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SLEEP APNEA & DIABETES

SLEEP APNEA & DIABETES. Juan A. Albino, MD, MPH, FCCP Village Sleep Lab 751-4955; January, 2016. Facts on Sleep Disorders. 12 to 18 Million people have Sleep Apnea 1/3 of Americans sleep less than 7 hrs/nite 1/3 are sleepy during the day

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SLEEP APNEA & DIABETES

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  1. SLEEP APNEA& DIABETES Juan A. Albino, MD, MPH, FCCP Village Sleep Lab 751-4955; January, 2016

  2. Facts on Sleep Disorders • 12 to 18 Million people have Sleep Apnea • 1/3 of Americans sleep less than 7 hrs/nite • 1/3 are sleepy during the day • 70% of high school students are not getting enough sleep • 5,000 to 6,000 fatal crashes each year caused by drowsy drivers • Women suffer more from insomnia

  3. Diabetes & Sleep: Facts • Diabetes: 25% have Sleep Apnea, & many do not know it, most not treated • Sleep Apnea: 40% have Diabetes, & treating Sleep Apnea greatly helps control Diabetes • Both Sleep Apnea & Diabetes can lead to Heart Attacks, Strokes, Heart Failure • Both also associated with Hypertension

  4. Sleep Disorders: Major Problem • Very common but easily missed • Can be disabling but develop slowly • Worsen or lead to other diseases • Can lead to much suffering, even fatal • But easy to diagnose and treat • Biggest problem: keep them in mind • New field in medicine: last 25 years • Need to raise awareness in the community

  5. Good Sleep Habits: Basics • Regular timesfor sleeping andawakening • Maintain bedroom dark, quiet, cool • Use bed only for sleep and sex • Avoid late daytime naps • Avoid at night: alcohol, caffeine, nicotine • Sleep around 7 to 8 hours every night • Prudent exercise and eating

  6. Common Sleep Disorders • Insomnia: wants to sleep but cannot • Sleep Deprivation: does not want to sleep but can; problem of sleep quantity • Sleep apnea: sleepy during day, snores at night because of obstruction in throat; problem of sleep quality • Restless Legs Syndrome: leg discomfort, relieved by movement that hinders sleep

  7. Restless Legs Syndrome • Leg discomfort, worse at night, relieved by movement, affects 5-10% of population • Discomfort difficult to describe, usually not pain • Irresistible urge to move, walk, strike, or rub legs, leads to insomnia, restlessness • Often familial, begins in childhood, often missed • Associated with iron deficiency, drugs, Periodic Limb Movement Disorder of Sleep • Easily treatable with medicines, usually mild • Restless Legs Syndrome Foundation is active

  8. Sleep Deprivation • Disasters: Exxon Valdez, Challenger Space Shuttle, Chernoble Nuclear Plant, Commuter plane crash in Kentucky • 33% of fatal truck accidents • 10% of fatal car accidents • Impairment the same whether: drunk, sleep deprived (<4-6hrs.), sleep apnea • Must be taken seriously: sleep 8 hours • Sleep subtle, lapses brief, lack awareness

  9. Insomnia: Acute or Chronic • Insomnia: inability to fall asleep, stay asleep, or wakes up early, with daytime impairment • Acute Insomnia (<4 weeks): stress, illness • Sleep medicines work well in acute stage • Chronic Insomnia: >4 weeks, often years • Treat basic problem: >60% psychological • Psychotherapy better than medicines, beware of caffeine, smoking, alcohol, poor sleep habits • Sleep Apnea causes sleep maintenance insomnia

  10. Sleep Apnea: Risk Factors • Affects: 4 to 5% of population: common • Family history, but often unknown • Obesity: 80 % of sleep apnea patients; central (visceral, apples) obesity (increasing problem) • Increasing age, Male gender • Large tonsils / adenoids in children • Small mandible, high narrow arch, large neck • Elderly & women: little snoring & not obese

  11. Sleep Apnea: Consequences • Night: snoring, stops breathing, snorting, gasping, bed partner worries, GERD, restless, headaches • Day: sleepy, tired, depressed, irritable, forgets, confused, sometimes few complaints • Accidents: work, home, motor vehicle • Higher death rates with severe sleep apnea • Hypertension, Heart Failure, Heart Attacks • Strokes, Atrial Fibrillation • Promotes Obesity ,Diabetes, Impotence

  12. Obstructive Sleep Apnea • What is OSA? • Cessation of airflow with ongoing respiratory effort • NormalSnoring SleepApnea

  13. Sleep Apnea: Diagnosis • History: snoring, snorting, gasping for air, fatigue, excessive daytime sleepiness • Associated conditions: Heart Disease, Obesity, Hypertension, Depression, Strokes, Impotence, Migraine, Confusion • Sleep Study: Polysomnogram in the lab or home sleep testing in some patients

  14. Sleep Apnea: Treatment • Behavioral: Weight Loss, Sleep on side with head raised, Oxygen, Avoid sedatives & alcohol • CPAP: proven therapy, needs motivation: widely available, 70% of patients adapt well • Oral or Dental appliances: pull forth mandible or tongue; expertise necessary • Surgery: tonsillectomy (children), tracheotomy, pull forth mandible or tongue • Bariatric Surgery: banding, bypass • Tongue Pacemaker (nerve pacing)

  15. Treatment Options CPAP Treatment Positive pressure opens airway 100% effective CPAP therapy

  16. Linkages • Obesity, sleep, stress, diet, exercise, and diabetes • If poor sleep wake up more hungry • Young thin healthy people: poor sleep leads to insulin resistance, a diabetic state • Proper amounts of sleep and exercise decrease appetite and obesity • Much easier to obtain proper sleep and treat sleep apnea than to diet

  17. Obesity • Obesity, Sleep Apnea promote each other • Hormonal links: leptin decreases and ghrelin increases hunger, while having opposite effects on sleep • Unfortunately medical trials with leptin have not been fruitful • Body is programmed: if not sleeping then eat more, in particular CHO and fat

  18. Obesity & Sleep Deprivation • Direct link with avoiding sleep and obesity • Risk of obesity rises with sleep deprivation • Less than 4 hours : 73% risk • Five hours : 50% risk • Six hours : 23% risk • Less sleep: lower leptin levels • Obese persons sleep less

  19. Control Sleep Apnea: Better Diabetes Control • Improve insulin sensitivity • Lower blood sugars • Lower HbA1-c • Lower dosages of oral hypoglycemic agents or take fewer medicines

  20. Websites • The Village Sleep Lab: (our website) www.VillageSleepLab.com • National Sleep Foundation: www.sleepfoundation.org • American Sleep Apnea Association: www.sleepapnea.org • Restless Legs Syndrome Foundation: www.rls.org • American Academy of Sleep Medicine: www.sleepeducation.com

  21. Websites • National Center on Sleep Disorders: www.nhlbi.nih.gov/health/resources/sleep/ • Insomnia: Cognitive Behavioral Therapy cbtforinsomnia.com and uwhealth.org/health/topic/mini/insomnia/uh1001.html • Commercial: www.MyResmed.com • Commercial: www.Respironics.com • Buyer Beware!!!

  22. Books • The Promise of Sleep by William Dement • Sleeping Well by Michael Thorpy • No More Sleepless Nights by Peter Hauri • A Woman’s Guide to Sleep Disorders by Meir H. Kryger • Restless LegsSyndromeby Robert H. Yoakum • Say Good Night to Insomnia by Gregg D. Jacobs

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