Learn about sleep deprivation

A sleep disorder (somnipathy) is any disruption in the sleep patterns of an individual. While some sleep disorders may leave you feeling unrefreshed, a number of symptoms are more severe including excessive sleepiness, snor¬ing, difficulty falling asleep during normal sleeping hours and abnormal be¬haviors such as restless leg syndrome. There are even disorders that cause you to get too much sleep.

Particular behaviors during normal daytime activities are telltale signs of sleep deprivation. If you are experiencing one or more of the following symptoms during the day, you may not be getting enough restful sleep at night, and you may even have a sleep disorder.

If you suspect that you are not getting enough sleep or that you might have a sleep disorder, speak to your physician or a sleep specialist. If your health care professional feels that you may have a sleep disorder they may ask that you keep a sleep diary, or they may even have you stay overnight at a sleep center for observation.

There are over 100 different types of sleep disorders.

Disturbance in the amount, timing, or quality of sleep. Dyssomnias result in excessive daytime sleepiness or an inability to fall asleep or stay asleep. Dyssomnias can originate from causes inside or outside the body.

• Insomnia
• Narcolepsy
• Inability to stay awake (hypersomnia)
• Sleep apnea
• Restless Legs Syndrome (RLS)
• Periodic Limb Movement in Sleep (PLMS)
• Circadian rhythm sleep disorder

Disorders of partial arousal from sleep, or disorders that interfere with sleep stage transitions. Behaviors not normally associated with sleeping may occur during sleep.
• Sleepwalking
• Sleep talking
• Nightmares
• Sleep terrors / night terrors
• Nocturnal leg cramps
• Sleep paralysis
• Grinding or clenching of the teeth (bruxism)
• Bedwetting
• Sudden Infant Death Syndrome (SIDS)

Sleep deprivation is highly treatable, and most individuals find that they experience relief from employing one or sometimes a combination of treatments. Mild to moderate sleep apnea can often be treated with behavioral modification, but most cases of sleep deprivation require a physician’s assistance to find the most effective treatment.

If sleep time isn't a good time for you, talk to your doctor or healthcare professional about your options. The American Academy of Sleep Medicine (AASM) makes sure that people with sleep problems get the best medical care.
Sleep medicine is a recognized medical subspecialty. Doctors who specialize in sleep medicine help people who are unable to sleep well. Sleep doctors are able to detect and treat both common and rare sleep disorders. Some common sleep disorders are insomnia, jet lag, sleepwalking, snoring and obstructive sleep apnea.
The AASM accredits centers and labs that treat people who have sleep problems. In 1977 the AASM accredited the first sleep disorders center. The AASM also certifies behavioral sleep medicine (BSM) specialists. These doctors help people improve their sleep by changing how they think and behave.

APNEA CAUSES PEOPLE TO AWAKE TIRED

As awareness of sleeep apnia mounts, suspected sufferers are spending their nights under an infrared camera's watchful eye in hundreds of so-called "sleep labs" across America, sensors dotting their skin and scalp.

Eleven o'clock is "lights out." At 11:02 sharp, Navarro yawns. A needle swings wildly on a monitor humming softly in the next room. At 11:10 p.m., Navarro turns onto his left side, and a half-dozen needles jerk in response.

This night will be like no other for Navarro, a 32-year-old computer programmer. For the next seven hours, his every breath, movement and heartbeat will be recorded as he spends the night in a sleep disorders laboratory.

He is here because doctors think he suffers from sleep apnea, a disorder marked by loud snoring and interrupted breathing. Once considered relatively obscure, sleep apnea is stirring increased concern among physicians because it can cause severe daytime fatigue, high blood pressure, stroke and heart problems; serious cases can be life-threatening.

A study published in the New England Journal of Medicine reported that sleep apnea is more common than once believed. The study found that 9% of women and 24% of men had sleep-disordered breathing; 2% of women and 4% of men in the middle-aged work force met the criteria for sleep apnea. That would make undiagnosed sleep apnea a major public health burden.

Depending on the severity of the apnea, treatment can include use of a night time face mask or even surgery. There's a less high-tech approach for those who snore or suffer apnea only while on their backs: sewing a tennis ball in the back of their pajamas tops so they will sleep on their sides instead.

Not surprisingly, roommates and spouses are often the first to spot potential apnea victims. Navarro is a longtime snorer; he can remember his college roommates waking him to request that he tone it down. His wife, Christine, grew worried when she noticed that he sometimes stopped breathing briefly during the night. She learned about sleep apnea from her doctor and urged her husband to get tested.

A video screen shows Navarro dozing peacefully. Pink computer paper moves steadily through the polysomnograph, a machine with 12 needles that records everything from his eye movements to heart contractions.

All night, monitors will record the needles' black tracks, paying special attention to those measuring Navarro's breathing. Sleep apnea victims have been known to stop breathing hundreds of times each night.

Wake up happy! Discover the proven sleep apnea treatments that guarantee a healthy and restful sleep! To grab your free report go to Best Sleep Apnea Treatments

HOW TO CHOOSE THE BEST TREATMENTS FOR SLEEP APNEA

If you are suffering from sleep apnia, there are several treatments for it. An obvious next step is continuous positive airway pressure. Other treatments include oral and dental devices to keep your airway open. If all else fails, surgery is an option.

To assess snoring and other symptoms of sleep apnea, have the patient run a tape recorder to record the sounds he or she makes while sleeping. Snoring related to sleep apnea differs from innocuous snoring. Benign snoring has a very monotonous, repetitive sound, but intermittent quiet periods between the loud snoring noises may be indicative of apnea.

Symptoms of apnea indicate referral to a sleep disorder clinic for complete polysomnography, because the diagnosis and classification of apnea can be made only in this setting.

Treatment of obstructive sleep apnea syndrome is multifaceted. The first intervention is advice-the advice you would give anyone who wanted to control snoring:

• Lose weight (if appropriate)
• Sleep on the stomach or on a side, not on the back
• Avoid alcohol at least 3-4 hours before retiring
• Avoid pharmacologic sleep aids
• Get enough hours of sleep each night.

An overnight polysomnogram is used to confirm the diagnosis and assess severity of physiologic disturbances. Initially, simple measures, such as avoidance of alcohol and sedatives before bedtime and sleeping on the side rather than the back, may be tried. Nasal continuous positive airway pressure is considered first-line therapy, and compliance can be improved by education and counseling of the patient.

A first-line medical treatment includes use of a nasal continuous positive air pressure (CPAP) device, which supplies pressure to the upper airway and prevents the airway from collapsing while the patient is asleep. The pressure appropriate for a given patient must be determined in a sleep laboratory.

Another procedure gaining popularity is uvulopalatopharyngoplastysurgical removal of redundant tissue from the soft palate. This procedure is most often used in patients who do not respond to CPAP because of a lack of patency in the upper air-way due to trauma, infections, or allergies. Uvulopalatopharyngoplasty is beneficial in only 50% of patients.

Tracheostomy gives the most consistent long-term benefit but is accompanied by significant emotional morbidity. Tracheostomy may be required for the 5% of patients whose apnea does not respond to other therapy.

Those patients may be able to clear their airway with a prescription dental device that holds the tongue in place or repositions the jaw. But those devices may also be uncomfortable, and they work much less reliably than the mask and pump.

A more effective alternative is surgery, which widens the airway by removing any flabby or enlarged tissue, making a groove in the back of the tongue, or sliding the jaw slightly forward.

SLEEP APNIA SYMPTOMS

Sleep apnia, and chronic sleep deprivation and all their consequences, are America's largest invisible medical problem. The current effort is to make the invisible visible.

Is it possible to sleep eight hours and still wake up feeling exhausted? Yes--if you have a disorder called sleep apnea. Apnea means "absence of breath," and, according to the American Lung Association, a person who has sleep apnea stops breathing for at least ten seconds at a time repeatedly (sometimes hundreds of times) during the night.

In children, sleep apnea can contribute to Sudden Infant Death Syndrome (SIDS). In adults, it can lead to a variety of problems including strokes and hypertension. And, because sufferers can have bouts of intense sleepiness during the day, sleep apnea may be at the root of many of the traffic accident deaths caused each year when people fall asleep at the wheels of their vehicles. Yet, medical experts acknowledge that the problem of sleep apnea has been largely ignored.

Sleep apnea needs to be diagnosed before it can be monitored or treated. Infants are classified as at risk for sleep apnea soon after birth; in fact, most infant apnea monitors are prescribed while the newborn is still in the neonatal intensive care unit (NICU). The doctor prescribes a "sleep monitor" to be used at home for several months. This device has an alarm that lets the caregiver know if the infant's cardiorespiratory rate has fallen outside the parameters set for that baby.

The procedure for adults is different. According to the U.S. Food and Drug Administration, a physician can diagnose sleep apnea and suggest treatment based on the patient's complaints of daytime sleepiness, insomnia, awareness of obstructed breathing during sleep, snoring, and headache or dry mouth on waking.

But, definitive diagnosis of sleep apnea can only be made after a test called polysomnography, which monitors multiple physiological parameters, has been performed. In most cases, the doctor sends the client directly to a sleep disorders center, also known as a sleep lab. Here the patient spends the night in a bedroom laboratory where his or her breathing pattern during sleep is evaluated.

Using a sleep diagnostic system, various skin sensors are attached to monitor physiological variables such as nose/mouth airflow, breathing pattern, heart rhythms, oxygen level, and muscle activity.

A trained technician, called a registered polysomnographic technologist (RPSGT), monitors these measurements and the patient's sleep habits continuously. The results are then evaluated by a physician specially trained in sleep disorders.

SLEEP APNEA OFTEN STRIKES PREMATURE BABIES

Apnea is sometimes misunderstood to be a precursor of sudden infant death syndrome (SIDS). But children with apnea rarely die. And there is no evidence that a baby with sleep apnia is at greater risk for SIDS.

Layne Melzer awoke around 8 a.m. Jan. 6 and looked at his 6-week-old son, Shane, beside him. Most mornings, it was the baby who roused him at dawn with lusty yells for food, so Melzer was surprised to find Shane still asleep. Then he took a closer look. Shane's skin was dusky, and he did not seem to be breathing. Melzer jiggled him tentatively, but the baby did not rouse. His color was darker now. Bluish.

Yelling to his wife to call 911, Melzer grabbed Shane and shook him -- hard this time. The baby's eyes opened at one point, but his gaze was blank.

Frantically trying to recall resuscitation techniques, Melzer put his mouth over Shane's and puffed twice. Then he turned the baby over and slapped him on the back. He slapped him again, and then a third time. Suddenly Shane gulped for air and began to cry. A moment later, the rescue squad arrived.

The crisis, though, was far from over. By noon, Shane was admitted to Childrens Hospital of Orange County with a tentative diagnosis of severe apnea.

The term apnea comes from the Latin words a and pneuma, which means without air. Medically, it refers to pauses in breathing.

The main consequence of apnea is damage to the brain and heart because of repeated periods of inadequate oxygen. A baby with untreated apnea can, in later years, exhibit learning and behavioral problems, even cerebral palsy, associated with brain damage. Shane Melzer's problem was central apnea, exacerbated by a viral infection.

Shane's breathing pauses were found to be frequent, long and responsible for repeated episodes of bradycardia -- the medical term for an abnormally slow heart rate. He met all the criteria for a diagnosis of severe apnea. Two days after being admitted to CHOC, he was transferred to the intensive care unit.

He just got worse. At 3:30 the morning following his transfer, the Melzers were awakened by a call from a doctor in the unit. Shane's apnea was so bad that he now required the assistance of a respirator to survive, the doctor told them. But Shane was fortunate to be in a hospital with expertise in the treatment of apnea.

Shane's apnea has caused no more trouble. His breathing pauses have never been severe enough to trigger the monitor, his parents report, and in every other respect, he is thriving.

Wake up happy! Discover the proven sleep apnea treatments that guarantee a healthy and restful sleep! To grab your free report go to Best Sleep Apnea Treatments

SLLEEP APNIA CAN BE DEADLY IF NOT DIAGNOSED

Although vastly under diagnosed and virtually untreated, sleep apnia can contribute to high blood pressure, cardiovascular problems and strokes. It also can be deadly.

In one study, Stanford University researchers looked at 159 truck drivers. They found that 79 percent had sleep apnea, and many were unable to control when they fell asleep driving. In another study looking at accidents in which drivers fell asleep at the wheel, 87 percent of the drivers died, taking with them one or two other people.

Men suffer from the condition almost three times more often than women, , in part because of anatomical differences in the upper airways. But because many women who suffer from it are post-menopausal, there is some speculation it also may be hormone-related, he said.

The most common and severe form of sleep apnea is obstructive sleep apnea. In many cases, it's caused by sagging muscles at the base of the throat, enlarged tonsils, a small airway opening or a large tongue, according to the American Medical Association Encyclopedia of Medicine. In about 20 percent of cases, being overweight is a major cause of the problem.

Obstructing the airway makes breathing labored and causes loud snoring. If there is complete blockage, the breathing stops altogether and the sleeper is briefly silent. This makes the diaphragm and chest muscles work harder; the sleeper gasps and briefly awakes as breathing is started again.

In central sleep apnea, the airway is opened but the diaphragm and chest muscles don't work, perhaps because of a disturbance in the brain's regulation of breathing during sleep, according to the AMA encyclopedia.

If you suspect you're suffering from sleep apnea, talk to your doctor, who may refer you to a lab where your sleep can be monitored. Losing weight and avoiding alcohol before bedtime may help. Wearing a mask attached to an air compressor that forces oxygen into the airway is an effective treatment for severe cases. And surgery that removes excess tissue from the throat is another possibility.

First think through what you want from the doctor and make it clear to him or her. For instance, if you go to the doctor with lower back pain and your blood pressure is high, your doctor may concentrate on treating the blood pressure because it's potentially life-threatening. However you should make it clear the back pain is still something you want treated. Second, ask questions. Studies show patients who ask questions do better, he said.

Third, be honest about what you can and can't do. If you can't take your medicine four times a day, tell the doctor. Maybe he can give it to you in another form. If you can't diet or exercise, it's important the doctor knows this, too.

Wake up happy! Discover the proven sleep apnea treatments that guarantee a healthy and restful sleep! To grab your free report go to Best Sleep Apnea Treatments

ARE SIDS AND SLEEP APNEA RELATED?

A study suggests that sudden infant death syndrome (SIDS) might be more common in families that suffer from the adult sleeping disorder sleep apnia.

Though the cause of SIDS remains mysterious, new evidence supports the idea that both disorders are caused by a narrowed upper airway resulting from the way the skull is formed, a characteristic that is inherited.

The study compared the number of SIDS cases in 29 families with sleep apnea and 35 families without sleep apnea. Researchers had families fill out questionnaires about the incidence of infant death. Subjects provided data from four generations of each family so that 352 sleep apnea family members and 408 control family members were covered.

The families prone to sleep apnea -- in which breathing stops for short periods during sleep and can lead to snoring or disturbed sleep -- reported eight unexplained infant deaths. The control families reported no unexplained, unexpected infant deaths, although one infant had died of mother-child blood-type incompatibility. Two of the sleep apnea families reported more than one SIDS death. In one case, a pair of twins had died without explanation. When researchers examined the facial structure of four of the six families that reported SIDS death, they found the shapes were significantly different from the normal families.

The results suggest that SIDS and adult sleep apnea are associated and that both could result from obstructive apnea due to facial structure narrowing the upper airway.

Sleep apnea runs in families. Other work has suggested that certain families may be at higher risk for SIDS, although like most things about SIDS, this remains debated. It is a thorny issue. The idea has been that sleep apnea may be the final common pathway of SIDS, but not necessarily the cause. The problem with SIDS research is that no one has ever witnessed a SIDS death which makes it hard to figure out how to prevent sids.

In children who often appear tired or have trouble staying awake in school, check for potential obstructive apnea caused by abnormally large adenoids or tonsils.

Another study that found that babies considered at high risk of SIDS -- those who had stopped breathing and were by chance found and resuscitated -- had a higher chance of having a father with sleep apnea-like symptoms. This could support the idea that sleep apnea is related to SIDS. But how they are related and whether it is causative is another question.

Wake up happy! Discover the proven sleep apnea treatments that guarantee a healthy and restful sleep! To grab your free report go to Best Sleep Apnea Treatments

SLEEP APNIA CAUSES AND SIDE EFFECTS

In sleep apnia, with each period of breathlessness (as many as twenty in an hour) the carbon dioxide level in the blood rises and there is a corresponding decrease in the blood oxygen levels. This, along with the stress and the struggle to draw breath, puts a strain on the heart.
Central apnea is caused by the temporary cessation of the message from the brain that tells the diaphragm to breathe. When a person suffers from a combination of obstructive and central apnea, it's called mixed sleep apnea, and is by far the most difficult to treat and control.

In pure central sleep apnea, the brain's respiratory control centers are imbalanced during sleep. Blood levels of carbon dioxide, and the neurological feedback mechanism that monitors it does not react quickly enough to maintain an even respiratory rate, with the entire system cycling between apnea and hyperpnea, even during wakefulness. The sleeper stops breathing, and then starts again. There is no effort made to breathe during the pause in breathing: there are no chest movements and no struggling. After the episode of apnea, breathing may be faster (hyperpnea) for a period of time; a compensatory mechanism to blow off retained waste gases and absorbs more oxygen.

While sleeping, a normal individual is "at rest", as far as cardiovascular workload is concerned. Breathing is regular in a healthy person during sleep, and oxygen levels and carbon dioxide levels in the bloodstream stay fairly constant. The respiratory drive is so strong that even conscious efforts to hold one's breath do not overcome it. Any sudden drop in oxygen or excess of carbon dioxide (even if tiny) strongly stimulates the brain's respiratory centers to breathe.

In central sleep apnea, the basic neurological controls for breathing rate malfunctions and fails to give the signal to inhale, causing the individual to miss one or more cycles of breathing. If the pause in breathing is long enough, the percentage of oxygen in the circulation will drop to a lower than normal level (hypoxia) and the concentration of carbon dioxide will build to a higher than normal level (hypercapnia). In turn, these conditions of hypoxia and hypercapnia will trigger additional effects on the body. Brain cells need constant oxygen to live; and, if the level of blood oxygen goes low enough for long enough, the consequences of brain damage and even death will occur. Fortunately, central sleep apnea is more often a chronic condition that causes much milder effects than sudden death. The exact effects of the condition will depend on how severe the apnea is, and the individual characteristics of the person having the apnea.

In any person, hypoxia and hypercapnia have certain common effects on the body. The heart rate will increase, unless there are such severe co-existing problems with the heart muscle itself or the autonomic nervous system that makes this compensatory increase impossible. The more translucent areas of the body will show a bluish or dusky cast from cyanosis, which is the change in hue that occurs due to lack of oxygen in the blood ("turning blue"). Overdoses of drugs that are respiratory depressants (such as heroin, and other opiates) kill by damping the activity of the brain's respiratory control centers. In central sleep apnea, the effects of sleep alone can remove the brains' mandate for the body to breathe. Even in severe cases of central sleep apnea, the effects almost always result in pauses that make breathing irregular, rather than cause the total cessation of breathing.

Sleep apnia can cause high blood pressure, depression, heart problems and in some cases sudden death. If you think that you or anyone in your family has sleep apnea, a visit to your family physician is highly recommended.