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.
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
Snoring can be a sign of a medical condition not only damaging to you health, but also to your relationship with your bed partner. All kidding aside snoring is no laughing matter (although your bed partner is probably is not thrilled about it). Snoring can be sign that your airway is not open and there can be a possible obstruction. Some snorers spend most of the night gasping for air due to a condition called Sleep Apnea. Sleep Apnea causes pauses in your breath interrupting your sleep and decreasing your blood oxygen levels. These sudden drops in blood oxygen levels during sleep apnea episodes increases your blood pressure and overworks the cardiovascular system and other major organs. If you have obstructive sleep apnea you have a higher risk of developing High Blood Pressure. Obstructive sleep apnea will also increase your risk of Heart Attack, Abnormal Heartbeats, and Stroke. If you already suffer from any Heart disease, you should be aware that multiple episodes of low blood oxygen (hypoxia or hypoxemia) can lead to sudden death from an irregular heartbeat. Most people who have sleep apnea don’t know they have it, a family member or bed partner will often be first to notice signs and will ask their sleep partner to seek treatment. Many snorers at this point will either call their doctor for a referral to a Sleep Dentist that can make them a custom oral appliance or hope they find some sort of “DIY boil and bite” online or at a local drug store.
The American Academy of Sleep Medicine (AASM) has approved oral appliance therapy (OAT) as a first line treatment for patients diagnosed with Obstructive Sleep Apnea. Cheap, over-the-counter appliances are clinically unproven and can be potentially dangerous. Just because they are inexpensive and convenient does not mean you should try them! Do you remember the saying ” You get what you pay for?” Most of these oral appliances are not FDA approved for Sleep Apnea despite their claims of being effective and proven to help. When these boil and bites are not fitted properly, (which is often the case since most people are not dental professionals that have experience taking proper impressions of teeth) these over-the-counter appliances can cause unwanted side effects, such as jaw problems, tooth movement or can even have an adverse effect- worsening your sleep apnea. At the Raphaelson Dental Sleep Center, we use the best materials and labs to create a custom, comfortable, and durable oral appliance with a precise fit. Also, we follow up on all oral appliance treatment with a diagnostic sleep study ensuring that the oral appliance fits and functions properly, treating Sleep Apnea. Another issue with these “do it your self oral appliances” according to Dr. Alan Lowe, professor of orthodontics at the University of British Columbia in Vancouver, is that they mask a relief in snoring without addressing the apnea. Many people often overlook what is called “silent apnea” that could still threaten their health or even lead to death.
So here is The Bottom Line- People with Sleep Apnea need to seek professional help from a doctor or a dental sleep specialist. If an oral appliance is an option for you, it should be fitted by a dentist specially trained in Dental Sleep Medicine. All of our dental sleep specialists at the Raphaelson Dental Sleep Center are qualified and trained in Dental Sleep Medicine, offering our patients optimal care in diagnosing and treating Sleep Apnea. If you believe you have Sleep Apnea please call our office for a complimentary Airway Evaluation. Most major medical insurances are accepted and offer benefits for Oral Appliance Therapy. Let us help you “Transform your sleep, and Redefine your Health”
Federal officials now say that sleep apnea played a role in the Hoboken Terminal Crash that occurred on September 29, 2016, which caused the fatal death of a woman and injury to over a hundred people. It has been confirmed that Thomas Gallagher, 48, who was the operator of the train, has been diagnosed with sleep apnea. The crash occurred at the Hoboken Terminal, at double the speed limit of 10mph. Thomas Gallagher told investigators that he had no recollection of the crash and only remembered waking up on the floor of the train cab.
The Federal Railroad Administration has issued a safety advisory that will urge railroads to screen and treat their engineers for Sleep Apnea. Those that are diagnosed with Sleep Apnea will not be able to operate a train until they are treated. They have also suggested installing inward facing cameras in train cabs to record and monitor the engineers actions and speed (especially in stations where the tracks end at a platform). This will help aid in any future investigations. The federal agency first recognized that Sleep Apnea was problem in 2004, when it began revising and outlining safety regulations for operating a train. Currently, engineers only have their vision and hearing tested every three years, as of a physical screening required by their job.
Amtrak, Metro North, and some freight railroads have already implemented screenings and treatment for Sleep Apnea. An interesting statistic- According to spokesman Aaron Donovan for Metro-North (a commuter railroad in New York City suburbs) a recent study found that 1 out of 9 of its engineers has Sleep Apnea. Metro North also had a deadly Sleep Apnea related crash in 2013, killing four people.
So what exactly is Sleep Apnea? Sleep apnea is chronic condition that causes one or more pauses in your breathing disrupting your sleep. Many people with Sleep Apnea suffer from excessive daytime sleepiness and fatigue, increasing their risk of an accident. Sleep Apnea can also increase the risk of recurrent Heart Attacks and abnormal heart beats as a result of low blood oxygen. It has also been related to other medical conditions such as Stroke, Diabetes, Depression, ADHD, and weight gain.
Some Sleep Apnea symptoms to we aware of:
As of now, the Long Island Railroad is in the process putting into effect sleep apnea screenings as part of their safety protocols. We are pleased that the Federal Railroad Administration is recognizing the dangers of untreated Sleep Apnea. If you have or know someone who displays any of the Sleep Apnea Symptoms that are mentioned above, please call our office to schedule a complimentary Airway Evaluation. Sleep Apnea can be easily treated with a custom made oral appliance, fitting much like a sports mouth guard or an orthodontic retainer. It supports the jaw in a forward position to help maintain an open upper airway. Also, it is many times a benefit that is covered by your medical insurance. At Raphaelson Dental Sleep Center, we are concerned about our patients health and safety and we are looking forward to helping you achieve a restful sleep.