Study shows high rate of truckers with undiagnosed sleep apnea

Truck drivers are not the best judges at diagnosing their own sleep apnea, a new study reports. Research showed that self-diagnosis and symptom reports fell far short of determining sleep apnea when compared to home testing. Only 4 percent of 517 commercial vehicle drivers in Australia reported an earlier diagnosis of sleep apnea. The study found another 41 percent when drivers were tested with home monitors.

Obstructive sleep apnea (OSA) has been associated with a higher risk of motor vehicle crashes. In December, the Federal Motor Carrier Safety Administration (FMCSA) announced new rules for the maximum hours of work per shift and mandatory rest periods for truck drivers. The FMCSA reduced by 12 hours the maximum number of hours a truck driver. Truck drivers also were mandated a break of at least 30 minutes after every eight hours worked.

The truckers in the Australian study worked an average of 65 hours a week. When surveyed, 40 percent of the drivers said they had trouble staying awake while driving in the last month. Of the commercial operators diagnosed with sleep apnea, less than half used continuous positive airway pressure (CPAP) therapy. CPAP is the first-line treatment for sleep apnea.

The study appears in the April edition of the journal SLEEP. Visit the Your Sleep website to find out if you are at risk for sleep apnea. Get help for sleep apnea at an AASM-accredited sleep center.

Image Courtesy KOMUnews

Sleep-disordered breathing linked with depression

Snorting, gasping or stopping breathing while asleep has been associated with nearly all depression symptoms. The Centers for Disease Control and Prevention (CDC) surveyed 9,714 Americans for a new study appearing in the April issue of SLEEP. The CDC determined that the likelihood of depression increased with the frequency of sleep-disordered breathing.

Symptoms reported included feelings of hopelessness and feeling like a failure. The association was made regardless of factors like weight, age, sex or race. The CDC study is the first nationally representative sampling to look at obstructive sleep apnea (OSA) and depression. Similar links have been made in previous studies, but in samples that were much smaller and more specific.

The study’s authors suggested that physicians screen for depression in the presence of sleep-disordered breathing, or vice versa. The said such screenings could help reduce the high incidence and under-diagnosis of both of these disorders.

Read more blog posts about sleep and depression. Or learn more about insomnia, or take a short quiz to test how well you sleep.

Snoring in infancy linked to impaired cognitive development

Two studies from Australia associate snoring in the first year of life to impaired cognitive development. Researchers suggest that lower cognitive development could become worse in these infants with age.

In the first study, 16 infants who started snoring shortly after birth were compared with 88 babies who did not snore. Infants were determined to be snorers if their snoring occurred three or more nights a week. Snoring because of a cold did not count. The results found that cognitive development was reduced in frequent snorers from the first month of life to six months.

The second study looked at 13 infants who snored frequently from the first month of birth to 12 months. These babies had significantly lower cognitive scores when compared with 78 infants who did not snore frequently.

Both studies were conducted through the University of Adelaide and University of Australia in South Australia. The research was published in the December edition of the journal Sleep Medicine.

Learn the facts about young children and sleep and about snoring. Additional stories about children and snoring are available on the Sleep Education blog.

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Sleep-disordered breathing & intimacy

Obstructive sleep apnea affects more than 12 million people nationwide. Daytime sleepiness and weight gain are usually the first symptoms that come to mind. Intimacy problems are an oft-overlooked aspect of untreated sleep-disordered breathing. Sleep apnea can cause erectile dysfunction in men and a loss of libido in women.

A recent study published in The Journal of Sexual Medicine looked at the prevalence of sexual dysfunction in women with sleep apnea. A sample of 80 women diagnosed with sleep apnea and 240 women without the disorder completed questionnaires about sexuality. Findings show female patients with sleep apnea had much higher rates of sexual problems.

A similar study conducted in 2009 used questionnaires to examine the prevalence of erectile dysfunction and sexual problems in men with sleep apnea. Almost 70 percent of men diagnosed with sleep apnea had erectile dysfunction, compared to 34 percent without the sleep disorder.

Sexual dysfunction may be linked to sex hormones such as testosterone. These hormones rise with sleep and drop when sleep duration or quality is insufficient. Brief wakings from sleep apnea secretly wreak havoc on your sleep quality, which can lower hormone levels.

Before you turn to that ubiquitous little blue triangle for help, find out if sleep apnea is causing your sex problems. The easiest way to know for sure is by getting an overnight sleep study at an AASM-Accredited Member Sleep Center. Common treatments for sleep apnea such as CPAP or oral appliance therapy can improve your sleep quality and intimacy so you won’t need to take a pill every time you want to be intimate.

Tonsillectomies help breathing problems in children

When tonsillectomies were first performed, they were mainly done as a way to combat recurrent sore throats. Yet, after a study was done in 1980, showing that only children with severe sore throats benefitted from the procedure, it was not performed as widely. However, tonsillectomies are now on the rise again.

According to the latest data from the Centers for Disease Control and Prevention, in 2006 nearly 530,000 tonsillectomies were done on children 15 and younger.

This spike is believed to be because of chronic snoring, breathing issues, and sleep problems. The tonsils are clusters of tissues located on both sides in the back of the throat. They can become enlarged and obstruct the upper airway. Almost 2 percent of children have obstructive sleep apnea according the American Academy of Sleep Medicine (AASM).

Most children see their symptoms improve within 6 months after the surgery. Tonsils have been associated with respiratory illness, sinus infections, ear disease and sleep disorders. The American Academy of Pediatrics says that before getting the procedure, children should be submitted to a sleep study so that a proper diagnosis can be made.

To find out if you or your child has sleep apnea, visit an AASM accredited sleep center to have a sleep study done.

A New Experimental Alternative to the CPAP

Continuous Positive Airway Pressure Treatment (CPAP) is the first-line treatment for sleep apnea. However, it does not work for all patients. The Medical University of South Carolina (MUSC) is testing an experimental alternative sleep apnea treatment that works by stimulating the muscles to keep the airway from closing.

The muscle stimulator resembles a pacemaker and is implanted beneath the skin in the chest. There are two leads extending from the stimulator. One goes to an electrode that is implanted on the nerve that leads to the tongue. A person’s breathing cycle stimulates the nerve.  The second lead goes to the chest muscles to detect breathing. When the person is ready for sleep, the stimulator can be turned on by a remote.

Dr. Gillespie, a sleep specialist, says that patients won’t feel the stimulation, but they may feel their tongue move forward. However, after a few days, it is not that noticeable.

The experimental surgery is being monitored as part of a trial by the Food and Drug Administration. It is only for those patients who have tried the CPAP treatment and it has not benefitted them.

To find out if you have sleep apnea, visit an AASM accredited sleep center to have a sleep study done.

Photo by: Robbie Kennedy

Mid-Life Sleep Changes May Accelerate Cognitive Decline

New research published in the journal SLEEP
shows that middle-aged adults who have negative changes in sleep duration may experience a decline in cognitive function comparable to four to seven years of aging. The findings suggest that poor sleep can accelerate the aging process and lead to dementia at an earlier age.

The study involved more than 5,400 London-based public employees ages 45 to 69. The researchers used a series of questionnaires and tests to examine the participants’ sleep habits and cognitive function over a span of approximately five years.

Results show that the study participants who began sleeping less than six hours per night scored lower on tests for cognitive reasoning, vocabulary and overall cognitive function.

People who moved to sleeping an unusually long amount of hours – more than eight per night – had an even worse outcome. Long-sleepers had lower scores on all of the cognitive function tests except for short-term verbal memory.

The reason why long-sleepers had a worse cognitive outcome is unknown because the study relied on questionnaires to determine sleep length. It’s possible that the subjects who reported more than eight hours had poor quality of sleep due to frequent wakings.

Sleep apnea has been linked to a cognitive decline that is often mistaken for dementia. People with sleep apnea may wake hundreds of times per night without even knowing it. As a result, they may feel tired and “foggy-headed” the next day. Common treatments such as CPAP can reverse the brain tissue damage caused by sleep apnea and reverse cognitive impairment.

A small decline in memory is a normal part of the aging process and is common in much older adults. As the study shows, when found in middle-aged adults, memory problems and overall cognitive decline can be a red flag for sleep apnea or unhealthy sleep habits.

Invest in your long-term health by making six to eight hours per night a priority. If you are still fatigued most mornings you may want to consult a sleep specialist and get tested for sleep apnea or other sleep disorders.

Did Sleep Medicine Help Boost U.S. Life Expectancy?

Life expectancy hit an all-time high in 2009, according to a new report from the U.S. Centers for Disease Control and Prevention. An American born in 2009 can now expect to live about 78 years and two months, a two month increase compared to 2008. Only 2.4 million Americans died in 2009, an all-time low and the 10th consecutive yearly decrease. As usual, women (80.6 years) had a longer life expectancy than men (75.7 years).

The CDC speculates that vaccinations, public health measures against smoking and better overall medical treatment for the life span improvements. Sleep medicine may be able to share some of the credit.

Deaths from heart disease, Alzheimer’s disease and diabetes – three diseases commonly associated with sleep apnea - all decreased in 2009. This raises the question, is an increase in awareness and treatment of sleep apnea contributing to these rates and helping Americans live longer?

Research shows that people with untreated severe sleep apnea are more than twice as likely to die. Even moderate cases increase the overall risk of death by 17 percent.

Diagnosis and treatment of sleep apnea may prevent countless deaths from heart disease. The pauses in breathing from untreated obstructive sleep apnea can put enormous strain on your heart. Heart disease risks associated with this include coronary heart disease, heart attack and congestive heart failure.

CPAP and other sleep apnea treatments may also slow the development of diabetes. Sleep disorders that disrupt sleep, including but not limited to sleep apnea increases the likelihood of getting diabetes.

Treatment can also limit sleep loss related to sleep apnea, which is a factor in the development of Alzheimer’s disease. CPAP also helps slow the cognitive decline of people with Alzheimer’s.

Think you might have sleep apnea? Find out by scheduling an overnight sleep study for diagnosis. it could save your life in the long run and help.

Note: The average life expectancy in the U.S. is still among the lowest of the developed western nations. The National Research Council reports that the heavy smoking in the past five decades has long figured for the slower growth in life expectancy. The national obesity epidemic is expected to offset the eventual gains from the recent reduction in smoking. Excess body weight a primary risk factor for heart disease and diabetes as well as sleep apnea.

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

Veterans Fight Sleep Apnea Well After the War is Over

As we honor the men and women who served their country this Veterans Day its important that we recognize a problem that plagues tens of thousands of vets.

U.S. Military medical experts report 1 in 5 veterans develop sleep apnea - that's four times the risk compared to the general population. More than 63,000 former troops receive treatment, and that number is bound to rise as baby boomers who served in the Vietnam War grow older.

There are a couple factors that explain why veterans have a much higher rate of sleep apnea. Wartime exposure to airborne toxins, smoke and dust can cause permanent respiratory damage, making breathing difficult. In addition, many injured or disabled troops may gain weight as they get older.

Many use their veterans benefits for treatment of sleep apnea. CPAP is the first-line treatment for obstructive sleep apnea (Continuous Positive Airway Pressure). Learn more about CPAP on Sleepeducation's CPAP Central webpage.

Image courtesy the U.S. Army

Sleep Apnea Risks Common among Hospital Patients

A large number of hospital patients may have a high risk for obstructive sleep apnea, a new study suggests. A survey conducted at Loyola University Health System found that more than 80 percent of respondents experienced some of the common warning signs of sleep-disordered breathing.

The results of the study don’t necessarily mean all of these people have sleep apnea. The only way to diagnose sleep apnea is through an overnight sleep study, conducted by a sleep medicine specialist. Instead the study indicates that these people reported some of the following risk factors:

• Loud snoring and/or pauses in breathing
• Daytime Fatigue
• High blood pressure
• Obesity
• Thick neck circumference
• More than 50 years of age
• Male Gender

157 out of 195 patients indicated they had at least three of the risk factors. Only 41 were evaluated in an overnight sleep lab. Doctors discovered 31 had obstructive sleep apnea.

Although sleep apnea is one of the more common sleep disorders, the rate reported in the study is abnormally high. This may be due to old age, obesity or overall poor health of hospital patients.

Read more about Obstructive Sleep Apnea at Sleepeducation.com.

Dedication to CPAP Takes a Positive Personality

Do you view CPAP as the machine that can save your health or is it a consequence of your lifestyle choices? How you answer may predict whether you’ll stick with CPAP or become the 25-50 percent of obstructive sleep apnea patients who leave their condition untreated.

A study in the journal Sleep and Breathing examined what types of personalities adhere to CPAP, the front-line treatment for obstructive sleep apnea.

A positive outlook plays the biggest role, researchers discovered. The ideal patient is optimistic and responsive to the rewards from treatment, such as increased energy and improved mood.Pessimists and people with strong feelings of fear and anxiety will likely have a much more difficult time in the initial stages of CPAP therapy.

The study involved 31 men and 32 women previously diagnosed with sleep apnea. Their personalities were classified using a series of personality inventories completed at the beginning of the study.

Researchers referred to each of the patient’s medical records to look at CPAP adherence. The study defined adherence as using CPAP for at least 4 hours a night for about 5 nights per week.

By comparing personality types to medical records, researchers discovered positive or negative outlook predicted CPAP adherence 3 out of 4 times.

The findings are great news for the type of people who look at the bright side of things. There’s still hope even if you see the glass as half empty. It just might take some extra work.

Doctors are increasingly referring CPAP patients to behavioral sleep specialists who can help you improve your outlook and tackle the challenges of changing your lifestyle.

Study Finds Long-term CPAP Causes Subtle Facial Changes

Canadian researchers have discovered a slight side-effect associated with the front-line treatment for sleep apnea. Long-term CPAP use can lead to nearly undetectable changes in facial structure. The changes won’t cause any health problems and the benefits of CPAP for sleep apnea outweigh any concerns, the researchers report.

Investigators at the University of British Columbia in Vancouver used X-rays to examine 46 Japanese patients with obstructive sleep apnea. The average patient had used CPAP for about three years. None said they noticed any facial changes.
The X-rays showed the patients upper and lower jaws were less prominent because of slight shifts in dental arches and incisor teeth. The change was so subtle it couldn’t cause any health concerns.

Extensive research shows CPAP can effectively treat obstructive sleep apnea and eliminate symptoms such as daytime fatigue, cognitive impairment, and erectile dysfunction. Some sleep apnea patients have a hard time getting used to wearing a CPAP mask each night, and may give up on therapy. Sleep apnea is a serious condition that should never be left untreated.

There are effective alternatives to CPAP. A special oral appliance that appears similar to a sports mouth guard helps with moderate sleep apnea. Surgical procedures can also open up the airways and eliminate sleep apnea. Weight loss and change in sleep position may reduce the symptoms of less serious sleep apnea cases. Be sure to consult a sleep specialist at an AASM accredited sleep center before taking action.

NTSB: Tired Trucker Caused Crash that Killed 10

The National Transportation Safety Board promises to turn up the pressure on the trucking industry, following a year-long investigation that ruled driver fatigue as the cause of a devastating semi crash on an Oklahoma highway. 10 people died, and five more were injured when Donald L. Creed, then 76, rammed through a line of cars stopped in traffic 90 miles northeast of Tulsa. Creed was apparently unaware and never tried to brake or swerve to avoid the stopped cars.

Investigators believe Creed only slept five hours before starting his shift at 3 a.m. He had been driving for 10 hours when he caused the accident. The Associated Press reports Creed had recently returned from vacation and was still readjusting to shift work.

Creed also had mild sleep apnea, and it’s not clear if he was receiving treatment.
The NTSB recommends federal regulators take action in response to the accident report. Measures would include require fatigue risk management program that would make sure drivers sleep before beginning their shift. The program would include sleep apnea screenings for drivers.

The Federal Motor Carrier Safety Administration is working on a similar model program that is expected to finish development in about two years. It would not be required under current regulations.

Other measures include requiring “black box” recorders for accident investigations and collision warning systems. The systems, currently available for $1,000 to $2,000, give visual and audio alerts when their truck is within 350 feet of colliding with another vehicle. The NTSB recommended the use of collision warning systems in 2001, but the devices were never required.

NTSB Chairman Deborah A.P. Hersman said in the Tuesday hearing, "The time to act on all three of these safety fundamentals is now so that this kind of horrific tragedy will not occur again."

Accident investigators claim the systems could save an estimated 96 lives each year by preventing as many as 4,700 accidents.

The U. S. National Highway Traffic Safety Administration (NHTSA) reports that drowsy driving is related to more than 1,500 deaths per year.

Perceived Control is the Secret to CPAP

The answer to sleep apnea seems so simple on the surface. Get diagnosed and get set up with CPAP, the front-line treatment for the sleep disorder.

The reality is many people give up on CPAP before seeing improvements in health, oftentimes because of comfort issues. These patients are putting their health at risk before giving the treatment much of a chance.

So what’s the secret to CPAP adherence? A new study in Sleep & Breathing suggests you have to believe in yourself. Confidence that you have control over sleep apnea will lead to quicker improvements and a better likelihood of permanently adopting the treatment.

The study involved 31 sleep apnea patients who were unfamiliar with CPAP. Each subject answered questions about knowledge, expectations and belief that their health can improve, before starting CPAP.

The patients received daily screenings for fatigue, CPAP adherence and mood during the first 10 days of treatment.

Data analysis shows patients who entered treatment with the belief that they can control CPAP saw the greatest overall benefits, including next-day improvements in fatigue and mood. Those who started treatment with inflated expectations were less likely to stick to CPAP.

Patients with less severe cases of CPAP also showed better adherence and overall daily health improvements.

Some patients may never adhere to CPAP. Alternative treatments like surgery or oral appliance therapy may be the best solution for certain people.

Never leave sleep apnea untreated. Risks include headaches, hypertension, cognitive problems associated with brain damage and even death.

Percy Harvin Sidelined Again with Migraines

After a 0-2 start to the season, things are looking bleaker by the day for the Minnesota Vikings. 40-year-old Quarterback Brett Favre is showing his age, and his primary target Sidney Rice won’t catch a pass until at least November.

The latest let-down involves the feel-good story of the NFL’s season opener. NBC’s Andrea Kremer reported mid-game that Percy Harvin found the cure for debilitating migraines. The athletic wide-receiver had sleep apnea and didn’t know it.

Harvin was diagnosed after collapsing on the field during practice last month. Numerous reports claimed CPAP treatment would solve the chronic migraines that plagued him since childhood. Harvin would be a whole new player capable of living up to his sky-high potential.

Then the news broke Wednesday that the 2008 first-round pick and future franchise wide receiver did not participate in team practice because of migraines.

Harvin’s health issues are huge blow for the Vikings, who have scored only 19 points over the first two regular season games.

Currently, it’s not entirely clear why the migraines have returned. There are two likely possibilities:

a) Harvin didn’t sleep with CPAP previous to practice

b) Something other than sleep apnea is causing the migraines

It’s disappointing that Harvin is having migraines again, but the sleep apnea diagnosis is a huge step forward for his health. After all, treatment can save his life.

Harvin’s doctors are more than likely re-evaluating his health. The Sleep Education Blog will continue to follow any developments. Look for breaking updates on Twitter: www.twitter.com/aasmorg

Thunderstorms and Obstructive Sleep Apnea

When the sky opens up and thunder and lightning come crashing down your first priority should be seeking shelter in a safe place. Worry about your CPAP machine or oral appliance later. There’s little evidence strong storms will have a noticeable effect on sleep-related breathing.

The latest newsletter from the Harvard Medical School warned readers about sleep apnea during thunderstorms. The warning is exaggerated to say the least based on the mixed findings of the study cited in the article.

Researchers at University of Washington looked at how weather-related decreases in barometric pressure affected the severity of sleep apnea. Results show only one of three measures related to sleep apnea significantly changed because of the weather.

Large drops in environmental air pressure can cause sleep apnea to worsen. Another study found sleep apnea worsened at high altitudes, where the pressure is lower.

It’s difficult to say that severe thunderstorms won’t influence sleep apnea, but the change probably won’t be great. If you’ve already been diagnosed with sleep apnea, continue to use your CPAP or oral appliance. Otherwise worry about how air pressure causes obstructed breathing only if you’re moving to Denver and you think you have the symptoms of sleep apnea.