Education

apneaSleep Apnea


BASICS:

Obstructive sleep apnea is a disorder in which breathing is briefly and repeatedly interrupted during sleep. The word "apnea" literally means "without breath." Apnea is defined as a cessation of breath that lasts at least ten seconds. Obstructive apneas occur when the muscles in the back of the throat are not able to keep the throat open, despite efforts to breathe. This causes blockages in the airway and breathing interruptions, or apneas. Obstructive apneas can result in two problems: fragmented sleep and lowered levels of oxygen in the blood. The combination of sleep disturbance and oxygen starvation can result in multiple problems, including automobile accidents, hypertension, heart disease, and mood and memory problems. Sleep apnea can be life-threatening and you should consult your doctor immediately if you feel you may suffer from it.

Although the connection between sleep apnea and heart disease is not entirely clear, we know that people with cardiovascular problems such as high blood pressure, heart attack, congestive heart failure, cardiac arrhythmia and stroke have a high prevalence of sleep apnea. Sleep apnea also results in excessive daytime sleepiness that increases the likelihood of accidents, hinders productivity and makes relationships more difficult.

OSA affects roughly five percent of adults in North America. It is very difficult at present to estimate the prevalence of childhood OSA because of widely varying monitoring techniques, but a minimum prevalence of 2 to 3% is likely, with prevalence as high as 10 to 20% in habitually snoring children. OSA occurs in all age groups and both sexes, but there are a number of factors that increase risk, including having a small upper airway (or large tongue, tonsils or uvula), being overweight, having a recessed chin, small jaw or a large overbite, a large neck size (17 inches or greater in a man, or 16 inches or greater in a woman), smoking and alcohol use, being age 40 or older, and ethnicity (African-Americans, Pacific-Islanders and Hispanics). OSA also seems to run in some families, suggesting a possible genetic basis.

Independently created by the National Sleep Foundation.


restlesslegsRestless Legs Syndrome

BASICS:

Restless Legs Syndrome (RLS) is a neurologic sensorimotor disorder that is characterized by an overwhelming urge to move the legs when they are at rest. The urge to move the legs is usually, but not always, accompanied by unpleasant sensations. It is less common but possible to have RLS symptoms in the arms, face, torso, and genital region. RLS symptoms occur during inactivity and they are temporarily relieved by movement or pressure. Symptoms of RLS are most severe in the evening and nighttime hours, and can profoundly disrupt a patient's sleep and daily life.

According to the National Center on Sleep Disorders Research, "restless legs syndrome is a common, under-diagnosed and treatable condition." Recent research suggests it affects about 10% of adults in North America and Europe, with rates increasing with age. Lower prevalence has been found in India, Japan and Singapore, indicating that racial, ethnic or genetic factors are associated with RLS. Researchers believe that RLS is commonly unrecognized or misdiagnosed as insomnia, depression, or other neurological, muscular, or orthopedic condition. A family history of the disorder is present in about 50% of patients.

RLS affects both men and women, and can start at any age. It may be confused with growing pains or restlessness when experienced by children. In addition, the severity of the disorder appears to increase with age. Older patients experience symptoms more frequently and for longer periods of time.

The exact cause of RLS is unknown but it has a primary form, not related to other disorders, and a secondary form related to an underlying condition such as kidney failure, pregnancy, or iron deficiency anemia. It may also be caused or made worse by certain medications. This is considered secondary RLS. When no other cause is found for RLS symptoms, it is considered a primary disorder. Primary RLS accounts for 40-60% of RLS diagnoses.

Recently, several research teams have taken a closer look at what might cause primary RLS. In particular, recent studies at Johns Hopkins and Pennsylvania State Colleges have found evidence for brain iron deficiency as a cause for primary RLS. This was first demonstrated in cerebrospinal fluid studies and more recently by the first-ever autopsy analysis of the brains of people with RLS. The autopsy studies reported that cells from the portion of the brain called the substantia nigra showed a deficit in one of the proteins that regulates iron status. However, this evidence suggests that the iron insufficiency in the brain of RLS patients comes directly from a failure of normal iron regulation. In terms of finding a cure, this is good news. The results of this study show that there is no brain damage in people with RLS, and that drugs that target the problem of iron uptake may be one way to approach future developments of a treatment.

More than 80 percent of people with RLS also suffer from a condition know as periodic limb movement disorder (PLMD). Characteristics of PLMD include involuntary leg twitching or jerking movements during sleep that occur repeatedly throughout the night and result in disrupted sleep.

In addition to poor quality and short sleep at night, research has shown that people with RLS generally experience a reduced quality of life in the absence of treatment. There is also evidence of a connection between RLS and attention-deficit hyperactivity disorder (ADHD).


Independently created by the National Sleep Foundation.


difficultsleepNational Sleep Foundation Offers Tips To Those Having Difficulty Sleeping

Sleep is an essential part of our daily lives and well-being. Lost sleep robs us of the opportunity to restore ourselves physically, emotionally, and even cognitively. Lost sleep and the resulting daytime sleepiness affect our mood, behavior and performance. In effect, we are how we sleep. How we sleep at night affects who we are, what we do and how we do it during the day, although we are not always aware of the signs and symptoms, as well as the costs and consequences caused by sleep disruptions. A night of seven to nine hours of restful, uninterrupted sleep becomes particularly important during times of high stress and anxiety.

"Not getting enough sleep impairs our work performance, increases the risk for injuries and makes it more difficult to get along with others," says Mark Rosekind, Ph.D, an expert on fatigue and performance issues. "Without sufficient sleep, it is more difficult to concentrate, make careful decisions and follow instructions, we are more likely to make mistakes or errors, and are more prone to being impatient and lethargic. Our attention, memory and reaction time are all affected. But while we may recognize these symptoms, we do not always associate them as being symptoms of sleep loss," he adds.

Dr. Rosekind also notes that while one night of significant sleep loss can affect alertness the next day, accumulated sleep loss over multiple nights is a problem that must be dealt with. Dr. Rosekind, president and chief scientist of Alertness Solutions in Cupertino, CA, is a member of the National Sleep Foundation's board of directors. He is former director of NASA's Fatigue Countermeasures Program.

In order to help people address their need for sleep and sleep problems, the National Sleep Foundation (NSF) offers the following information about sleep problems and symptoms that can signal inadequate sleep, and tips for helping people maximize the sleep they do get during these times of high stress and anxiety:

* Don't expect to fall asleep immediately after hearing or watching disturbing news. Stop watching or listening to news programs at least an hour before trying to go to sleep. Leave the war news (or other bad news on the TV or radio) in the living room or den and out of the bedroom.

* Engage in a relaxing, non-alerting activity at bedtime, such as reading or listening to music. For some people, soaking in a warm bath or hot tub can be helpful. Avoid activities that are mentally or physically stimulating.

* Do not eat or drink too much before bedtime. Alcohol is not a sleep aid; do not use it to try to help you sleep.

* Only get into bed when you are tired. If you do not fall asleep within 15 minutes, get out of bed, go to another room and engage in a relaxing activity, such as reading. Return to your bed when you are sleepy.

* Create a sleep-promoting environment that is quiet, dark, cool and comfortable.

During the day:

* Consume less or no caffeine. Excess caffeine has the potential to disturb sleep at night. If you feel tired during the day, substitute a short nap of about 15-20 minutes for caffeine. Naps can relieve acute sleepiness and restore alertness, but for people suffering from insomnia, daytime naps should be avoided.

* Avoid alcohol and nicotine, especially close to bedtime.

* Exercise, but not within three hours before bedtime.

Anytime:

* Talk to other people. Many people think their symptoms of sleeplessness are unique to them. If you talk to others, you will find that many share your problems. Learning how others have coped can be helpful.

* Seek professional help. If you are unable to deal with the sleeplessness and it is becoming a problem for you, you might benefit from professional help. Your family doctor will know about medications that can help you fall asleep without a hangover the following day.

* Remember - sleeplessness associated with an acute stressful situation usually improves on its own. Be patient.

Common sleep problems during times of stress:

* Insomnia is characterized by difficulty falling asleep, waking up frequently during the night, waking up too early or feeling unrefreshed upon awakening. If these symptoms persist for more than a few days, seek help from a physician or other health care provider. Be cautious about self-treatments, such as alcoholic beverages, that may worsen the problem or not be effective.

* Nightmares can increase during periods of great stress for all people, though they occur most frequently in children age 3-6. Avoid eating or taking high-dose vitamins before bed, which can increase brain activity and the onset of nightmares. Also, avoid alcohol, caffeine and other stimulants. Exercise and relaxation techniques may be helpful.

* Excessive Daytime Sleepiness (EDS) and Fatigue, with symptoms such as difficulty concentrating or dozing off while watching TV or reading, is best handled by stopping what you are doing and taking a nap, or retiring early and going to sleep. Be cautious about treating EDS with caffeine or over-the-counter stimulants, as they temporarily mask sleep loss and can cause sleep disruption. If EDS persists for more than a few days, speak to a physician or other health care provider.

Symptoms That Can Signal Inadequate Sleep:

* Dozing off while engaged in an activity such as reading, watching TV, sitting in meetings or sitting in traffic

* Slowed thinking and reacting

* Difficulty listening to what is said or understanding directions

* Difficulty remembering or retaining information

* Frequent errors or mistakes

* Narrowing of attention, missing important changes in a situation

* Depression or negative mood

* Impatience or being quick to anger

* Frequent blinking, difficulty focusing eyes, or heavy eyelids

Helping children

At times of acute stress or trauma, parents and guardians should expect children to experience sleep problems, regardless of their age. It may take a few weeks for them to get back to their normal routines, but if the problems continue beyond that time, consider seeking further help from your child's physician or other health care provider, the school psychologist, or your child's teacher.
There are things parents can do to help minimize the impact of stressful events on their children, and help them get a restful night's sleep.

For all children:

* Your child's anxiety may affect their falling asleep. Find out about his/her concerns and talk about them. While you should try to avoid these conversations at bedtime, don't shut off the conversation; talk briefly and offer to continue the conversation tomorrow.
* To avoid insomnia, try to maintain your child's usual bedtime and bedtime routines.
* Avoid foods and beverages containing caffeine at least four hours before bedtime, and exposure to news broadcasts at least an hour before bedtime.

Middle School and Younger Children:

* If your child has trouble falling asleep alone, avoid a drastic response (e.g. everyone sleeping together). Stay near until your child falls asleep. Provide reassurance by telling him/her you will check in.

* Turn on a light in the hallway or next room, but not the bedroom. Music can provide some soothing noise. The presence of a family pet in the bedroom (even a goldfish!) is often reassuring.

* If your child has nightmares and wakes up in the middle of the night, don't have a long discussion about the dream; be reassuring and help your child fall back to sleep. In the morning, if they tell you about a bad dream, that is a good time to talk either about the dream or the events that may have precipitated it.

* If your child is significantly anxious at bedtime, relaxation techniques (familiar tapes, deep breathing exercises) can be distracting and anxiety-reducing.

Adolescents:

Teens may be more affected by events than we realize and, therefore, at higher risk for sleep problems. Their greater understanding of events can be accompanied by a greater degree of worrying, making them more at risk for insomnia than younger children.
* Show teens the extra support, doting, and soothing that is given to younger children.
* Teens may experience insomnia or phase delay... going to bed later than usual because of talking on the phone, watching television, e-mailing friends, etc. Parents must set limits on this behavior, and keep their teen on a normal bedtime routine.

Independently created by the National Sleep Foundation.


womensleepMost Common Sleep Problems in Women

Nearly 40 million American men and women suffer from sleep disorders.

However, sleep problems affect more women than men. New research exploring women's sleep experiences may lead to specially tailored treatments.

Insomnia

Insomnia is the most common sleep problem. Women are more likely than men to report insomnia. In fact, according to the 2002 NSF Sleep in America poll, more women than men experience symptoms of insomnia at least a few nights a week (63% vs. 54%) and they are more likely to have daytime sleepiness. Sometimes, women begin to have sleepless nights associated with menstruation, pregnancy or menopause, and find it difficult to break poor sleep habits. Fortunately, there are a number of approaches to improving sleep, including those you can do yourself, such as exercise, establishing regular bed and wake times, dietary changes (less or no caffeine and alcohol) and improving your sleep environment. One recent study found that overweight, post-menopausal women who exercise in the morning experience less difficulty falling asleep and better quality sleep than evening exercisers.

If insomnia persists and lifestyle, behavioral or diet changes do not help, a doctor may prescribe a sleep-promoting medication (hypnotic). In some instances, there may be an underlying and treatable cause, such as depression (women are twice as likely to report depression as men), stress, anxiety, reflux, bladder problems or pain. Doctors may prescribe antidepressants (for depression), anxiolytics (anti-anxiety drugs), medications for heartburn, incontinence or pain and/or hypnotic medications to improve sleep.

Sleep Apnea

Sleep apnea is a serious sleep disorder that is characterized by snoring, interrupted breathing during sleep, and excessive daytime sleepiness. An estimated 18 million Americans have sleep apnea, including one in four women over 65. While apnea is more common in men, it increases in women after age 50. Because being overweight is a risk factor for sleep apnea, the increase in abdominal fat during menopause may be one reason menopausal women are 3.5 times as likely to get this sleep disorder. Some attribute the prevalence to hormonal changes such as the decrease in progesterone. Studies have also found that sleep apnea is associated with increased blood pressure, a risk for cardiovascular disease and stroke. If any of these symptoms appear, it is important to address them with your doctor. A number of effective treatment approaches are available.

Restless Legs Syndrome (RLS) and Periodic Limb Movement Disorder (PLMD)

RLS is a neurological movement disorder that affects as many as 12 million Americans. Its symptoms are outlined below. Because the unpleasant feelings occur at rest and are relieved by movement, RLS sufferers have difficulty sleeping. In the NSF 2002 Sleep in America poll, 18% of the female adult population reported RLS symptoms a few nights a week or more. Due to difficulties sleeping, RLS can lead to daytime sleepiness, mood swings, anxiety and depression. One study found that 42% of those with RLS stated that it affected their relationship with their partner.

Although we do not know the exact cause of RLS, recent research indicates that iron or folate deficiency may be a risk factor. Treatment may include iron or vitamin supplements, lifestyle changes and medications.

About 80% of those with RLS also have PLMD or involuntary leg twitching or jerking movements during sleep that can occur every 20-30 seconds. These symptoms can be bothersome to a bed partner, but are also treatable.

Narcolepsy

Feeling sleepy during the day or at times you expect to be awake may indicate a need for more sleep, the presence of a serious but treatable disorder such as those already mentioned, or narcolepsy, a chronic neurological disorder that affects approximately one in 2,000 people. Narcolepsy symptoms frequently appear in teen years. In addition to excessive daytime sleepiness, people with narcolepsy have sudden "sleep attacks" (an overwhelming urge to sleep), suddenly lose muscle tone or strength (cataplexy) and may have disturbed nighttime sleep. Women who are pregnant or considering having a child should discuss medications with their doctor. Recent scientific breakthroughs have led to new understanding of the cause of this condition, and new treatments have given doctors more ways to help manage its symptoms.
Nocturnal Sleep-Related Eating Disorder

Persons with nocturnal sleep-related eating disorder (NS-RED), an uncommon condition, eat food during the night while they appear asleep. Since parts of the brain that control memory are asleep, people with NS-RED cannot remember nighttime eating. One study indicates that over 66 percent of sufferers are women. NS-RED can occur during sleepwalking. It can be caused by medications (e.g. some drugs prescribed for depression or insomnia) or by sleep disorders (e.g. sleep apnea, restless legs syndrome) that cause awakenings and trigger sleep eating.

Independently created by the National Sleep Foundation.


menopauseUnderstanding Menopause

Menopause is a time of major hormonal, physical and psychological change for women although menopausal symptoms vary from woman to woman. During the perimenopause or transition phase, a woman's ovaries gradually (over several years) decrease production of estrogen and progesterone. If a woman has her ovaries surgically removed (oophorectomy), periods end abruptly and menopausal symptoms become more severe. One year after menstrual periods have stopped, a woman reaches menopause, on average around the age of 50. From peri-menopause to post-menopause, women report the most sleeping problems. Most notably, these include hot flashes, mood disorders, insomnia and sleep-disordered breathing. Sleep problems are often accompanied by depression and anxiety.

Generally, post-menopausal women are less satisfied with their sleep and as many as 61% report insomnia symptoms. Snoring has also been found to be more common and severe in post-menopausal women. Snoring, along with pauses or gasps in breathing are signs of a more serious sleep disorder, obstructive sleep apnea (OSA).

Changing and decreasing levels of estrogen cause many menopausal symptoms including hot flashes, which are unexpected feelings of heat all over the body accompanied by sweating. They usually begin around the face and spread to the chest affecting 75-85% of women around menopause. Prior to the hot flash, body temperature rises accompanied by an awakening. Hot flashes last on average three minutes leading to less sleep efficiency. Most women experience these for one year, but about 25% have hot flashes for five years. While total sleep time may not suffer, sleep quality does. Hot flashes may interrupt sleep and frequent awakenings cause next-day fatigue.

Sleep Tips During Menopause
  • Eat healthy. Avoid large meals, especially before bedtime. Maintain a regular, normal weight. Some foods that are spicy or acidic may trigger hot flashes. Try foods rich in soy as they might minimize hot flashes.
  • Avoid nicotine, caffeine and alcohol, especially before bedtime.
  • Dress in lightweight clothes to improve sleep efficiency. Avoid heavy, insulating blankets and consider using a fan or air conditioning to cool the air and increase circulation.
  • To reduce stress and worry, try relaxation techniques, massage and exercise. Talk to a behavioral health professional if you are depressed, anxious or having problems.

Independently created by the National Sleep Foundation.