Sleep Disorders

When Pounds Go, Sleep Apnea May Improve
10 percent weight loss increases remission odds, but any amount helps, experts say

By Amanda Gardner
HealthDay Reporter

MONDAY, Sept. 28 (HealthDay News) -- People with sleep apnea who are also obese may triple the chances of eliminating their sleep problems by losing weight, a new study suggests.

Losing about 10 percent of their body weight was enough to bring on total or near-total remission, said Gary Foster, head of the Center for Obesity Research and Education at Temple University in Philadelphia, and lead author of the study.
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For Some Weight Loss Programs to help lose weight quick visit: Diet and Fitness Programs

Sleep Apnea Raises Risk of Death, Especially for Men: Report
Major study links disordered breathing to deadly cardiovascular complications

By Alan Mozes
HealthDay Reporter

TUESDAY, Aug. 18 (HealthDay News) -- The classic manifestations of sleep apnea -- loud snoring, interrupted breathing and sleep disruption -- nearly double the risk for chronic disease and premature death among middle-aged and elderly men, according to major new research.

Even patients with moderate sleep apnea face an increased death risk, as much as 17 percent, compared with those who do not have sleep-disordered breathing problems, the decade-long U.S. study finds.
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WHAT IS A SLEEP DISORDER?

We all look forward to a good night's sleep. Sleep allows our body to rest and to restore its energy levels. Without enough restful sleep, not only can we become grumpy and irritable, but also inattentive and more prone to accidents. Like food and water, adequate sleep is essential to good health and quality of life.

There are two types of sleep: non-rapid eye movement -- or NREM sleep -- and rapid eye movement -- or REM sleep. NREM sleep includes four stages, ranging from light to deep sleep. Then we go into REM sleep, the most active stage of sleep when dreaming often occurs. During REM sleep, the eyes move back and forth beneath the eyelids and muscles become immobile. We cycle through the NREM-REM stages of sleep approximately every 90 minutes.

Researchers believe that two body systems -- the sleep-wake process and our circadian biologic clock -- regulate our sleep. They program our bodies to feel sleepy at night and awake during the day.

The sleep-wake process works by balancing the amount of sleep a person needs based on the time spent awake. Our circadian biologic clock is a 24-hour body rhythm affected by sunlight. It regulates hormones such as melatonin, which is secreted during the night and promotes sleep, and other processes like body temperature. Sleeping at a time that is in sync with this rhythm is important for healthy sleep.

Sleep needs change over a person's lifetime. Children and adolescents need more sleep than adults. Interestingly, older adults need about the same amount of sleep as younger adults -- seven to nine hours of sleep per night.

Unfortunately, many older adults often get less sleep than they need. One reason is that they often have more trouble falling asleep. A study of adults over 65 found that 13 percent of men and 36 percent of women take more than 30 minutes to fall asleep.

Also, older people often sleep less deeply and wake up more often throughout the night, which may be why they may nap more often during the daytime. Nighttime sleep schedules may change with age too. Many older adults tend to get sleepier earlier in the evening and awaken earlier in the morning.

There are many possible explanations for these changes. Older adults may produce and secrete less melatonin, the hormone that promotes sleep. They may also be more sensitive to -- and may awaken because of -- changes in their environment, such as noise.

Older adults may also have other medical and psychiatric problems that can affect their nighttime sleep. Researchers have noted that people without major medical or psychiatric illnesses report better sleep.

Not sleeping well can lead to a number of problems. Older adults who have poor nighttime sleep are more likely to have depressed mood, attention and memory problems, excessive daytime sleepiness, more nighttime falls, and use more over-the-counter or prescription sleep aids. Poor sleep is also associated with a poorer quality of life.

Many people believe that poor sleep is a normal part of aging, but it is not. In fact, many healthy older adults report few or no sleep problems. Sleep patterns change as we age, but disturbed sleep and waking up tired every day are not part of normal aging. If you are having trouble sleeping, see your doctor or a sleep specialist. There are treatments that can help.

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Forget Counting Sheep. Walk Your Way to Better Sleep

Are you tired of being tired? Would you rather be dreaming than watching late-night TV?

Millions of Americans suffer from poor sleep. Being active throughout the day helps you relax more at night. If you give your body the rest it needs, you'll be rewarded with many health benefits, including:

Clearer thoughts
More energy
Positive mindset
Healthy weight maintenance
Muscle strength
Stress relief
Better decision-making ability
Stronger immune system

A good night's sleep is important to your overall well-being - and being active can improve your sleep cycle. When you sleep well, you'll wake feeling more rested and alert. Daily walks relieve insomnia and other sleep disorders by:

Loosening tight muscles
Reducing stress
Promoting longer, deeper sleep periods known as slow wave—the phase of sleep that helps restore the body
Lessening symptoms of depression and anxiety

Sleep Like a Log

How well and how long you sleep affect how you feel. Science has proven that good, sound sleep is necessary for health.

University of Chicago researchers found that lack of sleep reduces the amount of human growth hormone. This hormone is responsible for the body's fat-to-muscle ratio. Restful sleep creates a balance of the hormone and leads to better health.
When you haven't slept well, your body craves energy. So glucose is released in the bloodstream. This slows your metabolism and can cause weight gain. On the other hand, good sleep helps you maintain a healthy metabolism.

Without enough sleep, you feel sluggish and tired—you don't want to exercise. The result is a negative cycle that leads to many problems.

Right balance of sleep and exercise creates a positive cycle for your body. It works both ways: activity helps satisfy your body's need for sleep, and a better sleep pattern motivates you to keep moving.

Walk to Sleep

Take the first step toward healthier sleep and exercise by walking. These ideas will help:

Ease yourself into a walking program. Move at the pace that's right for you. Walk as far and as long as is comfortable, working up to longer, brisker walks. The steady introduction of activity gives your body time to get used to it. This reduces the chance for sore muscles - a common excuse to give up too quickly.
Take a short stroll before and after dinner. This helps soothe your nerves while burning calories. The use of energy combined with the stress release relaxes your body and mind, helping you sleep better and longer.
Companionship helps you stay motivated. Partner with a friend or family member, or even take the dog for a walk.
Cool down after walking. Once you're used to walking, keep this in mind: the ideal walk is brisk enough to make you break a sweat, but not so fast that you run out of breath. Make the last bit of your walk slower. This brings your heartbeat down to its resting rate, which prepares your body for a decent night's sleep.

Walking has a long-term impact on your sleep as well as giving short-term relief. On restless nights, instead of turning on the TV, get up and pace around the house. Take in deep breaths as you move. Shake out your arms and legs. Stretch out your neck. When you climb back into bed, you'll feel more prepared for a healthy trip into dreamland.

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Insomnia

Insomnia is the most common sleep complaint at any age. It affects almost half of adults 60 and older.

If you have insomnia, you may experience any one or any combination of the following symptoms.

taking a long time -- more than 30 to 45 minutes -- to fall asleep
waking up many times each night
waking up early and being unable to get back to sleep
waking up feeling tired, and unable to function well during the day

Short-term insomnia, lasting less than one month, may result from a medical or psychiatric condition. Or it may occur after a change in personal circumstances like losing a loved one, relocating, financial worries, or being hospitalized. If insomnia lasts longer than a month, it is considered chronic, even if the original cause has been resolved.

Many factors can cause insomnia. However, the most common reason older adults wake up at night is to go to the bathroom. Prostate enlargement in men and continence problems in women are often the cause. Unfortunately, waking up to go to the bathroom at night also places older adults at greater risk for falling.

Disorders that cause pain or discomfort during the night such as heartburn, arthritis, menopause, and cancer also can cause you to lose sleep. Medical conditions such as heart failure and lung disease may make it more difficult to sleep through the night, too.

Neurologic conditions such as Parkinson's disease and dementia are often a source of sleep problems, as are psychiatric conditions, such as depression. Although depression and insomnia are often related, it is currently unclear whether one causes the other.

Many older people also have habits that make it more difficult to get a good night's sleep. They may nap more frequently during the day or may not exercise as much. Spending less time outdoors can reduce their exposure to sunlight and upset their circadian biologic clock and their sleep cycle. Drinking more alcohol or caffeine can keep them from falling asleep or staying asleep.

Also, as people age, their sleeping and waking patterns tend to change. Older adults usually become sleepier earlier in the evening and wake up earlier in the morning. If they don't adjust their bedtimes to these changes, they may have difficulty falling and staying asleep.

Lastly, many older adults take a variety of different medications that may negatively affect their sleep. Many medications have side effects that can cause sleepiness or affect daytime functioning.

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Sleep-disordered Breathing

Sleep apnea and snoring are two examples of sleep-disordered breathing -- conditions that make it more difficult to breathe during sleep. When severe, these disorders may cause people to wake up often at night and be drowsy during the day.

Snoring is a very common condition affecting nearly 40 percent of adults. It is more common among older people and those who are overweight. When severe, snoring not only causes frequent awakenings at night and daytime sleepiness, it can also disrupt a bed partner's sleep.

Snoring is caused by a partial blockage of the airway passage from the nose and mouth to the lungs. The blockage causes the tissues in these passages to vibrate, leading to the noise produced when someone snores.

There are two kinds of sleep apnea: obstructive sleep apnea and central sleep apnea. Obstructive sleep apnea occurs when air entering from the nose or mouth is either partially or completely blocked, usually because of obesity or extra tissue in the back of the throat and mouth. If these episodes occur frequently or are severe, they may cause a person's sleep to be fragmented throughout the night. This may disrupt their sleep and make them sleepy during the day.

Central sleep apnea is less common. It occurs when the brain doesn't send the right signals to start the breathing process. Often, both types of sleep apnea occur in the same person.

Obstructive sleep apnea is more common among older adults and among people who are significantly overweight. Obstructive sleep apnea can increase a person's risk for high blood pressure, strokes, heart disease, and cognitive problems. However, more research is needed to understand the long-term consequences of obstructive sleep apnea in older adults.
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Movement Disorders

Two movement disorders that can make it harder to sleep include restless legs syndrome, or RLS, and periodic limb movement disorder, or PLMD. Both of these conditions cause people to move their limbs when they sleep, leading to poor sleep and daytime drowsiness. Often, both conditions occur in the same person.

Restless legs syndrome is a common condition in older adults and affects more than 15 percent of people 80 years and older. People with RLS experience uncomfortable feelings in their legs such as tingling, crawling, or pins and needles that are alleviated by moving the leg. This often makes it hard for them to fall asleep or stay asleep, and causes them to be sleepy during the day.

Although scientists do not fully understand what causes restless legs syndrome, it has been linked to a variety of conditions. Some of these conditions include iron deficiency, kidney failure and dialysis, pregnancy, and nerve abnormalities.

Periodic limb movement disorder, or PLMD, is a condition that causes people to jerk and kick their legs every 20 to 40 seconds during sleep. As with RLS, PLMD often disrupts sleep -- not only for the patient but the bed partner as well. One study found that roughly 40 percent of older adults have at least a mild form of PLMD.

Another condition that may make it harder to get a good night's sleep is rapid eye movement sleep behavior disorder, also known as REM sleep behavior disorder. It is somewhat more common in men over the age of 50.

REM sleep, or rapid eye movement sleep, is the most active stage of sleep where dreaming often occurs. During normal REM sleep, the eyes move back and forth beneath the eyelids, and muscles cannot move. In more severe forms of REM sleep behavior disorder, the muscles become quite mobile and sufferers often act out their dreams.

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Diagnosis

Before you visit the doctor, it may be very helpful for you to ask for and keep a sleep diary for a week or more. A sleep diary will give you and your doctor a picture of your sleep habits and schedules and help determine whether they may be affecting your sleep.

During your appointment your doctor will ask you about your symptoms and may have you fill out questionnaires that measure the severity of your sleep problem. It is also helpful to have your bed partner come with you to your appointment since he or she may be able to report symptoms unknown to you like loud snoring, breathing pauses, or movements during sleep.

Since older people are more likely to take medications and to have medical problems that may affect sleep, it is important for your doctor to be aware of any health condition or medication you are taking. Don't forget to mention over-the-counter medications, coffee or caffeine use, and alcohol since these also may have an impact on your sleep.

The doctor will then perform a physical examination. During the exam the doctor will look for signs of other diseases that may affect sleep, such as Parkinson's disease, stroke, heart disease, or obesity. If your doctor feels more information is needed, he or she may refer you to a sleep center for more testing.

Sleep centers employ physicians and others who are experts in problems that affect sleep. If the sleep specialist needs more information, he or she may ask you to undergo an overnight sleep study, also called a polysomnogram, and/or a daytime sleepiness, or a nap test. A polysomnogram is a test that measures brain waves, heart rate, breathing patterns and body movements.

A common sleepiness test is the multiple sleep latency test. During this test, the person has an opportunity to nap every two hours during the daytime. If the person falls asleep too quickly it may mean that he or she has too much daytime sleepiness.

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Treatment

Based on your sleep evaluation, your doctor or sleep specialist may recommend individual treatment options. It is important to remember that there are effective treatments for most sleep disorders.

If you are diagnosed with a sleep disorder, your doctor may suggest specific treatments. You should ask for information to find out more about your condition and ways to improve your sleep.

There are a number of therapies available to help you fall asleep and stay asleep. You may want to try limiting excessive noise and/or light in your sleep environment. Or, you could limit the time spent in bed while not sleeping, and use bright lights to help with circadian rhythm problems. Circadian rhythm is our 24-hour internal body clock that is affected by sunlight.

Relaxation techniques also may be helpful in reducing physical and emotional tensions that can interfere with sleep. There are also cognitive therapies aimed at changing attitudes and concerns people may have about insomnia and not being able to sleep well.

Some specialists believe medications also can be useful early in your treatment, and if necessary, you can use them from time to time if you have trouble falling asleep.

People who are diagnosed with sleep apnea should try to lose weight if possible, but often they may need other treatments as well. Adjusting your body position during the night may benefit you if you experience sleep apnea more often when you lie on your back.

The most effective and popular treatment for sleep apnea is nasal continuous positive airway pressure, or CPAP. This device keeps your air passages open by supplying a steady stream of air pressure through your nose while you sleep.

To use the CPAP, the patient puts on a small mask that fits around the nose. Air pressure is delivered to the mask from a small, quiet air pump that sits at the bedside. The patient not only wears the mask at night but also during naps, since obstructions can occur during these times as well.

If you have a mild case of sleep apnea, sometimes a dental device or appliance can be helpful. If your condition is more severe and you don't tolerate other treatments, your doctor may suggest surgery to increase the airway size in the mouth and throat. One common surgical method removes excess tissue from the back of the throat.

Very often, people who suffer from movement disorders during sleep such as restless legs syndrome or periodic limb movement disorder are successfully treated with the same medications used for Parkinson's disease. People with restless legs syndrome often have low levels of iron in their blood. In such cases doctors often prescribe supplements.

Medications can also treat people with REM behavior disorder. If there are reports of dangerous activities such as hitting or running during these episodes, it may be necessary to make changes to the person's sleeping area to protect sufferers and their bed partners from injury.

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Sleeping Well

A good night's sleep can make a big difference in how you feel. Here are some suggestions to help you.

Follow a regular schedule -- go to sleep and wake up at the same time, even on weekends. Sticking to a regular bedtime and wake time schedule helps keep you in sync with your body's circadian clock, a 24-hour internal rhythm affected by sunlight.

Try not to nap too much during the day -- you might be less sleepy at night.

Try to exercise at regular times each day. Exercising regularly improves the quality of your nighttime sleep and helps you sleep more soundly. Try to finish your workout at least three hours before bedtime.

Try to get some natural light in the afternoon each day.

Be careful about what you eat. Don't drink beverages with caffeine late in the day. Caffeine is a stimulant and can keep you awake. Also, if you like a snack before bed, a warm beverage and a few crackers may help.

Don't drink alcohol or smoke cigarettes to help you sleep. Even small amounts of alcohol can make it harder to stay asleep. Smoking is dangerous for many reasons, including the hazard of falling asleep with a lit cigarette. Also, the nicotine in cigarettes is a stimulant.

Create a safe and comfortable place to sleep. Make sure there are locks on all doors and smoke alarms on each floor. A lamp that's easy to turn on and a phone by your bed may be helpful. The room should be dark, well ventilated, and as quiet as possible.

Develop a bedtime routine. Do the same things each night to tell your body that it's time to wind down. Some people watch the evening news, read a book, or soak in a warm bath.

Use your bedroom only for sleeping. After turning off the light, give yourself about 15 minutes to fall asleep. If you are still awake and not drowsy, get out of bed. When you get sleepy, go back to bed.

Try not to worry about your sleep. Some people find that playing mental games is helpful. For example, think black -- a black cat on a black velvet pillow on a black corduroy sofa, etc. Or, tell yourself it's five minutes before you have to get up and you're just trying to get a few extra winks.

If you are so tired during the day that you cannot function normally and if this lasts for more than 2 to 3 weeks, you should see your family doctor or a sleep disorders specialist.

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Forget Counting Sheep. Walk Your Way to Better Sleep

Sleep Like a Log

Walk to Sleep