Women with Sleep Apnea Show Higher Brain Damage, Anxiety than Men

An estimated 18 million Americans have obstructive sleep apnea (OSA), including one in four women over 65, according to the National Sleep Foundation.

And several recent studies have linked OSA to health disorders specifically in women. Sleep apnea has been linked to dementia in older women,  and another observational study found that women with untreated severe OSA are 3.5 times more likely to die from cardiovascular disease than women without OSA.

Here’s another reason for women to take sleep apnea seriously: A first-of-its-kind study out of the UCLA School of Nursing discovered that women with sleep apnea are more likely to suffer a higher degree of brain damage than men with sleep apnea.

What is obstructive sleep apnea? OSA is a disorder that occurs when a person's breathing is repeatedly interrupted during sleep, sometimes hundreds of times a night. During each obstruction, the oxygen level in the blood drops, which over time, causes myriad health problems. For people with sleep apnea, the combination of disturbed sleep and oxygen starvation may lead to hypertension, heart disease and mood and memory problems, among other disorders.

The new UCLA study

UCLA has been on the cutting edge of sleep apnea research. About 10 years ago, the same UCLA research team that conducted the new study was the first to show that men with OSA have damage to their brain cells.

For the latest multi-year study, entitled "Sex Differences in White Matter Alterations Accompanying Obstructive Sleep Apnea,” the researchers studied patients diagnosed with OSA at the UCLA Sleep Laboratory. They compared the nerve fibers in the patients' brains, known as “white matter,” to the nerve fibers of people without OSA or other sleep problems. The goal was to find the differences in brain damage, if any, between men and women with OSA.

Results of the study

The researchers found that women are actually more affected by sleep apnea than men. Additionally, women with OSA have more severe brain damage than men suffering from a similar condition. The women with sleep apnea also showed higher levels of depression and anxiety symptoms.

Specifically, the study found that women were impacted in the cingulum bundle and the anterior cingulate cortex areas in the front of the brain involved in decision-making and mood regulation.

Based on the results, chief investigator Paul Macey said, “Doctors should consider that OSA in women may be more problematic and therefore need earlier treatment in women than men.”

With the results of this study as a foundation, the next step is for the researchers to find out if treating sleep apnea can help the brain.

In a “chicken or egg” scenario, did the OSA cause the brain damage, or did the brain damage cause the OSA?  Or did the common conditions, such as depression, dementia or cardiovascular issues cause the brain damage, which in turn leads to sleep apnea?

The study and resulting questions are fascinating, and one thing is for sure: both men and women who are having trouble sleeping should get checked for obstructive sleep apnea and other sleep disorders.

Researchers estimate that up to 85 percent of people with severe sleep apnea have not been diagnosed yet.

Many times, sleep apnea can be misdiagnosed as chronic fatigue, insomnia, depression, or some other non-specific condition, so be specific about the symptoms you are experiencing.

Don't wait to get checked—it could save your life, or someone you love.

For more information, read the article, “Women with sleep apnea have higher degree of brain damage than men, UCLA study shows.”

“Social Jetlag” Contributing to Global Weight Gain

Here’s another reason to get more sleep — and another new term to describe one of our modern maladies: “social jetlag.” What exactly is social jetlag? It is a syndrome caused by the discrepancy between our internal body clock and our social clock. And according to Professor Till Roenneberg, Ph.D. at the University of Munich's Institute of Medical Psychology in Germany, that gap between how much sleep we need and how much we’re actually getting is contributing to our global weight gain and the growing worldwide obesity epidemic.

Each of us has a physiological clock, and that internal clock — also known as our circadian rhythm — is regulated by daylight and darkness to prompt us to go to sleep or wake up. We also have a social clock of things that make up our daily lives, such as our work schedules and social calendars. The problem is, in our modern society of too-late work hours and too much time in front of computer screens, we are listening to our social clocks more than our physiological clocks, causing a greater sleep gap known as social jetlag. As a person’s circadian rhythm gets more out of whack, their physiological clock gets set later and later, keeping them awake into the night, and feeling chronically tired during the day.

Professor Roenneberg and his fellow researchers in Munich discovered the negative effects of social jetlag after compiling and studying the sleep habits of more than 65,000 adults over the past 10 years. Roenneberg and his team recorded sleep times and other data of the participants, such as height and weight, and started to draw conclusions.

The results of the study — which you can read in the May 10 issue of Current Biology — showed that people with different weekday and weekend sleep schedules—i.e., those with more social jetlag — were three times more likely to be overweight. That is a significant increase worth repeating: Three times more likely to be overweight!  Furthermore, the body mass index (BMI) of the overweight participants tended to increase as the gap between their weekday and weekend sleep clocks widened.

Two-thirds of participants reported at least one hour's difference in their average weekday and weekend sleep schedules, and more than 10 percent reported three-plus hours difference between their weekday and weekend sleep schedules. Roenneberg and his colleagues also found that people who are chronically sleep-deprived are also more likely to smoke and drink more alcohol and caffeine.

The results of the study are similar to those of previous studies linking a higher body mass index and even diabetes to the irregular sleep schedules and sleep deprivation of shift workers. But I applaud the efforts of Roenneberg and his team for their work in particular, because they are bringing a public awareness of a growing syndrome that is affecting many people worldwide — not just shift workers or those with irregular work schedules.

So, why does social jetlag cause weight gain? One of the theories is that late hours encourage irregular meal times and late-night eating, when the body has more difficulty digesting and metabolizing food. That translates into body fat. Another is that chronically tired people are less likely to exercise and more likely to smoke and drink, further contributing to weight gain.

Whatever the causes, it is in all our personal best interests to become more aware of our own physiological clocks and get more restful sleep. Doing so can help us all maintain a healthy body weight, avoid many health problems, feel better and live happier, more productive lives. In the words of Professor Roenneberg, “Good sleep and enough sleep is not a waste of time but a guarantee for better work performance and more fun with friends and family during off-work times.” Knowledge of the study and an increased awareness of the effects of social jetlag can also have positive effects on the economy and education: Companies can make more informed decisions about employees’ work schedules and schools can make more educated decisions about school hours.

So, now that you have this new knowledge about social jetlag, your physiological and social clocks and how a gap between your weekday and weekend sleep schedules can contribute to your weight gain, what are you going to do about it? I present you with a personal challenge that will only help you feel better. I challenge you to get more sleep. Turn off the TV and computer and go to bed earlier. Forego that invitation for a late-night dinner. Spend more time outdoors, and if you’re stuck in an office all day, try to sit near a window. I promise you, you’ll feel less social jetlag.

To read Professor Roenneberg and his team’s full report entitled, “Social Jetlag and Obesity,” published in the May 10 issue of Current Biology.

Sleepy on the Job? Tips for a Better Night’s Sleep

There’s no denying that sleep deprivation, and the health issues that result, are becoming more prevalent in our go-go, techno society. But a recent sleep study by the National Sleep Foundation (NSF) grabbed my attention as particular cause for concern.

Every year, the NSF releases a Sleep in America® poll.  For its 2012 survey, the NSF examined the specific sleep habits and work performances of transportation workers—pilots, train operators, truck, bus, taxi and limousine drivers. The transportation workers were asked about the duration and quality of their sleep, specifically on work nights, and how it affects their work performance.

Some of the results of the survey are:

• About one-fourth of the train operators and pilots polled said that sleepiness has affected their job performance at least once a week.
• One in five pilots polled—about 20 percent—said they have made a “serious error” as a result of on-the-job sleepiness.
•  One in five pilots and one in six train operators admit to a “near miss” due to on-the-job sleepiness.
• Pilots and train operators are more likely than non-transportation workers to have been involved in a sleep-related car accident while commuting.
• Among all workers surveyed, train operators and pilots report the most work day sleep dissatisfaction.
• Almost two-thirds of train operators and one-half of pilots say they rarely or never get a good night’s sleep on work nights.
• About one-third of bus, taxi, and limo drivers said they rarely or never get a good night’s sleep on work nights.

The results of the poll are some cause for alarm, and reinforce the growing problem of sleep disorders and the potential risks they pose, such as commuter car accidents and errors by public transportation drivers responsible for many people.

Persistent sleep problems left untreated can also lead to myriad health problems, including memory and concentration problems, increased risk of high blood pressure, hypertension, stroke and heart attacks, depression, diabetes and sexual dysfunction. Severe cases of sleep apnea can even be fatal.

Besides these sobering health risks, an untreated sleep disorder can also be the root cause of poor performance at work or school, car accidents and other activities that require focus and concentration.

Common Symptoms of Sleep Disorders

Many people experience some occasional difficulty sleeping and/or daytime fatigue. But how does a person know if he or she has a temporary sleep problem that can be remedied with some simple behavioral changes, or if it is a legitimate disorder such as snoring, sleep apnea, sinusitis or nasal obstruction that should be diagnosed and treated properly?

The first step is to be aware of some common symptoms of sleep disorders. Keep in mind that symptoms vary between disorders, such as snoring, sleep apnea, insomnia, restless leg syndrome, nasal obstruction, narcolepsy, so it pays to do some research based on what you are personally experiencing.

Some common symptoms of sleep disorders include:

• Trouble falling asleep at night
• Waking throughout the night
• Chronic snoring
• Morning headaches
• Poor memory
• Daytime sleepiness/falling asleep during the day/low energy
• Bad moods/ irritability
• Increased depression
• Trouble concentrating/driving/making decisions

The Link Between Lifestyle and Sleep Problems

If you or someone you know is experiencing some of the above common symptoms of sleep disorders, the next step is to examine if lifestyle habits are contributing to the difficulty sleeping, fatigue and irritability during the day and other symptoms.
Some behavioral/lifestyle questions to ask include:

• Am I watching TV or using the computer late at night and too close to bedtime?
• Am I consuming too much caffeine during the day?
• Am I taking a medication that may be affecting my sleep quality and duration?
• Is there something particularly stressful going on in my life that is causing me worry and anxiety?
• Am I exercising enough to help alleviate some of that stress and tension?

See a Specialist—And Be Specific

Many sleep problems can be remedied by making some common sense behavioral changes. However, if you or someone you know is experiencing one or more of the above symptoms on a regular basis, see a qualified ear, nose and throat doctor or otolaryngologist to get diagnosed and treated properly. There are multiple options and minimally invasive techniques available today to treat your sleep disorder.

When you see a specialist, be specific about the symptoms you are experiencing. Many times, sleep apnea and other sleep disorders can be misdiagnosed as chronic fatigue, insomnia, depression, or some other non-specific condition. Some doctors, for example, still associate sleep apnea more with men than women, and are too quick to prescribe a medication, rather than do a full sleep disorder work up.

It may help to keep a sleep log (or, more accurately, lack of sleep log) next to your bed to write down what you are experiencing, when you wake and some symptoms you experience. Again, to try and avoid misdiagnosis, go to a qualified sleep specialist and be specific about your symptoms. Don’t wait — it could save your life.

To read the full report, see “Sleepy Pilots, Train Operators and Drivers”  on the National Sleep Foundation website.

Driver Fatigue Brought to Light in NYC Bus Crash Investigation

Driver Fatigue

The tragic bus accident that killed 15 people after it violently crashed on I-95 just outside of the Bronx last week has raised multiple questions for federal investigators. Among the causes being investigated by the National Transportation Safety Board was whether the bus driver was so fatigued he was not capable of driving properly. To determine that, they will be checking surveillance video and room records at Mohegan Sun where the bus traveling from, carrying people back to New York City’s China Town.

Although there are numerous questions as to why the driver, a convicted felon, should have even been behind the wheel of the bus in the first place, there is no question that even if fatigue wasn’t the cause of this crash, it is a major cause of crashes--not just for buses, but for trucks, airplanes, trains and boating accidents as well.

Last fall the American Automobile Association (AAA) Foundation for Traffic Safety polled 2,000 drivers. One-third of them admitted to either nodding off or completely falling asleep while they were driving in the past year. The results were surprising, indicating the problem is much more profound than previously expected.

More than half of those polled by AAA reported they fell asleep on a high-speed highway. Although it might seem more common to doze off during long car rides, 59% said they’d been driving under an hour before they had fallen asleep and only 20% had been driving for more than three hours. Twenty-six percent reported that it happened in the middle of the day, between noon and 5pm.

The National Highway Traffic Safety Administration estimates that drowsy driving “results in 1,550 deaths, 71,000 injuries and more than 100,000 accidents each year” and that fifty-seven percent of  driving crashes caused by fatigue involved the driver drifting into other lanes or even off the road.

The cause in this growing US problem can be contributed to many factors, not the least of which is the link between daytime fatigue and snoring. Results of a Canadian study published a few years ago linked drivers with sleep apnea with more than double the risk of car and truck accidents. Sleep loss, whether it is associated with snoring, insomnia, or simply poor sleep habits, impairs a driver’s reaction time. It causes people to lose the ability to perform important tasks, impedes memory, reasoning, and the ability to learn and perform math. Prolonged sleep loss can also lead to depression and hallucinations, and can cause health problems involving the heart and immune system and be a contributing factor to obesity which leads to further health issues such as diabetes.

If you’re feeling fatigued, it’s best to not get behind the wheel at all. Here are some tips to help stay awake while driving. If you are having trouble getting restful sleep, it is important that you speak to your doctor about it, because it is likely more serious that you think.

Originally published in The Huffington Post, for which Dr. Volpi is a regular contributor.

Drivers with Sleep Apnea – A Deadly Blend

Drivers with sleep apnea continue to be a hazard, and pose a worrisome combination. Hundreds of International researchers and doctors convened at the 3rd Annual Swedish Sleep Medicine Congress this past April in Gothenburg, where an important research study which examined public transportation drivers in Sweden who had undiagnosed sleep apnea. Results could potentially impact professional drivers everywhere for years to come.

Mahssa Karimi of the Center for Sleep and Vigilance Disorders presented her findings of a study conducted which examined sleep disorders of 116 bus and tram drivers in Gothenburg. The researchers had to first diagnose the drivers, many of whom had not previously sought medical attention for sleep disorders and sleep apnea. It was discovered that 19% had sleep apnea.

Since past studies have linked drivers with sleep apnea to a higher rate of car and truck crashes, these findings point to the importance of getting sleep apnea patients, especially those who are on the roads for a living, the treatment they need to keep the public safe. As Karimi said, “Our findings suggest that it's important to systematically examine professional drivers and other professional groups entrusted with the safety of others in order to be able to treat any sleep disorders, as their work demands alertness and concentration at all times."

Two years ago, a study published in the medical journal Thorax and conducted by Vancouver Coastal Health Research Institute and University of British Columbia revealed that sleep apnea patients are at double the risk of being in a car crash, and are three to five times more likely to be in a serious car crash involving personal injury. In the largest study of its kind, researchers used data from the Insurance Corporation of British Columbia to study 1,600 patients with and without sleep apnea.

In another study conducted by the medical director of Lifespan's Employee Health and Occupational Services, Dr. Philip Parks, and The Cambridge Health Alliance, further showed the link of obesity in truck drivers and sleep apnea. Researchers examined 456 truck drivers from more than 50 employers. Of those, 17% had Obstructive Sleep Apnea, most who were older, obese and had higher than average blood pressure. "It is well-known that obesity, a leading risk factor for obstructive sleep apnea, is on the rise in the United States. Truck drivers with sleep apnea have up to a 7-fold increased risk of being involved in a motor vehicle crash," said Dr. Parks. Due to that study, the Federal Motor Carrier Safety Administration is deliberating recommendations to require sleep apnea screening for all obese drivers based on body mass index.

Unfortunately, many of the patients in these studies didn’t even report that they had daytime sleepiness, suggesting that many don’t realize they have sleep apnea and aren’t aware of the potential hazard they cause while driving. Considering that sleep apnea causes excessive daytime sleepiness, impairs motor skills and diminishes thought function, we at Manhattan Snoring and Sleep Center strongly recommend that if you suspect that you have any symptoms of sleep apnea, you seek diagnosis and treatment right away, especially if you drive professionally. The risks to yourself and others when you’re on the road make sleep apnea and driving a dangerous combination. Contact us today.