Sleep Education

Healthy Sleeping

Getting a good night’s sleep is just as important to your overall health as eating well and getting a good night’s sleep is just as important to your overall health as eating well and exercising regularly. That’s why it’s important to understand that snoring or regularly waking up tired means you probably aren’t getting the type of quality sleep you need and exercising regularly. That’s why it’s important to understand that snoring or regularly waking up tired means you probably aren’t getting the type of quality sleep you need and getting a good night’s sleep is just as important to your overall health as eating well and exercising regularly. That’s why it’s important to understand that snoring or regularly waking up tired means you probably aren’t getting the type of quality sleep you need.

What causes snoring?

What causes snoring is a question that can be answered multiple ways. From an anatomical standpoint, snoring is caused by a partially closed upper airway (the nose and throat). Everyone’s neck muscles relax during sleep, but sometimes they relax so much that the upper airway partly closes and becomes too narrow for enough air to travel through to the lungs. When this happens, it means that a person isn’t taking in enough oxygen for the body to perform its important functions. The brain then sends a signal to the body to wake up to get the oxygen it needs, likely resulting in the person waking up throughout the night without realizing it.

Why do people snore?

Why do some people snore and others don’t? Those who have enlarged tonsils, an enlarged tongue or excess weight around the neck are more prone to snoring. And structural reasons like the shape of one’s nose or jaw can also cause snoring. The snoring sound itself is a result of the narrowing of a person’s airway, which causes a throat vibration and the snoring sound. No matter the reason, 40% of normal adults snore regularly, whether they realize it or not.

Snoring and Sleep Apnea

Snoring and sleep apnea are linked at an alarming rate – 1 in 3 men and approximately 1 in 5 women who are habitual snorers suffer from some degree of obstructive sleep apnea. Sleep apnea prevents you from getting the healthy sleep you need to lead a refreshed, energetic life. It has also been linked to a number of other health conditions like type 2 diabetes, obesity, heart failure and unexplained hypertension. So regardless of what is specifically causing snoring for you, if you snore — or if you suspect you snore — consider it a sign that something might not be right.

References

Ohayon MM et al. Snoring and breathing pauses during sleep: telephone interview survey of a United Kingdom population sample. BMJ. 1997;314:860–3 Young T et al. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 1993; 28(17):1230–5 

Why is sleep important?

To understand why sleep is important, think of your body like a factory that performs a number of vital functions. As you drift off to sleep, your body begins its night-shift work: Healing damaged cells, boosting your immune system, recovering from the day’s activities, recharging your heart and cardiovascular system for the next day

We all know the value of sleeping well, and we’ve all experienced the feeling of being refreshed after a good night’s sleep – and the feeling of fatigue after a poor night’s sleep. But even though we know this, with our busy society, many of us are not getting the quality sleep needed to truly receive the health benefits of sleep.

Understanding the Sleep Cycle

Understanding what happens during sleep also means understanding the sleep cycle, which consists of two recurring phases: REM (rapid eye movement) and NREM (non-REM or non-rapid eye movement). Both phases are important for different functions in our bodies.

NREM sleep typically occupies 75–80% of total sleep each night. Many of the health benefits of sleep take place during NREM sleep – tissue growth and repair occurs, energy is restored and hormones that are essential for growth and development are released.

REM sleep typically occupies 20–25% of total sleep each night. REM sleep, when dreaming occurs, is essential to our minds for processing and consolidating emotions, memories and stress. It is also thought to be vital for learning, stimulating the brain regions used in learning and developing new skills.

If the REM and NREM cycles are interrupted multiple times throughout the night — either due to snoring, difficulties breathing or waking up frequently throughout the night — then we miss out on vital body processes, which can affect our health and well-being the next day and long term.

What happens if you don't get enough sleep?

If your body doesn’t get a chance to properly recharge – by cycling through REM and NREM – you’re already starting the next day at a disadvantage. You might find yourself: Feeling drowsy, irritable or sometimes depressed Struggling to take in new information at work, remembering things or making decisions Craving more unhealthy foods, which could cause weight gain

If this happens night after night, it places a tremendous strain on your nervous system, body and overall health. So if you’re not sleeping well or aren’t feeling rested when you wake up in the morning, it’s important to talk to your doctor and ask if a sleep study is right for you.

References

Morselli L et al. Role of sleep duration in the regulation of glucose metabolism and appetite. Best Pract Res Clin Endocrinol Metab 2010;24(5):687–702. 

How to get a good night's sleep

Getting a good night’s sleep requires more than just going to bed on time. Try following these five sleep tips to give yourself the best chance of getting consistent, quality sleep each night. And if you feel like you’re doing everything you can to get a good night’s sleep but no longer have the energy to do the things you love, there might be more to the story. Sleep apnea affects more than 1 in 3 men and 1 in 6 women between age 30­–70, with most people being undiagnosed.1 Talk to your doctor and ask about a sleep apnea test – which can be done in a sleep lab or the comfort of your own home.

     1. Allocate enough time for sleep. Sleep is just as important as diet and exercise, so it’s important to allocate the right amount of time in your day for sleep and plan the rest of your schedule accordingly. Getting a good night’s sleep means 7–8 hours each night for adults (including older adults), 9–10 hours for teens, at least 10 hours for school-aged children and 11–12 hours for preschool-aged children.

     2. Create consistent sleep habits. As creatures of habit, we’re usually more successful when following a routine. Sleep is no different. From your pre-sleep ritual to going to bed and waking up at the same time, you’ll find that consistency makes it easier to fall asleep each night.

     3. Create a comfortable sleep environment. Make sure your bedroom is cool, quiet and comfortable – especially your bed. It may take some experimenting and an investment on your part, but finding an ultra-comfortable bed and pillow is invaluable. We spend one-third of our lives in bed, making it the one area of your life you don’t want to compromise on comfort.

     4. Turn it off before bed. Whether it’s television, reading, email or texting, give yourself a nice window of time to unplug and relax before bedtime. Your body should associate your bed with sleep and these activities ramp up your brain activity rather than relaxing it. Television and bright light can also suppress melatonin production – making it difficult to fall asleep. 

     5. Utilize sleep technology. There are a variety of technologies out there that can help improve your sleep. The S+ by ResMed is the world’s first non-contact sleep sensor; it combines a bedside sleep monitor, smartphone app and web-based app to help you track and better understand your sleeping patterns. It then creates personalized feedback and suggestions to help improve your sleep.

If your body doesn’t get a chance to properly recharge – by cycling through REM and NREM – you’re already starting the next day at a disadvantage. You might find yourself: Feeling drowsy, irritable or sometimes depressed Struggling to take in new information at work, remembering things or making decisions Craving more unhealthy foods, which could cause weight gain.

References

Peppard et al. Increased prevalence of sleep-disordered breathing in adults Am J Epidemiol.2013;177(9):1006–14

What is sleep Apnea?

Sleep apnea is a disorder that causes your body to stop breathing while you sleep. It’s a potentially fatal condition, with harmful short- and long-term complications, that affects more than 1 in 3 men and 1 in 6 women.

What causes sleep Apnea?

There are three main types of sleep apnea:

     1. Obstructive sleep apnea (OSA), which more than 80% of sleep apnea patients have, occurs when enlarged and/or relaxed throat muscles obstruct your upper airway, blocking air from entering and leaving your lungs.

     2. Central sleep apnea (CSA), so named for its relation to the central nervous system, occurs when the brain stops signaling for the body to breathe until it detects a lack of oxygen and/or a heightened level of carbon dioxide that needs to be exhaled.

     3. Complex sleep apnea (CompSA) is a combination of OSA and CSA. (Here are more details on the different types of sleep apnea.

Eventually your brain senses that you’ve stopped breathing and causes you to wake up just enough to gasp and start breathing again. Then you fall back to sleep and the cycle begins again. This can happen more than 120 times every hour, even though you may not remember waking up.

Short-Term effects of Sleep Apnea

Of course apneas cause the immediate life-threatening danger of not inhaling enough oxygen (or exhaling enough poisonous carbon dioxide). But the body’s constant waking due to these apneas can also cause sleep deprivation. This can lower people’s energy and attentiveness the next day, negatively affect their moods and relationships with others, and raise the risk for memory loss, cognitive impairment and injury.

Long-Term effects of Sleep Apnea

Untreated sleep apnea has been linked to an increased risk for other chronic and life-threatening conditions such as hypertension (high blood pressure)2 and heart failure,3 as well as poorer glucose control in patients with type 2 diabetes.4

The first step toward treating sleep apnea and living healthier is recognizing the signs and symptoms of sleep apnea and asking your doctor to get screened and tested.

Roughly 80% of people with sleep apnea don’t know they have it, partly because they can never witness their own nighttime symptoms.

Common sleep Apnea symptoms

While snoring is still the strongest predictor of sleep apnea in men and women,6 not everyone who snores has it. And more important, not everyone who has it snores. Below are other common sleep apnea symptoms:

• Constant
• Tiredness
• Poor concentration
• Night sweats
• Weight gain
• Lack of energy
• Forgetfulness
• Sexual dysfunction
• Frequent urination at night

In addition, women often show subtler, atypical symptoms such as insomnia, morning headaches, depression and anxiety. These symptoms often lead to misdiagnoses such as depression, insomnia or menopausal side effects. If you have these symptoms, be sure to ask your doctor about whether you might have sleep apnea.

Respiratory Conditions

Your ability to breathe in air when you’re asleep or awake may be affected by your lower airway—that is, your lung area. This may be due to a number of lower airway conditions.

• Chronic Obstructive Pulmonary Disease (COPD)

Chronic obstructive pulmonary disease (COPD) is a progressive long‐term lung disease that involves inflammation and thickening of the airways. Over time the disease makes it more difficult to breathe because the airways are obstructed, restricting the flow of air in and out of the lungs.

When this happens less oxygen reaches the blood, and it becomes harder to get rid of the waste gas carbon dioxide.

COPD is made up of two chronic conditions: chronic bronchitis which is a persistent cough with mucus, and emphysema which is characterized by the destruction of lung tissue.

Causes of COPD

The main cause of COPD is tobacco smoking, with smokers at a higher risk of respiratory problems and mortality. Other risk factors include exposure to air pollution, and occupational exposure to dust and chemicals.

• How common is COPD?

According to the latest figures from the World Health Organization4 65 million people across the globe are living with moderate to severe COPD. Over the next decade deaths from COPD are projected to increase by more than 30%4 and by 2030 it is expected to become the third leading cause of death worldwide.  Your ability to breathe in air when you’re asleep or awake may be affected by your lower airway—that is, your lung area. This may be due to a number of lower airway conditions.

What happens during normal breathing?

To find out what could be affecting your ability to breathe properly, it’s helpful to first understand what normal breathing looks like.

• Breathing is automatic

It might sound simple, but it’s important to realize that breathing is not something we have to consciously remember to do. It’s a reflex that is controlled by nerve cells in the brain and spine.

The upper and lower airways

The respiratory system is made up of 2 parts: the upper and lower airways.

The lower airway is protected by the chest cavity, which also contains the heart and lungs.

• The breathing process

What starts the breathing process is actually the effort you make (from your chest) to draw air into your body.

When you breathe, the air entering your nose is cleaned, warmed and moistened. It then travels through your throat to the windpipe, and down to the bronchi in the lungs.

As you inhale and exhale, your chest and ribs expand and contract to allow for the air going in and out.
 

Abnormal breathing

As you can imagine, the everyday act of breathing can become very difficult if you have a respiratory condition that affects the muscles, nerves, reflexes or organs involved in breathing.

Diagnosis

There are a number of conditions that could be affecting your ability to breathe properly, either while you’re asleep or awake. For example, if you have obesity hypoventilation syndrome (OHS), being overweight places a lot of pressure on the muscles around your lower airway, making it difficult for you to take in enough air. If you have a chest wall disorder, the muscles and nerves used during breathing are affected, making it difficult to breathe properly on your own.

Generally, if your inability to breathe properly is part of a broader condition, then you will be diagnosed as part of the broader condition. Your doctor or care provider will determine the best diagnosis method for your condition and let you know the next steps to getting treated. Learn more about other respiratory conditions such as COPD, NMD, or CSR that affect your ability to breathe or about respiratory conditions in children. 

Sleep studies

If your inability to breathe at night is causing you to have apneas (you stop breathing while you’re asleep), your care provider might request that you get a sleep study. Sleep studies are used to assess whether or not you have sleep apnea, and if so, how severe it is. You can do a sleep study in a sleep clinic or in the comfort of your own home. Read more about sleep studies at UHST.com

Obesity Hypoventilation Syndrome (OHS)

As the name suggests, obesity hypoventilation syndrome (OHS) affects people who are overweight or obese.

Hypoventilation means that breathing is too shallow or too slow. Because the body needs to work harder to breathe, the respiratory system* becomes exhausted and the body ends up with high levels of carbon dioxide in the blood.

Around 90% of patients with OHS also have obstructive sleep apnea (OSA).

What is obesity hypoventilation syndrome (OHS)?

As the name suggests, OHS usually affects people who are overweight or obese.

Hypoventilation means that breathing is too shallow or too slow. Because your body needs to work harder to breathe, your respiratory system* becomes exhausted and you end up with carbon dioxide levels that are too high and oxygen levels that are too low.

If you have OHS you might be experiencing:

• Shortness of breath
• Excessive Daytime Sleepiness (EDS)
• Morning headaches
• Depression

Around 90% of people with OHS also have Obstructive Sleep Apnea

Why is treatment important?

As you can imagine, not being able to breathe deeply enough might not only affect your ability to do some of the activities you love, but also places a lot of strain on your organs.

Left untreated, OHS often results in:

• Heart failure on the right side of the heart
• Pulmonary hypertension (where the blood pressure in the arteries that carry blood from the heart to the lungs is higher than normal)
• Polyglobulia (where there is an abnormal increase in the number of circulating red blood cells. Also known as polycythemia).

Because of the serious effects of OHS, it’s important to find out if you have it and get it treated.

If you are already being treated for OSA, and still feel sleepy during the day and have headaches, talk to your care provider about being tested for OHS.

References

Parameswaran, K, Todd, DC, Soth, M . Altered respiratory physiology in obesity. Can Respir J 2006;13(4): 203-210

The benfits of treatment

In addition to feeling better physically, there are many other benefits to treating OHS with noninvasive ventilation (NIV).

     1. The exchange of oxygen and carbon dioxide between the blood and the air in your lungs is improved

     2. There is less pressure put on the muscles that help you breathe

     3. There is a positive effect on your lung function

     4. Higher life expectancy compared to those with OHS that are not treated with NIV

References

Olson AL, Zwillich C. The obesity hypoventilation syndrome. Am J Med 2005 Sep; 118(9): 948-56. 02

Nowbar S, Burkart KM, Gonzales R, Fedorowicz A, Gozansky WS, Gaudio JC, Taylor MR, Zwillich CW. Obesity-associated hypoventilation in hospitalised patients: prevalence, effects, and outcome. Am J Med. 2004 Jan 1; 116(1): 1-7. 03

Berg G, Delaive K, Manfreda J, et al. The use of healthcare resources in obesity hypoventilation syndrome. Chest. 2001; 120: 377-383. 04

Budweiser, S., Hitzl A.P., Jörres, R.A., Schmidbauer, K., Heinemann, F., Pfeifer, M., (2007). Health-related quality of life and long-term prognosis in chronic hypercapnic respiratory failure: a prospective survival analysis. Respir Res 8(17): 92. 

Neuromuscular disease (NMD)

Neuromuscular disease (NMD) is the name given to a range of diseases and conditions that affect the nerves controlling your muscles. If the nerves can’t communicate with your muscles, your muscles then can’t function properly.

Restrictive Lung disease

The chest wall is vital to the mechanical action of breathing. It includes the bony structures (ribs, spine, sternum), respiratory muscles (the organs in your body that help you breathe), and nerves that connect the central nervous system to the respiratory muscles. If you have restrictive lung disease, it's likely that your breathing is restricted, and you may have long-term respiratory failure. The most common restrictive lung disorders that lead to respiratory failure are thoracoplasty, scoliosis and/or kyphoscoliosis.