Sleep Apnea Awareness week serves as an important reminder that sleep health is as important to a family’s health as good nutrition, good hygiene and regular preventative medical care. Children and adults both need regular sleep in age- appropriate amounts. Infants sleep for a good part of the twenty four hour cycle, not surprising in that we know that sleep is necessary for brain development and learning.
As we move through childhood to adulthood, sleep is every bit as important even if the hours required decrease over time. The demands of our society and 24/7 culture are the biggest obstacle to healthy sleep habits. Proper sleep hygiene requires a regular bedtime, a dark and cool environment absent of distractions and adequate time in bed to meet our requirements. If one feels no need to nap, wakes without an alarm and gets up at the same time weekdays and weekends, they are probably getting good adequate sleep. If they don’t meet those standards they are lacking sleep in either quality or quantity. Medical disorders of sleep quality cause symptoms of sleep disruption despite an adequate opportunity to sleep.
Obstructive sleep apnea (OSA) is clearly the most important medical disorder of sleep which causes and worsens many other medical conditions such as high blood pressure, stroke, heart attack, diabetes and obesity. OSA is most commonly evidenced by regular (often loud) snoring while asleep followed by a cessation of breathing (apnea) or loud gasping and choking sounds. These apneas cause disruption of the patient’s (and bed partner’s) sleep leading to poor sleep quality and symptoms of daytime sleepiness and fatigue.
These are the obvious symptoms of OSA but it is the silent impact of OSA on overall health that is the largest concern. Repetitive episodes of breathing pauses at night with the body’s alarm systems being triggered over and over leaves a profound toll on one’s cardiovascular health, leading to premature disease and death. Chronic fatigue and sleepiness leads to gradual weight gain, which in turn worsens the OSA leading to a vicious cycle of deterioration in health status and quality of life. Diagnosis and effective treatment today is readily available and to date millions of Americans have experienced the life changing benefits of OSA treatment.
OSA was originally felt to be a disease of middle-aged obese males but over the past 25 years research has shown that children, thin people and women can also have profound OSA. Clear links between OSA and ADD have been shown to be very significant and probably a cause of the ADD in many children. Any child who snores and has any behavioral issues or learning issues should be evaluated for OSA. Treatment in children may be a tonsillectomy or any one of several treatments previously limited to adults.
In men the problem may begin in adolescence and slowly progress until they reach medical attention in their mid-forties. Recently it has been recognized that women have increase prevalence of OSA in the perimenopausal years and may have profound symptoms of sleep disruption. This is in addition to the sleep fragmentation and disruption common to menopause. Studies have shown that estrogen replacement therapy in the ten years after menopause reduces the prevalence of OSA in women but eventually they catch up to men so that the gender prevalence is 50/50 after age 60.
This week I urge all who have loved ones who snore regularly to “say something”. Those whose children and spouses snore regularly should have this reported to their physicians. To those who believe that they themselves snore, now is a great time to seek their own medical attention. Silence about OSA causes death disability and infirmary which is treatable.
By Dr. Michael Coppola – Executive Vice President of Medical Affairs at NovaSom®