Less Than Six Hours Sleep/Night Increases Strokes

Lack of sleep and an increase in strokes. According to new research, the two conditions are very connected, even in otherwise healthy adults.

In early June, the University of Alabama at Birmingham released the results of a study that regularly sleeping less than six hours a night significantly increases the risk of stroke symptoms in middle-age to older adults who are of normal weight and at low risk for obstructive sleep apnea (OSA). That’s worth repeating: Less than six hours of sleep per night increases the risk of strokes in adults of normal weight and not at risk for OSA.

It seems that under six hours of sleep per night is the critical variable, but why? Let’s take a look at the study. The University of Alabama researchersfollowed 5,666 people  for up to three years who had no history of strokes or stroke-like symptoms, transient ischemic attacks (when blood flow to the brain stops for a brief period causing stroke-like symptoms), or high risk for OSA at the start of the study.

For a period of three years, the researchers followed and studied the subjects’ first stroke symptoms, stroke risk factors, depression symptoms, demographic information and other various health behaviors. What they found was—after adjusting for body-mass index (BMI)—there was a strong association between daily sleep periods of less than six hours and a greater incidence of stroke symptoms for middle-age to older adults, even beyond other risk factors. Interestingly, the researchers did not find any link between short sleep periods and stroke symptoms in overweight and obese participants.

Still, the connection between short sleep and strokes is worthy of great attention from the medical community and general public. I agree with the Alabama study’s lead author, Megan Ruiter, PhD., who said, “The results of the Alabama study provide a strong argument for increasing physician and public awareness of the impact of sleep as a risk factor for stroke symptoms, especially among persons who appear to have few or no traditional risk factors for stroke.”

It looks like the medical community is taking this message to heart. Another study announced in late July is going on at the Alberta Health Services and the University of Calgary.  There, Dr. Patrick Hanly of the university’s Hotchkiss Brain Institute is leading a study to learn more about the physiological connection between sleep apnea and stroke—specifically, the brain’s blood flow response in people with and without sleep apnea.

For the study, participants with sleep apnea stay overnight in the sleep laboratory at Calgary’s Foothills Medical Centre, where their breathing and cardiovascular responses are continuously monitored while they sleep. The next day, their brain blood flow response to reduced oxygen levels is assessed while they are awake. Then, the participants receive supplemental oxygen during sleep for two weeks, and are tested again to see if their cerebral defense mechanisms have improved. The researchers are also studying people without sleep apnea to see if their cerebral defense mechanisms function better than in those with sleep apnea. Hanly and team’s theory is that it is the lack of oxygen, or hypoxia, that people with sleep apnea experience during sleep that impairs the body’s normal defense mechanisms in the brain. A better understanding of this connection will lead to better prevention and treatment strategies.

I applaud the work of the Alabama and Calgary researchers. It’s time we all wake up to the health benefits of more–and better—sleep.

For more information, read the University of Alabama at Birmingham study, “Under 6 Hours of Sleep Tops Risks for Stroke in a Low-risk Population.”

Ready to Treat Your Sleep Apnea? You Have Options.

This month’s blog is for anyone who has been diagnosed with obstructive sleep apnea (OSA) and is currently using or considering using a Continuous Positive Airway Pressure (CPAP) machine while sleeping.

Many patients are not happy about the prospect of sleeping with an mask on. If you do opt for CPAP therapy, realize that CPAP machines have come a long way. If you’re adamant you do not want to use a CPAP mask, thankfully, you have options.

First, I want to briefly explain what obstructive sleep apnea does to a person’s nighttime breathing. When you fall asleep, your muscles relax, and the soft palate at the back of the throat can sag. When this happens, the upper airway can become obstructed, causing the soft palate and uvula to vibrate, causing snoring.

When the airway is completely obstructed, breathing stops for a period of time, until the body is jerked awake in reaction. This is obstructive sleep apnea. OSA can cause interrupted breathing hundreds of times a night, usually around 20 seconds per pause.

This paused breathing causes waking through the night, preventing deep, restorative sleep. This often leads to a host of problems, from daytime sleepiness and reduced job performance to hypertension,heart disease, mood and memory problems.

A CPAP machine helps this condition by pumping a continuous flow of air into the nasal passages, keeping the airway open, and preventing or greatly reducing snoring and paused breathing.

Many people don’t like wearing the nasal mask for CPAP therapy. Some feel claustrophobic or claim it causes dry mouth, nasal congestion or skin irritations. Realize there are different machines out there, so it’s important to choose the right machine for you—choose a small, quiet machine with a comfortable mask that fits you well. A humidifier attached to the CPAP machine can reduce throat dryness.

If CPAP therapy is not for you, there are some non-surgical treatment options. One of the latest is the Pillar Procedure, a safe, non-invasive treatment for mild to moderate OSA symptoms. During the Pillar Procedure, three tiny polyester implants are placed into the soft palate through a small delivery tool without incisions or stitches. Over the following weeks, the implants, together with the body's natural fibrotic response, stiffens the upper palate and creates structural support. This reduces the tissue vibration that causes snoring and the tissue collapse that causes obstructive sleep apnea. I do the Pillar Procedure at my Eos Sleep office, and it usually takes around 20 minutes.

Another is a more comfortable alternative to CPAP, called the Provent Device. This FDA-approved treatment involves a small nasal valve that fits into the nostrils and is secured by an adhesive bandage. The valve is powered by your own breathing and creates positive airway pressure much like CPAP, but does not require a machine or mask.

Bilevel Positive Airway Pressure (BiPAP) is similar to CPAP therapy, but the machine has two air pressure levels, one for breathing in and one for breathing out. The air pressure for breathing out is usually set lower than the incoming air, and you may find it more comfortable to breathe out against a lower air pressure.

Whatever OSA treatment option you choose, you owe it to yourself to seek proper treatment and use your chosen therapy regularly.  The benefits are great—snoring and paused breathing will be reduced or eliminated, helping you—and your partner—to sleep and feel better during the day.

Why Home Sleep Testing is Revolutionizing Sleep Apnea Treatment

Although home sleep apnea testing equipment has be utilized for a few years, it wasn’t until recent findings presented at the American Thoracic Society 2010 International Conference confirmed that patients that used the home sleep test showed similar improvements in their obstructive sleep apnea (OSA) treatment as did patients who had their sleep testing performed in an overnight lab.

Prior to the findings of this study, it was commonly thought that patients would have the most successful treatment if they stayed overnight in a lab, because they would be spending more time with a technician who provides education of OSA and the importance of its treatment, which would improve the patient’s compliance using the standard CPAP (continuous positive airway pressure) device of their treatment once at home. Since many patients complain about the discomfort of the CPAP, compliance is difficult for many.

However, as this study found, of 300 patients who randomly either underwent their sleep testing in the lab or at home, 185 of them completed three months of follow-up treatment. The results of their OSA improvements using CPAP treatment where similar regardless of whether they had their sleep testing done in the lab or in the home.

The Manhattan Snoring and Sleep Center now offers home sleep testing equipment to qualified patients, and has found similar results as this study with its own patients who either under go sleep testing at the center’s overnight lab or at home.

A home sleep test is used only to diagnose sleep apnea, and obstructive sleep apnea is the most common type, as well as the most serious. It is caused by an obstructed upper airway in which soft tissue of the palate, throat or tongue blocks the flow of air as a person struggles to breathe. Since OSA symptoms can lead to severe health conditions, it is very serious and important that patients receive expert medical care and guidance. There are other physical causes of snoring and apnea, and since home sleep tests only diagnose apnea, a patient should have a thorough physical exam first to see if the test is right for them or if a different line of treatment is necessary. Even if sleep apnea is suspected, there are other factors that may make a test in an overnight sleep lab necessary.

Visit the Manhattan Snoring and Sleep Center website for more information about the home sleep test. If you suspect that you have sleep apnea or if snoring is keeping you from getting a good night’s sleep, contact us today to schedule an appointment.