by Vicki Cohn DDS, D. ABDSM, is the Clinical Director of Sleep Apnea Dentists of New England.
Continuous positive airway pressure (CPAP) is the first line of treatment for obstructive sleep apnea (OSA) but some people have difficulty tolerating it. CPAP can be uncomfortable, and it can dry out the mouth and cause nasal congestion. Fortunately, oral appliance therapy can be a successful alternative to CPAP for some people.
What is an oral appliance?
A custom-made oral appliance is a small device that fits over the teeth and is worn while you sleep. A mandibular advancement device (MAD) is the primary oral appliance for treating OSA. Insurance may cover oral appliance therapy using the same criteria as CPAP. Be aware that some insurance companies require you to try CPAP before covering oral appliance therapy.
When is oral appliance therapy a good option?
Oral appliance therapy can be an option for those with mild to moderate OSA and those who cannot tolerate or do not want to try CPAP. It is possible to go right from diagnosis to oral appliance therapy skipping CPAP altogether if you and your doctor determine it is an appropriate choice. All oral appliance therapy requires a prescription from a treating physician who will diagnose OSA and refer you to a dental sleep provider. The success of oral appliance therapy may improve when made by a dentist with dental sleep training. Some people may find CPAP easier to tolerate with an oral appliance or when they can alternate between therapies.
How does it treat OSA?
OSA is characterized by three major areas of collapse in the airway tube— high/upper: behind the soft palate to the top of the tongue; middle: where the tongue can fall back; and low: at the level of the epiglottis (this is rarer). Most people with OSA collapse in at least two places, but currently, there is no way to know in which of the three areas the collapse occurs.
A trained dental sleep medicine provider can make a MAD which will hold the jaw and tongue in a forward position during sleep, expanding the upper airway. This targets two of the three possible areas of airway collapse. The good news is that this helps the majority of patients who try it. CPAP targets all three areas of possible collapse, so it helps to open the entire airway, but it can be more challenging to use. Studies have shown that for mild to moderate OSA, the effectiveness of MAD is similar to CPAP. One reason may be that MAD compliance is higher.
How will my dentist determine if it is working?
There is some trial and error in finding the right jaw position to improve OSA. Your dentist may start by bringing the jaw forward until there is symptomatic relief. After a few months, a sleep study may be done, and any necessary adjustments will be made. Once the appliance is fit to the optimal position, dental visits will likely continue yearly to check the fit and integrity of the appliance.
While CPAP and oral appliances are the most widely used treatments for OSA, other treatments are available if these don’t work for you. It may be as simple as changing the position of your sleep or weight loss, or as intensive as surgery. If you suspect you suffer from sleep apnea, consult a sleep specialist.
Comments Off on Sleep deprivation: A cause of high blood pressure?
by SadofNE
Is it true that sleep deprivation can cause high blood pressure?
Answer From Francisco Lopez-Jimenez, M.D.
Possibly. Sleep experts recommend that adults get 7 to 8 hours of sleep each night. Getting less than six hours of sleep is known to be bad for overall health. Stress, jet lag, shift work and other sleep disturbances make it more likely to develop heart disease and risk factors for heart disease, including obesity and diabetes. A regular lack of sleep may lead to high blood pressure (hypertension) in children and adults.
The less you sleep, the higher your blood pressure may go. People who sleep six hours or less may have steeper increases in blood pressure. If you already have high blood pressure, not sleeping well may make your blood pressure worse.
It’s thought that sleep helps the body control hormones needed to control stress and metabolism. Over time, a lack of sleep could cause swings in hormones. Hormone changes can lead to high blood pressure and other risk factors for heart disease.
Don’t try to make up for a lack of sleep with a lot of sleep. Too much sleep — although not as bad as too little sleep — can lead to high blood sugar and weight gain, which can affect heart health. Talk to your health care provider for tips on getting better sleep, especially if you have high blood pressure.
One possible, treatable cause of lack of sleep contributing to high blood pressure is obstructive sleep apnea. This sleep disorder causes breathing to repeatedly stop and start during sleep. Talk with your care provider if you feel tired even after a full night’s sleep, especially if you snore. Obstructive sleep apnea may be the cause. Obstructive sleep apnea can increase the risk of high blood pressure and other heart problems.
Dementia is also associated with abnormalities in the brain’s white matter that are hallmarks or markers of cerebrovascular diseases.
A recent observational study shows that severe obstructive sleep apnea and reduced deep sleep were independently associated with white matter abnormalities related to cerebrovascular diseases in cognitively unimpaired older adults.
These findings show that severe obstructive sleep apnea and poor sleep quality can lead to an increase in the biomarkers of cerebrovascular disease, potentially increasing the risk of cognitive decline and stroke.
Obstructive sleep apnea is the most common type of sleep-breathing disorder that affects nearly a billionTrusted Source individuals across the globe.
A recent study published in Neurology suggests that obstructive sleep apnea and a reduction in deep sleep, also known as slow-wave sleep, were independently associated with an increase in white matter abnormalities in the brain.
The white matter abnormalities assessed in the study are known markers of cerebrovascular disease and are also observed in mild cognitive impairment and Alzheimer’s disease.
The findings from this observational study thus suggest that obstructive sleep apnea and poor sleep quality could potentially lead to increased white matter abnormalities, subsequently increasing the risk of dementia and stroke.
The study’s author Dr. Diego Carvalho, a neurologist at the Mayo Clinic in Rochester, MN, told Medical News Today:
“White matter abnormalities increase with aging and may contribute to cognitive decline, dementia, and stroke. Since there is no treatment to reverse or slow them down other than risk factor prevention, it is important to understand what may contribute to their development.”
“In our study, we found that severe sleep apnea and decreased deep sleep were associated with more white matter abnormalities. Although we cannot infer a direct causal relationship with a cross-sectional study design, the findings raise the possibility that sleep interventions may prevent the progression of white matter disease. Although there is already compelling evidence that sleep apnea is involved in white matter abnormalities, the potential role of slow-wave sleep (or deep sleep) in white matter health is much less understood,” added Dr. Carvalho.
Obstructive sleep apneaTrusted Source is a sleep-breathing disorder characterized by episodes of interruption of breathing due to partial or complete blockage of the upper airway. The episodes of reduced breathing are known as hypopnea, whereas apnea refers to events involving a complete blockage of the upper airway.
The apnea-hypopnea index (AHI) describes the number of apnea and hypopnea events per hour. Specifically, obstructive sleep apnea involves at least five such episodes of apnea or hypopnea per hour.
The interruption of breathing triggers a compensatory response that leads to arousal from sleep. Thus, obstructive sleep apnea leads to sleep disturbances and an experience of feeling unrefreshed after sleep.
Several studies have shown that poor sleep quality is associated with an increased risk of cognitive decline and dementia.
The accumulation of misfolded deposits of the amyloid-beta and tau proteins is a hallmark of Alzheimer’s disease. A previous study showed a higher accumulation of the amyloid-beta protein in the brains of individuals experiencing excessive daytime sleepiness.
In contrast, a brain imaging studyTrusted Source showed that cognitively unimpaired individuals with higher tau levels in their brains were at an increased risk of obstructive sleep apnea.
These studies suggest a bidirectional relationship between sleep quality and pathological changes associated with Alzheimer’s disease.
In addition to the accumulation of misfolded proteins, individuals with dementia also show damage to neurons.
The brain tissue can be categorized into white matter and gray matter. The gray matter consists of the cell bodies of neurons, whereas the white matter consists of axons that transmit information.
Several of the axonal processes in the white matter are encased in an insulating layer called the myelin sheath. The myelin sheath gives white matter its color and allows the axons to conduct electrical impulses more rapidly and efficiently.
Individuals with dementia and mild cognitive impairment show abnormalities in the white matter. Some of these white matter abnormalities, such as white matter hyperintensitiesTrusted Source and a decline in the integrity of the white matter tract, are also markers for cerebrovascular diseases, which are diseases of the blood vessels in the brain.
White matter hyperintensities are hyperintense regions identified using MRI that represent lesions of white matter generally caused by cerebral small vessel disease.
The integrity of the white matter tract is measured in terms of fractional anisotropy using a technique called diffusion tensor imaging. These white matter abnormalities due to damage to blood vessels may contribute to cognitive decline.
Sleep disorders such as obstructive sleep apnea are also associatedTrusted Source with increased risk of cerebrovascular diseases. Thus, sleep disorders could potentially lead to cerebrovascular disease-related white matter abnormalities and increase the risk of dementia.
For instance, there is evidence from the authors’ own work showing that individuals with daytime sleepiness have elevated levels of the neurofilament light chain protein in their blood, though research evidence is contradictoryTrusted Source.
The neurofilament light chain protein is a protein associated with the myelin sheath covering the axons of neurons. Thus, elevated neurofilament light chain protein levels suggest damage to myelinated axons and, thus, white matter damage.
In the present study, the researchers examined the association between sleep quality, including the presence of obstructive sleep apnea, with white matter abnormalities in the brain of cognitively unimpaired individuals.
The new study consisted of 140 individuals participating in the Mayo Clinic Study of Aging (MCSA), a population-based cohort study that aims to characterize the prevalence and risk factors associated with mild cognitive impairment and dementia.
The study included individuals who had previously undergone a brain MRI scan and at least one polysomnography test as a part of the MCSA study.
A polysomnographic study is a sleep study that assesses multiple parameters associated with sleep, including brain waves, breathing and heart rate, and blood oxygen levels. The average duration between the brain MRI scan and the polysomnography test was 1.74 years.
The researchers aimed to only include participants who were cognitively unimpaired at the time of both the MRI and the polysomnography test. The study consisted of 90.7% of the participants who were cognitively unimpaired at the time of both assessments.
Only participants with obstructive sleep apnea were included in the study. These participants were categorized as having either mild, moderate, or severe obstructive sleep apnea on the basis of the number of episodes of apnea and hypopnea per hour.
The researchers first examined the association between sleep patterns and white matter abnormalities. Sleep can be dividedTrusted Source into the non-rapid eye movement (NREM) and rapid eye movement (REM) phases.
Furthermore, the NREM phase can be further subdivided into N1-N3 phases, with the N1 being the lightest sleep phase and N3 involving deep sleep. These phases show differences in their patterns of brain waves, eye movements, and muscle tone.
Using brain waves collected during polysomnography, the researchers found that a lower fraction of time spent in the N3 phase or slow wave sleep was associated with elevated levels of white matter damage.
This association was present after accounting for variables such as age, sex, genetic risk of Alzheimer’s disease, and cardiovascular risk factors.
In a separate analysis, the researchers looked at the association between obstructive sleep apnea severity and markers of white matter damage. They categorized patients as either having severe or mild-to-moderate obstructive sleep apnea and matched individuals from the two groups for age, sex, and N3 sleep levels for this analysis.
Individuals with severe obstructive sleep apnea showed higher white matter abnormalities than those with mild-to-moderate.
Individuals in the two groups did not show differences in cardiometabolic risk factors, but the individuals with severe obstructive sleep apnea showed higher arousal levels. This indicates the fragmentation of sleep in individuals with severe obstructive sleep apnea.
Dr. Sandra Narayanan, a board-certified vascular neurologist and neuro-interventional surgeon at Pacific Stroke & Neurovascular Center at Pacific Neuroscience Institute in Santa Monica, CA, not involved in the research told us that these findings show that, while obstructive sleep apnea is associated with cardiovascular disease, it could independently increase the risk of cerebrovascular diseases.
Dr. Narayanan said: “[Obstructive sleep apnea] is an important vascular comorbidity, as it is significantly associated with an increased risk of hypertension, cardiovascular disease, and stroke. This study demonstrates a separate association of OSA with imaging biomarkers of cerebrovascular disease.”
Some of the previous studies showing a link between sleep quality and white matter abnormalities have not controlled for cardiometabolic risk factors. These cardiometabolic factors can increase the risk of cerebrovascular conditions, such as stroke, thus potentially biasing the results.
One of the strengths of the present study was that the researchers controlled for cardiometabolic risk factors.
The authors acknowledged that their study had a few limitations. They noted that they only collected sleep data during the initial few hours of sleep.
This could have biased the data on sleep patterns. For instance, the period of REM sleep tends to increase during the night, whereas the duration of deep sleep tends to decline.
Dr. Narayanan noted: “While the imaging biomarkers of CVD noted in this study were not independently linked during the course of this study to the development of incident stroke, the presence of white matter hyperintensities is strongly associated with cognitive impairment, stroke, and death in numerous other studies.”
“Fractional anisotropy (FA) is a marker of white matter integrity, as noted in diffusion tensor imaging (DTI),“ she explained. “Decreased FA is associated with other neurodegenerative disorders such as Alzheimer’s dementia and Parkinson’s disease, but has a poor prognostic value for motor recovery following stroke.”
The authors also noted that the study had an observational design, and further studies are needed to show that obstructive sleep apnea and reduced slow-wave sleep can cause an increase in the biomarker of cerebrovascular disease.
If you snore the house down, you may be suffering from obstructive sleep apnea, or OSA — a potentially dangerous condition in which people stop breathing for 10 seconds or more at a time.
Yet even if you’re a rock star at snoring, you may not know you have obstructive sleep apnea unless someone tells you about your nocturnal roars. That’s why it’s important for partners and friends to speak up and encourage snorers to get professional help.
But what if you have an odd or quirky symptom besides snoring? You and your loved ones may have no idea that you are in danger, and the condition could go undiagnosed for years.
“Greater than 30 million people have sleep apnea in the United States, yet it’s often underdiagnosed or misdiagnosed,” said sleep specialist and pulmonologist Dr. Raj Dasgupta, an associateprofessor of clinical medicine at the University of Southern California’s Keck School of Medicine.
“It’s really misdiagnosed in women versus men because women may not present with the classic, heroic snoring that men often show,” he said.
Here are five weird signs of obstructive sleep apnea to watch for, according to Dasgupta.
Night sweats
There are many reasons people may sweat at night. It could be too hot, especially with the persistent heat waves in the past few years due to the climate crisis. Certain medications can cause night sweats, as can cancer, thyroid issues, the flu and bacterial infections, and the onset of menopausal symptoms, according to the Mayo Clinic.
But research has shown that about 30% of people with obstructive sleep apnea have reported night sweats, Dasgupta said.
“It’s because your body isn’t getting enough oxygen you fall into this sympathetic fight-or-flight mode, which triggers night sweats,” he said. “The research showed people with OSA that had night sweats were also more likely to have really low oxygen levels on top of having obstructive sleep apnea.”
Sleep apnea can cause you to wake up tired, have difficulty regulating emotions and suffer from brain fog, experts say.
Frequent awakenings
Many people get up at night to empty their bladders — it can be caused by alcoholoverindulgence, diabetes, edema, high blood pressure, certain medications, pregnancy, prostate issues and even drinking too many fluids before bed, according to the Cleveland Clinic.
But getting up at least two times a night to urinate — which is called nocturia — can also be a sign of obstructive sleep apnea, Dasgupta said.
“One study found about 50% of patients with OSA had nocturia, and they noted that treatment for the sleep disorder did cut back on awakenings,” he said.
Nevertheless, frequent nighttime urination is not commonly asked about in screening questionnaires on sleep apnea in primary provider offices, Dasgupta said.
Teeth grinding
Grinding or clenching teeth while sleeping is called bruxism, and it too may be a sign of obstructive sleep apnea, Dasgupta said.
“Certainly, anxiety and other factors can cause bruxism, but a common cause is obstructive sleep apnea,” he said. “There’s a theory on why — the airway becomes obstructed, so the muscles in the mouth and jaw move to try to free the blocked airway. That’s not been proven, but it is an interesting hypothesis.”
Most people who grind or clench their teeth use a mouthguard suggested by their dentist for protection, but it won’t protect the jaw, Dasgupta said.
“So, a person might also develop TMJ (dysfunction), which is pain in the temporomandibular joint, and that may also lead to other issues, such as headaches,” he said.
Morning headaches
Studies have found a link between having obstructive sleep apnea and waking up with a headache, Dasgupta said.
“They typically occur daily or most days of the week and may last for several hours after awakening in the morning,” he said. “The cause of the headaches is not well-established and may be multifactorial.”
Headaches caused by obstructive sleep apnea don’t appear to lead to nausea or increased sensitivity to light and sound. Instead, they seem to be a pressing sensation on both sides of the forehead that lasts about 30 minutes, according to a June 2015 study.
Depression, fatigue and insomnia
Some symptoms of obstructive sleep apnea can disguise themselves as issues of mental health, brain fog or other sleep problems, Dasgupta said.
“Sleep affects our ability to think, react, remember and solve problems,” he said. “Women especially have a tendency to underreport atypical symptoms such as insomnia, fatigue and depression.”
If obstructive sleep apnea awakens you, it may be hard to go back to sleep. A person may suspect insomnia, not realizing that a different issue may be triggering the awakenings.
Symptoms of daytime fatigue include a lack of motivation to accomplish everyday tasks, a lack of productivity at work, memory problems and a low interest in being social, Dasgupta said. Those are also signs of depression, so if the sleep issues aren’t brought up at a health visit, the underlying cause may be missed.
For better sleep quality, it’s best to avoid foods high in fats and sugars, a new study confirms. CWP, LLC/Stocksy
A study conducted by scientists from Uppsala University investigated the impact of a high-fat/high-sugar diet, also known as a junk food diet, on sleep.
The researchers found that after consuming the unhealthy diet, the quality of deep sleep in participants worsened compared to when they followed a healthier diet.
Although the duration of sleep and overall sleep structure were not significantly different between the two diets, the unhealthy diet was associated with reduced deep sleep quality and changes in some important sleep patterns.
Limited evidence exists regarding the influence of certain foods on sleep, leading researchers to conduct a randomised trial investigating the effects of a high-fat/high-sugar diet on sleep.
A new study, published in ObesityTrusted Source, aimed to gather intervention-based evidence by examining the impact of this diet on sleep patterns in healthy individuals.
The researchers found that after consuming the unhealthy diet, the quality of deep sleep in the participants worsened compared to when they followed the healthier diet.
A group of 15 healthy men took part in a study where they were given two different diets to follow. They were randomly assigned to either a high-fat/high-sugar diet or a low-fat/low-sugar diet for one week each.
After each diet, the researchers recorded the participants’ sleep patterns in a laboratory setting using a method called polysomnography, a sleep monitoring technique.
They looked at the duration of sleep, as well as the different stages and patterns of sleep, including things like oscillatory patterns and slow waves.
The study found that the duration of sleep was not significantly different between the two diets, as measured by both actigraphy — a method of monitoring sleep using a wearable device — and in-lab polysomnography.
When comparing two different diets, the researchers found that the structure of sleep remained similar after one week on each diet.
However, when they compared a diet high in fat and sugar to a diet low in fat and sugar, they noticed that the former diet was linked to lower levels of certain sleep characteristics during deep sleep.
These characteristics included delta power, which is a measure of slow brain waves, the ratio of delta to beta waves, and the amplitude of slow waves.
All of these changes suggested that the quality of deep sleep was reduced on the high-fat/high-sugar diet.
Dr. Florencia Halperin, chief medical officer at Form, a company that provides medical treatment for obesity and associated metabolic conditions, not involved in this research, told Medical News Today that “evidence has been mounting over the last decade about the relationship between sleep and metabolic disease.”
“Poor sleep adversely affects hormonal and metabolic parameters and increases the risk of weight gain and metabolic disease. At the same time, weight gain increases the risk of sleep disorders such as sleep apnea. So the relationship is very complex, and there is so much we still don’t understand.”
Dr. Halperin pointed out that “the results suggested that consumption of an unhealthier [high-fat/high-sugar] diet results in changes to the pattern of sleep.”
“While the macro-architecture was not affected, changes in some sleep parameters observed (less relative power in delta frequencies and a lower delta to beta ratio) were consistent with a less restorative sleep state, as might be seen in an older population,” Dr. Halperin noted.
Kristen Carli, a registered dietitian nutritionist, also not involved in this research, highlighted a few limitations to the study, noting the small sample size of only 15 healthy young men.
“No women, older adults, or children were evaluated meaning that these results should not be extrapolated to the general population,” Carli pointed out.
Dr. Halperin agreed, saying that “we must keep in mind only 15 people were studied, they were all men, and only studied for 1 week — so we will need further research to validate these findings.”
However, Dr. Halperin noted that “this study is important and relevant to patients and the public because it provides novel insight into how lifestyle factors such as the diet we consume affect our sleep, which in turn affects our overall health.”
“This is early evidence that a typical unhealthier diet may affect our sleep in very specific ways, and therefore our sleep-regulated health parameters, such as cognition and hormone secretion, which then modulate other effects on our health.”
– Dr. Florencia Halperin
Dr. Halperin explained that while the study helps to raise awareness about the relationship between sleep and overall health, the current findings are unlikely to impact medical practice at the current time, given the early nature of this research.
However, “I may share this research with [my patients] to educate them about the many many ways changing our diet can contribute to improved health — even without any weight loss!” Dr. Halperin said.
Carli pointed out that the “implications of this study are that the high-fat/high-sugar diet can impact sleep quality.”
“While the results of this one study should not be extrapolated widely, these results are not exactly surprising,” she added.
“Sugar has been shown to impact sleep quality in prior researchTrusted Source, as well as a high-fat diet. However, I will note many researchers pose whether the diet is impacting the sleep quality or the other way around. Regardless, as a registered dietitian, there are many other health benefits, besides sleep quality, to consider choosing a low-fat/low-sugar diet, including weight loss, heart health, chronic disease prevention, etc.”
– Kristin Carli
Ultimately, as Dr. Halperin explained, “this evidence suggests that a healthier diet might help us get healthier sleep.”
“Another way to look at it is that this is perhaps one more proof point that our parents were right after all — we all need to eat our veggies, and go to bed on time!”
Comments Off on Why do more women struggle with insomnia than men?
by Vicki Cohn
Sleeping is an essential part of our lives. It helps us recharge for the next day. Research in this area has helped understand various sleep disorders.
But most research has dodged the question of how different women’s sleep patterns are compared to men.
Why is insomnia more common in women?
The National Sleep Foundation survey, one of the first surveys in this field, found that 46% of women reported troubles with sleep almost every night. Other studies also conclude that insomnia is 40% more prevalent among women.
A prominent reason for this difference is biological, where hormone production during pregnancy, postpartum, menopause and menstruation changes. But social and cultural reasons, like work and family, also play a role, according to the survey.
Gender and sleep
Gender differences have important scientific consequences. For instance, almost a decade ago, the Food and Drug Administration reduced the recommended dose of zolpidem, a drug similar to Ambien, by half for women to treat insomnia. This came after the discovery that women metabolized the drug much slower than men — which led to gender-specific guidelines.
“It was important to raise the issue of sex differences — which is biological differences between women and men — to point out that there are differences in sleep in both the sexes,” said Dr. Monica Mallampalli, the senior scientific adviser for Healthywomen.org and a board member for Alliance of Sleep Apnea Partners.
For example, obstructive sleep apnea, a sleep disorder in which breathing repeatedly stops and starts, is typically found in men. But women also experience it, Mallampalli explained.Report ad
“Usually, they’re misdiagnosed or undiagnosed, and the symptoms that they present are very different than what a typical man would present,” she said, adding, “it’s also mostly hormonal.” Fibromyalgia, a condition that causes pain all over the body, has also been linked to insomnia, peaking at puberty and menopause for women, both periods of hormonal change.
What are the types of sleep problems women face?
1. Depression, anxiety and stress
Sleep is often tied to mental health and women are proven to be more likely to suffer through depression and anxiety. Studies show that women are more likely to ruminate about their concerns which can hamper their ability to fall asleep or go back to sleep.
2. Pregnancy
According to a study, around 30% of women say they rarely sleep and more than 50% have insomnia-like symptoms. Neck and back pain paired with difficulty finding a comfortable sleeping position can disturb the quality of sleep. These problems can persist after childbirth.
This syndrome creates a strong under to move limbs, especially legs, when lying down. Restless leg syndrome is also more common in men than women. Mallampalli adds that this syndrome is commonly seen in pregnant women.
How do you improve your quality of sleep?
Environmental stimuli such as a bright light in the bedroom, traffic noises, music, television, room temperature, pets and bedpartners can all affect sleep. The Society for Women’s Health Research created a Women & Sleep guide which suggests darkening rooms with blackout shades and drapes, turning off electronics in the room and double-paning windows for noise cancellation.
Earplugs, eye masks and white noise machines are also extremely helpful. Caffeine and electronic gadgets should be avoided at night time, as well as stimuli like nicotine and alcohol, according to researchers.
Mallampalli, who was involved in creating this guide, believes that by spreading awareness, more women will be able to advocate for themselves and ask their physical care physicians about sleep health. And this is how a change can begin.
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