About Sleep

Living With Sleep Disorders

Sleep Difficult,
Treatable Diagnosis in Children

Ten Ways to Sleep Better

1. Go to sleep and wake up at the same time each day.
   Keeping a regular sleep schedule, even on weekends, helps to develop a sleep-wake rhythm that encourages better sleep.
2. Create a comfortable sleep environment.
   You can try to control a number of the elements in your bedroom that will promote good sleep, such as:
   • - Temperature
     • Cool is better than hot.
   • - Light
     • Keep your bedroom as dark as possible. You might even consider wearing an eye mask.
   • - Noise
     • Less noise means more sleep. You can reduce noise levels with rugs and drapes, earplugs, background “white noise” (such as a fan), or soothing music.
   • - Comfort
     • A good mattress can improve the quality of sleep.
   • - Function
     • Try not to use your bedroom for work activities, such as balancing the checkbook or studying. Make your bedroom a stress free zone.
3. Avoid alcohol and caffeine.
   Alcohol may help you get to sleep, but it will make your sleep restless and uneasy. Caffeine – contained in tea, cola, and chocolate, as well as in coffee – is a stimulant and can cause problems for people trying to fall asleep.
4. Watch your diet.
   A heavy meal or spicy foods right before bedtime can lead to nighttime discomfort, and fluids can require disruptive trips to the bathroom. A light snack, however, can prevent hunger pangs and help you sleep better.
5. Get out of bed if you are not sleeping.
   If you don’t fall asleep within 15 minutes, get up. Get back into bed only when you feel sleepy.
6. Exercise regularly.
   Exercise in the afternoon – at least 3 hour before bedtime, so you won’t be too “revved up” – will help you get deeper, more restful sleep.
7. Cut back on or stop tobacco use.
   Nicotine, like caffeine, is a stimulant. It may cause problems with falling asleep, waking up, and nightmares.
8. Avoid watching the clock.
   Set the alarm and place the clock out of sight. Constant checking can even cause insomnia.
9. Create a relaxing bedtime routine.
   Read a good book, listen to music, practice relaxation techniques, or take a warm bath.
10. Talk to your doctor.
    Discuss your sleep problems with your doctor.

Sleep-Disordered Breathing KEY FACTS & FIGURES

Prevalence of OSA

• 1 in 5 adults has mild OSA (Source: Young 2004)
• 9% of woman, 24% of men in middle-aged work force suffer from OSA (Source: Young 1993)
• Prevalence similar to asthma (17 million) and diabetes (15.7 million) (Source: Am. Academy of Allergy, Asthma & Immunology; Am. Diabetes Assoc.)
• 85% of cases remain undiagnosed (Source: Young 1997)

Signs of Symptoms of OSA

• Excessive daytime sleepiness (EDS)
• Irregular breathing during sleep
• Obesity
• Nighttime gasping, choking or coughing
• Frequent nocturnal urination
• Morning headaches
• Gastro–esophageal reflux (GE Reflux)
• Hypertension
• Large neck size

Increased Risk Factors for OSA

• Male gender
• Obesity (BMI > 30)
• Diagnosis of hypertension
• Family history of OSA
• Upper airway or facial abnormalities
• Large neck circumference (>17” men; >16” women)
• Excessive use of alcohol or sedatives
• Smoking
• Endocrine and metabolic disorders

Co–morbid Associations with OSA

• Hypertension
• Cardiovascular diseases (arrhythmias, myocardial infarctions, heart failure)
• Stroke
• Type II diabetes
• Mood disorders (anxiety and/or depression)
• Obesity

Health Care Costs (Economic consequences of untreated SDB)

• Undiagnosed patients used $200,000 more in the two year period prior to diagnosis than matched controls (Source: Kryger 1996)
• Prior to apnea diagnosis, patients utilized 23–50% more medical resources (Source: Smith 2002)
• Total economic cost of sleepiness = approximately $43–56 billion (Source: Leger 1994)
• Undiagnosed moderate to severe sleep apnea in middle-aged adults may cause $3.4 billion in additional medical costs in the US (Source: Kapur 1999)

Traffic Accidents

• 15-fold increase of being involved in traffic accident (Source: Horstmann 2000)
• People with sleep apnea are at twice the risk of having a traffic accident (Source: Teran-Santos 1999)
• Treating all US drivers suffering from sleep apnea would save $11.1 billion in collision costs and save 980 lives annually (Source: Sassani 2004)

Cardiovascular Links

• 4.7 million people in the US have heart failure
• Approximately 50% of HF patients have SDB (Source: Javaheri 1999)
• HF is the most expensive disorder to treat (Medicare – $20.4 billion p.a.)
• Arrhythmias noted in 50–75% of OSA patients (Source: Somers 2004), 30% in cardiovascular patients (Source: Shafer 1999)

Hypertension Links

• Studies have shown that sleep apnea is an independent risk factor of hypertension
• 30–80% of patients with hypertension have sleep apnea (Sources: Logan 2001; Sjostrom 2002)
• 50–90% of sleep apnea patients have hypertension (Sources: Peppard 2000; Lavie 2000)

Stroke Risk

• 65% of stroke patients have SDB (Source: Dyken 1996)
• Up to 70% of patients in rehabilitation therapy following stroke have significant SDB (AHI > 10) (Source: Good 1996)

Links to Type II Diabetes

• 50% of male diabetics have sleep apnea (Source: Einhorn 2005)
• OSA may have a casual role in the development of diabetes (Source: Reichmuth 2003)
• OSA is associated with insulin resistance (independent of obesity) (Source: Punjabi 2002)
• 30% of patients presented to a sleep clinic have impaired glucose intolerance (Source: Meslier 2003)

Treatment of OSA with CPAP

• Treatment of OSA resulted in a 10 mmHg reduction in blood pressure (Source: Becker 2003)
• Would reduce stroke risk by 35% and coronary heart disease risk by 20%
• CPAP treatment reduces the need for acute hospital admission due to CVD in patients with OSAS (Source: Peker 1997)
• One month of CPAP improves daytime blood pressure, heart rate, and left ventricular function (Source: Kaneko 2003)
• CPAP reduces blood glucose levels (Source: Babu 2005)
• 2 nights of CPAP improves insulin sensitivity, sustained at least 3 month interval (Source: Harsch 2003)
• For every dollar spent on CPAP, $3.49 would be saved in reduced collision costs (Source: Sassani 2004)