Counseling Sheet

Agatha M. Thrash, M.D.
Preventive Medicine

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Sleep apnea often begins in middle life and can be complicated by accidents and heart attacks or strokes. It has been found that abdominal obesity, insulin resistance, and high levels of blood cytokine are all associated with sleep apnea and may contribute to the development of the problem (Journal of Clinical Endocrinology and Metabolism, 85:1151, 2000).

Night sweats often occur because of improper air exchange—breathing too shallow, or too infrequently. To make this diagnosis, take a tape recorder to bed, placing the microphone in such a way that the sound of the breathing can be recorded especially during the first part of the night. Record the breathing pattern for about an hour, if possible. Notice if there are periods of very slow breathing, or even absence of breathing. A period of absent breathing for more than 30 seconds repeated seven or more times an hour is called sleep apnea. If you breathe less than ten times a minute, it can be too little breathing, especially if your breathing is shallow.

1. Sleep apnea is a pause in breathing of ten seconds or more. The cause of sleep apnea is unknown. Some feel that narrower airways than other snorers cause the apnea, which results from the tongue dropping back so far it gets sucked into the airway. Older techniques for surgery had a success rate of only 50 percent for sleep apnea. Symptoms include excessive daytime sleepiness, fatigue, forgetfulness, and irritability. It is estimated that between two and three thousand people die each year in their sleep because of sleep apnea. Since they sleep little during the night, they may have difficulty driving or operating machinery because of sudden uncontrollable drowsiness or brief naps. Complex problems may become more difficult for these persons to learn or grasp.

Persons who have sleep apnea may need to use a machine to help them breathe deeply at night. If continuous positive airway pressure (CPAP) is used by individuals who have sleep apnea, there is an improvement m mental functioning, even if the user averages only three to four hours per night for use of the equipment. It improves mood and a sense of alertness, as well (The Lancet 343.572,1994).

Because of oxygen depletion during breathing stoppage, the heart has to beat faster to keep oxygen circulating, and it eventually becomes damaged or beats irregularly. They are also much more likely to suffer from hypertension. Those with sleep apnea are five times more likely to have high blood pressure than people who sleep normally. In another study of 50 men with high blood pressure, 26 percent had sleep apnea, a higher percentage than in the general population. It is well to tape record the apnea cycles to convince the snorer that the problem is real.

2. A remedy frequently thought of is elevating the bed with two or three bricks under the bedposts at the head.

3. A tongue-retaining device can be obtained only through a sleep center, but can be effective in eliminating apnea in 82 percent of cases.

4. Continuous positive airway pressure may be another desirable method. It has a 90 percent success rate among snorers. Newer surgical procedures have an 80 percent success rate for snoring.

5. Leaving off supper and taking a cup of mint tea can be helpful in both night sweats and sleep apnea. Being certain to get more than seven hours sleep, preferably a bit more than eight hours of sleep every night can be helpful to combat sleep apnea and excessively slow breathing. One should be very careful to have fresh air in the bedroom at night, no restrictive clothing, and to avoid poor sleeping posture.‍

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Sleepiness in Daytime‍

Regularity in sleep habits, even if the number of hours spent sleeping is the same, greatly reduces sleepiness in the daytime. Those individuals also fall asleep more quickly after going to bed than those with an irregular sleep time, and sleep more soundly during the night. Poor concentration, a poor mood, and increased daytime sleepiness all result from irregularity in sleep time (Sleep 19:432, 1996).

Individuals who have sleepiness throughout the day, and especially afternoon drowsiness, should try extending their nighttime sleep by two hours for four successive days. This will help to relieve cumulative fatigue.

After about the age of 60-70, the body's biologic time clock sets the time for bedtime back to around 7 or 8 p.m. Then about eight hours later the morning alarm is set, waking individuals at 4 to 5 am. The problem is elderly people do not go to bed at 7 or 8. Therefore, they tend to have sleepiness and the ability to drift into sleep at almost any time they are still.

If you sleep only four or five hours per night, be certain to get to bed earlier rather than sleeping later in the morning. You will be more alert, and improve your overall performance the next day.