapy are also effective options for lesser cases.

If you think you may have sleep apnea, get checked out at one of the more than 2,200 AASM-accredited sleep disorders centers in the United States. Go to http://www.sleepcenters.org/ to find a sleep center near you.

Image by Nick Wilkes

Chronic Insomnia a Death Risk for Men

Consider seeking cognitive-behavioral therapy for long-term insomnia, especially if you are a male. New research shows men who consistently get less than six hours of sleep are four times more likely to die.

A long-term mortality study published in the September issue of the journal SLEEP demonstrates why identifying and treating insomnia early on should become a top health priority.

The study involved 741 men and 1,000 women with an average age of 50 years old. Researchers determined which subjects had insomnia using sleep diaries, physical exams and overnight sleep studies. About four percent of men had chronic insomnia and slept less than six hours per day.

After 14 years, more than half the male insomniacs had died. Only 9.1 percent of “good sleepers” were deceased. Death risk was even higher for men who had insomnia and diabetes or hypertension. The results were adjusted to account for risky conditions such as obesity, alcohol use and obstructive sleep apnea.

There was little difference in mortality rates for females with insomnia and "good sleepers." The authors of the study couldn’t determine why the relationship seemed to only affect men. One reason may be because they followed women for only 10 years, as opposed to 14 years.

Among all participants, one in five males died over the course of the study, while only 5 percent of women died.

Reduce your risk by aiming for the ideal amount of sleep for adults – 7 to 8 hours each night. Long-sleepers also have higher than average mortality rates, a recent study reports.

A number of other studies have also looked at the link between sleep duration and mortality. Previous findings show chronic insomnia increases the risk of type 2 diabetes and hypertension and is associated with neurocognitive deficits.

Learn more about cognitive-behavioral therapy, the leading treatment for long-term insomnia at sleepeducation.com.

Image by babblingdweeb

Study: insomnia linked to earlier death

Having any of the four types of chronic insomnia carries an increased risk of death, according to a new abstract (#0607) on display at SLEEP 2010.

The 20-year study followed tracked the health problems and sleeping habits more than 2,200 people. Each subject responded to two to three mailed surveys in 1989, 1994 and 2000. Using the social security death index, researchers found 128 study participants died prior to 2010.

Those who reported having insomnia in at least two surveys were three times more likely to have died than people who didn’t have insomnia. The risk of death only slightly differed for each of the four types of insomnia: waking up too early, getting back to sleep, getting to sleep and staying asleep.

The results were adjusted for body mass index, age, gender and other self-reported medical conditions.

Waking often to urinate linked to increased death risk

Many people every night wake up in the middle of the night for a trip to the bathroom, and in most cases they think nothing of it. When it happens multiple times a night, there’s new reason to be concerned. New research shows nocturia, or frequent overnight urination, signals a higher risk of dying.

The study released by the American Urological Association found the elevated risk applies to men and women of all ages.

Death rates were highest for men with nocturia aged 20 to 40. Women between 50 and 64 were also among the most at-risk.

The authors at the New England Research Institutes discovered the relationship by comparing mortality rates to responses about nighttime urination in a national survey conducted between 1988 and 1994.

The data was adjusted to account for a number of confounding risk factors, including diabetes, cardiovascular disease and hypertension.

The authors suggest the increased risk of death may be due to any combination of outside risk factors causing sleep disruption. In some cases using the bathroom may happen after waking up for reasons other than needing to urinate.

For instance, people with obstructive sleep apnea may wake because of a pause in breathing and make a trip to the bathroom. Individuals with insomnia may also get out of bed frequently, possibly due to anxiety.

Both insomnia and sleep apnea have been linked to higher mortality rates.

Further research is needed to determine exactly why people who frequently wake up to urinate have a higher risk of death.

Long sleepers at risk, mortality study warns against abnormal sleep lengths

The findings of a new study on sleep and mortality might make you think twice about sleeping in regularly. The long-term consequences might be dire; the study suggests people who sleep too much or too little sleep are at high risk for death.

The study published in the May issue of SLEEP adds to the chorus of warnings about the harmful effects of poor sleep habits.

Researchers analyzed pooled data from 16 previous studies. They looked at questionnaire results and death certificates.

They found short sleep duration, defined in the study as less than seven hours, raised people’s risk for death by 12 percent.

People who slept more than eight or nine hours a night were 30 percent more at risk.

Because of the limitations of the study, the researchers were unable to determine whether abnormal sleep length led to the spike in mortality or the subjects were already unhealthy therefore they slept longer.

The authors speculate those sleeping habits could be due to undiagnosed health issues. Further research is needed to find out if sleep duration is an indicator of poor health.

Insomnia, Sleep Duration & Risk of Death

A new study examined the relationship between insomnia, sleep duration and the risk of death. The results were published this month in the journal Sleep.

The study involved 3,430 ethnic Chinese adults in Taiwan. They answered questions about lifestyle and sleep in 1990 – 1991.

They reported their habitual sleep duration. They also answered the question, “How frequent is your insomnia complaint?” The four response options ranged from “no insomnia” to “insomnia nearly every day.”

The median follow-up period was 15.9 years. Deaths were identified from official death certificates. Home visits also confirmed the deaths.

Results show that 901 participants died, and 420 developed heart disease. The relative risk of death for people who reported sleeping five hours or less was 15 percent higher than in those who slept seven hours. The risk of death was 34 percent higher in people who reported sleeping nine hours or more per night.

“Our data indicate that an optimal sleep duration (7-8 h) predicted fewer deaths,” the authors wrote.

People who reported having “insomnia nearly every day” had a risk of death that was 70 percent higher than those who had “no insomnia.” They also were 78 percent more likely to have had a heart disease event during the follow-up period.

Combining sleep duration with insomnia also revealed elevated risks for “long sleepers.” The risk of death was 2.5 times higher in people with frequent insomnia who reported sleeping nine hours or more. They also were twice as likely to have had a heart disease event.

“This finding may reflect ‘nonrefreshing sleep’ for reasons other than insomnia, such as sleep apnea” wrote the authors.

A study presented at SLEEP 2009 linked mortality risk to insomnia with short sleep duration. That research team also has found that insomnia with short sleep time is a significant risk factor for hypertension and diabetes.

Read more about insomnia.

Image by Brent Ho

Life, Death & Sleep

This week the CDC reported that in 2007 life expectancy at birth reached a record high of 77.9 years in the U.S.

Women (80.4 years) had a longer life expectancy than men (75.3 years). There also was a gap between the life expectancy of whites (78.3 years) and blacks (73.7 years).

Hawaii had the lowest age-adjusted death rate of all the states. West Virginia had the highest rate. In general, states in the Southeast had higher death rates than those in other regions of the country.

The three leading causes of death were heart disease, cancer and stroke. This order has not changed since 1980. But it is likely that cancer will overtake heart disease as the leading cause of death in the U.S. at some point in the near future.

Does sleep have anything to do with life expectancy? Research has found some intriguing connections.

Numerous studies have examined the relationship between sleep duration and mortality. A recent review of the evidence linked short sleep duration with a 10-percent increase in the risk of death. Studies also have linked short sleep to an increased risk of diabetes, obesity and hypertension.

In October the CDC released new survey data about the sleep of people in the U.S. The sleep data seem to correlate with the death-rate trends described above.

Hawaii had one of the highest age-adjusted percentages of people who always got enough sleep. Southern states had higher percentages of problem sleepers. The age-adjusted percentage of people who never got enough sleep was highest in West Virginia.

A recent study found increased mortality in people with insomnia and a short sleep duration. The highest risk of dying was in men with chronic insomnia who slept five to six hours.

And studies have repeatedly found that obstructive sleep apnea is a serious health hazard. The UCLA Stroke Center reports that OSA is found in almost 50 percent of stroke patients.

People with sleep apnea have a higher risk of heart disease. And having severe sleep apnea has been linked with a much higher risk of dying.

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

Image by Robin Ducker

Use of Codeine in Children After a Tonsillectomy Can Be Fatal

According to a new case report, the use of codeine for pain after tonsillectomies can be deadly in children who have a rare gene that causes the body to metabolize the drug at a faster rate than usual.

The gene is found in about one percent of white people, but could be present in as many as 30 percent of people of African origins, notes U.S. News & World Report.

The report was released after the death of a two-year old boy with the gene, who was given codeine after having his tonsils removed.

The child, who had a history of snoring and sleep-study confirmed sleep apnea, underwent a tonsillectomy at an outpatient clinic and was taken home. He died two days after the surgery when his body produced more than twice the normal level of morphine.

Prescribing codeine for children who have tonsillectomies to cure sleep apnea can be dangerous if the surgery does not cure the disorder, as the drug can suppress breathing.

Researchers involved in the study said that the tragedy shows the importance of keeping children in the hospital for observation for at least 24 hours after the surgery to ensure that the sleep apnea is gone.

According to the AASM, obstructive sleep apnea (OSA) is a sleep related breathing disorder that is seen in about two percent of young children. It can develop in children at any age, but it is most common in preschoolers. OSA often occurs between the ages of 3 and 6 years when the tonsils and adenoids are large compared to the throat.

Learn more about childhood sleep apnea on SleepEducation.com.

Sleep Apnea Increases Death Risk

A new study published today provides strong evidence that severe obstructive sleep apnea increases your risk of death.

The study shows that the people with severe OSA were 46 percent more likely to die than those who did not have OSA. The risk of death in people with moderate OSA was increased by 17 percent.

The risk of death was even higher in men between the ages of 40 and 70; those with severe OSA were two times more likely to die than men their age who did not have OSA.

“Our study results really raise concern about the potentially harmful effects of sleep apnea,” principal investigator Dr. Naresh Punjabi said in a Johns Hopkins statement. “Such an increased risk of death warrants screening for sleep apnea as part of routine health care.”

Eight percent of men and three percent of women in the study had severe OSA. High blood pressure, diabetes and heart disease were more common in people with moderate to severe OSA.

Learn more about the study on SleepEducation.com.



Last year a study in the journal Sleep reported similar findings. People with severe sleep apnea were three times more likely to die during an 18-year follow-up period. The study also suggested that treating sleep apnea with regular CPAP use may prevent premature death.

On SleepEducation.com you can learn how CPAP therapy can be a life saver for people with OSA. You also can answer these questions to learn more about your risk for sleep apnea.

Contact an AASM-accredited sleep disorders center for help with sleep apnea.

Sleep Duration & Risk of Death

The AASM reports that most adults need about seven to eight hours of nightly sleep to feel alert and well rested during the day. But is it dangerous if you regularly get less sleep or more sleep? Does “short sleep” or “long sleep” increase your risk of death?

A new study took a look at the evidence. The systematic review analyzed data from other studies. In each study sleep duration was measured by self-report.

Sixteen studies measured short sleep and mortality. The combined results show that having a short sleep duration was associated with a 10 percent increase in the risk of death.

Why? Other research offers possible explanations. Studies have linked short sleep to an increased risk of diabetes, obesity and hypertension.

What about long sleep duration? Seventeen studies reported data on long sleep duration and mortality. The risk of death for long sleepers was increased by 23 percent; their risk of cardiovascular-related death was increased by 38 percent.

A 2008 study in the journal Sleep suggested a possible explanation for this relationship. The study involved 9,789 U.S. adults between 32 and 86 years of age.

There was no link between sleep duration and mortality in middle-aged adults between the ages of 32 and 59. But in elderly adults between 60 and 86 years of age, both short sleep and long sleep were associated with an increased risk of death.

The mortality risk was increased by 27 percent in elderly adults who reported that they usually sleep five hours or less; the risk was increased by 36 percent in older adults who reported sleeping nine hours or more.

“The relationship between sleep duration and mortality is largely influenced by deaths in elderly subjects,” the authors concluded. “Long sleep duration is unlikely to contribute toward mortality.”

Insomnia Linked to Increased Risk of Death

A study being presented today at SLEEP 2009 in Seattle, Wash., links insomnia with short sleep duration to increased mortality. This risk was found in men. The study also found an increased risk in women; but it was not statistically significant.

The study involved 1,741 adults. Their sleep was monitored in a sleep lab. Then they were followed up for 10 to 14 years.

Results show that the highest risk of dying was in men with chronic insomnia who slept five to six hours in the sleep lab. They were five times more likely to die during follow-up; men with insomnia who slept five hours or less were 4.5 times more likely to die. Controlling for depression and sleep-disordered breathing did not change the pattern.

The same research team published a related study in the April 1 issue of the journal Sleep. They reported that insomnia with short sleep time is a significant risk factor for hypertension.

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

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.

Co-sleeping, Bed Sharing & Infant Deaths

A new study reports that infant mortality rates attributable to accidental suffocation and strangulation in bed have quadrupled since 1984. The rates of these deaths increased from 2.8 to 12.5 deaths per 100,000 live births from 1984 to 2004.

Why the dramatic increase? The Washington Post reports that it could be an issue of data shifting.

There are stricter guidelines for sudden, unexpected infant deaths. As a result these deaths are being classified more carefully. Some deaths once classified as SIDS may now be classified as suffocation.

There also may be a link to a recent rise in co-sleeping and bed sharing. Another article in the Washington Post reports that bed sharing in the U.S. doubled from 1993 to 2000.

In one Georgia county three infants recently suffocated in bed. In each case reports indicate that a parent rolled onto the child while sleeping.

A recent study found a bed-sharing rate in the U.S. of 42 percent when infants are 2 weeks old. The rate was 34 percent at 3 months of age and 27 percent at 12 months.

Bed-sharing rates are much higher in some other cultures. In one study about 61 percent of Thai infants shared the bed with their parents.

A common reason for bed sharing is to make it easier to breastfeed. A study found that bed-sharing infants breastfeed longer and more often.

But research also has linked co-sleeping to an increased risk of infant death. One study found that the risk is highest with couch sharing. It also found a higher risk of death for bed-sharing infants who are less than 11 weeks old.

A study in the journal Sleep analyzed the advice provided in 39 parenting books. Forty percent opposed co-sleeping; 28 percent endorsed it; 32 percent took no position.

Different patterns of co-sleeping were recommended in the books. Some promote co-sleeping only during the first weeks or months after birth; others recommend long-term co-sleeping in a “family bed.”

An American Academy of Pediatrics policy statement recommends infant room sharing. It advises parents that infants should sleep in the parents’ bedroom and close to their bed. The baby can be brought into the bed for feeding or comforting.

But an infant should be placed on a separate sleep surface when the parent is ready to return to sleep. The sleep surface should be firm. Soft objects and loose bedding should be kept out of the crib, cradle or bassinette.

Infants always should be placed to sleep on their back.