Dr. Don McLaughlin N Main St. Rutland VT (802)

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Brice Craig
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Dr. Don McLaughlin www.snoresnomore.com dr.

1 Dr. Don McLaughlin N Main St. Rutland VT (802) Booklet for Better Sleep Working with Sleep Apnea Part 1 of 3

Sick and Tired of Always Being Tired? Do you snore loudly and/or regularly? Have you been observed gasping for breath or stopping breathing during sleep?

Do you fall asleep sitting, reading, watching TV or driving? Do you have frequent problems with memory or concentration? Do you have a difficult time wearing your CPAP?

2 Sick and Tired of Always Being Tired? Do you snore loudly and/or regularly? Have you been observed gasping for breath or stopping breathing during sleep? Do you wake up tired and groggy in the morning, or wake up with a headache? Are you tired or fatigued during the day, no matter how many hours you sleep? Do you fall asleep sitting, reading, watching TV or driving? Do you have frequent problems with memory or concentration? Do you have a difficult time wearing your CPAP? Is your spouse tired during the day because you keep him/her awake at night with your snoring? Has your doctor told you that your blood pressure is rising? Do you feel like you just aren t with it at work anymore? Many patients tell us that they have put on a little weight that they can t explain. Are you stressed out and constantly tired? Have you been to your doctor and he can t seem to find anything wrong? Or they treat certain symptoms and never really seem to get back to the way they used to feel. In this three-part report, I will explain how anything that narrows your airway or throat can be a critical factor in solving a whole host of medical problems, including: Headaches Weight Gain Snoring Chronic Fatigue Syndrome Sleep Apnea Insomnia Fibromyalgia Hormone Imbalances Depression and many others If you feel like you just aren t your old self lately, you might be surprised to find that the way you breath while you sleep might be the source of all of your problems. Many found that when they have dealt with their collapsed airway and diminished breathing ability, they started feeling: 1. Refreshed when they woke up 2. Increased motivation to get things done and exercise 3. The urge to wake up earlier and go to bed later 4. Increased mental acuity and quickness 5. Increased energy level, a renewed zest for life and improvement in their overall health I ve written this report to help educate you about help that is available for you so that you get back to the real you!

3 The Good News is: We Can Do Most of Your Care Right Here! We will perform a simple screen for sleep apnea. From this screening we ll be able to give you or find out: 1. Your comprehensive health history 2. Your sleep quality we ll perform a sleep evaluation for you. 3. If you qualify to get rid of your CPAP machine. 4. Easy-to-understand answers to your questions and concerns about snoring and sleep apnea We have a CAT scanner that shows us if you have an airway obstruction. (Our CAT Scan helps us confirm and validate your medical condition for your medical insurance to pay your claim!) If we determine that you have some airway obstruction from our initial screening, we can then offer you a sleep study in your own bed or a sleep study in a sleep center depending on your symptoms! We offer you an at-home sleep study that will allow a board-certified sleep physician to confirm your diagnosis. Many patients say that they had to stay overnight at a hospital for a sleep study (PSG). Then they had to go to a hospital to have a CAT Scan to evaluate their airway. We do all of this right here in our office! We offer COMFORTABLE snoring and sleep apnea solutions. We have innovative solutions for you may be able to use a CPAP alternative to treat sleep apnea. You might be able to throw away your CPAP machine. Many patients are able to treat their sleep apnea with simple, custom-fitted FDA-approved oral dental appliances. Discover the difference in your life with these sleep apnea solutions. Restore nighttime breathing and get a great, refreshing night s sleep! Those who have untreated sleep breathing disorders have: Shorter life spans Lower quality of life Medical expenses that are double those who have their sleep disorders managed Today, I am going to start by explaining the three major categories of sleep disturbances responsible for many of the symptoms listed above: Simple Snoring Upper Airway Resistance Syndrome (UARS) Obstructive Sleep Apnea Syndrome (OSAS) These sleep disorders might be the explanation for why you feel chronically tired, no matter how long you sleep. Because you don t sleep well, you feel more stressed and exhausted. It can significantly impact not only the quality of your life, your job and school performance, but your relationships as well. We see many people who have sought care from their physician and had various tests, knowing something just doesn t feel right. Their doctor often finds something that needs to be treated, like hypothyroidism (low thyroid levels) or chronic fatigue syndrome (CFS). In many cases, treating these issues helps somewhat, but never completely remedies your problems.

4 Frustrated Because Your Doctors Can t Tell You What s Wrong? What I m going to explain here is that many people simply aren t sleeping well, with subsequent chronic, long term low oxygen levels in their bloodstream. This desaturation, or low oxygen levels, causes some surprising long-term damage to internal organs and tissues. The rate of this problem in the general population is truly alarming. I will show you a totally different way of looking at how you sleep. I m going to give an explanation for why you re still tired, even if you sleep for 10 hours. It s a radically different approach to looking at sleep, and I hope our information here is practical and helpful to you. How common is Obstructive Sleep Apnea Syndrome (OSAS)? This is the most serious of the three categories of sleep disorders we will talk about. In a study by the National Sleep Foundation, 67% of adults reported that their partner snores. Many couples sleep separately to minimize the problems caused by chronic loud snoring. It s estimated that 20% of men and 5% of women in their thirties snore; 60% of men and 40% of women in their sixties snore; and 40% of adults older than 40 snore (approx. 87 million Americans). About 35% of habitual snorers are estimated to have obstructive sleep apnea (OSAS), which is a staggering percentage of the population. However, of most concern is the fact that about 80-90% of people with OSAS are not diagnosed, implying that a significant number of snorers have undiagnosed OSAS. Twenty-five percent of men and 10% of women suffer from some form of OSAS (approx. 30 million Americans). Fewer than 10% of OSAS sufferers have been diagnosed (approx 3 million Americans). Of those diagnosed with OSAS, fewer than 25% have been successfully treated. Are You At Risk for Sleep Apnea? Sleep apnea occurs in all age groups and both sexes, but there are certain factors that put you at higher risk: A family history of sleep apnea Being overweight A large neck size (17 inches or greater for men, 16 inches or greater for women) Being age 40 or older Having a small upper airway Having a recessed chin, small jaw or a large overbite Smoking and alcohol use Ethnicity Many people have figured out that something s not quite right, sought treatment, been diagnosed with sleep apnea, tried wearing a CPAP device, and are still frustrated because they can t tolerate wearing the CPAP or other treatment options they were offered.

5 There is a 50% failure rate with those trying to wear the CPAP device, the most commonly prescribed solution for Obstructive Sleep Apnea Syndrome (OSAS). So whether you are undiagnosed, or frustrated by not being able to tolerate or wear the CPAP or are struggling with managing your situation, there is good news about OSAS: Sleep Apnea is a Highly Treatable Disorder Next, you will learn about Snoring, Upper Airway Resistance Syndrome and Obstructive Sleep Apnea Syndrome. Is it just snoring or is it sleep apnea? Not everyone who snores has sleep apnea, and not everyone who has sleep apnea snores. So how do you tell the difference between simple snoring and a more serious case of sleep apnea? The biggest tell tale sign is how you feel during the day. Normal snoring doesn t interfere with the quality of your sleep as much as sleep apnea does, so you re less likely to suffer from extreme fatigue and sleepiness during the day. The Three Different Levels of Sleep Disorders Simple Snoring Let s first talk about the simplest and the least harmful sleep disorder: simple snoring. Simple or nuisance snoring is just a partial, mild upper airway collapse. More than 40 million adults snore. Simple or nuisance snoring is harmless unless it bothers the sleep of your bed partner. If the bed partner s sleep is affected by this snoring, their health can truly be altered. While snoring is more common in men, many women also keep their bed partners awake. In susceptible people, when enough muscle relaxation occurs, the tongue presses on the flabby tissue at the back of the throat and the airway starts collapsing. The air rushes through this narrowed airway space and the increased air turbulence causes the flabby tissue to flap back and forth causing the annoying sound we know as snoring. As many as half of adults snore at least occasionally. Sometimes snoring may indicate a serious health condition. Lifestyle changes, such as losing weight, avoiding alcohol close to bedtime or sleeping on your side, can help stop snoring. Oral appliance therapy is extremely effective in helping these suffering bed partners. Upper Airway Resistance Syndrome An easy way to understand Upper Airway Resistance Syndrome (UARS) is to think of it as severe snoring, although there are times when UARS can occur with little noise.

6 UARS is a condition where the air passageway narrows so much that chest muscles and diaphragm have to work much harder to pull air into the lungs. UARS is halfway between snoring and obstructive sleep apnea. As snoring gets worse, it becomes UARS. Untreated UARS can worsen and evolve into obstructive sleep apnea. There are some major differences between those with obstructive sleep apnea and people suffering from UARS. While obstructive sleep apnea is more common in men, women are as likely to suffer from UARS as men. While people with sleep apnea are more likely to be overweight, it is extremely common for UARS suffers to be normal weight. Chronic insomnia with frequent awakenings and difficulty resuming sleep are more common in those with UARS than with sleep apnea. To understand how difficult it is for someone with UARS to breathe, try to imagine breathing for an extended period of time through an opening no bigger than a straw. Very loud snoring is the result of the very labored breathing associated with UARS. At some point, the effort of this very labored breathing becomes so intense that the sleeper starts to wake up from deeper levels of sleep, take a few fuller breaths, and go back into deeper levels of sleep, only to start the process all over again. Surprisingly, UARS sufferers are not aware of the difficulty that they have breathing in their sleep. Many UARS patients experience daytime sleepiness and high blood pressure. Women in the later stages of pregnancy will often develop UARS as they gain weight. Studies have estimated that 14 percent of women snore while 28 percent of pregnant women snore. People with UARS get reports from their physician that their blood pressure is rising, requiring blood pressure medication to get it under control. However, sleep studies are rarely done to find the underlying problem taking place during sleep. Obstructive Sleep Apnea Syndrome Obstructive sleep apnea is the most severe breathing disorder we ve discussed here and the most common form of sleep apnea. This disorder occurs when the soft tissues of the back of the mouth and throat and the tongue relax during sleep and block the airway or trachea. This obstructs the flow of air into the lungs. In obstructive sleep apnea, breathing can stop for a significant period of time, two minutes or more. This airway obstruction leads to hypoxemia (low oxygen saturation in the blood) and apnea (cessation of breathing) for potentially life-threatening periods of time. Those who have an obstructive sleep apnea have to strain just to get air. At some point during their sleep, their throat gets closed off and they are unable to get air into their lungs at all. These people eventually wake up so that they are able to get air. They experience periodic bouts of suffocation and highly reduced levels of oxygen (desaturation), putting a serious strain on the body. Obstructive sleep apnea can cause very low levels of oxygen. The technical definition of hypoxemia is when the oxygen saturation in the body is less than 90 percent. If the oxygen level falls below 80 percent, the condition is referred to as severe hypoxemia. On average, the normal oxygen levels in our blood stream are about mm Hg. In people suffering from hypoxemia, this can fall to as low as 60 mmhg.

7 Hypoxemia has a profound negative effect on your quality of life. Some people with obstructive sleep apnea develop cyanosis (blueness of the skin) due to the severe lack of oxygen. In obstructive sleep apnea, low levels of oxygen eventually cause the sleeping person to wake up and take some normal breaths. They then fall back into a deeper sleep. In obstructive sleep apnea, this cycle can occur as much as 20 to 30 times an hour. This is very detrimental to restful sleep and overall health. Symptoms of obstructive sleep apnea include snoring between periods of apnea (not breathing) and choking or shortness of breath. Complications of obstructive sleep apnea include sleep deprivation and irregular heart rhythms. Untreated obstructive sleep apnea can cause high blood pressure, heart abnormalities and damage to internal organs from the low oxygen levels. The people at highest risk for having obstructive sleep apnea are those who smoke or use alcohol, sleeping pills or other sedative drugs. Other risk factors include being overweight and having physical abnormalities of the throat or nose that restrict airflow into the lungs. Obstructive sleep apnea can occur in any age group, is more common in men than women and has some hereditary connection. We are able to make a diagnosis of obstructive sleep apnea by taking a thorough medical and family history, exploring the patients symptoms and completing a comprehensive physical examination. Diagnostic testing includes a sleep test at a sleep lab or by having a Home Sleep Test (HST). The at-home sleep test is effective in helping a sleep physician diagnose sleep disorders. Sleep tests evaluate oxygen levels, heart rate and a variety of other factors during sleep. It is possible that a diagnosis of obstructive sleep apnea can be missed because people with the disorder are often not aware of the causes of their symptoms and do not seek prompt treatment. I sincerely hope the information in this has given you a great introduction to sleep apnea. It s just a small portion of what I plan to share with you over the course of this three-part report. Tomorrow, you will learn more about treatment options for these sleep apnea syndromes.

Obstructive Sleep Apnea

Obstructive Sleep Apnea Introduction Obstructive sleep apnea is an interruption in breathing during sleep. It is caused by throat and tongue muscles collapsing and relaxing. This blocks, or obstructs,