Healthy Sleep Frederick Tolle, M.D., dabsm Community Health Network
Adults should sleep 7 or more hours per night on a regular basis to promote optimal health. Getting less than 7 hours of sleep on average may increase your risk of several adverse health outcomes: diabetes high blood pressure heart disease stroke depression impaired immune system increased risk of death Sleeping less than 7 hours per night also can impair performance. There is increased risk of errors and accidents when you don t get enough sleep each night
Healthy Sleep Keep a consistent sleep schedule. Set a bedtime that is early enough for you to get at least 7 hours of sleep. Don t go to bed unless you are sleepy. If you don t fall asleep after 20 minutes, get out of bed. Establish relaxing bedtime rituals. Use your bed only for sleep and sex. Make your bedroom quiet and relaxing. Keep the room at a comfortable, cool temperature. Limit exposure to light in the evenings. Don t eat a large meal before bedtime. If you are hungry at night, eat a light, healthy snack. Exercise regularly and maintain a healthy diet. Avoid consuming caffeine in the late afternoon or evening. Avoid consuming alcohol before bedtime. Reduce your fluid intake before bedtime.
Sleep Apnea Chronic disorder characterized by pauses in breathing (apneas) or instances of shallow breathing (hypopneas) during sleep Results in low oxygen which causes blood circulation disturbances. Person becomes briefly aroused in order to breathe, resulting in fragmented sleep Individuals with sleep apnea are rarely aware of it (80% are undiagnosed!) Apnea Video
OSA: Epidemiology Peppard et al., 2013 Estimated prevalence in North America (varies by diagnostic criteria used in the study) 20-30% in males and 10-15 % in females OR 15% in males and 5% in females The prevalence of OSA in the United States has increased by 14-55% since the early 90s
Risk Factors (Strohl, 2016) Age Gender (2-3x more common in men than women until menopause when the gap narrows) Craniofacial and upper airway abnormalities Obesity In a 4-year longitudinal study: a 10% increase in weight was associated with a 6- fold increase in incident OSA In a population-based study of over 1000 adults, the prevalence of OSA was: 63% in obese males 22% in obese females 11% in males of normal weight 3% in females of normal weight
2 Major Criteria or 1 + 2 Minor Criteria
Cardiovascular Morbidity Type 2 Diabetes HTN CAD Cardiac Arrhythmia Heart Failure Stroke All-Cause Mortality (2-3 increased risk in severe OSA) OSA Adverse Outcomes Cognitive Deficits MCI & Dementia Daytime Sleepiness Car Accidents (2-3x more common) Depression (2x as common) Strohl, 2016; Osorio, 2015
Sleep Center Attended Sleep Study At Home Sleep Study
Treatment CPAP therapy Needs to be used regularly! Compliance can be objectively monitored Weight loss Loss of 10% of body weight reduces AHI by 30-50%! There are many ways to CPAP adherence, such as troubleshooting device side effects and behavioral therapy Alternative options: oral appliances, upper airway surgery, etc.
Treatment Benefits Strohl, 2016; Osorio, 2015 Improvements in Quality of life Systemic blood pressure control Decreased cardiovascular morbidity & mortality Cognitive Improvements Executive Functioning Delayed Long-term Memory Attention/Vigilance Global Cognitive Functioning
Baseline 3 mo. CPAP 12 mo. CPAP Castronovo et al., 2014
Treatment Benefits: Increase in Grey Matter Volume AND Brain Functioning
Here s to good Dr. Tolle
References Berry, R. B., Brooks, R., Gamaldo, C. E., et al for the American Academy of Sleep Medicine. (2012). The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications. Darien, IL: American Academy of Sleep Medicine. Canessa, N., Castronovo, V., Cappa, S., Aloia, M., Marelli, S., Falini, A., &... Ferini-Strambi, L. (2011). Obstructive Sleep Apnea: Brain Structural Changes and Neurocognitive Function before and after Treatment. American Journal Of Respiratory & Critical Care Medicine, 183(10), 1419-1426 8p. doi:10.1164/rccm.201005-0693oc Castronovo, V., Scifo, P., Castellano, A., Aloia, M. S., Iadanza, A., Marelli, S., &... Falini, A. (2014). White matter integrity in obstructive sleep apnea before and after treatment. Sleep, 37(9), 1465-1475. doi:dx.doi.org/sp-00071-13 Malhotra, et al. (2015). On the cutting edge of obstructive sleep apnea: where next? Lancet Respir Med; 3:397-403. doi:10.1016/s2213-2600(15)00051-x National Healthy Sleep Awareness Project. (2015). http://www.sleepeducation.org/healthysleep/seven-and-up-healthy-sleep-duration National Healthy Sleep Awareness Project. (2016). http://www.sleepeducation.org/docs/default-document-library/sleep-apnea-riskassessment.pdf National Heart, Lung and Blood Institute. (2012). http://www.nhlbi.nih.gov/health/health-topics/topics/sleepapnea Osorio, R., Gumb, T., Pirraglia, E., Varga, A., Lim, J., Wohlleber, M., &... Lu, S. (2015). Sleep-disordered breathing advances cognitive decline in the elderly. Neurology, 84(19), 1964-1971. doi:10.1212/wnl.0000000000001566 Peppard, P. E., Young, T., Barnet, J. H., Palta, M., Hagen, E. W., & Hla, K. M. (2013). Increased Prevalence of Sleep-Disordered Breathing in Adults. American Journal Of Epidemiology, 177(9), 1006-1014. Rosenzweig, I., et al. (2015). Sleep apnoea and the brain: a complex relationship. Lancet Respir Med, 3:404-414. doi:10.1016/s2213-2600(15)00090-9 Strohl, K. P. (2016). Overview of obstructive sleep apnea in adults. In T. Post (Ed.), UpToDate. Waltham, Mass.: UpToDate. Retrieved from www.uptodate.com