This week I will be helping identify and talk about some of the interesting sleep disorders.  The most common one is snoring.  What the most recent studies have found is that snoring even if it is not associated with sleep apnea may be indication of health issues.

In children sleep apnea may not be present but snoring may be a sign that your child may need to be treated.  Snoring alone can disrupt sleep, limit the amount of sleep your child may be getting or may just prevent your child from getting into the deeper sleeps needed to grow and to heal.  If your child has symptoms of ADD or ADHD it may be due to that sleep disruption. 

If you find that your child is snoring evaluation by their doctor is the best way to get to the bottom of the problem. Some dentists are also looking at sleep apnea, as they can visualize issues with their upper airway.  The physician may have the child evaluated by an ENT or have them do a sleep study to evaluate the extent of the snoring and to see if their breathing is being affected. 

In adults snoring is not just associated to obstructive sleep apnea.  Snoring itself has been associated with high blood pressure and diabetes.  They have also associated it with dementia and memory loss.  Some people may only snore when they reach certain stages of sleep causing the disruptions to happen at approximately the same time each night.  Usually during REM sleep, where we dream, are muscles are the most relaxed and this can bring on snoring and sleep apnea.  Also it may be worse when someone is sleeping on their back because the tongue relaxes and moves to the back of the throat. 

If you have snoring and you have been tested for sleep apnea with a mild or negative result than you may still want to treat it.  An oral appliance made by a dentist who specializes in sleep would be your best option.  Because different oral appliances work for different people I would make sure that the person you are working with knows how to create more than 1 appliance.  You may also want to attempt to use positional therapy so you do not sleep on your back.  You can use a wedge pillow which will allow you to sleep with your head elevated.  The more productive way however is the tennis ball method, where you create a pocket on the back of a t-shirt, place a couple of tennis balls in them and sleep in it for about a month.  This will help encourage you to stay off your back when you sleep.

Snoring, no matter how we look at it, is not a fun for the person who has it or the person who has to listen to it.  You should do what you can to deal with it to keep yourself and your family as healthy and well rested as possible.

Not everyone who snores actually have sleep apnea.  In fact Upper Airway Resistance is an independent diagnosis that can disrupt sleeping but you do not stop breathing throughout the night.  The issues are not just that of the person who has the problem but those who live with them. 

Upper Airway Resistance, or AURS is when the back of the throat and soft palate is crowded and causes snoring or vibrations that can be very loud and disturbing. 

In children the solution can be as easy as removing the tonsils and adenoids allowing for more space and easier breathing.  This allows a child to sleep easier and reach slow wave sleep, the time in sleep growth and healing happens, to occur.  It also allow for an easier transition into REM sleep.  This normal sleep architecture helps children to learn and retain information as well as have less behavioral problem. 

In adults the solution is not always as easy.  The airway can be restricted due to issues such as deviated septum in the nose, being overweight or just age causing a relaxation of the tongue when we sleep causing crowding.  One of the easiest solutions is to sleep on your side or stomach.  This allows the tongue to fall forward when you sleep.  Another solution is to elevate the head of the bed.  Again this will help to support the airway and keep it open. 

Some of the more interesting solutions people have come up with that have been shown to work are mouth and tongue exercises. Using a didgeridoo, an Australian woodwind instrument, has been shown to help strengthen the muscles in the throat and help decrease snoring.   Singing has also been said to help. 

My final suggestion is that an oral appliance created specifically for you might be helpful.  Always use a dentist who knows how to create the best device for you.  They should know how to create more than one type of device.  They should also be a fellow of the American Board of Dental Sleep Medicine.  An oral appliance would allow the tongue and the jaw to be slightly repositioned to eliminate the snoring.

I always suggest that it will be helpful to talk to your doctor about your medical options.  Whether you use a traditional therapy or one of the non-traditional therapies I would suggest that you take care of this issue not for your health but also for those who you live with or vacation with.

We talk about our weight all the time.  We try new food plans, we take up different exercise programs and we say positive affirmations until we are blue in the face.  We ask our doctors for help and they tell us to try harder, eat less and exercise even more.  When was the last time you were asked how well you sleep?  Our quality of sleep affects our weight more than we can ever imagine. 

 Why You Need to Get 7-8 Hours

We run on less and less sleep so we can get more done and connect to more people.  This lack of sleep has a harsh effect on our brain.  It will not only effect how we make decisions, deal with emotions and are able to concentrate but it will also affect our appetite.  Sleep deprivation causes us to make rash decisions.  This can lead to more volatile emotions and negative emotions like stress and anger.  This leads to stress eating.  It can also lead to eating foods that are high in fat, sugar or salt. 

Sleep deprivation also increases the feelings of hunger.  People who are sleep deprived will eat more frequently to help keep them awake.  Again the foods they choose tend to be high in fat, salt and sugar.  This just makes it harder to stay on your choice of food plans.

Sleep Disorders Affect Your Weight

Sleep apnea has been associated with many health problems but the biggest problem where your weight is concerned is the effect it has on your hormones.  In particular you Cortisol levels tend to be elevated and stay elevated throughout the night.  The stress response every time you stop breathing or have difficulty breathing as obvious by snoring your body responds with the fight or flight reflex and Cortisol is produced and stays elevated   High Cortisol levels keep you from being able to lose weight. 

Treating sleep apnea and snoring requires you to talk to your doctor about the problems you are having sleeping.  You will want to explain all your symptoms not just that you are having difficulty sleeping.  People with sleep apnea do not always snore so do not assume that you do not have sleep apnea if you do not snore. 

There are many doctors who will say “well, if you lose weight you will not have sleep apnea and snoring” but in order for you to be successful with the weight loss you really need to treat this problem.  Your body does not like to be stressed and if you are changing your food and your exercise but you are still stressing your body every night you will not be successful at losing weight.  You need to be your best advocate.

Do Not Underestimate the Small Stuff

Weight loss is a challenge under the best circumstances.  There are little things you can do to help you to make the weight loss journey a little easier.  Sleep is one of the biggest influences that require very little specific work.  Making sure you sleep 7-8 hours a day and that the sleep quality are two of the little changes you can do that will help you achieve your goal.

  More people and their physicians are looking at sleep habits and problems that might be contributing to problems such as hypertension, difficult to control diabetes and congestive heart failure.  They are also looking beyond medications to take care of issues like chronic fatigue.  Snoring is looked at as something more significant then an annoyance.  To find out the source of the problem a sleep study has been scheduled.  Unfortunately not much is explained before the study and it is hard to figure out what is expected by talking to friends and family.  There are a few tips to make the experience more pleasant and get a good night sleep

 

1. Take a tour of lab.  If the doctor owns the lab you can probably take the tour the day the appointment is scheduled.  However, if you are going to an independent or hospital based lab then taking the time to visit the facility to will give you and idea of what to expect and if you feel you can not sleep in that facility it gives you a chance to call another center or discuss other options with your physician
2. Make sure your sleep clothes are comfortable.  Many facilities keep the rooms cool to prevent sweating.  If you know that you will be cold bring socks and warmer clothes.  If you tend to be hot during the night shorts and a t-shirt may be all you need.
3. Bring your pillow or blanket.  Bring something with you that will make you feel like you are sleeping at home.  Many people prefer their own pillow or blanket.  Other may bring their child’s teddy bear or an object that belongs to their spouse. 
4. Read all the paperwork and instructions carefully.  Different facilities have different requirements for preparation.  Some basics will be to have your hair washed with no products in it, no lotion on your face and legs, and to avoid caffeine the day of the study. Make sure all paperwork is filled out and a list of all medications you are on is attached. Some labs will want you off or on certain medications. 
5. Talk to your doctor if you feel you can not fall asleep.  Some labs will prescribe a sleep aid for you to take if you try to fall asleep and are unable to.  If you know you have anxiety issues or you have a history of first night effect, the inability to fall asleep in a strange bed the first night, having some medication as a back up might prevent you from having to come back for a second study.  This is also useful if you need a titration study.  Adjusting to CPAP can take some times.  If you have a sleep aide or anti anxiety medication it might make the adjustment to the CPAP go a little more smoothly.

 

Having a sleep study can be very stressful if you do not prepare for it.  But these steps will help to make you more comfortable and allow your sleep through the night.  The closer your sleep is to sleep at home the more likely the lab will be able to find a problem you might be having. 

Your wife or husband tell you they need to go to bed before you or they will never sleep.  You know if you are going on a trip you can not share a room with anyone else  because they will complain.  Do you know when a snore is something you need help for or just annoying?

The fact is that no matter what a snore is not normal.  If you snore there is something in your anatomy that says you need to have it evaluated.  It may be just that you have a large uvula that vibrates when you breath at night.  It could also mean you have sleep apnea, a condition where you stop breathing or breathing is partially obstructed and your oxygen levels in your blood drop. 

If you have plain snoring this can be treated with several medical treatments including medications, surgery, or an oral appliance.  You might also benefit from positional therapy.  This is where you avoid sleeping on your back.  You can use a special pillow or other device.  My personal favorite is to take a t-shirt sew or glue a pocket down the center of the back of the shirt and place 3 tennis balls into the pocket then close it.  Every time the person rolls onto their back they become uncomfortable and roll to their side.

If you are not sure if you might have sleep apnea take the Sleep Quiz.  If you have a score of 9 or greater then it is time to speak with your physician.  Sleep apnea is important to treat because sleep apnea can contribute to many health issues including depression, high blood pressure and diabetes. 

If your child is a snorer you should take the time to talk to his or her pediatrician.  Sleep disorders can very easily be disguised as irritability,  short attention span and can lead to other health problems.  It can be caused by enlarged tonsils and adenoids.  It can also be caused by a small airway.  The current research is discussion new medication treatments to help children. 

No matter who in the family is snoring it is something that is not normal.  It is something that should be evaluated by a professional.  If they can sleep quieter then everyone will get a better night sleep.