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Sleep Apnoea - SLEEP MATTERS!

Article by Dr Peter Richard Pedersen

 

Sleep Apnoea

THURSDAY, May 1, 2014 (HealthDay News) -- Seniors who slept too little or too much during midlife or after are at increased risk for memory problems, as are those whose sleep habits changed over time, a new study suggests.

Researchers looked at more than 15,000 women, 70 and older, who took part in a large study of health professionals. The women were depression- and stroke-free when they underwent their initial assessment.

Participants who slept five hours or less, or nine hours or more a day -- either in midlife or later life -- had worse memory than those who slept seven hours a day. The difference in memory was equivalent to nearly two extra years of age, the researchers said.

Women whose amount of sleep changed by more than two hours a night over time had poorer memory than those who had no sleep changes, according to the study published May 1 in the Journal of the American Geriatrics Society.

"Given the importance of preserving memory into later life, it is critical to identify modifiable factors, such as sleeping habits, that may help achieve this goal," study leader Elizabeth Devore, of Brigham and Women's Hospital in Boston, said in a hospital news release.

"Our findings suggest that getting an 'average' amount of sleep, seven hours per day, may help maintain memory in later life and that clinical interventions based on sleep therapy should be examined for the prevention of [mental] impairment," she added.

The study adds "to our knowledge about how sleep impacts memory. More research is needed to confirm these findings and explore possible mechanisms underlying these associations," Devore concluded.

While the study found an association between sleep time during midlife and older age and memory function in older women, it did not prove a cause-and-effect relationship.

Sleep apnoea

Sleep apnoea occurs when the walls of the throat come together during sleep, blocking off the upper airway at the level of the tongue. Breathing stops for a period of time (generally between a few seconds and up to one minute) until the brain registers the lack of breathing or a drop in oxygen levels and sends a small wake-up call. The sleeper rouses slightly, opens the upper airway, typically snorts and gasps, then drifts back to sleep almost immediately.

In most cases, the person suffering from sleep apnoea doesn’t even realise they are waking up. This pattern can repeat itself hundreds of times over every night, causing fragmented sleep. This leaves the person with unrefreshed sleep, excessive daytime sleepiness and fatigue. It’s estimated that about five per cent of Australians suffer from this sleep disorder, with around one in four men over the age of 30 years affected.

Degrees of severity

The full name for this condition is obstructive sleep apnoea. Another rare form of breathing disturbance during sleep is called central sleep apnoea. It is caused by a disruption to the nerve messages sent between the brain and the body. The severity of sleep apnoea depends on how often the breathing is interrupted.

As a guide:

  • Normal – less than five interruptions an hour

  • Mild sleep apnoea – between 5 and 15 interruptions an hour

  • Moderate sleep apnoea – between 15 and 30 interruptions an hour

  • Severe sleep apnoea – over 30 interruptions an hour.

 

Symptoms

People with significant sleep apnoea have an increased risk of motor vehicle accidents and hypertension and may have an increased risk of heart attack and stroke. In the over-30 years age group, the disorder is about three times more common in men than women.

Some of the associated symptoms include:

  • Daytime sleepiness, fatigue and tiredness

  • Poor concentration

  • Irritability and mood changes

  • Impotence and reduced sex drive.

Causes

Obesity is one of the most common causes of sleep apnoea. A loss of around 5kg to 10kg may be enough to dramatically reduce the severity of the disorder.

Other contributing factors include:

  • Alcohol, especially in the evening – this relaxes the throat muscles and hampers the brain’s reaction to sleep disordered breathing

  • Certain illnesses, like reduced thyroid hormone or the presence of a very large goitre

  • Large tonsils, due, for instance, to excessive growth hormone or a congenital abnormality

  • Medications, such as sleeping tablets and sedatives

  • Nasal congestion and obstruction.

Treatment

Treatment for sleep apnoea relies on changes to lifestyle, including losing weight and cutting down on alcohol. Any contributing medical condition, such as low production of thyroid hormone, also needs to be corrected. Any surgical conditions such as large tonsils should be corrected.

The most effective treatment available is a mask worn at night that keeps the back of the throat open by forcing air through the nose. This is called ‘nasal continuous positive airway pressure’ (CPAP). However, some people with sleep apnoea find the mask difficult to tolerate.

Another treatment is the use of a mouthguard (or oral appliance or mandibular advancement device). When properly made, it is effective for mild to moderate sleep apnoea. Mouthguards are also used in severe sleep apnoea if the person cannot tolerate the CPAP mask. They work by holding the jaw forward during sleep.

Where to get help:

Your doctor or Sleep disorders clinics.

Things to remember:

Sleep apnoea occurs when the walls of the throat come together during sleep, blocking off the airway above the voice box.

Around one in four men over the age of 30 years have some degree of sleep apnoea.

Conservative treatment includes weight loss and cutting back on alcohol.

Active treatment includes nasal CPAP, mouthguards or surgical correction of upper airway obstruction.

Daytime sleepiness may distinguish simple snorers from people with sleep apnoea. 

Sleep Apnea, exercises for throat, and tongue...

We’re all aware of various devices which can be worn to prevent snorin , but there may be a simpler alternative that is worth a shot too. Exercises can make a significant difference to a tired snorer and their partner. The following patient information sheet can be printed to give to your patients.

Tongue and throat exercises, if practiced diligently over a period of time, may be of great benefit in reducing snoring. Repeat each of the following exercises 5 times each, twice daily:

  1. Slowly open and close your mouth to its full extent, making sure the lips meet when closing. 

  2. Pucker your lips (as if about to kiss). Hold for a count of 10. Relax. 

  3. Spread your lips into a big, exaggerated smile. Hold. Relax.

  4. Mix Exercises 2 & 3: Pucker-Hold-Smile-Hold.

  5. Try to pucker with your mouth wide open, without closing your jaws together. Hold & relax. 

  6. Close your lips and press them tightly together. 

  7. Close your lips firmly, then make a ‘slurping’ noise, as if sipping a drink.

  8. Open your mouth and stick out your tongue. Be sure your tongue comes straight out of your mouth and doesn’t go off the side. Hold, relax and repeat several times. Work toward sticking your tongue out farther each day, but still pointing straight ahead.

  9. Stick out your tongue and move it slowly from corner to corner of your lips. Hold in each corner, relax and repeat several times. Be sure your tongue actually touches each corner each time.

  10. Stick out your tongue and try to reach your chin with the tongue tip. Hold at the farthest extension.

  11. Stick out your tongue and try to touch your nose with the tongue tip. Hold at farthest extension.

  12. Stick out your tongue. Hold a spoon upright against the tip of your extended tongue and try to push it away while your hand holds the spoon in place. 

  13. Repeatedly stick your tongue in and out as fast as you can.

  14. Flick your tongue from corner to corner as quickly as you can.

  15. Move tongue all around your lips in a circle as quickly as you can, making sure you stay in constant contact. 

  16. Open and close mouth as quickly as you can, making sure your lips close each time.

  17. Say ‘Ma-Ma-Ma-Ma’ as quickly as possible, ensuring there's an ‘em’ and an ‘ah’ sound each time.

  18. Repeat with ‘La-La-La-La.’

  19. Repeat with ‘Ka-Ka-Ka-Ka’ as quickly and accurately as you can.

  20. Repeat with ‘Kala-Kala-Kala-Kala.’ 

  21. Gargle loudly with warm water.

  22. Sing through the vowel sounds (A-E-I-O-U) as loudly as you can (or dare). Songs like ‘Old McDonald Had a Farm’ are also good. 

  23. Make a long S sound, feel the virbration.


Chronic Headache Linked To Snoring 

A new study finds a link between snoring and chronic daily headache. The study, published in the April 22 issue of Neurology, the scientific journal of the American Academy of Neurology, examined the snoring habits of people with chronic daily headache and people with occasional headaches. 

Chronic daily headache was defined as people with at least 15 headaches per month. Occasional headache was defined as two to 104 headaches per year. 

People with chronic daily headache were more than twice as likely to also be chronic snorers than those with occasional headaches. The result was the same even when adjusting for factors that can affect breathing in sleep, such as body mass index and alcohol intake.

'If we can show that the snoring is causing the headaches, then we may be able to stop or lessen people's headaches by treating their snoring,' said study author Ann Scher, PhD, of the National Institute on Aging in Bethesda, Md. 'This would be a great relief to people who suffer from chronic daily headache.'

The study involved 206 people aged 18 to 65 who had suffered from chronic daily headache for five years or less and 507 people with occasional headache. Those with chronic headache had an average of 260 days with headaches per year. Those with occasional headache had an average of 24 headache days per year. 

The participants were asked how often they snored, and researchers classified their headache types. Scher noted that few studies have validated the accuracy of having patients report their own snoring status. To test the validity, the researchers analysed the link between snoring and chronic daily headache data separately by gender, age, marital status and headache type and found no significant differences.

Those with chronic daily headache were more likely to be female, have a lower educational level and have been previously married (divorced, widowed or separated) than those with occasional headache. 

Scher said more research is needed to determine the link between snoring and chronic daily headache. 'The headaches could be causing the snoring, or the snoring could be causing the headaches, or both,' she said. 'Chronic headache can result in disturbed sleep, and sedating medications used to treat pain can aggravate sleep-disordered breathing. On the other side, sleep deprivation or excessive sleep can trigger migraine attacks in some people.' 

Jab Stops Snoring In Its Tracks 

An injection in the back of the mouth can prevent snoring, reports the New Scientist.

Scott Brietzke told delegates at a meeting of the American Academy of Otolaryngology’s Head and Neck Surgery in Denver. This ‘snoreplasty’ technique is effective, relatively painless and costs only about $35 per patient.

Patients undergo treatment that involves injecting a chemical called tetradecyl sulphate into the fleshy soft palate at the back of the throat. Scar tissue is then formed which stiffens the soft palate, reducing the amount of fluttering of the tissues and hence snoring.

The technique was developed at the Walter Reed Army Medical Center in Bethseda, Maryland and can reduce the loudness of snoring from 11 decibels to 2 decibels.

Andrew Cummin of London’s Charing Cross Hospital, commented, ‘This certainly seems preferable to trimming the soft palate. Trimming the palate can cause irreparable damage. If too much of the palate is removed, patients can experience regurgitation of fizzy drinks through the nostrils, or they can have trouble swallowing.’

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