How Sleep Can Affect Your Health – For Good or For Bad
By Dr. Narayan Krishnamurthy, MD
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Information provided by Dr. Narayan Krishnamurthy, Pulmonary and Sleep Medicine Specialist; Tuscaloosa Lung & Sleep Consultants (Tel: 205-345-2255) and Medical Director of the DCH Sleep Lab. Dr. Krishnamurthy is a Fellow of the College of Chest Physicians, a Fellow of the Royal College of Physicians (UK) and a Fellow of the American college of Physicians. He is a Diplomate of American Board of Sleep Medicine and a Fellow of the American Association of Sleep Medicine. |
Adequate sleep every night hasn’t always been considered a necessary part of enjoying good health. Today, sleep deprivation is considered a major factor in many medical and psychosocial problems and can play a major role in serious industrial and motor vehicle accidents.
Night after night millions of Americans are not getting recommended adequate sleep of seven to eight hours. Sleep deprivation can lead to neurobehavioral deficits (the way the brain affects emotion, behavior and learning) that can lead to poor job performance and sleepiness-related errors and accidents.
Obstructive Sleep Apnea (OSA) has evolved as a leading cause of sleep deprivation and its prevalence is estimated to be up to 25% in the general population depending on the severity and as high as 45% in obese adults. Men’s risk of OSA is twofold higher than women but this difference is less striking after menopause. OSA has been directly implicated in causing hypertension as well as progression of several common medical conditions such as heart failure, irregular heart, stroke and sudden death due to repeated drop in oxygen level while asleep. More recently, it has been associated with development of diabetes due to metabolic alteration occurring while asleep, independent of other risk factors.
Driving drowsy can be as dangerous as drinking and driving.
• Sleepiness slows reaction time, decreases awareness and impairs judgment, all of which may lead to a greater likelihood for potential accidents.
• Studies have shown that being awake for 24 hours straight is the equivalent of being legally intoxicated. Even a small amount of alcohol when a person is already sleepy can affect his or her ability to stay awake while driving. Drinking one alcoholic drink while sleepy is like having several drinks at once.
• Drowsy drivers often have “micro-sleeps,” in which their eyes are open but they are not really aware of their surroundings. This makes them less likely to attempt to avoid a crash.
Majority of causes of sleep deprivation including OSA is effectively treatable but require discipline and compliance with treatment, under adequate medical supervision.
With each disturbed breathing event, the brain briefly arouses people with sleep apnea in order for them to resume breathing, but consequently sleep gets severely fragmented and of poor quality. There is a simultaneous drop in hormonal stability and oxygen level, which can occur several hundreds of times causing severe cardiovascular and metabolic instability. There is a direct correlation between OSA and cardio¬vascular disease and even death. This becomes more serious with those who already have chronic lung or heart ailments.
Sleep Apnea
Sleep apnea is the most common sleep disorder and may not be very obvious to patients or to those who live closely, unless thoroughly evaluated by a sleep or pulmonary specialist. The Greek word “apnea” literally means “without breath.” People with untreated sleep apnea stop breathing repeatedly during their sleep, sometimes hundreds of times during the night and often for a minute or longer, many times unnoticed or unaware. Sleep apnea is very common and affects millions of Americans. Risk factors include being male, overweight and over the age of 40. However, sleep apnea can happen to anyone at any age, even children. Untreated, sleep apnea can be a factor causing high blood pressure and other cardiovascular disease, memory problems, weight gain, impotency and headaches. In addition, untreated sleep apnea may be responsible for job impairment, marital problems and motor vehicle crashes.
There are three types of sleep apnea, with obstructive sleep apnea (OSA) being the most common. During sleep, OSA is caused by a blockage of the airway, usually when the soft tissue in the rear of the throat collapses and closes. In central sleep apnea, the airway is not blocked but the brain fails to signal the muscles to breathe. Mixed apnea is a combination of the two.
Treatment
Fortunately, sleep apnea can be diagnosed and treated. Obesity is a major risk factor for the development and progression of OSA. The incidence of OSA in obese individuals is twice that of non-obese adults. A 10% weight loss can result in 20% improvement in OSA severity. Several treatment options exist, and research into additional options continues. At present, the most effective treatment is Continuous Positive Airway Pressure therapy (CPAP). CPAP therapy is used with a mask placed around the nose with positive pressure forced to open the airways. Following initial evaluation by a specialist, several other causes of sleep deprivation and breathing difficulty is excluded and treated.
Diagnosis of sleep apnea is then made and optimal pressure as well as type of equipment is determined in a fully accredited sleep lab, under a board certified sleep specialist. Majority of patients can achieve improvements in fatigue, excessive sleepiness and difficulty breathing. Significant improvement in blood pressure, diabetes and other morbid factors with less need for medication can be achieved. To achieve good adherence to treatment, regular follow up with adjustment of pressure and mask fitting is required under the care of a Pulmonary/Sleep specialist. Most medical insurance covers fully or partially the sleep studies and CPAP equipment.
Other major causes of sleep deprivation include insomnia due to a number of causes and inadequate sleep hygiene. Indiscrete medication can have disastrous consequence and drug dependency. Cognitive behavioral therapy has been shown to be superior to medication following a thorough initial sleep disorder assessment as indicated above. It is typically delivered in a group format with counseling and reinforcement at multiple sessions.
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