SLEEP APNEASLEEP APNEAThe Village Sleep LabThe Village Sleep Lab

Accredited by the Accredited by the American Academy of Sleep American Academy of Sleep

MedicineMedicine

Juan A. Albino, MDJuan A. Albino, MDBoard Certified in Sleep MedicineBoard Certified in Sleep Medicine

751-4955751-4955February, 2009February, 2009

Thank You !!!Thank You !!!Ron Kiedrowski, Rotary ClubRon Kiedrowski, Rotary ClubPhillip Ratliff, AWAKE Group (753-Phillip Ratliff, AWAKE Group (753-

8773)8773)Heather Ellington, Office Manager Heather Ellington, Office Manager Jim Grazis, RPSGT, CRT, TechnologistJim Grazis, RPSGT, CRT, TechnologistMelyssa Rivera, TechnologistMelyssa Rivera, TechnologistMiyoshi Scott, NurseMiyoshi Scott, Nurse

Common Sleep DisordersCommon Sleep Disorders

InsomniaInsomnia: wants to sleep but cannot : wants to sleep but cannot Sleep DeprivationSleep Deprivation: does : does notnot want to want to

sleep but can; problem of sleep sleep but can; problem of sleep quantityquantity

SLEEP APNEASLEEP APNEA: : sleepy during day, during day, snoressnores at night because of obstruction at night because of obstruction in throat; problem of sleep in throat; problem of sleep qualityquality

Restless Legs SyndromeRestless Legs Syndrome: leg : leg discomfort, relieved by movement that discomfort, relieved by movement that hinders sleep hinders sleep

Good Sleep Habits: BasicsGood Sleep Habits: Basics

Regular times for sleeping and Regular times for sleeping and awakeningawakening

Maintain bedroom dark, quiet, coolMaintain bedroom dark, quiet, cool Use bed only for sleep and sexUse bed only for sleep and sex Avoid late daytime napsAvoid late daytime naps Avoid at night: alcohol, caffeine, nicotineAvoid at night: alcohol, caffeine, nicotine Sleep around 7 to 8 hours every nightSleep around 7 to 8 hours every night Prudent exercise and eating Prudent exercise and eating Avoid stressful situations at bed timeAvoid stressful situations at bed time

Restless Legs SyndromeRestless Legs Syndrome

Leg discomfort, worse at night, Leg discomfort, worse at night, relieved by movement, affects 5-10% relieved by movement, affects 5-10% of populationof population

Familial, begins in childhoodFamilial, begins in childhoodAssociated with iron deficiency, drugs, Associated with iron deficiency, drugs,

Periodic Limb Movements of SleepPeriodic Limb Movements of SleepEasily treatable with medicinesEasily treatable with medicinesRestless Legs Syndrome FoundationRestless Legs Syndrome Foundation

Sleep DeprivationSleep Deprivation

DisastersDisasters: Exxon Valdez, Challenger Space : Exxon Valdez, Challenger Space Shuttle, Chernobyl Nuclear Plant, Commuter Shuttle, Chernobyl Nuclear Plant, Commuter plane crash in Kentuckyplane crash in Kentucky

33% of fatal truck 33% of fatal truck accidents accidents 10% of fatal car accidents10% of fatal car accidents Impairment the same whether: drunk, Impairment the same whether: drunk,

sleep deprived (<4-6hrs.), sleep apneasleep deprived (<4-6hrs.), sleep apnea Must be taken seriously: sleep 7-8 hoursMust be taken seriously: sleep 7-8 hours Leads to obesity and diabetesLeads to obesity and diabetes

Insomnia: Acute or Insomnia: Acute or ChronicChronic

Insomnia: inability to get to sleep, stay Insomnia: inability to get to sleep, stay asleep, wakes up early, with daytime asleep, wakes up early, with daytime impairmentimpairment

Acute Insomnia (<4 weeks): stress, illnessAcute Insomnia (<4 weeks): stress, illness Sleep medicines work well in acute stageSleep medicines work well in acute stage Chronic Insomnia: >4 weeks, often yearsChronic Insomnia: >4 weeks, often years Treat basic problem: >60% psychologicalTreat basic problem: >60% psychological Psychotherapy and behavioral therapy Psychotherapy and behavioral therapy

better than medicines, not easy to treat better than medicines, not easy to treat Psychologists, Psychiatrists, PCPPsychologists, Psychiatrists, PCP

Sleep Apnea: Risk FactorsSleep Apnea: Risk Factors

Affects: 4 to 5% of population: commonAffects: 4 to 5% of population: common Family history, Sleep maintenance insomniaFamily history, Sleep maintenance insomnia Obesity: 80 % of sleep apnea patients; Obesity: 80 % of sleep apnea patients;

central (visceral, apples) obesitycentral (visceral, apples) obesity Increasing age, Male genderIncreasing age, Male gender Large tonsils / adenoids in childrenLarge tonsils / adenoids in children Small mandible, large neckSmall mandible, large neck Elderly & women: little snoring & not obeseElderly & women: little snoring & not obese

Sleep Apnea: Sleep Apnea: ConsequencesConsequences

NightNight: snoring, stops breathing snorting, : snoring, stops breathing snorting, gasping, bed partner worriesgasping, bed partner worries

DayDay: sleepy, tired, depressed, irritable, : sleepy, tired, depressed, irritable, impotent, forgets, ? few complaintsimpotent, forgets, ? few complaints

AccidentsAccidents: work, home, motor vehicle: work, home, motor vehicle Higher death rates with severe sleep apneaHigher death rates with severe sleep apnea HypertensionHypertension, Heart Failure, Heart Attacks, Heart Failure, Heart Attacks StrokesStrokes, Atrial Fibrillation, Atrial Fibrillation Promotes Promotes ObesityObesity and and DiabetesDiabetes

What is OSA?•NO AIRFLOW DESPITE RESPIRATORY EFFORT

•NORMAL SNORING SLEEP APNEA

Obstructive Sleep Apnea

Sleep Apnea: TreatmentSleep Apnea: Treatment

BehavioralBehavioral: : Weight LossWeight Loss, , Sleep PositionSleep Position (Sleep on side, head raised), (Sleep on side, head raised), OxygenOxygen, Avoid , Avoid sedatives sedatives

CPAPCPAP: proven therapy, needs motivation: : proven therapy, needs motivation: widely available, 70%: patients adapt wellwidely available, 70%: patients adapt well

SurgerySurgery: tracheostomy, tonsillectomy, pull : tracheostomy, tonsillectomy, pull forth mandible or tongueforth mandible or tongue

Bariatric SurgeryBariatric Surgery: banding, bypass (Bob : banding, bypass (Bob Eisenhauer 259-1485; Lewis Jones 753-3459)Eisenhauer 259-1485; Lewis Jones 753-3459)

Dental appliancesDental appliances: also pull forth mandible : also pull forth mandible or tongue; expertise necessaryor tongue; expertise necessary

Continuous Positive

Airway Pressure:

CPAP Keeps airway open

100% effective, simple

CPAP therapy

Treatment Options: CPAP

Summary: Sleep ApneaSummary: Sleep Apnea Very common and dangerousVery common and dangerous Easily diagnosed and treatedEasily diagnosed and treated Benefits of treatment:Benefits of treatment: sleep better at sleep better at

nightnight, also, also Feel better during the dayFeel better during the day: less sleepiness : less sleepiness

and fatigue, more energy, less accidentsand fatigue, more energy, less accidents Reduce risk factorReduce risk factor for heart disease and for heart disease and

strokesstrokes Control betterControl better: obesity, diabetes, : obesity, diabetes,

hypertensionhypertension Bed partner sleeps betterBed partner sleeps better: less noise and : less noise and

less worry (but dog is scared of CPAP)less worry (but dog is scared of CPAP)

WebsitesWebsites

The Village Sleep Lab: www.villagesleeplab.comThe Village Sleep Lab: www.villagesleeplab.com National Sleep Foundation: National Sleep Foundation:

www.sleepfoundation.orgwww.sleepfoundation.org American Sleep Apnea Association: American Sleep Apnea Association:

www.sleepapnea.orgwww.sleepapnea.org Restless Legs Syndrome Foundation: www.rls.orgRestless Legs Syndrome Foundation: www.rls.org American Academy of Sleep Medicine: American Academy of Sleep Medicine:

www.sleepeducation.comwww.sleepeducation.com Commercial: www.talkaboutsleep.comCommercial: www.talkaboutsleep.com Commercial: www.MyResmed.comCommercial: www.MyResmed.com Commercial: www.Respironics.comCommercial: www.Respironics.com

BooksBooks

The Promise of SleepThe Promise of Sleep by William Dement by William Dement Sleeping WellSleeping Well by Michael Thorpy by Michael Thorpy No More Sleepless NightsNo More Sleepless Nights by Peter Hauri by Peter Hauri A Woman’s Guide to Sleep DisordersA Woman’s Guide to Sleep Disorders by by

Meir H. Kryger Meir H. Kryger Restless LegsRestless Legs SyndromeSyndrome by Robert H. by Robert H.

YoakumYoakum Say Good Night to InsomniaSay Good Night to Insomnia by Gregg D. by Gregg D.

JacobsJacobs