To Sleep, Perchance To Dream, Public Talk

To Sleep, Perchance To Dream To Breathe

Presentation on Behalf of

Sleep Apnea Association of Curacao

to the Citizens of the Island

***

Edward Grandi, Exec. Director

American Sleep Apnea Association

Presentation Objectives

• Sleep

• Sleep Disordered Breathing

• Call to Action

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Sleep – in General

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Sleep – in General

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Sleep – in General

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Circadian Rhythm and the Body

• Melatonin • Body Temperature

• Cortisol

• Melatonin • Body Temperature

• Cortisol

Sleep – in General

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Sleep – in General

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The Purpose of Sleep?

• Slow Wave Sleep

– Growth Hormone

• Rapid Eye Movement (REM) Sleep

– Memory Consolidation

– Learning

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Recovery, Regeneration & Realignment

Sleep Deprivation - Consequences

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Sleep Deprivation - Consequences

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Blood Pressure – An Indicator

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Sleep Deprivation - Consequences

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Sleep Deprivation - Consequences

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How Much Sleep Do We Need?

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The amount of sleep people need depends on various factors, such as the

quality of their sleep, health, age, how much exercise they have done, when

they last ate, etc. A new born needs up to 18 hours sleep each day, while an

adult usually needs between 7 and 8.

Below is a rough estimate of how much sleep people need each day,

according to age:

• Infant (newborn) - 18 hours

• Baby (1 to 12 months old) - 14 to 18 hours

• Baby/toddler (1 to 3 years old) - 12 to 15 hours

• Young child (5 to 12 years old) - 9 to 11 hours

• Teenager - 9 to 10 hours

• Adult - 7 to 8 hours

• Pregnant woman - at least 8 hours

(Source: National Health Service, UK)

Sleep disorders – In General

• Insomnia

• Narcolepsy

• Restless Leg Syndrome – Willis/Eckbom Disease

• Circadian Rhythm Disorder

• Parasominas

• Sleep Disordered Breathing

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10 Commandments of Good Sleep Hygiene

• Fix regular times for going to bed and for getting up.

• If you nap during the day, don't allow yourself more than 45 minutes of sleeping time.

• Stop consuming alcoholic beverages four hours before bedtime and don't smoke at all.

• Avoid caffeine beginning six hours before bedtime. This includes not only coffee and tea, but many soft drinks and chocolate as well.

• Avoid heavy, spicy, or sugary foods starting four hours before bedtime. A light snack just before retiring is okay.

• Exercise regularly, but not right before bed.

• Use comfortable bedding.

• Find a comfortable temperature setting for your bedroom, and keep the room well ventilated.

• Block out all distracting noise and eliminate as much light as possible.

• Reserve your bed for sleep and sex. It is not an office, a workroom, a movie theater, or TV viewing venue.

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Questions on Sleep

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Chronic Intermittent Hypoxemia

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Sleep Apnea

Sleep Fragmentation & Sleep Deprivation

Sleep Apnea - evolution

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Signs, Symptoms and Risk Factors

•Loud Chronic Snoring •Witnessed pauses in breathing •Large neck size (> 17” men, > 16” women) •Excessive Daytime Sleepiness •Nocturia •GERD •Hypertension •Type 2 Diabetes •Erectile Dysfunction

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• High Blood Pressure/Hypertension

• Diabetes

• Impaired Thinking

Co-morbid conditions with OSA

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High Blood Pressure/Hypertension

Peppard, PE; NEJM, 2000; Wisconsin Sleep Cohort Study

Sleep Apnea - Consequences

SDB and Mortality: The Wisconsin Sleep Cohort—Young et al SLEEP, Vol. 31, No. 8, 2008

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Sleep Apnea – in particular

Marin,JM et.al, Lancet 2005:365:1046-1053

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Blood Pressure - Revisited

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Diabetes

d i a b e t e s r e s e a r c h and

c l i n i c a l p r a c t i c e 8 1

( 2 0 0 8 ) 2 – 1 2

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Impaired Executive Functioning

Beebe DW, Gozal D J Sleep Res 2002;11:1-16, p 3

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Treatment Options for OSA

•Lifestyle Changes •Oral Appliances •Positive Airway Pressure •Surgical Options

Mild Moderate Severe

AHI > 5 & < 15 AHI >15 & <30 AHI >30

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Treatment Options for OSA

LIFESTYLE CHANGES:

• Lose Weight

• Stop Smoking

•Reduce or Eliminate Alcohol Use

•Reduce or Eliminate Sedatives

•Avoid Sleeping on Your Back

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Treatment Options for OSA

ORAL APPLIANCE THERAPY:

• Tongue Retaining Device

• Mandibular Advancement Device

a. Fixed

b. Adjustable

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Treatment Options for OSA Positive Airway Pressure Therapy

•Continuous •Bi-level •Auto-titrating •Variable-titrating (ASV)

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Treatment Options for OSA •Surgical Options

•Minor surgery

•Correcting deviated septum

•Removing turbinate

• Pillar procedure

• Hyoid and tongue procedures

•Major surgery

• Uvulopalatopharyngoplasty (UPPP)

• Maxillomandibular advancement (MMA)

•Tracheostomy

Can Treating OSA Make a Difference?

• Daytime Sleepiness

– Yes

• Elevated Blood Pressure

– Yes

• Insulin Resistance

– Yes

• Depression

– Yes

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Call to Action

• Practice good sleep hygiene

• Recognize the risk factors for sleep apnea

• Make your therapy work for you

• Communicate about your condition when going to the hospital

• Support others who have the condition

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Testimony

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Edward Grandi - 202-293-3650 - egrandi@sleepapnea.org