Sleep Health

  • Best CPAP Alternatives

    If you have sleep apnea, here’s what to know about dental devices, tongue trainers, mouth tape, and more.

    Consumer Reports | By Kevin Loria

    When you have obstructive sleep apnea, or OSA addressing it is key. Left untreated, OSA is linked to daytime sleepiness and an increased risk of anxiety, diabetes, hypertension, and stroke.

    With OSA, your breathing pauses during sleep because something blocks your airway, like your tongue or relaxed throat muscles, explains Richard Schwab, MD, chief of the division of sleep medicine at the University of Pennsylvania Perelman School of Medicine in Philadelphia. Losing weight, quitting smoking, and limiting alcohol can all help ease obstructive sleep apnea symptoms such as snoring, says Ana Krieger, MD, medical director of the Center for Sleep Medicine at Weill Cornell Medicine in New York City.

    CPAP Machine

    Sleep apnea’s severity is determined by something called your apnea-hypopnea index (AHI): the number of times per hour you fully or partially stop breathing for 10 seconds or longer. The primary treatment for people with moderate (15 to 29 AHI) or severe (30 AHI and higher) obstructive sleep apnea is a continuous positive airway pressure (CPAP) machine, which keeps your airway open by pumping air through a mask you wear over your mouth and/or nose when you sleep.

    Many people have difficulty tolerating CPAP and don’t stick with it, however. The good news is that CPAP machines have become smaller and quieter, with more comfortable options available. And for some people with mild (5 to 14 AHI) or even moderate OSA, less invasive alternatives to CPAP may be worth considering.

    A Common CPAP Alternative

    A dental device designed to move the jaw so that the tongue shifts toward the front of the mouth can help keep the airway open. It’s one of the primary alternatives to CPAP, Schwab says, and can also be used with CPAP to help make severe obstructive sleep apnea milder.

    A dentist who specializes in sleep medicine (find one at dentalsleep.org) will be able to customize its fit to help your breathing without causing harm to your bite or teeth, says Kevin Postol, DDS, president-elect of the American Academy of Dental Sleep Medicine. These custom-made oral appliances can cost between $2,000 and $4,000, according to Schwab, but may be covered by insurance.

    There are much cheaper options available online to treat snoring, but experts say these may not help with OSA, and could move teeth out of place or cause jaw issues if they’re not properly fitted.

    Other Sleep Apnea Treatments

    • Position therapy: For some, sleeping on the back can make obstructive sleep apnea dramatically worse. In these cases, switching to side sleeping—perhaps using pillows or a tennis ball attached to a shirt back—can sometimes get AHI into the mild range.
    • Tongue trainer: In 2021, the Food and Drug Administration approved a tongue-stimulating device for mild sleep apnea called eXciteOSA, which people wear for 20 minutes a day for six weeks and then 20 minutes a couple of times a week indefinitely. It costs $1,650 and is not covered by insurance. More research is still needed on its efficacy, Krieger says.
    • Mouth tape: While it’s a popular suggestion that may reduce snoring, taping the mouth shut is not an effective or safe option for people with obstructive sleep apnea, Schwab says.
    • Surgery: Some people who can’t tolerate CPAP have upper airway surgery to reduce the size of their soft palate or other tissue in their throat. But such options don’t always work, have serious potential complications, and cannot be reversed. So in general, they should not be first-line treatments, Schwab says. A newer option is a surgically implanted device called Inspire. Approved in 2014, it stimulates a nerve that moves your tongue to keep your airway open. Inspire can be removed if it is not tolerated, but it should also be tried only if someone is unable to use CPAP, and it is not an option for everyone.

    Could Weight Loss Meds Treat OSA?

    Because sleep apnea is an anatomic disorder, drugs typically have not been effective, Schwab says. But GLP-1 weight loss medications such as Wegovy may be used in the future, perhaps in concert with an oral appliance or airway surgery.

    That’s on the table because obesity is a primary risk factor for OSA: One 2022 study found that for every 7-pound drop in weight, there’s a roughly 7 percent drop in AHI. But more research on using these meds for obstructive sleep apnea is needed.

    Editor’s Note: This article also appeared in the April 2024 issue of Consumer Reports On Health.

  • Sleep deprivation: A cause of high blood pressure?

    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.

  • Sleep deprivation: A cause of high blood pressure?

    Is it true that sleep deprivation can cause high blood pressure?

    Answer From Francisco Lopez-Jimenez, M.D.

    Restless Sleep

    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.

  • Sleep apnea associated with 50% higher risk of memory problems.

    Original Article | Medical News Today

    • A new study analyzes the impact of sleep apnea symptoms on memory and thinking.
    • Sleep apnea is a sleep disorder that sometimes causes people to stop breathing.
    • The study subjects participated in a survey where they reported any symptoms of sleep apnea and difficulty with remembering things.
    • The study shows an association between sleep apnea symptoms and a higher rate of memory and thinking problems.

    Getting a good night’s sleep is important for many reasons, from having the energy to go about one’s daily tasks to optimal brain performance.

    Sleep apnea can interfere with this, and according to the National Council on Aging, it may impact around 39 million adults in the United States.

    While experts know sleep apnea can impact quality of life and even contribute to mood disordersTrusted Source, there is still more to learn.

    A researcher based in Boston recently conducted a cross-sectional study to determine whether a correlation between sleep apnea and thinking and memory problems exists.

    The findings showed that having sleep apnea symptoms correlated with a 50% increase in memory and thinking problems.

    The researcher will present the findings at the American Academy of Neurology’s Annual Meeting in April 2024. The research hasn’t yet been published in a peer-reviewed journal.

    Sleep apnea linked to thinking and memory issues

    Most people with sleep apnea have obstructive sleep apnea (OSA), but some experts have said that OSA is underdiagnosed.

    For instance, researchersTrusted Source note, “it is believed that more than 85% of patients with clinically significant OSA have never been diagnosed.”

    With the notion that sleep apnea could be underdiagnosed in mind, researcher Dr. Dominique Low wanted to learn more about a possible connection between sleep apnea and cognition. Dr. Low works at Boston Medical Center in Massachusetts and is a member of the American Academy of Neurology.

    Dr. Low pulled data from a government-funded survey called the 2017–18 National Health and Nutrition Examination Survey (NHANES) to establish a potential link between sleep apnea and thinking and memory.

    The study participants included 4,257 adults ages 20 and older. Of the questionnaires they completed for the NHANES, they answered questions about sleep quality, memory, and thinking.

    Dr. Low used the data from these questionnaires to determine how people who reported sleep apnea symptoms compared to people without these symptoms.

    The participants also answered questions on their memory quality, whether they had any periods of confusion, and if the participants thought they had trouble making decisions.

    A total of 1,079 participants reported sleep apnea symptoms, including snoring and gasping for breath while asleep.

    Of people who indicated they had sleep apnea symptoms, 33% also reported symptoms of memory and thinking problems. This is significantly higher than the number of people without sleep apnea symptoms who reported such problems, which was only 20% of that group.

    After adjusting for other factors like age, race, and gender, Dr. Low observed that people with sleep apnea symptoms had a 50% higher chance of having thinking and memory issues compared to participants who didn’t report sleep apnea symptoms.

    “Our study found participants who had sleep apnea symptoms had greater odds of having memory or thinking problems,” Dr. Low said in a news release. “These findings highlight the importance of early screening for sleep apnea.”

    Despite the implications of these findings, it’s important to note that a correlation does not indicate causation. Scientists must conduct further research that does not rely solely on self-reported symptoms to establish the effects of sleep apnea symptoms on memory and thinking.

    Reducing the risk of cognitive decline

    Dr. Joey R. Gee, a neurologist at Providence Mission Hospital in Mission Viejo, California, spoke with Medical News Today about how sleep apnea may impact memory. Dr. Gee was not involved with the study.

    “Apnea may have an impact due to poor oxygenation through the night or also impairing appropriate sleep cycles with frequent arousals,” Dr. Gee noted. “Impaired executive functions, such as working memory and attention through the day, are greatly impacted.”

    Dr. Gee said that while untreated sleep apnea may impact cognitive function, the risk could be reduced with appropriate treatment.

    “Just as untreated sleep apnea increases the risk of impairment in executive function and attention, treatment can substantially reduce the risk of progressing cognitive decline,” Dr. Gee said.

    Dr. Thomas Kilkenny, the director of the Institute of Sleep Medicine at Staten Island University Hospital in New York, not involved in the study, emphasized the importance of treating sleep apnea as soon as it is detected.

    “If the patient can be treated early in OSA, these brain damages will not occur,” Dr. Kilkenny told MNT. “There will be a decrease in the amount of cognitive decline in OSA patients.”

    Dr. David Merrill, a geriatric psychiatrist and director of the Pacific Neuroscience Institute’s Pacific Brain Health Center at Providence Saint John’s Health Center in Santa Monica, California, not involved with the study, shared his thoughts on the findings with MNT:

    “With high quality, restorative sleep, the brain’s function is enhanced and protected as we age,” explained Dr. Merrill. “If sleep is chronically disrupted, this can lead to a number of health issues, including headaches, fatigue, and memory loss that worsens over time. The disrupted, poor-quality sleep seen in sleep disorders leads to both acute and chronically worsening changes in the brain. Normally, a good night’s sleep literally allows for repair and restoration of brain function to the levels seen at the beginning of the prior day.”

    Dr. Merrill also spoke about the importance of treating sleep apnea and noted that it is a risk factor for developing dementia. While that may sound scary, he said that using a CPAP machine can help reduce risk.

    Research studiesTrusted Source have shown that even 4 hours per night using a CPAP device results in significantly less worsening of cognitive decline over time,” said Dr. Merrill.

    What to know about sleep apnea

    Sleep apnea, including obstructive sleep apnea and central sleep apnea, can affect people of all ages but, as the National Council on Aging notes (link above), it is most prevalent in middle-aged and older adults.

    Some symptomsTrusted Source of sleep apnea a person may detect on their own include:

    • sleepiness during the day
    • headaches
    • difficulty focusing

    A person’s partner may notice additional symptoms such as snoring or gasping for breath while asleep.

    “Signs of obstructive sleep apnea are usually readily apparent,” Dr. Kilkenny said.

    “Loud snoring, restlessness, and daytime fatigue are the hallmarks of OSA,” he noted. “If someone snores even to a minor degree, they should bring this to the attention of their physician so they can get tested for OSA before damage occurs.”

    People with sleep apnea can treat it using a continuous positive airway pressure (CPAP) machine.

    They may also try to improve symptoms by making lifestyle changes such as losing weight. They may also have surgery or use an oral appliance.

  • Recent studies show how a migraine can be predicted.

    Sleep quality and energy levels are two of the biggest indicators of an impending migraine attack, the study showed. Get inspired by a weekly roundup on living well, made simple.  

    Wouldn’t it be helpful to have a sense of when a debilitating migraine may be on the way?

    You may be able to do so, a new study has shown.

    Migraine

    “The major finding from this study was that changes in sleep quality and energy on the prior day were related to incident headache in the next day,” said Dr. Kathleen Merikangas, principal investigator of the study that published Wednesday in the journal Neurology.

    Migraines are nothing to shake your head at, and they certainly aren’t just nuisance headaches. Chronic migraines are the leading cause of disability in people younger than 50, according to a February 2018 study.

    More symptoms than you think may be tied to your migraines

    The study team found that sleep quality and energy were important indicators of a migraine attack on the following day.

    Those who had bad sleep quality and low energy one day were more likely to have migraines the next morning, the data showed. An increase in energy and greater-than-average stress usually foretold a migraine would appear later the next day.

    “It’s a very exciting study because of how well done and how detailed and how large it is,” said Dr. Stewart Tepper, vice president of the New England Institute for Neurology and Headache in Stamford, Connecticut. Tepper was not involved in the research.

    The differences point to the importance of your circadian rhythm — which regulates your cycles of sleep and wakefulness — in how headaches manifest. The findings may inform the treatment and prevention of migraine attacks.

    Migraine prevention

    Knowing when a migraine is coming can make all the difference — especially with growing interest in treating one before it starts, Tepper said.

    “If we can identify things in the environment that people can change, then we’d like to be able to prevent the attack in the first place,” Merikangas said. “If we can do that with behavioral interventions … then they may be able to prevent it by either going to sleep to offset it or some other intervention that would prevent us from having to use medication to prevent the attack.”

    Tepper, however, said he is not so sure if changes in behavior can always prevent a migraine attack.

    FDA approves new nasal spray to treat migraine headaches in adults, Pfizer says

    A migraine attack isn’t just a headache. And warning signs such as fatigue, neck pain and sleep disturbance may be early symptoms of an attack — not only a trigger of one, he added.

    Instead, Tepper advises intervening with medication before the head pain starts in hopes of warding off any pain at all.

    How much is too much?

    It makes sense that people might be conservative about using medication for migraine pain, Tepper said.

    An older class of medications, called triptans, was associated with more migraines and a resulting chronic migraine condition if used more than 10 days in a month, he said.

    But a newer option, rimegepant — sold as Nurtec — doesn’t seem to carry the same risk.

    “There’s no downside because rimegepant has almost no side effects and is not associated with transformation into chronic migraine,” Tepper said.

    What you can do about migraines

    Your doctor can recommend pain medication to address your migraines, but it also helps to know the signs of an upcoming attack, Tepper said.

    As well as monitoring sleep, exercise and diet, Merikangas suggests finding a way to monitor stress to be able to track the indicators of a migraine.

    There are five typical signs of an oncoming migraine headache, Tepper said. Those are sensitivity to light, fatigue, neck pain, and sensitivity to noise and dizziness, he said.

    5 ways to reduce your stress this year

    Cognitive behavioral therapy is often useful to help manage the stress that can trigger migraine attacks. What’s more, taking vitamins and supplements, such as magnesium and riboflavin, can be effective in reducing migraine frequency, Kylie Petrarca, a nurse and education program director at the Association of Migraine Disorders, said in a previous CNN article.

    It isn’t just about avoiding the pain, Merikangas said.

    “It’s really important to think of the full context of our health,” she said. “By being able to characterize not just headaches, but also all these other systems, we might be able then to get a handle on causes of negative health events.”

  • Why people should prioritize sleep quality over quantity.

    By Analisa Novak – February 19, 2024 / 11:59 AM EST / CBS News

    When it comes to maintaining heart health, it’s not just how long you sleep — it’s how well you sleep that matters equally, if not more, said Dr. Shelby Harris, a behavioral sleep psychologist and clinical associate professor at Albert Einstein College of Medicine.

    “Poor quality sleep really can influence our heart health as well,” Harris told “CBS Mornings” in an interview during American Heart Month

    Harris said the body’s balance of ghrelin and leptin, hormones that regulate hunger, is also disrupted by poor sleep, leading to increased consumption of high-sugar and high-fat foods. 

    Sleep disorders like sleep apnea and insomnia are closely linked to heart health. Sleep apnea, characterized by snoring and breathing pauses, affects both men and women, though women are evaluated less frequently for it. 

    Strategies for improving sleep quality include limiting alcohol and caffeine intake, reducing screen time before bed and managing how much liquid you drink before bed. 

    “Once you have better quality then we try to work on the quantity of sleep possible,” Harris said.

    For those struggling to achieve a longer sleep duration, getting a good quality amount of sleep but shorter is ideal when you first are trying to tackle this goal. 

    “For some people, I might have them go to bed later and then I might slowly have them go to bed earlier over time as opposed to that shifting back and forth. Because that can create a lot of problems for people as well,” she said. 

    Harris said that sleeping pills and aids are not ideal for most people, but said cognitive-behavioral therapy for insomnia may offer an alternative solution to medication. 

    She said most people try four to eight sessions of the therapy and if that doesn’t work, then she would recommend sleeping aids. 

    “You work on not just the hygiene but you work on the timing of sleep. … We work on thoughts about sleep, a lot of people put pressure on themselves to sleep and they worry about what’s going to happen if they don’t sleep and so we work on that aspect,” she said. 

    Harris said dietary choices also play a role in a good night’s sleep. She said people should avoid consuming large or heavy meals, such as a big dinner, before going to bed.

    Instead, opting for a small, light snack that includes a mix of protein and carbohydrates can be beneficial. “That’s a really good mix to help you throughout the night so you don’t wake up hungry, which a lot of people do as well,” said Harris.