Raphaelson Dental would like to bring high blood pressure awareness to our patients, especially women and encourage you to get your blood pressure reading. Normal blood pressure is 120/80, whereas prehypertension is defined as 120-139/80-89, with a reading of 140/90 defined as hypertension (more commonly referred to as high blood pressure). So what are the connections between women’s health, hypertension, and sleep disorders?
Check out some facts below:
Women’s health and hypertension
Source: Centers for Disease Control and Prevention:
Women are about as likely as men to develop high blood pressure during their lifetimes.
For people 65 years old or older, high blood pressure affects more women than men.
Women of African American descent have higher blood pressure than men.
Among blue-collar workers, women have a higher prevalence of hypertension than their male counterparts.
Certain types of birth control can also raise a woman’s risk for high blood pressure.
Women with high blood pressure who want to become pregnant should try to lower their blood pressure before becoming pregnant.
Expectant mothers with high blood pressure are more likely to have complications during pregnancy than those with normal blood pressure.
High blood pressure can place an expectant mother’s kidneys and other vital organs at risk, which can lead to low birth weight, preeclampsia, and preterm labor
Healthy blood pressure is critical for your overall health and well-being. High blood pressure increases the risk of having strokes, heart attacks, or developing heart disease or heart arrhythmias.
So how does this connect to your sleep patterns?
Certain sleep problems such as circadian rhythm disorders, insomnia, obstructive sleep apnea (OSA), primary snoring, restless leg syndrome (RLS), shift work disorder, and sleep deprivation can aggravate preexisting hypertension and may even lead to is developement.
Need more facts?
Snoring during pregnancy may increase the risk for both pregnancy-induced hypertension and intrauterine growth retardation. (BioMed Research International, 2016)
Preliminary data from one study suggests that obstructive sleep apnea (OSA) affects 8.1 percent of pregnant women by the second trimester, with an additional link made between OSA, hypertension, and diabetes. (BioMed Research International, 2016)
Among postmenopausal women, with symptoms of insomnia are at a higher risk of developing coronary heart disease or cardiovascular disease. (Journal of Women’s Health, 2013)
A 2006 study focused on insomnia and hypertension found that more than 60 percent of women versus less than 40 percent of men, that had coronary artery disease reported problems with insomnia; those with insomnia tended to be older and had experienced high blood pressure for longer. (Blood Pressure, 2006)
Penn Medicine is currently researching women who have pulmonary arterial hypertension who also have daytime fatigue and insomnia to determine what might be a cause of their sleep-wake problems. (Penn Medicine, 2017)
A recent meta-analysis concluded that sleep-disordered breathing is an independent stroke predictor; a separate Taiwan study reviewed gender-related differences and found a higher increase in stroke incidence among women than men, with women under the age of 35 showing the greatest risk increase. (Neurology, 2016)
Women who had sleep apnea were almost twice as likely to develop what’s known as preeclampsia, a type of pregnancy-related high blood pressure. (Obstetrics & Gynecology, 2016)
Untreated OSA leads to multiple problems in women (oxidative stress, inflammation, tissue damage, sympathetic activation and metabolic dysregulation) which predispose the body to atherosclerosis (“hardening of the arteries”). This confirms OSA as a common cause of systemic hypertension. (Journal of Sleep Medicine and Disorders, 2016)
Pregnant women with OSA have a higher risk of gestational hypertension and are more likely to undergo a cesarean section than women without OSA. (Journal of Sleep Medicine and Disorders, 2016)
Its time to connect the dots
If you struggle with daytime fatigue and sleepiness/ sleep, you may want to discuss a potential sleep disorder as the hidden culprit behind your blood pressure if it becomes high and difficult to manage. Raphaelson Dental Sleep Center can help diagnose your symptoms with a convenient home sleep study. Make an appointment today, our goal is to restore your health!
Has your child been recently diagnosed with ADHD? Do he or she sleep well, or do they toss and turn all night long? Millions of children and adults struggle with symptoms of Attention Deficit Hyperactivity Disorder (ADHD). It is a condition with symptoms of poor concentration, impulse control, organization, and memory. It can be a frustrating and difficult condition, often affecting a child’s performance in school.
What if those children diagnosed with ADHD are, suffering from another disorder — a sleep disorder? Recent studies suggest that Sleep Apnea can be the underlying problem that causes ADHD. A diagnosis of ADHD in children frequently comes about after a child displays behavioral symptoms such as Lack of focus: difficulty paying attention, problems listening, forgetfulness, disorganization; Agitation, excitable, impulsive behavior: excessive talking, inability to sit still, difficulty playing quietly, tendency to interrupt, difficulty sharing or waiting for one’s turn.
In a study published by Sleep Research Society, found that children with obstructive sleep apnea had higher rates of behavioral problems including difficulty paying attention, hyperactivity, communication problems, and aggressiveness. They were also more likely to have learning difficulties and low academic performance than those without sleep-disordered breathing.
In this large-scale study that included 11,000 children, it was found that those with sleep-disordered breathing were more likely to show signs of hyperactivity, trouble interacting with peers, and conduct issues including aggressiveness and inability to follow rules. The study examined the effects of sleep-disordered breathing on children as young as 6 months. Researchers found that very young children who experienced some form of sleep-disordered breathing were, by the age of 7, were 40-100% more likely to have behavioral problems, diagnosed as ADHD.
Often enlarged tonsils and adenoids are the most common causes of sleep apnea in children. But obesity and chronic allergies can also be a cause. People with obstructive sleep apnea have episodes when they stop breathing, because of an obstruction of the airway causing them to temporarily wake up multiple times at night. As with adults, children with sleep apnea will be tired during the day. They may have problems concentrating and might have other symptoms related to lack of sleep.
If you have been told that your child has ADHD it might be wise to have them checked out for Obstructive Sleep Apnea. Sleep apnea in children is treatable. To confirm the diagnosis, the child may get a need a sleep study. At Raphaelson Dental Sleep Center we offer a convenient home sleep study that can help diagnose these symptoms since not every child with enlarged tonsils or with loud snoring has sleep apnea. Our sleep physician will evaluate your child’s test results to rule out OSA, and we will often refer your child to an ENT for follow up treatment. We feel that surgery is often the treatment of choice for kids with anatomical factors that cause OSA such as enlarged tonsils and adenoids. Call us today if you are interested in a sleep study that can be performed in the comfort of your home.
Obstructive sleep apnea (OSA) not only has a large effect on the heart but can also alter and cause severe effects to the brain. These changes in brain matter can damage to neurons that can lead to memory loss, Alzheimer’s disease and other complications. In recent studies, it is shown that those with sleep apnea have changes of neurotransmitters in the brain.
People with sleep apnea tend to experience symptoms that include excessive daytime fatigue, shortened attention span, moodiness, shortened response time and reduced short-term recall. These are just a small range of daytime symptoms caused by lack of sleep and waking up multiple times throughout the entire night. Studies have shown that people with sleep apnea have trouble converting short-term memories into long-term ones. This memory-creating process occurs during sleep, and if you don’t sleep it leads to impaired memory formation and forgetfulness.
Sleep apnea may hasten memory and cognitive thinking declines, leading to earlier diagnoses of mild cognitive impairment and Alzheimer’s disease. On an average people with OSA were diagnosed with mild cognitive impairment (MCI) nearly 10 years earlier than those who are healthy according to New York University researchers.
Patients with Alzheimers Disease have a five times higher chance of presenting with OSA than cognitively non-impaired individuals of similar age. In addition, data also suggests that around half of patients with Alzheimers Disease have experienced OSA at some point after their initial diagnosis. The changes in cerebral blood flow and the cellular redox status in OSA patients contribute to cognitive decline and may further aggravate Alzheimer’s progression.
“This study is adding to the emerging story that sleep apnea may be contributing in some way to the acceleration of cognitive decline as you age,” said study coauthor. Dr. Andrew Varga, an instructor in medicine at the New York University Sleep Disorders Center. “And that is potentially another good reason to get evaluated and treated.”
Sleep Apnea can actually change the size of the brain. Duress caused during an apnea ( which starves the brain of oxygen) paired with chronic fatigue, can cause physical, & measurable brain damage. Researchers at UCLA compared the mammillary bodies, structures in the brain that are responsible for memory storage of several adults suffering from sleep apnea with those of healthy people. It was concluded that the mamillary bodies in the people with the sleep disorder were nearly 20% smaller.
Doctor Seung Bong Hong of the Sungkyunkwan University School of Medicine in Seoul to concluded that “Poor sleep quality and progressive brain damage induced by OSA could be responsible for poor memory, emotional problems, decreased cognitive functioning and increased cardiovascular disturbances.” In 2008, a UCLA study found significant damage in the brain’s fiber pathways and structural changes in its white matter. These are areas that regulate mood, memory, and blood pressure.
A February 2016 study published in the Journal of Sleep Research by the UCLA School of Nursing investigated the injury caused to the insular cortex of the brain by sleep apnea. It focused on the levels of two important brain chemicals, called neurotransmitters: glutamate and gamma-aminobutyric acid, known as GABA. “We actually found substantial differences in these two chemicals that influence how the brain is working,” said Paul Macey, the lead researcher on the study and an associate professor at the UCLA School of Nursing. “It is rare to have this size of the difference in biological measures,” Macey said. “We expected an increase in the glutamate because it is a chemical that causes damage in high doses and we have already seen brain damage from sleep apnea. What we were surprised to see was the drop in GABA. That made us realize that there must be a reorganization of how the brain is working.” Macey results were encouraging. “In contrast with damage, if something is working differently, we can potentially fix it.” “Stress, concentration, memory loss — these are the things people want fixed.”
There is evidence that treating sleep apnea, (with an Oral Appliance or in this particular study with CPAP therapy) can possibly return a patients’ brain chemicals back to its normal levels. According to the American Academy of Sleep Medicine, studies evaluated the effects of therapy on several subjects who had significant damage of their brain matter. However, after a year of treatment, the patients’ white matter was almost completely restored, while their gray matter had a faster recovery time of only three months. The results of several studies suggest that the early treatment of OSA, particularly in the early stages of Azlhermiers and dementia, may decelerate dementia progression (Ancoli-Israel et al., 2008; Cooke et al., 2009b; Troussière et al., 2014).
If you have symptoms of Sleep Apnea, talk to your us and find out more about testing for sleep apnea. Raphaelson Dental Sleep Center offers a home sleep study that can help diagnose your symptoms. If you’re ready to schedule a sleep study contact us now.
References:
Ancoli-Israel S., Coy T. (1994). Are breathing disturbances in elderly equivalent to sleep apnea syndrome? Sleep 17, 77–83. [PubMed]
Ancoli-Israel S., Klauber M. R., Butters N., Parker L., Kripke D. F. (1991). Dementia in institutionalized elderly: relation to sleep apnea. J. Am. Geriatr. Soc. 39, 258–263. 10.1111/j.1532-5415.1991.tb01647.x [PubMed] [Cross Ref]
Ancoli-Israel S., Palmer B. W., Cooke J. R., Corey-Bloom J., Fiorentino L., Natarajan L., et al. . (2008). Cognitive effects of treating obstructive sleep apnea in Alzheimer’s disease: a randomized controlled study. J. Am. Geriatr. Soc. 56, 2076–2081. 10.1111/j.1532-5415.2008.01934.x [PMC free article] [PubMed] [Cross Ref]
Cooke J. R., Ancoli-Israel S., Liu L., Loredo J. S., Natarajan L., Palmer B. S., et al. . (2009a). Continuous positive airway pressure deepens sleep in patients with Alzheimer’s disease and obstructive sleep apnea. Sleep Med. 10, 1101–1106. 10.1016/j.sleep.2008.12.016
Troussière A. C., Charley C. M., Salleron J., Richard F., Delbeuck X., Derambure P., et al. . (2014). Treatment of sleep apnoea syndrome decreases cognitive decline in patients with Alzheimer’s disease. J. Neurol. Neurosurg. Psychiatr. 85, 1405–1408. 10.1136/jnnp-2013-307544 [PubMed] [Cross Ref]
American Academy of Sleep Medicine
Macey, P. M., Sarma, M. K., Nagarajan, R., Aysola, R., Siegel, J. M., Harper, R. M. and Thomas, M. A. (2016),
Obstructive sleep apnea is associated with low GABA and high glutamate in the insular cortex.
Journal of
Sleep Research. doi: 10.1111/jsr.12392
http://news.health.com/2008/06/11/sleep-apnea-damage-brain-memory/
>Science Daily
>https://www.uclahealth.org/news/sleep-apnea-takes-a-toll-on-brain-function
University of California – Los Angeles. “Memory Loss Linked To Common Sleep Disorder.” ScienceDaily. ScienceDaily, 13 June 2008.
WebMD
Far too many Americans see sleep as a luxury rather than a necessity. Many of us work long hours and overbook our schedules with other activities, getting an average of 6 hours of sleep. Sleep mental and physical recharge is important for your health. However when it is time to catch some zzzs’ many people have a hard time falling asleep. Below are some natural remedies, herbs, and tips that promote a better night sleep.
The science of sleep…
When you consume tryptophan, it is converted to 5-HTP, which then turns into serotonin. The serotonin then converts to melatonin, which makes you sleepy and tells you is time to go to bed. More melatonin is produced at night, while the amount lessens with more light or in the morning. Melatonin also controls your body temperature, working with the central nervous system to sync our biological clock.
Let’s get started…
1. Cherries or Cherry Juice
Cherries are rich in tryptophan, an essential amino acid. Tryptophan converts to serotonin which then turns into melatonin.
2. Valerian Root
Valerian root is a natural sedative and sleep aid. It increases the amount of GABA (gamma-aminobutyric acid) which aids in regulating your nerve cells and has a calming effect. It is also used as a natural anxiety remedy because of these calming properties. You should be aware that Valerian Root might be a little smelly.
3. Electronics
Your bedroom is not a place to watch T.V. It’s also not intended to be your second office, it should be a place to rest. Electronics not only keep you awake and they carry stress into your room. So it’s probably best to get any form of a screen out of sight, it is clinically proven to disrupt your sleep.
4. Schedule A Routine
We are creatures of habit. Establishing a routine every night will help with an easier to transition from being awake to going to sleep. Some ideas before bedtime can include drinking a cup of warm tea or milk, taking a warm bath (consider adding some lavender into your bath for aromatherapy), or reading a chapter in your favorite book.
5. Melatonin
This can be taken in a capsule form, however many foods carry melatonin such as Cherries (like we mentioned earlier Tryptophan is converted to melatonin) and Bananas. Bananas contain tryptophan, and potassium & magnesium as well, which are also muscle relaxants.
6. Exercise
Not only will you sleep better, but you’ll have more energy throughout your day. Set up a daily routine, even if it is just walking 30 minutes a day.
7. Chamomile
Chamomile helps relax your muscles. There is a theory that a substance called apigenin can bind to GABA receptors which affect the central nervous system and sleepiness. If possible, try to use fresh flower Chamomile for your tea. You can add a little bit of honey or lemon for taste as well.
8. Aromatherapy
In a study that followed brain activity with an EEG machine, subjects that were exposed to the scent of lavender experienced better moods and their brainwaves suggested that Lavender does increase drowsiness.
9. Magnesium
Most people have a magnesium deficiency, primarily due to their poor diet. Magnesium is vital to the function of GABA receptors, which is the main neurotransmitter that calms your central nervous system and prepares you for sleep. The best way to boost up magnesium is to eat a balanced diet, however taking supplements will also help.
10 . Saint John’s Wort
Saint John’s Wort is used frequently used to help with depression but it can also aid with disrupted sleep. Its main constituent-hypericin raises the overall level of serotonin in the brain. More serotonin creates more melatonin in your system.
11. Catnip
Catnip has a sedative effect on humans. The compound responsible for this is called nepetalactone. While it can make cats wild and hyper, it has an opposite effect on humans making you relaxed, drowsy, and ready for bed. Enjoy it in the form of a warm tea before bed with a little bit of honey.
These tips are not intended to replace seeking medical attention for a sleep disorder. If you have problems falling or staying asleep for a prolong period of time you should talk to one of our dental professionals or your primary care provider about your symptoms. As we have mentioned in a previous blog insomnia and sleep apnea are linked and if let untreated can lead to serious medical consequences. Raphaelson Dental Sleep Center offers a home sleep study that can help diagnose your symptoms. It is important to seek to root cause of your sleep problem. Insomnia is one of the primary symptoms of OSA, and can only be treated with an oral appliance, CPAP or corrective surgery. Also, you should always consult with your primary physician before taking any of the herbs mentioned above.
Did you know that your personalized care at Raphaelson Dental Associates begins the moment you fill out your paperwork? Our dental family cares about you, not just a tooth or your mouth. We find that is it very important to know what is going on systemically with our patients, and sometimes we are given these clues from what we see your mouth. These clues can help us potentially save a person’s life.
Sleep Apnea awareness is becoming more relevant in the media since the terminal crash in Hoboken and the more recent accident in Brooklyn with the LIRR. We believe Sleep Apnea is not talked about enough, and that is why so many people go undiagnosed. Sleep apnea is very personal to some of our employees and their families. We have seen the negative effects it can have on a person’s health when it is left untreated and that is why we feel it is important to screen our patients for this potentially dangerous sleep disorder.
As mentioned above our personalized care starts with your paperwork- primarily your medical health history. Chronic headaches, high blood pressure, stroke, acid reflux, heart attacks, depression, and stroke have all been linked to Obstructive Sleep Apnea. If you have any of these conditions our team will dig a little deeper into your medical history and look for common physical oral signs of OSA. When the mandible (lower jaw) is pushed back; the tongue, fatty tissue of the neck, and muscles in the upper airway are also displaced backward. This causes an obstruction of the airway when a patient with OSA sleeps on their back (which happens to be the exact position they are in our operatory chairs). As dental professionals, we can see these obstructions and other common physical signs of OSA during a routine check up or dental exam. These common physical signs include heavy wear on teeth from grinding, a scalloped tongue, a higher Mallampati classification, enlarged tongue or uvula, a soft palate, and a narrow airway. During sleep, a patient with OSA clenches and grinds their teeth in order to wake up and resume breathing, which results in tooth wear. Patients with Class 3 or Class 4 Mallampati (see the picture below) usually have some form of OSA because of the small space in their throat that allows for the passage of air. A patient with a scalloped tongue is trying its best to push forward and open the airway again. When the tongue is in this state, the teeth can easily exert pressure on it to cause scallops or grooves at the edges.
If our dental professionals observe any of these physical signs of OSA and our patients experience any of its symptoms, we will refer them for a Sleep Study. A Sleep Study or polysomnography is the only way to diagnose OSA. Raphaelson Dental Sleep Center offers a convenient Home Sleep Study that measures the number of times you have stopped or reduced breathing per hour ( known as the Apnea-Hypopnea Index). It also measures the drop in your blood-oxygen levels. Keep in mind that oxygen values under 90 percent are considered low and dangerous. After you have completed your Home Sleep Study, a sleep physician will read the results to determine whether you have sleep apnea. If you have Obstructive Sleep Apnea, the sleep physician will let your know whether your results are mild, moderate or severe.
If you have any of symptoms of Obstructive Sleep Apnea please contact our office for a FREE Consultation. Common symptoms include: snoring, gasping for air, excessive daytime sleepiness, snoring, gasping during sleep, or insomnia. At Raphaelson Dental Sleep Center, our patients with Sleep Apnea are treated with an Oral Appliance. Oral appliances are custom and comfortable, they fit like a sports mouth guard or an orthodontic retainer. The oral appliance holds the lower jaw forward keeping the airway open, preventing the tongue and muscles in the upper airway from collapsing and obstructing the airway. Raphaelson Dental Sleep Center works with hundreds of medical insurance companies for Sleep Apnea treatment. Our sleep coordinators will contact your insurance company to verify medical coverage and to obtain any needed authorization prior to your treatment.
Currently, seventy million Americans have sleep disorders and sleep apnea affects at least 12 million to 18 million of them. Sleep apnea is a disorder that causes uncontrollable pauses in breathing, or shallow breaths during sleep. Snoring is a common symptom, although you may have sleep apnea even if you do not snore. Untreated, sleep apnea can be potentially life-threatening, can lead to serious medical consequences and a decreased quality of life. Pauses in your breathing cause less oxygen to make its way to the brain, overworks the cardiovascular system and other organs in your body. People with sleep apnea are triggered to wake up suddenly out of sleep and gasp for air in a Flight or Fight response. These sleep apnea episodes will wake you up from a deep sleep into light sleep stage, never allowing you to get the restful sleep you need. The multiple episodes of low blood oxygen (hypoxia or hypoxemia) can lead to sudden death from an irregular heartbeat. Sleep apnea can cause symptoms, including loud snoring, choking noises, poor sleep, and feelings of fatigue during the day. Long-term complications of sleep apnea can include an increased risk of heart disease, stroke, diabetes, obesity, depression, memory problems, viruses and sexual dysfunction. Sleep Apnea can cause accidents, learning or memory problems and a poor performance in school or at work.
Fortunately, sleep apnea can be treated with a custom oral appliance, which supports the jaw in a forward position to help maintain an open upper airway. Lifestyle changes which include losing weight, reducing inflammation, improving your diet and starting a regular exercise routine will also help prevent Sleep Apnea.
1. Oral Appliance Therapy
Sleep Appliances are worn much like an orthodontic appliance or sports mouth protector. Worn during sleep to prevent the collapse of the tongue and soft tissues in the back of the throat, oral appliances promote adequate air intake and help to provide normal sleep in people who snore and have Sleep Apnea. Oral appliances are considered first-line therapy for patients who have been diagnosed Obstructive Sleep Apnea according to the American Academy of Sleep Medicine. They are also a great alternative for patients that cannot tolerate their prescribed CPAP. The oral appliance holds the lower jaw forward keeping the airway open. It prevents the tongue and muscles in the upper airway from collapsing and obstructing the airway.
Our oral appliances at Raphaelson Dental Sleep Center are very sleek in design- consisting of smooth, durable and comfortable material. It is also one of the strongest appliances currently available, making it an ideal treatment option for all patients, especially those who clench or grind their teeth at night.
2. Maintain a Healthy Weight
When you are overweight the fat deposits around your upper airway can obstruct normal breathing. If you’re a man with a neck circumference over 17 inches (43 centimeters) or women over 15 inches (38 centimeters, you have a significantly higher risk for sleep apnea.
Obesity increases a person’s risk for Sleep Apnea and poor sleep causes obesity affecting a person’s Leptin and Ghrelin (it is a vicious cycle). Sleep Apnea is most common among adults over 45 who are overweight, especially men, but can also affect women, people of normal weight and even children.
If you’re overweight or obese start with a goal of losing ten percent of your body fat. Here are some tips that can help you:
Eat a high fiber diet: This means adding more fresh vegetables, fruit, nuts, seeds, sprouted beans or legumes, and ancient whole grains to your diet. Try to add at least 25–30 grams daily.
Eat foods that have healthy fats and high protein: Try cooking with coconut oil. It has natural fat-burning characteristics, and it benefits your gut too. Others healthy foods to add: olive oil, avocado, animal fats from lean meat, nuts and seeds. High protein foods are satisfying for hunger and help will help you build lean muscle too. Start off your morning with cage-free eggs, add some chicken to your lunch and maybe a fish to your dinner.
Get regular exercise: Exercise is not only essential to losing weight and live a healthy lifestyle but is also promotes a good sleep. It helps regulate hormones, burns calories and can break up nasal congestion. Go for a thirty-minute walk a couple of days a week. Park your car a little further from your destination. Take group classes at your local gym.
Natural oils: Grapefruit, cinnamon, and ginger oil can help control your appetite, hormones and digestive symptoms.
4. Avoid Excessive Alcohol and Smoking
Alcohol relaxes the throat muscles, including the uvula and palate, which are important for controlling breathing. Smoking and alcohol can cause inflammation and fluid retention in the airway. And just in case you needed another reason to quit, people who smoke are three times more likely to have obstructive sleep apnea. So try to stop smoking and skip your night cap. If you plan drink do it at least three hours before going to bed.
Over the counter sleep aids, sedatives, and some prescriptions can have the same effects. Keep in mind, you are still waking up at night with these over the counter and prescription sleep aids although you may not be conscious of it. They only way to get a better sleep is to treat the root problem. Also, a lot of these medications can cause you to be more groggy during the day.
5. Treat Acid Reflux, Congestion and Coughs
Acid reflux/heartburn, congestion, and chronic coughs can interfere with normal breathing. Nasal congestion leads to difficulty breathing through the nose and can worsen symptoms of obstructive sleep apnea. Acid reflux causes irritation and swelling around certain throat muscles. Coughs might also irritate your upper airways and increase snoring. Reducing exposure to allergies and raising your head while sleeping can help reduce reflux and congestion. A humidifier will help drain your sinuses and more air to move through your airways. You can also rub essential oils such as eucalyptus oil which is also found in Vicks Vaporub on your chest before sleeping to help naturally open your airways and soothe a stuffy nose or a sore throat.
Insomnia is a common sleep disorder that can make it difficult to fall asleep and stay asleep. Insomnia is also a common symptom of sleep apnea. Although many may believe that chronic insomnia is a completely separate sleep disorder from obstructive sleep apnea (OSA), there is evidence that suggest the two overlap. Clinical studies show that 39% to 58% of patients with Obstructive Sleep Apnea also have insomnia.
The link between these two sleep disorders is very strong. According to a study published by the Journal of Sleep Medicine, Dr. Barry Krakow tested 20 patients with insomnia and found 18 of the 20 suffered from sleep-disordered breathing. Eleven of those patients had Obstructive Sleep Apnea, the most common form of sleep apnea.
In studies conducted by Dr. Wickwire, (Director of Behavioral Sleep Medicine and co-director of the Center for Sleep Disorders at Pulmonary Disease and Critical Care Associates in Columbia, Maryland) it is noted that many of his patients with insomnia also have narrow upper air passageways. In addition, they are either undiagnosed for sleep apnea, or a have a condition called upper airway resistance syndrome (UARS). Upper airway resistance syndrome is very similar to obstructive sleep apnea (OSA) in that the soft tissue of the throat relaxes, obstructs the airway and results in a disturbed sleep. The difference is that the length of time of each breathing pause is not long enough to be called an actual apnea. The multiple pauses in breathing experienced with UARS causes the body to have a stress response keeping the insomniac awake and their mind racing. “There is clear evidence that patients with sleep apnea are at increased risk for comorbid chronic insomnia, and patients with insomnia suffer elevated rates of occult sleep disordered breathing,” says Dr. Wickwire.
People with insomnia have similar symptoms of sleep apnea including frequent urination during the night (nocturia), dry mouth, morning headaches, daytime sleepiness, and snoring. Unfortunately, patients and primary care physicians are not aware of the connection of insomnia with sleep breathing disorders. Consequently, many of these patients go undiagnosed for years. Patients with insomnia are often treated with sleep medications that can have potential serious side effects. Keep in mind, there is no medication that can provide a good night’s sleep if you have OSA. If you are an insomniac who wakes during the night, you should rule out obstructive sleep apnea as a possible root cause of your sleep problems.
At Raphaelson Dental Sleep Center we offer our patients a free airway evaluation to determine whether there are any obstructions in the airway that can be causing OSA and symptoms of insomnia. We also provide our patients with at convenient home sleep study that identifies and diagnoses sleep apnea. Most major medical insurances offer benefits for sleep apnea treatment and our sleep coordinators will help assist you with any questions
OSA is a condition in which breathing stops for 10 seconds or more during sleep, sometimes hundreds of times a night. This sleep disorder affects approximately 18 million people in the United States and is linked to type 2 diabetes. There are a number of factors are believed to be involved in the link between sleep apnea and diabetes, including the following:
Stress response. Repeated arousals from deep sleep and interruptions in the delivery of oxygen to the body’s tissues caused by sleep apnea lead to the stress, or “fight or flight,” response. The fight or flight response causes increased heart rate and increased blood pressure. When it occurs repeatedly over time, it is a risk factor in the development of chronic high blood pressure, insulin resistance (one of the hallmarks of Type 2 diabetes), and cardiovascular disease.
Increased cortisol levels. Sleep deprivation increases blood levels of cortisol, which increases both blood glucose levels and insulin secretion.
Inflammatory response. Sleep apnea is associated with both local inflammation of the upper airways and systemic inflammation, or inflammation of the endothelium (the lining of the blood vessels) and other organ systems.
Lack of oxygen. During apneas the level oxygen deprivation may also cause the release of pro-inflammatory cytokines—proteins involved in the body’s immune response—that are associated with glucose intolerance and insulin resistance.
There have been many years of clinical research supporting a connection between obstructive sleep apnea (OSA) and Type 2 diabetes. Now, a more recent study suggests a link between the severity of a person’s OSA and the risk of developing Type 2 diabetes.
During a study at University of Toronto, researchers observed 8,678 adults with suspected OSA who underwent a sleep study between 1994 and 2010. The severity of each person’s sleep apnea was determined by measuring their apnea-hypopnea index (AHI), which indicates the number of times a person stops breathing or breathes irregularly each hour. Based on these results, they were placed into one of four OSA categories — none, mild, moderate, or severe. After, they were medically observed through May 2011 to examine whether or not they went on to develop Type 2 diabetes.
Over the course of the follow-up 1,017 (11.7%) of the participants developed Type 2 diabetes. After adjusting study, to include other risk factors known to increase a person’s chances of developing diabetes (age, sex, body-mass index, neck circumference, smoking, and income status), people with severe OSA were found to have a 30% higher risk of developing Type 2 diabetes than people without OSA. Also, those with mild or moderate OSA were found to have a 23% increased risk of developing Type 2 compared to those without OSA. Other risk factors for diabetes included experiencing breathing difficulties during the rapid eye movement (REM) stage of sleep, low oxygen levels in the blood, sleep deprivation, and activation of the sympathetic nervous system as indicated by increased heart rate.
“After adjusting for other potential causes, we were able to demonstrate a significant association between OSA severity and the risk of developing diabetes,” Tetyana Kendzerska, MD, PhD. “The OSA-related predictors of increased diabetes risk that we found in our study may allow for early preventative interventions in these patients.”
Note: (There were some limitations of the study that included a lack of data on family history of diabetes and race.)
See the study: http://www.atsjournals.org/doi/abs/10.1164/rccm.201312-2209OC#.U5HsXS_DmKs
