Great Lakes Sleep Diagnostics - Information for Adult Patients

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Sleep Apnea and Heart Disease

Untreated Sleep Problems Compound Health Problems of Older Americans

Obesity and Sleep

What is the connection between sleep apnea and heart disease?

The connection between sleep apnea and heart disease is evolving very rapidly. People with cardiovascular problems such as high blood pressure, heart failure and stroke, have a high prevalence of sleep apnea. Whether sleep apnea actually causes heart disease is still unclear, but we do know that if you have sleep apnea today, the chance that you will develop hypertension in the future increases significantly. One of the problems in defining the relationship between sleep apnea and heart disease is that people with sleep apnea often have other co-existing diseases as well.

If you treat people with high blood pressure and sleep apnea, or heart failure and sleep apnea, the measures of blood pressure or heart failure are significantly improved. There is good evidence to think there is a cause-and-effect relationship between hypertension and sleep apnea.

Why does your blood pressure go up when your sleep is disrupted by sleep apnea?

Your blood pressure will go up because when you’re not breathing, the oxygen level in your body falls and excites receptors that alert the brain. In response, the brain sends signals through the nervous system and essentially tells the blood vessels to “tighten up” in order to increase the flow of oxygen to the heart and the brain, because they have priority.
The problem is that things that go on at night tend to carry over in the daytime, even when the sleep apnea patient is awake. The low oxygen levels at night seem to trigger multiple mechanisms that persist during the daytime, even when the patient is breathing normally.

How can CPAP (continuous positive airway pressure) reduce the cardiovascular consequences of sleep apnea?

The available evidence tells us that when you treat people with sleep apnea using CPAP, their blood pressure is not only lower at night—it’s also lower during the day. That’s a very good thing. Moreover, people with atrial fibrillation [a common type of irregular heart beat] with sleep apnea that is appropriately treated have only a 40% chance of coming back for further treatment of their atrial fibrillation. If their sleep apnea is untreated, the chance of a recurrence of atrial fibrillation goes up to 80%. The message to heart patients with sleep apnea is: With treatment of your sleep apnea, your chances of improvement are considerably better.

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UNTREATED SLEEP PROBLEMS COMPOUND HEALTH PROBLEMS OF OLDER AMERICANS
Woman Sleeping New National Sleep Foundation Poll Contradicts Commonly Held Beliefs About Sleep in Older Adults
Washington, DC (April 1) - While some older adults are very healthy and have normal sleep patterns, frequent untreated sleep problems may be interfering with the ability of many others to cope with chronic medical conditions, according to a poll released today by the National Sleep Foundation (NSF).
Exploding many common myths that associate poor sleep and less sleep with aging, the 2003 Sleep in America poll shows that older adults typically do not sleep less than their younger counterparts, averaging about seven hours of sleep each night. However, it also finds that some 37 million older Americans suffer from frequent sleep problems that if ignored, can complicate the treatment of a host of common, serious age-related medical conditions, from arthritis to diabetes, heart and lung disease and depression. Poor sleep is also associated with three other problems affecting many older adults: bodily pain, excess weight and ambulatory restrictions, such as difficulty walking or going up and down stairs.
"The 2003 Sleep in America poll indicates that poor health and not age is a major reason why many older people in this country report sleep problems, providing an important wake up call that identifying and treating these sleep problems must be a priority concern," said Richard L. Gelula, NSF's executive director. "The fact that a person is 60 or 70 years old doesn't preclude the possibility of sleeping well and benefiting from this restorative process to remain vital and active. That's why we must drive home the message that sleeping well is vital to aging well."
Marking the Foundation's first effort to look at the sleep habits and patterns of America's older adults—those between the ages of 55 and 84—NSF's 2003 Sleep in America poll finds a direct association between the number of diagnosed medical conditions that older adults report and the quality of their sleep. The more medical conditions, the more sleep problems.
However, NSF's new poll shows that poor sleep among older adults often goes unnoticed by the medical community. Although the majority of older adults (67%) report frequent sleep problems, only a small fraction (one in eight) says his or her sleep problems have been diagnosed. This means of the 37 million older adults reporting sleep problems, only about seven million have been diagnosed, leaving 30 million to count sheep. NSF is urging the medical community to treat sleep as an integral part of disease management, especially in older patients.
"In spite of the emerging science linking sleep and health, only a small fraction of the many reported sleep complaints of older adults are actually diagnosed and treated," says NSF President, James K. Walsh, PhD. "The 2003 Sleep in America poll reinforces the position that sleep problems should not be viewed as an aspect of normal aging, and they can significantly increase the overall burden of illness on patients," Walsh adds.
Dr. Walsh is Executive Director and Senior Scientist of the Sleep Medicine and Research Center at St. Luke's Hospital in Chesterfield, Mo.

SLEEP AND HEALTH FOR OLDER AMERICANS
NSF's 2003 Sleep in America poll shows that inadequate sleep is clearly associated with many of the major diseases prevalent in older adults. Of special significance, the poll links ongoing sleep problems with 82 percent of those who report being diagnosed with depression, 81 percent who have suffered a stroke, 76 percent diagnosed with heart disease, and 75 percent diagnosed with lung disease. Sleep problems are also a factor for 72 percent of older adults diagnosed with diabetes or arthritis, and 71 percent of those who have been diagnosed with hypertension.
Sleep problems are especially acute among those older adults who have more than one medical condition: eight in ten with four or more medical conditions report a sleep problem compared to about one half of those with no reported medical conditions (80% vs. 53%). In addition, the poll connects poor sleep with three physical problems affecting many older people: bodily pain, excess weight and ambulatory limitations.
According to the newest findings:
• More than three-quarters (77%) of those who report having frequent bodily pain also report a sleep problem.
• Sleep problems are equally common among older adults who are classified as obese (77%) and are linked with two-thirds (64%) of those who are considered overweight by medical standards; and
• The vast majority of older people with impaired mobility are likely to report a sleep problem (84%), with two-thirds experiencing a symptom of insomnia.
• Moreover, about four in ten of those with impaired mobility report unpleasant feelings in their legs, a symptom of Restless Legs Syndrome, a serious, treatable sleep disorder.
Insomnia is the most common sleep problem, with about one-half of older adults (48%) reporting they frequently experience at least one symptom. (Symptoms of insomnia include difficulty falling asleep, waking a lot during the night, waking up too early and not getting back to sleep, and waking feeling unrefreshed).
While waking up a lot in the middle of the night is the most common insomnia complaint, the biggest overall problem disrupting the sleep of older adults is the need to get up and go to the bathroom, with nearly two thirds (65%) reporting this disturbance at least a few nights a week.
Rounding out the link between sleep and health, the poll finds that the better the sleep, the better the perceived health of older adults. Those who rate their health as "very good" or "excellent," for example, report less daytime sleepiness than those with "fair" or "poor" health (9% vs. 29%). They also report fewer insomnia symptoms (38% vs. 71%), and fewer sleep problems (59% vs. 85%). And the healthy are less likely to categorize their sleep as "fair" or "poor" (13% vs. 47%).

COMPARING SLEEP PATTERNS OF OLDER AND YOUNGER ADULTS

Besides charting the sleep patterns of older adults, the 2003 Sleep in America poll dispels the notion that the older we are, the less we sleep. In fact, the poll shows older adults sleep about the same amount as their younger counterparts1, though their sleep habits are substantially different.
Providing an up-to-date look at how older adults are sleeping, the poll finds that:
• The sleep patterns of older adults are more consistent than those of their younger counterparts. Older adults get about the same amount of sleep on weeknights (7.0 hrs/night) and weekends (7.1 hrs/night), while younger adults sleep less during the week (6.7 hrs/night), increasing their sleep on weekends (7.6 hrs/night). About 13 percent of older adults sleep less than six hours on weeknights compared to l6 percent of those 18-54.

• The frequency of adults' sleep problems tends to diminish slightly with age. Of those aged 55-64, seven in ten (71%) report experiencing a frequent sleep problem compared to 65 percent of those aged 65-74, and 64 percent of those aged 75-84.
When it comes to the sleep patterns of older men and women, the poll finds no major gender differences. However, older women are more likely to report at least one symptom of insomnia (50% vs. 45%), while older men are more likely to report they snore (40% vs. 26%) and experience pauses in breathing during sleep (10% vs. 5%).
About one-third of older adults nap regularly, and the frequency of naps increases with age.

LIFESTYLE

To complete the picture of America's older adults and their sleep, the 2003 Sleep in America poll examines lifestyle factors that can impact the quantity and quality of sleep.
Key findings include:

• Older adults feel connected, not isolated. Three-fourths of older adults polled say it is very easy for them to find a family member or friend to talk to when needed. However the 25 percent who feel more isolated say they are more likely to sleep less than six hours a night (l9% vs.12%), and experience a symptom of insomnia (59% vs. 45%).
• Older adults exercise. About one-half of older adults (52%) report exercising to improve their fitness three or more times a week. Only one-quarter of those polled say they exercise less than once a week. The more older people exercise, the less likely they are to describe their sleep quality as fair or poor (20% vs. 32%), and the less likely they are to report symptoms of insomnia (43% vs. 58%) than those who exercise infrequently.

1 Data for young adults, 18-54, from NSF 2002 Sleep in America poll.

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Obesity and Sleep

The statistics are alarming: About 65% of Americans are now overweight or obese, according to the Centers for Disease Control and Prevention. The number of obese adults (those with a Body Mass Index of 30 or more) jumped from 15% in 1980 to 27% in 1999. More than 15% of children from 6 to 19 years were overweight in 2000, which is three times higher than in 1980.
Why are we as a nation getting fatter? Most experts attribute it to our sedentary lifestyle combined with our caloric intake; to put it simply, we're eating more and exercising less. The result is weight gain. We're also getting less sleep than we used to. And the combination of high calories, little exercise and sleep deprivation is a perfect model for obesity.
An Epidemic of Obesity
This epidemic of obesity is particularly serious for children. The CDC says that 1 in 3 American children born in 2000 will develop diabetes, and children under 10 years of age are already developing type 2 diabetes, which is primarily seen in adults—usually not until past the age of 40.
Uncontrolled diabetes can lead to hypertension and increased risk of heart attack. It also damages the eyes, kidneys and other vital organs. The earlier one develops the disease, the greater the potential for long-term damage, especially if the diabetes isn't diagnosed and brought under treatment.
The problem of obesity in children is a major concern for another reason: the increased incidence of sleep apnea. A 20-year review of obesity-associated diseases among children aged 6 to 17 conducted by the CDC found a significant increase in hospital discharges for a number of obesity-related medical conditions.
Obesity and Sleep Problems
The problem is no less serious for adults. An estimated 18 million Americans have sleep apnea, which is often associated with people who are overweight. Sleep apnea is a serious, potentially life-threatening condition that is characterized by brief interruptions in breathing during sleep. The risk of sleep apnea increases due to compromised respiratory function as a result of weight gain, especially in the neck and truck area.
Someone who is overweight and suffering from sleep apnea may not be as motivated to exercise or diet. When sleep apnea leads to daytime sleepiness, it may be much harder to begin or sustain an exercise program, which has been shown to help most people begin or maintain weight loss.
Not only does obesity contribute to sleep problems, but sleep problems can also contribute to obesity. A 1999 study by scientists at the University of Chicago found that building up a sleep debt over a matter of days can impair metabolism and disrupt hormone levels. After restricting 11 healthy young adults to four hours' sleep for six nights, researchers found their ability to process glucose (sugar) in the blood had declined—in some cases to the level of diabetics.
A follow-up study tested healthy men and women with an average body mass index; half were normal sleepers, the other half averaged 6 hours or less. Glucose tolerance tests showed that the short sleepers were experiencing hormonal changes that could affect their future body weight and impair their long-term health. To keep their blood sugar levels normal, the short sleepers needed to make 30% more insulin than the normal sleepers, which predisposed them to putting on weight.
Recent research suggests that at least one factor in obesity can be sleep deprivation. Poor sleep and sleep deprivation may increase appetite. Because the psychological manifestations of fatigue, sleep and hunger are similar, as adults, we sometimes confuse them—we tend to eat when we're actually sleepy, because we think fatigue is a sign of hunger. Sleep mask
Treating Sleep Problems and Obesity
Sometimes the best way to treat obesity can be to treat an underlying sleep problem. For example, successful treatment of sleep apnea (usually with nasal continuous positive airway pressure, or CPAP) may reduce sleepiness and then motivate patients to effectively lose weight, which will in turn help the obesity and the sleep apnea. Most experts say as little as a 10% decrease in weight can lead to significant clinical improvement in the severity of sleep apnea. However, in the more severe cases of apnea, CPAP is a necessary first step to better sleep and feeling motivated to embark on a weight loss program.
So if you are overweight or obese and sleep poorly or feel tired during the day, what should you do? Sleep experts say:

Talk to your bed partner who is likely to hear loud snoring and apnea (pauses in breathing).
Talk to your primary care clinician about a referral to a sleep center in order to get a diagnosis.
After determining the diagnosis, discuss with your healthcare provider undertaking a weight loss plan. This is especially important for obese patients who are contemplating gastric surgery, since the use of CPAP before and after the surgery can be very important—in fact, life-saving.
After losing at least 10% of your body weight, consider undertaking another sleep study to determine further treatment.

Suggestions for Overweight Patients With Sleep Problems
Sleep experts say there are a number of things you can do to lose weight and improve your sleep:

Make healthy choices for your meals. Avoid fast foods. Eat more fish, fruits and vegetables; avoid foods high in carbohydrates or fats.
Start getting consistent exercise, which will improve the quality of your sleep. Most experts, however, say to avoid exercising less than 3 hours before bedtime, because exercise is alerting and can make it harder to fall asleep.
Examine your sleep schedule. Are you getting at least 7 hours of sleep each night? Do you wake up feeling refreshed or tired? Do you wake up frequently during the night?

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