SLEEP APNEA Obesity DIABETES Headaches Juan A Albino

SLEEP APNEA: Obesity, DIABETES, & Headaches Juan A. Albino, MD, FCCP Village Sleep Lab 751 -4955; September, 2006

Thank You !!! l l l l l Jim Smith, Diabetes Support Group Phillip Ratliff, AWAKE Group (753 -8773) Lois Brach, AWAKE Group (753 -4260) Normarie M. Albino M. D. , President, Wife Heather Ellington, Office Manager John Crawford, Technical Director Thomas Chaput, Sleep Technologist Tamara Dillon, Sleep Technologist Miyoshi Scott, Nurse Meagin Franey, Receptionist

Common Sleep Disorders l Insomnia: wants to sleep but cannot l Sleep Deprivation: does not want to sleep but can; problem of sleep quantity l Sleep apnea: sleepy during day, snores at night because of obstruction in throat; problem of sleep quality l Restless Legs Syndrome: leg discomfort, relieved by movement that hinders sleep

Good Sleep Hygiene: Basics l Regular times for sleeping and awakening l Maintain bedroom dark, quiet, comfortable l Use bed only for sleep and sex l Avoid late daytime naps l Avoid at night: alcohol, caffeine, nicotine l Sleep around 8 hours every night l Prudent exercise and eating l Avoid stressful situations at bednight

Restless Legs Syndrome l Leg discomfort, worse at night, relieved by movement, affects 5% of population l Familial, begins in childhood l Associated with iron deficiency, drugs, Periodic Limb Movement of Sleep l Easily treatable with medicines l Restless Legs Syndrome Foundation, June K. Wharton (259 -0979)

Sleep Deprivation l Disasters: Exxon Valdez, Challenger Space Shuttle, Chernoble Nuclear Plant, Commuter plane crash in Kentucky l 33% of fatal truck accidents l 10% of fatal car accidents l Impairment the same whether: drunk, sleep deprived (<4 -6 hrs. ), sleep apnea l Must be taken seriously: sleep 8 hours l Leads to obesity and diabetes

Chronic Insomnia l Acute Insomnia (<4 weeks): stress, illness l Chronic Insomnia: >4 weeks, often years l Treat basic problem: 50% psychological l Treat primary insomnia, begins childhood l Psychotherapy and behavioral therapy l Medications, new ones coming out l PCP, Psychologists, Psychiatrists

Sleep Apnea: Risk Factors l Family history l Obesity: 80 % of sleep apnea patients; central (visceral, apples) obesity l Increasing age l Male gender l Large tonsils / adenoids l Small mandible, large neck l Smoking, alcohol, sedatives

Sleep Apnea: Consequences l Social / Psychological: work, family l Personal: fatigue, tired, depression, irritability, impotence, memory l More accidents: work home motor vehicle l Higher death rates with severe apnea l Hypertension, Congestive Heart Failure l Heart Attacks, Strokes, Atrial Fibrillation l Obesity, Diabetes, Headaches, Migraines

Obstructive Sleep Apnea What is OSA? • Cessation of airflow with ongoing respiratory effort • Normal Snoring Sleep Apnea

Sleep Apnea: Treatment l Behavioral: Weight Loss, Sleep Position (Sleep on side, head raised), Oxygen, Avoid sedatives and alcohol l CPAP: proven therapy, needs motivation: widely available l Surgery: tracheostomy, tonsillectomy, pull forth mandible or tongue l Dental appliances: also pull forth mandible or tongue; expertise necessary

Treatment Options Treatment -CPAP treatment – Positive pressure maintains airway patencey – Titration – 100% effective CPAP therapy

Linkage l Obesity, sleep, stress, diet, and exercise l One study: if not enough sleep wake up with greater hunger l Proper amounts of sleep and exercise decrease appetite and obesity l Much easier to obtain proper sleep and treat sleep apnea than to diet

Sleep Apnea & Other Conditions l Diabetes worsened by Sleep Apnea l Better control of Sleep Apnea leads to better control of Diabetes l Sleep deprivation leads to a diabetic state l Hypertension worsened by Sleep Apnea l Fibromyalgia associated with sleep apnea l Migraine headaches triggered by sleep apnea (stress & low oxygen)

Obesity l Obesity, Sleep Apnea promote each other l Hormonal links: leptin decreases and ghrelin increases hunger, while having opposite effects on sleep l Unfortunately medical trials with leptin have not been fruitful l Body is programmed: if not sleeping then eat more, in particular CHO and fat

Obesity and Sleep Deprivation l Direct link with avoiding sleep and obesity l Risk of obesity rises with sleep deprivation l Less than 4 hours : 73% risk l Five hours : 50% risk l Six hours : 23% risk l Less sleep: lower leptin levels l Obese persons sleep less

Obesity & Sleep Apnea l Sleep apnea, obesity promote each other l BMI: Body Mass Index l Underweight: <19 l Normal : 19 – 24 l Overweight : 25 – 29 l Obese : 30 – 39 l Morbidly Obese: 40 or above l If obese RISK of Sleep Apnea is the BMI

Approach to Weight Loss l Directly Dieting in long run: 5 to 10% l By regular Exercise: 20 to 30% l Avoid Sleep Deprivation when associated with obesity: 50 to 70% l Treatment of Sleep Apnea associated with obesity: 50 to 70% l Treating sleep disorders is a promising approach to obesity control

Sleep and Diabetes l Sleep problems: risk factors for Diabetes l Sleep problems worsen Diabetes l Sleep deprivation worsens insulin resistance and glucose intolerance l Sleep apnea does the same l Control of sleep problems improves DM l CPAP improves Diabetes control

Control Sleep Apnea: Better Diabetes Control l Improve insulin sensitivity l Lower blood sugars l Lower Hb. A 1 -c l Lower dosages of oral hypoglycemic agents or less medicines

Metabolic Sydrome l Early risk factor: cardiovascular disease l Affects: 50 million Americans l High waist: men >40” women >35” l High triglycerides: >150 mg/dl l Low HDL: men <40 mg women <50 mg l High blood pressure: >130/85 l High fasting glucose: >100 l Add: sleep deprivation or sleep apnea

Websites l National Sleep Foundation: sleepfoundation. org l American Sleep Apnea Association: sleepapnea. org l Restless Legs Syndrome Foundation: rls. org l National Center on Sleep Disorders: healthfinder. gov/orgs/HR 2536. htm

Books l The Promise of Sleep by William Dement l Sleeping Well by Michael Thorpy l No More Sleepless Nights by Peter Hauri l A Woman’s Guide to Sleep Disorders by Meir H. Kryger