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Getting enough Sleep?
Image May 2016

 

More than a third of American adults are not getting enough sleep on a regular basis, according to a new study in the Centers for Disease Control and Prevention's (CDC) Morbidity and Mortality Weekly Report. This study documents estimates of self-reported healthy sleep duration (7 or more hours per day) for all 50 states and the District of Columbia.

The American Academy of Sleep Medicine and the Sleep Research Society recommend that adults aged 18-60 years sleep at least 7 hours each night to promote optimal health and well-being. Sleeping less than 7 hours per day is associated with an increased risk of developing chronic conditions such as obesity, diabetes, high blood pressure, heart disease, stroke, and frequent mental distress.

"As a nation we are not getting enough sleep," says Wayne Giles, M.D., director of CDC's Division of Population Health, in a release. "Lifestyle changes such as going to bed at the same time each night; rising at the same time each morning; and turning off or removing televisions, computers, and mobile devices from the bedroom, can help people get the healthy sleep they need."

CDC researchers reviewed data from the 2014 Behavioral Risk Factor Surveillance System (BRFSS), a state based, random-digit-dialed telephone survey conducted collaboratively by state health departments and CDC. The prevalence of healthy sleep duration varied by geography, race/ethnicity, employment, and marital status.

The CDC recommends the following Healthy Sleep Tips:

  • Healthcare providers should routinely assess patients' sleep patterns and discuss sleep-related problems such as snoring and excessive daytime sleepiness.
  • Healthcare providers should also educate patients about the importance of sleep to their health.
  • Individuals should make getting enough sleep a priority and practice good sleep habits.
  • Employers can consider adjusting work schedules to allow their workers time to get enough sleep.
  • Employers can also educate their shift workers about how to improve their sleep.
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Women and sleep
Image  June 2016

 

According to the National Sleep Foundation, nearly 40 million American men and women suffer from sleep disorders however sleep problems affect more women than men.  Women are more likely than men to take longer to fall asleep, tend to be more sleep deprived, are at an increased risk for insomnia, and often report different sleep disorder symptoms than men. 

Sleep Apnea symptoms in women are often different and more subtle than they are in men.  Knowing these differences can help women and their loved ones identify and treat sleep apnea.  Unawareness of these differences has led many cases of female sleep apnea to go unnoticed or misdiagnosed. 

Misdiagnoses:  Due to the more subtle, nontraditional sleep apnea symptoms, women are often    diagnosed in error with one of the following conditions, according to the National Sleep Foundation:  anemia, cardiac or pulmonary   illness, depression, diabetes, fatigue from overwork, fibromyalgia, hypertension, hypochondria, hypothyroidism, insomnia, menopausal changes, or obesity. 

Nearly 40% of patients diagnosed with sleep apnea today are female, up from 30% just a decade ago, however women may still be less likely to be diagnosed and treated because many healthcare providers have a predefined notion of the type of patient who has sleep apnea.  

The Key Differences:  Many women don’t snore, especially those with Upper Airway Resistance Syndrome.  Women can experience insomnia, morning headaches, fatigue, tiredness, depression, and anxiety.  Women with sleep apnea also tend to have fewer apneic events per hour (lower AHIs) than men, as well as more subtle and REM-related apneas.  This makes them harder to diagnose and be noticed by their bed partners.

Insomnia:  Insomnia is the most common sleep problem reported by women. Sometimes women begin to have sleepless nights    associated with menstruation, pregnancy, or menopause and find it difficult to break poor sleep    habits.  If insomnia persists after incorporating lifestyle, behavioral, and dietary changes, consider prescribing a sleep-promoting medication.  Also consider other underlying & treatable causes such as depression, stress, anxiety, reflux, bladder problems or pain. 

Narcolepsy:  Women with narcolepsy have sudden “sleep attacks” (an over-whelming urge to sleep), suddenly lose muscle tone or strength (cataplexy) triggered by emotion, and may have disturbed nighttime sleep.  Narcolepsy affects approximately one in 2000 people and is treated with stimulants or antidepressants.

Pain and Sleep:  Pain conditions like fibromyalgia, migraine or tension headaches, rheumatic, and arthritic conditions as well as heartburn are all more common among women.  Pain may make it harder to fall asleep or lead to nighttime or early awakenings.

Restless Legs Syndrome (RLS) and Periodic Limb Movement Disorder (PLMD):  Treating PLMs remains controversial.  However, consider evaluating for secondary causes of RLS such a low serum ferritin or B12/folate prior to starting medication.  Unmanaged RLS can lead to daytime sleepiness, mood swings, anxiety and depression. 

Shift Work:  Difficulty falling asleep is a common effect as is obtaining quality sleep during day hours.  Women who work the night shift get less sleep and have more   disrupted sleep.  Female shift workers may experience weight gain, irregular menstrual cycles, infertility, pregnancy complications or other medical conditions. 

Sleep Apnea:  An estimated 18 million Americans have sleep   apnea including one in four women over age 65.  While apnea is more common in men, it increases in women after age 50.  Excess weight and hormonal changes during and after menopause are associated with an increased risk for developing this sleep disorder.   

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consequences of poor sleep in teens
Image  August 2016  

Just like a healthy diet and exercise, sleep is critical for children to stay healthy, grow, learn, do well in school, and function at their best.  

The primary consequences of poor sleep among children and adolescents are behavior problems, impaired learning and school performance, mood and emotional problems, and health problems including obesity. Concerning new evidence also indicates that adolescents’ sleep may be related to high-risk behaviors such as substance use, suicidal behaviors, and drowsy driving.  A recent study found that greater media use in teens was linked to higher body mass index, largely because of reduced sleep time. 

It is not just a matter of getting sufficient sleep quantity—children and adolescents also need adequate sleep quality.  Young children can be deceptively hyperactive with insufficient sleep or because of a sleep disorder.  Any child or adolescent (or parent) who snores, falls asleep at inappropriate times, or has other sleep disorder symptoms should be thoroughly evaluated. 

A major developmental change during adolescence is that the body’s clock moves to a later timing for sleep.  This is only thought to be about one hour of a change, and another two hours of change is due to social factors, such as work pressures and access to technology. 

To address these challenges, families can work together to make sleep a priority so everyone can sleep as much as they need in a safe, quiet, comfortable environment.  A recent study also showed that reducing screen time, increasing sleep, and eating dinner together helped kids maintain a healthy weight.  Therefore, help students understand sleep is as important to their health as nutrition and exercise.     sleep foundation.org

Five Reasons Teens Need Adequate Sleep

  • Less likelihood of experiencing depressed moods
  • Reduced likelihood for tardiness and absenteeism
  • Reduced risk of car crashes caused by falling asleep
  • Reduced risk of metabolic & nutritional deficits, including obesity
  • Better grades

 

Limiting Screen Time 

Children get more sleep, do better in school, behave better, and see other health benefits when parents limit content and the amount of time their children spend on the computer or in front of the TV, according to a study, published in JAMA Pediatrics.  Douglas Gentile, PhD, lead author and an associate professor of psychology at Iowa State, says the effect is not immediate and that makes it difficult for parents to recognize. As a result, parents may think it is not worth the effort to monitor and limit their children’s media use.  But Gentile says they have more power than they realize.

Considering that children average more than 40 hours of screen time a week, not counting time spent on a computer at school, even small changes can make a difference, researchers say.  They are not suggesting parents completely eliminate screen time, but find a healthy balance. The study found there is a ripple effect associated with the benefits of limiting both screen time and media content and there is a direct impact on sleep, academics, and behavior. However, limited screen time also indirectly affects body mass index. The study found that children got more sleep if parents limited screen time, which also resulted in lower risk of obesity. Parents limiting exposure to violent media resulted in increased prosocial behavior and lowered aggressive behavior 7 months later.    sleepreviewmag.com/2014/04

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Economic Burden of Untreated Sleep Apnea
Image  September 2016  

The American Academy of Sleep Medicine (AASM) released an analysis, titled “Hidden health crisis costing America billions,” that reveals the cost of undiagnosed obstructive sleep apnea. A companion report was also released , titled “In an age of constant activity, the solution to improving the nation’s health may lie in helping it sleep better,” which summarizes the results of an online survey completed by patients currently being treated for obstructive sleep apnea (OSA). The reports are available for free download on the AASM website. Both reports were commissioned by the AASM and prepared by the global research and consulting firm Frost & Sullivan.

Frost & Sullivan estimates that OSA afflicts 29.4 million American men and women, which represents 12% of the US adult population. They also calculated that diagnosing and treating every patient in the US who has sleep apnea would produce an annual economic savings of $100.1 billion.

Treating sleep apnea improves productivity and safety while reducing health care utilization, notes AASM immediate past president, Nathaniel Watson, MD, MS. His editorial about the report is published in the August issue of the Journal of Clinical Sleep Medicine.

Frost & Sullivan calculated that the annual economic burden of undiagnosed sleep apnea among US adults is approximately $149.6  billion. The estimated costs include $86.9 billion in lost productivity, $26.2 billion in motor vehicle accidents, and $6.5 billion in workplace accidents. Untreated sleep apnea also increases the risk of costly health complications such as hypertension, heart disease, diabetes, and depression. The report estimates that undiagnosed sleep apnea also costs $30 billion annually in increased healthcare utilization and medication costs related to these comorbid health risks.

“The high quality, patient-centered care provided by board-certified sleep medicine physicians can significantly reduce the health and economic burdens of sleep apnea,” says AASM president Ronald Chervin, MD, MS, in a release.

   sleepreviewmag.com     aasmnet.org

 

Tips for Improving Sleep Quality with CPAP


  • It may take some time to acclimate to CPAP therapy however the following tips can improve sleep quality: Recommend using CPAP for short periods of time while watching TV or reading. This will help acclimation to the mask and make it feel more natural when trying to fall asleep.
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  • Encourage CPAP as part of the bedtime routine. Using CPAP every night and for every nap makes it easier to adjust to therapy.
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  • Consider small adjustments to increase comfort. Adjust the mask, tubing, and headgear until the proper fit is achieved.
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  • Consider a special pillow that is shaped for a PAP mask and/or tubing.
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  • Assess for proper mask fit. The most common problem causing CPAP non-compliance is poor mask fit.Ensure it is not too big or too small, is not causing skin irritation, and is not leaking.
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  • Encourage use of the ramp and C-flex/EPR features. Ramp starts the device on a low pressure setting and gradually increases the pressure over time. C-flex or EPR allow pressure relief on exhalation enhancing tolerance.
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  • Recommend using a saline nasal spray to ease mild nasal congestion. A nasal spray or decongestant can help with nasal or sinus congestion which can be a common problem with CPAP treatment.
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  • Recommend using heated humidity. Many patients have fewer complaints when using humidification.
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  • Encourage Support Groups. Support groups reinforce education provided on CPAP and also tend to increase the number of hours for CPAP use.   
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new report outlines the price of drowsy driving
Image  October 2016  

A report from the Governors  Highway Safety Association (GHSA) states that nearly 83.6 million sleep-deprived Americans are driving every day.  And it’s taking a toll—an estimated 5,000 lives were lost in drowsy driving-related crashes last year, according to Wake Up Call! Understanding Drowsy Driving and What States Can Do.   The report was funded through a grant from State Farm with guidance from an expert panel.

In a newly available National Highway Traffic Safety Administration (NHTSA) estimate provided to GHSA for this report, the agency reveals the annual societal cost of fatigue-related fatal and injury crashes is $109 billion, not including property damage.

The GHSA report, which comes as US motor vehicle deaths were up 7.7% nationwide in 2015, examines the cause and effect of drowsy driving as well as how states and others can best address it.

To help State Highway Safety Offices (SHSOs) address the behavioral side of drowsy driving and develop strategies to combat it, the report explores the crash characteristics and drivers who are most at risk. “Teens and young adults are involved in more than half of all drowsy driving crashes annually,” says GHSA executive director Jonathan Adkins. “People who work nights or long or irregular shifts are also more likely to get behind the wheel when they are too tired to drive, along with the estimated 40 million Americans who suffer from a sleep disorder.

That, says report author Pam Fischer, merits a change in how we view sleep. “Sleep is a restorative and life-sustaining activity that is just as important as eating right and exercising. When we skimp on sleep, we’re less able to react quickly—a critical element of safe driving. Our mental and physical health also suffers.”

The report recommends SHSOs partner with other sectors, including public health, business, academia, and nonprofits, to change the culture. “Just like drunk driving and seat belts, it’s going to take all of us to get the public to recognize the seriousness of drowsy driving,” says Fischer.  http://www.sleepreviewmag.com/

 


 

Who is at risk?

  • Commercial Drivers
  • Drivers with untreated sleep disorders such as sleep apnea
  • Teen Drivers
  • Drivers who use sedating medications
  • Shift workers
  • Drivers who do not get adequate sleep

 


 

Promoting Healthy Sleep

The National Healthy Sleep Awareness Project (NHSAP) is a collaborative initiative funded by the CDC to unite partners and stakeholders to promote the achievement of the four sleep health objectives of Healthy People 2020, which is a 10-year agenda to improve the nation’s health.

 Those objectives are:

        1. Increase the proportion of persons with symptoms of obstructive sleep apnea (OSA) who seek medical evaluation.
        2. Reduce the rate of vehicular crashes per 100 million miles traveled that are due to drowsy driving.
        3. Increase the proportion of students in grades 9 through 12 who get sufficient sleep.
        4. Increase the proportion of adults who get sufficient sleep.

 

The ongoing campaigns launched by the NHSAP– including “Sleep Well, Be Well”, “Stop the Snore”, “Awake at the Wheel”, and “Sleep Recharges You”- are raising public awareness of the importance of healthy sleep.  Campaign resources, including infographics and health advisories, are available for download at www.projecthealthysleep.org. 

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