to sleep, perchance to dream, public talk
TRANSCRIPT
To Sleep, Perchance To Dream To Breathe
Presentation on Behalf of
Sleep Apnea Association of Curacao
to the Citizens of the Island
***
Edward Grandi, Exec. Director
American Sleep Apnea Association
Presentation Objectives
• Sleep
• Sleep Disordered Breathing
• Call to Action
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Sleep – in General
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Sleep – in General
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Sleep – in General
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Circadian Rhythm and the Body
• Melatonin • Body Temperature
• Cortisol
• Melatonin • Body Temperature
• Cortisol
Sleep – in General
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Sleep – in General
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The Purpose of Sleep?
• Slow Wave Sleep
– Growth Hormone
• Rapid Eye Movement (REM) Sleep
– Memory Consolidation
– Learning
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Recovery, Regeneration & Realignment
Sleep Deprivation - Consequences
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Sleep Deprivation - Consequences
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Blood Pressure – An Indicator
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Sleep Deprivation - Consequences
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Sleep Deprivation - Consequences
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How Much Sleep Do We Need?
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The amount of sleep people need depends on various factors, such as the
quality of their sleep, health, age, how much exercise they have done, when
they last ate, etc. A new born needs up to 18 hours sleep each day, while an
adult usually needs between 7 and 8.
Below is a rough estimate of how much sleep people need each day,
according to age:
• Infant (newborn) - 18 hours
• Baby (1 to 12 months old) - 14 to 18 hours
• Baby/toddler (1 to 3 years old) - 12 to 15 hours
• Young child (5 to 12 years old) - 9 to 11 hours
• Teenager - 9 to 10 hours
• Adult - 7 to 8 hours
• Pregnant woman - at least 8 hours
(Source: National Health Service, UK)
Sleep disorders – In General
• Insomnia
• Narcolepsy
• Restless Leg Syndrome – Willis/Eckbom Disease
• Circadian Rhythm Disorder
• Parasominas
• Sleep Disordered Breathing
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10 Commandments of Good Sleep Hygiene
• Fix regular times for going to bed and for getting up.
• If you nap during the day, don't allow yourself more than 45 minutes of sleeping time.
• Stop consuming alcoholic beverages four hours before bedtime and don't smoke at all.
• Avoid caffeine beginning six hours before bedtime. This includes not only coffee and tea, but many soft drinks and chocolate as well.
• Avoid heavy, spicy, or sugary foods starting four hours before bedtime. A light snack just before retiring is okay.
• Exercise regularly, but not right before bed.
• Use comfortable bedding.
• Find a comfortable temperature setting for your bedroom, and keep the room well ventilated.
• Block out all distracting noise and eliminate as much light as possible.
• Reserve your bed for sleep and sex. It is not an office, a workroom, a movie theater, or TV viewing venue.
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Questions on Sleep
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Chronic Intermittent Hypoxemia
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Sleep Apnea
Sleep Fragmentation & Sleep Deprivation
Sleep Apnea - evolution
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Signs, Symptoms and Risk Factors
•Loud Chronic Snoring •Witnessed pauses in breathing •Large neck size (> 17” men, > 16” women) •Excessive Daytime Sleepiness •Nocturia •GERD •Hypertension •Type 2 Diabetes •Erectile Dysfunction
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• High Blood Pressure/Hypertension
• Diabetes
• Impaired Thinking
Co-morbid conditions with OSA
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High Blood Pressure/Hypertension
Peppard, PE; NEJM, 2000; Wisconsin Sleep Cohort Study
Sleep Apnea - Consequences
SDB and Mortality: The Wisconsin Sleep Cohort—Young et al SLEEP, Vol. 31, No. 8, 2008
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Sleep Apnea – in particular
Marin,JM et.al, Lancet 2005:365:1046-1053
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Blood Pressure - Revisited
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Diabetes
d i a b e t e s r e s e a r c h and
c l i n i c a l p r a c t i c e 8 1
( 2 0 0 8 ) 2 – 1 2
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Impaired Executive Functioning
Beebe DW, Gozal D J Sleep Res 2002;11:1-16, p 3
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Treatment Options for OSA
•Lifestyle Changes •Oral Appliances •Positive Airway Pressure •Surgical Options
Mild Moderate Severe
AHI > 5 & < 15 AHI >15 & <30 AHI >30
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Treatment Options for OSA
LIFESTYLE CHANGES:
• Lose Weight
• Stop Smoking
•Reduce or Eliminate Alcohol Use
•Reduce or Eliminate Sedatives
•Avoid Sleeping on Your Back
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Treatment Options for OSA
ORAL APPLIANCE THERAPY:
• Tongue Retaining Device
• Mandibular Advancement Device
a. Fixed
b. Adjustable
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Treatment Options for OSA Positive Airway Pressure Therapy
•Continuous •Bi-level •Auto-titrating •Variable-titrating (ASV)
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Treatment Options for OSA •Surgical Options
•Minor surgery
•Correcting deviated septum
•Removing turbinate
• Pillar procedure
• Hyoid and tongue procedures
•Major surgery
• Uvulopalatopharyngoplasty (UPPP)
• Maxillomandibular advancement (MMA)
•Tracheostomy
Can Treating OSA Make a Difference?
• Daytime Sleepiness
– Yes
• Elevated Blood Pressure
– Yes
• Insulin Resistance
– Yes
• Depression
– Yes
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Call to Action
• Practice good sleep hygiene
• Recognize the risk factors for sleep apnea
• Make your therapy work for you
• Communicate about your condition when going to the hospital
• Support others who have the condition
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Testimony
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