Sleep Apnea

  • Sleep Apnea, Sleep Study

    Rethinking What Counts as ‘Well-Treated’ Obstructive Sleep Apnea

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    A patient advocate realizes that perfect can become the enemy of good care for OSA patients who fail or refuse CPAP.

    By Emma Cooksey | Original Post SLEEP REVIEW

    Years ago, I got into a heated exchange with an Italian dentist on social media. I cringe when I reflect on it now. 

    The dentist shared that he had a patient with severe obstructive sleep apnea (OSA) who was unable to use his CPAP machine. Fitting a custom oral appliance, the dentist reduced the man’s apnea-hypopnea index (AHI) from the 70s to only nine events per hour. Instead of applauding a good outcome and the improved quality of life the patient was experiencing, I complained, “Obstructive sleep apnea isn’t properly treated until the AHI is under five events per hour.” 

    The exasperated dentist calmly pointed out that the patient had abandoned his CPAP therapy and had left his OSA entirely untreated before he got his oral appliance.

    “Isn’t an AHI of nine with an oral appliance better than an AHI in the 70s with no treatment?” he asked.

    Physicians Consulting

    Since this exchange, I have been ruminating on this question. In that time, I have recorded more than 140 episodes of my podcast, “Sleep Apnea Stories,” interviewing people living with sleep apnea about their treatment choices as well as experts from different specialties. I have learned so much about the broad spectrum of experiences in our sleep apnea community and the reasoning behind individual treatment choices. 

    I can understand the frustration of board-certified sleep specialists who prescribe CPAP therapy to their patients, only to see it abandoned. I am a huge advocate of more support and resources for new CPAP users struggling to adapt to their therapy. Early intervention with practical troubleshooting and empathy can be all that’s needed to take someone from giving up on their therapy to successful adherence. This could be a group CPAP therapy clinic for new users to get support in person, or an online coaching model similar to what companies like Lofta and BetterNight provide.

    The very best sleep clinics offering superb support to new CPAP users still have a significant number of people who either never start CPAP therapy or abandon it over time. For those people who are leaving their OSA entirely untreated, we need a new attitude of pragmatism. Arguing that CPAP therapy offers the best results in people who use it isn’t helping the group who won’t or can’t use their machine.

    The great news for patients is that the range of viable treatment options for OSA is expanding. The GLP-1 tirzepatide is already available as Zepbound, an injectable medication for people with both OSA and obesity. The oral pill version orforglipron has recently reported positive phase 3 trial results. Also in the “coming soon” category is Apnimed’s AD109, a once nightly oral pill that works to maintain upper airway muscle tone during sleep. The successful phase 3 trials for AD109 open up a whole new frontier of using pharmacotherapy to target the cause of OSA. 

    The dental sleep medicine community, not to be outdone, has been working hard on appliances with integrated SpO2 sensors. These oral appliances will enable the sharing of data, including wear time, oxygen desaturation index, pulse rate, and more, not only with patients but also directly with doctors. 

    Ear, nose, and throat surgeons have more techniques at their disposal than ever too. Top surgeons continue to refine throat surgeries to include new techniques like transoral robotic surgery. Hypoglossal nerve stimulation implants are evolving with the new Inspire V system with quicker surgery time and a Bluetooth patient remote. Nxyoah’s Genio neurostimulator just earned FDA clearance.

    With so many treatment options currently available, and on the horizon, it is time we adopt a more pragmatic approach to considering a person’s OSA “well-treated.” Offering a treatment other than CPAP to lessen the severity of the OSA is far better for quality of life and health outcomes than no treatment at all.

    As a patient advocate, I feel strongly that every person with an OSA diagnosis should be educated on and offered all the treatment options that could be useful to them.

    I have, in short, changed my tune and now agree with the Italian dentist I argued with. I wish I could remember his name so I could apologize directly. Reducing the severity of obstructive sleep apnea and improving the quality of life for each individual is a worthy goal, even without hitting fewer than five events per hour.

  • Obstructive Sleep Apnea, Sleep, Sleep Apnea, Sleep Food, Sleep Health

    Foods That Affect Sleep: What to Eat (and Avoid) for Better Rest

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    Written By Vicki Cohn, DDS, D.ABDSM

    Sleep is essential for our physical and mental well-being, yet many of us struggle to get enough of it. If you’re among the countless people who find themselves tossing and turning at night, it might be time to rethink your diet. The foods you consume throughout the day can have a profound effect on your ability to fall asleep and stay asleep. Let’s dive into the science behind how certain foods can impact your sleep quality, and explore which ones you should include in your diet for better rest — and which ones to avoid.

    Foods That Help Promote Sleep

    1. Almonds
      Almonds are an excellent source of magnesium, a mineral known to help improve sleep quality by promoting muscle relaxation and reducing stress. They also contain melatonin, a hormone that regulates your sleep-wake cycle. A small handful of almonds before bed may help you fall asleep faster and experience deeper sleep.
    2. Cherries
      Cherries, especially tart cherries, are one of the few natural sources of melatonin. This powerful sleep hormone helps to regulate your circadian rhythm. Drinking tart cherry juice or snacking on fresh cherries in the evening can give your body the melatonin boost it needs to fall asleep naturally.
    3. Bananas
      Bananas are rich in potassium and magnesium, both of which help to relax muscles and nerves, making it easier to wind down at night. They also contain tryptophan, an amino acid that your body uses to produce serotonin, which is converted into melatonin. The combination of these nutrients makes bananas a great choice for improving sleep.
    4. Oats
      Oats are a natural source of melatonin, making them a great bedtime snack. They also contain a form of soluble fiber known as beta-glucan, which has been shown to lower cholesterol and improve heart health. The slow-releasing carbs in oats can also help stabilize blood sugar levels, preventing nighttime wakefulness due to dips in blood sugar.
    5. Herbal Tea (Chamomile, Lavender, Peppermint)
      Herbal teas like chamomile, lavender, and peppermint are well-known for their calming properties. Chamomile contains apigenin, an antioxidant that binds to specific receptors in the brain to promote relaxation and sleep. Lavender is also associated with improved sleep quality and has been shown to reduce symptoms of insomnia. Peppermint tea can help relax muscles and relieve stress, making it easier to unwind before bed.
    6. Kiwi
      Kiwi is packed with antioxidants, vitamin C, and serotonin, all of which can contribute to improved sleep quality. Studies have shown that consuming kiwi before bed may help reduce the time it takes to fall asleep, enhance sleep quality, and increase sleep duration. Plus, their high fiber content can help regulate digestion, preventing discomfort that might interfere with your rest.
    7. Turkey
      Turkey is another food high in tryptophan, an amino acid that helps the body produce serotonin and melatonin. While you might think of turkey as a food reserved for Thanksgiving, incorporating it into your dinner can help promote restful sleep, especially when paired with carbohydrates like sweet potatoes or whole grains.

    Foods That Can Disrupt Sleep

    1. Caffeine
      Caffeine is a well-known stimulant found in coffee, tea, chocolate, and some sodas. It works by blocking adenosine, a brain chemical that promotes sleep. Even if you enjoy a cup of coffee in the afternoon, it can interfere with your ability to fall asleep later in the evening. It’s best to limit your caffeine intake to the morning hours and avoid it at least 6 hours before bedtime.
    2. Alcohol
      While alcohol may make you feel drowsy at first, it can interfere with your sleep cycle. Alcohol disrupts REM sleep, the stage of sleep that is crucial for cognitive functions like memory and learning. It can also lead to frequent awakenings during the night, resulting in a less restful sleep. If you want a good night’s rest, it’s best to avoid alcohol close to bedtime.
    3. Spicy Foods
      Spicy foods can cause discomfort, especially if you’re prone to acid reflux or heartburn. Capsaicin, the compound that gives spicy foods their heat, can increase your body temperature, making it harder for your body to cool down and enter sleep mode. Additionally, the digestive issues caused by spicy foods can keep you up at night.
    4. Heavy or Fatty Meals
      Rich, greasy meals like fast food, pizza, or steak might feel satisfying in the moment, but they can disrupt sleep by triggering indigestion or acid reflux. When you eat large or fatty meals too close to bedtime, your body has to work harder to digest the food, which can cause discomfort and make it difficult to relax and fall asleep. Try to have your last meal 2-3 hours before bed, and avoid overly greasy foods in the evening.
    5. Sugary Snacks
      Foods high in sugar and refined carbs can cause blood sugar spikes followed by crashes that can disturb your sleep. If you consume a sugary treat before bed, you may experience a burst of energy followed by a sudden drop in energy, which can cause you to wake up during the night. Opt for healthier, lower-sugar snacks like fruit or yogurt if you need a late-night bite.
    6. Sugar substitutes Saccharin, Aspartame, Sucralose – these products can actually make you hungrier and apt to eat more, and there is evidence that they can create insomnia 
    7. Processed Meats
      Processed meats like sausages, bacon, and hot dogs are high in sodium and unhealthy fats, both of which can interfere with sleep. Excessive salt can cause bloating and dehydration, which may make it difficult to sleep comfortably. The nitrates and preservatives in processed meats can also disrupt your body’s ability to relax and stay asleep.

    Tips for Better Sleep Through Nutrition

    • Keep your meals light: Eating large meals before bed can interfere with your digestion and sleep quality. Opt for a light snack instead, such as a small bowl of yogurt or a banana.
    • Balance your nutrients: Make sure to incorporate foods that support both your physical and mental well-being, including magnesium, potassium, tryptophan, and antioxidants.
    • Stay hydrated: Dehydration can cause disruptions to your sleep cycle, so be sure to drink enough water during the day. However, avoid excessive amounts of liquids right before bed to minimize bathroom trips during the night.
    • Avoid foods you may be sensitive or allergic to:  Foods that you are sensitive to may create overall inflammation.  Inflammation will adversely affect your sleep quality. For instance, for some people dairy products can create nasal congestion – increased nasal congestion will decrease sleep quality, increase sleep apnea and may be associated with decrease O2 during sleep
    • Avoid late night meals and snacks: Late night eating can increase you sleep apnea and decrease sleep quality.  Start paying attention to your sleep quality after eating late to see how it affects you.
    • Establish a bedtime routine: Pairing your diet with healthy sleep hygiene practices — such as avoiding screens before bed, keeping your bedroom cool and dark, and maintaining a consistent sleep schedule — can optimize your rest.

    Conclusion

    What you eat plays a more significant role in your sleep than you might think. By incorporating sleep-friendly foods into your diet and steering clear of those that disrupt rest, you can improve both the quality and duration of your sleep. A balanced diet rich in nutrients like magnesium, potassium, and melatonin — along with healthy sleep habits — can help you wake up feeling refreshed and energized every morning. So, the next time you’re thinking about what to snack on before bed, remember: your sleep might just depend on it!

  • Sleep, Sleep Apnea, Sleep Apnea Dentist

    Beyond CPAP

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    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.

  • Sleep, Sleep Apnea, Sleep Study

    Why the First Half of Your Sleep is Crucial for Brain Reset

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    Original Article | Sleep Review Magazine

    Recent findings reveal that the initial hours of sleep play a crucial role in weakening neuron connections, paving the way for new learning the following day.

    Summary: A study by University College London, published in Nature, shows that during the first half of sleep, the brain reduces connections made between neurons while awake, supporting the Synaptic Homeostasis Hypothesis. This “reset” prepares the brain for new learning. Using zebrafish with optically translucent genes for easy imaging of synapses, researchers found that sleep helps manage the strength of neuron connections based on prior wakefulness. The study raises questions about the second half of sleep, suggesting it might serve other brain functions like waste clearance or cell repair.

    Key Takeaways: 

    • The first half of sleep is crucial for weakening the connections between neurons that are formed during wakefulness, helping to reset the brain for new learning the next day.
    • The study utilized optically translucent zebrafish, allowing researchers to visually track how synapses in the brain were altered during different sleep-wake cycles.
    • While the first half of sleep focuses on synaptic weakening, the function of the second half remains less understood, with theories suggesting it may involve brain waste clearance or cell repair.

    During sleep, the brain weakens the new connections between neurons that had been forged while awake—but only during the first half of a night’s sleep, according to a new study in fish by University College London scientists.

    The researchers say their findings, published in Nature, provide insight into the role of sleep but still leave an open question about what function the latter half of a night’s sleep serves. The researchers say the study supports the Synaptic Homeostasis Hypothesis, a key theory on the purpose of sleep which proposes that sleeping acts as a reset for the brain.

    “When we are awake, the connections between brain cells get stronger and more complex. If this activity were to continue unabated, it would be energetically unsustainable. Too many active connections between brain cells could prevent new connections from being made the following day,” says lead author professor Jason Rihel, PhD, in a release. “While the function of sleep remains mysterious, it may be serving as an ‘offline’ period when those connections can be weakened across the brain, in preparation for us to learn new things the following day.”

    Study Shows Sleep’s Impact on Brain

    For the study, the scientists used optically translucent zebrafish, with genes enabling synapses to be easily imaged. The research team monitored the fish over several sleep-wake cycles.

    The researchers found that brain cells gain more connections during waking hours and then lose them during sleep. They found that this was dependent on how much sleep pressure (need for sleep) the animal had built up before being allowed to rest; if the scientists deprived the fish from sleeping for a few extra hours, the connections continued to increase until the animal was able to sleep.

    “If the patterns we observed hold true in humans, our findings suggest that this remodeling of synapses might be less effective during a mid-day nap when sleep pressure is still low, rather than at night when we really need the sleep,” says Rihel in a release. 

    Neural Rearrangement Peaks in Early Sleep

    The researchers also found that these rearrangements of connections between neurons mostly happened in the first half of the animal’s nightly sleep. This mirrors the pattern of slow-wave activity, which is part of the sleep cycle that is strongest at the beginning of the night.

    “Our findings add weight to the theory that sleep serves to dampen connections within the brain, preparing for more learning and new connections again the next day,” says first author Anya Suppermpool, PhD, in a release. “But our study doesn’t tell us anything about what happens in the second half of the night. There are other theories around sleep being a time for clearance of waste in the brain, or repair for damaged cells—perhaps other functions kick in for the second half of the night.”

    Photo 97439374 © Siriporn Kaenseeya | Dreamstime.com

  • Sleep Apnea, Sleep Health, Sleep Study

    Study reveals sleep effects how young you feel

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    By Eric Ralls Earth.com staff writer

    Have you ever noticed how a well-maintained classic car can turn heads and exude a timeless charm? Its age has become subjective. Just like a vintage automobile that has been meticulously cared for, feeling young is not merely a superficial notion — it is intrinsically connected to tangible health benefits.

    Subjective age, the internal gauge that measures how old we perceive ourselves to be, transcends the realm of simple self-perception.

    Much like how a classic car’s performance and longevity are tied to its upkeep, research has revealed that individuals who feel younger than their chronological age tend to enjoy longer lifespans, superior mental and physical well-being, and a host of positive psychological attributes.

    These findings have led experts to propose the integration of subjective age as a biophysical indicator of aging, serving as a vital component of comprehensive health assessments.

    Young and Youthful Woman

    Sleep-age connection

    Researchers at Stockholm University have discovered that sleep affects how old you feel. The study, published in the scientific journal Proceedings of the Royal Society B, reveals that feeling sleepy can make you feel ten years older.

    Leonie Balter, a researcher at the Department of Psychology, Stockholm University, explains, “Given that sleep is essential for brain function and overall well-being, we decided to test whether sleep holds any secrets to preserving a youthful sense of age.”

    Power of a good night’s sleep

    In the first study, 429 individuals aged 18 to 70 were asked how old they felt, how many days in the past month they had not gotten enough sleep, and how sleepy they were.

    The results showed that for each night with insufficient sleep in the past month, participants felt on average 0.23 years older.

    To further investigate the causal relationship between sleep and subjective age, the researchers conducted a second study involving 186 participants aged 18 to 46.

    Participants restricted their sleep for two nights, with only four hours in bed each night, and another time slept sufficiently for two nights, with nine hours in bed each night.

    The findings were striking. After sleep restriction, participants felt on average 4.4 years older compared to when having enjoyed sufficient sleep.

    Staying young at heart by safeguarding your sleep

    The effects of sleep on subjective age appeared to be related to how sleepy they felt. Feeling extremely alert was related to feeling 4 years younger than one’s actual age, while extreme sleepiness was related to feeling 6 years older than one’s actual age.

    “This means that going from feeling alert to sleepy added a striking 10 years to how old one felt,” says Leonie Balter.

    Previous studies have shown that feeling younger than one’s actual age is associated with longer, healthier lives. There is even support for subjective age to predict actual brain age, with those feeling younger having younger brains.

    The implications of this study are clear. “Safeguarding our sleep is crucial for maintaining a youthful feeling. This, in turn, may promote a more active lifestyle and encourage behaviours that promote health, as both feeling young and alert are important for our motivation to be active,” states Leonie Balter.

    Unlocking the secrets of age by sleeping

    In a world where we are constantly searching for the fountain of youth, it turns out that the secret to feeling young again might be as simple as getting a good night’s sleep.

    By prioritizing our sleep and ensuring that we get enough rest each night, we can not only feel more alert and energized but also maintain a youthful sense of age.

    So, the next time you find yourself longing for the vitality of your younger years, remember that the key to unlocking that feeling might just be a few extra hours of shut-eye.

    More about subjective age

    As discussed above, subjective age refers to how old an individual feels, regardless of their chronological age. It is a personal perception that can be influenced by various factors, such as physical health, mental well-being, and life experiences.

    People often report feeling younger or older than their actual age, and this subjective age can have significant implications for their overall health and quality of life.

    Benefits of feeling younger

    Numerous studies have shown that feeling younger than one’s chronological age is associated with a range of positive outcomes.

    Individuals who feel younger tend to have better physical and mental health, higher levels of life satisfaction, and a more positive outlook on life.

    They are also more likely to engage in healthy behaviors, such as regular exercise and maintaining a balanced diet.

    Impact of subjective age on longevity

    Research suggests that subjective age may even predict longevity. A study published in the Journal of the American Medical Association found that individuals who felt younger than their actual age had a lower risk of mortality compared to those who felt older.

    This finding highlights the potential importance of subjective age as a biophysical marker of aging and its relevance in health assessments.

    Factors influencing subjective age

    Several factors can influence an individual’s subjective age, including:

    • Physical health: Chronic illnesses, disabilities, and poor physical functioning can make people feel older than their chronological age.
    • Mental health: Depression, anxiety, and stress can contribute to feeling older, while positive emotions and a sense of purpose can help individuals feel younger.
    • Social connections: Strong social support and engaging in meaningful relationships can promote a youthful sense of age.
    • Life experiences: Major life events, such as retirement, the loss of a loved one, or becoming a grandparent, can impact how old an individual feels.

    Harnessing the power of subjective aging

    In summary, subjective age is a fascinating concept that has garnered increasing attention from researchers and healthcare professionals alike.

    By understanding the factors that influence subjective age and its potential implications for health and well-being, we can develop strategies to promote a more youthful mindset and improve overall quality of life.

    Encouragingly, recent research on the link between sleep and subjective age suggests that we may have more control over how old we feel than previously thought.

    The full study was published in the journal Proceedings of the Royal Society B Biological Sciences.

    —–

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  • Sleep Apnea, Sleep Apnea Dentist, Sleep Health

    Sleep deprivation: A cause of high blood pressure?

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    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.

    Sleep Deprived

    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.