An Introduction to Sleep Medicine & Sleep-Related Breathing Disorders

Transcription

1 An Introduction to Sleep Medicine & Sleep-Related Breathing Disorders Implications for Growth, Development, & Airway A DENTAL APPROACH TO EVALUATION, DIAGNOSIS, TREATMENT & MANAGEMENT Dr. Karen M. Wuertz, DDS, PA 676 Battlefield N, STE A, Chesapeake, VA DrKaren@DentalTransformations.com Alexandria VA April 2017

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6 How many types of sleep disorders are there? There are over 100 different types of sleep disorders ranging from difficulty sleeping at night to problems with excessive daytime sleepiness. Therefore it is critical to receive the correct diagnosis and work with a qualified physician to develop an effective treatment plan. How many affect breathing and airway? Sleep Related Breathing Disorders» Snoring» Upper Airway Resistance Syndrome (UARS)» Obstructive Sleep Apnea (OSA)» Central Sleep Apnea (CSA)

7 Some of the most devastating human and environmental health disasters have been partially attributed to sleep disorders, sleep loss and night shift work-related performance failures. Exxon Valdez oil tanker Three Mile Island nuclear reactor meltdowns The National Traffic Safety Administration estimates that 100,000 crashes each year are the results of sleepy drivers. These crashes cause 1550 deaths, 71,000 injuries and $12.5 billion in property loss and diminished activity. The scary part is that the number of such crashes may be much higher, perhaps even double.

8 The Centre for Disease Control and Prevention (CDC) in the United States has declared insufficient sleep a 'public health problem'. Indeed, according to a recent CDC study, more than a third of American adults are not getting enough sleep on a regular basis. The US sustains by far the highest economic losses (up to $411 billion a year) due to the size of its economy, followed by Japan (up to $138 billion a year).

9 On an annual basis, the US loses an equivalent of about 1.23 million working days due to insufficient sleep. Sleep deprivation is linked to a higher mortality risk. An individual that sleeps on average less than six hours per night has a ten per cent higher mortality risk than someone sleeping between seven and nine hours. An individual sleeping between six to seven hours per day still has a four per cent higher mortality risk.

10 25 Scarey & Surprising things!

11 Common causes of insomnia Stress Anxiety Depression Stimulants Excessive use of caffeine Energy drinks coffee Medications Antidepressants ADHD meds Corticosteroids Thyroid hormone HBP meds Some contraceptives Pain relievers w/ caffeine, diuretics Diet pills

12 Common causes of insomnia Allergies Colds Sinus infections Other upper respiratory problems Makes breathing difficult Nocturia Frequent urination Constantly getting up in the middle of the night Chronic Pain Arthritis Chronic fatigue syndrome, fibromyalgia, inflammatory bowel disease, headaches, lower back pain.

13 American adults lose about 11 days a year to insomnia and often go to work too tired to do their jobs properly.

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16 Antihistamines (Benadryl, Advil PM, Dramamine, Unisom, Zzzquil, etc.): These over-the-counter antihistamines are a common alternative for people who don t want to take prescription drugs. The most common side effects of antihistamines are dryness, constipation, upset stomach, and feeling groggy the next day.

17 Benzodiazepines (Xanax, Valium, Restoril, Halcion, Ativan): Typically prescribed for anxiety, these prescription drugs activate the GABA receptors in the brain and cause sedation and relaxation. They are considered extremely addictive with very difficult withdrawal symptoms, and can cause a similar black-out effect with users. ATIVAN

18 Selective Gamma-aminobutyric acid medications (Ambien, Lunesta, Sonata): These prescription medications target the GABA receptors in the brain. GABA is the neurotransmitter that reduces alertness and promotes relaxation. Unfortunately, this medication is known to cause side effects like hallucinations, memory disturbances, and black-outs wherein people report sleepwalking, sleep-eating, and even sleep-driving.

19 Adult Sleep Apnea Video

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21 Every day we teach our internal circadian timing system what time it is is it day or night? and if that message is substantially different every day, then the clock isn t able to set things appropriately in motion In the last few years, we have learned there is a master clock in the brain, and other clocks in other organs in liver or kidneys or lungs.the master clock is the coxswain, trying to get everybody to work together to improve efficiency and health. So if the coxswain is changing the pace, all the crew become disorganized and don t function well. This disrupted rhythm, as well as the shortage of sleep, can have far-reaching effects on adolescent health and well-being, she said.

22 While studies show that both adults and teens in industrialized nations are becoming more sleep deprived, the problem is most acute among teens, said Nanci Yuan, MD, director of the Stanford Children s Health Sleep Center. In a detailed 2014 report, the American Academy of Pediatrics called the problem of tired teens a public health epidemic. I think high school is the real danger spot in terms of sleep deprivation, said William Dement, MD, PhD, founder of the Stanford Sleep Disorders Clinic, the first of its kind in the world. It s a huge problem. What it means is that nobody performs at the level they could perform, whether it s in school, on the roadways, on the sports field or in terms of physical and emotional health.

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24 Normal Sleep Stages Non-REM N1 Light Sleep 4-5% of total sleep time is considered normal increases to 15% by age 70 N2 Restful Sleep 45-50% of normal sleep time

25 Normal Sleep Stages N3 Delta or slow wave sleep Range of total sleep: 10-20% Percentage decreases with age Above 40-50% in children May be completely absence by age Usually appears only in the first 1/3 of the sleep episode Growth hormone usually released during N3 sleep

26 Rapid eye movement sleep Observed eye movements 20-25% total sleep time Body paralysis atonia Mind very active Very vivid hallucinatory imagery or dreaming Do problem solving

27 For the health and wellbeing of the nation, we should all be taking better care of our sleep, and we certainly should be taking better care of the sleep of our youth.

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29 Risk Factors Obesity Oropharyngeal Neck Circumference Maxillomandibular Endocrine Genetic Ethnic Familial ETOH,sedatives, GA Smoker Nasal congestion Age > 30, Rise OSA^ >35 Tonsils,Uvula,S palate, narrow M > 17, F > 16 Retro or Micrognathia Acromegaly, Hypothyroid Down Syndrome Related to craniofacial morph Family member history Relaxes the pharyngeal mms Inflammation and edema Anatomical or allergies Older we get