Dealing with snoring helps both partners

Notes from Dr. Norman Blumenstock
"Laugh and the world laughs with you. Snore and you sleep alone"

Unlike high blood pressure or blood sugars, snoring is unique in that it causes problems not just to the person with the issue, but to both partners. As a result, 25 percent of married couples state that they sleep separately because their partners snore. Besides sleeping alone, it can also adversely affect our health. For-tunately, there is a lot that can be done to turn down the noise, improve our relationships and maintain our best health.

Dr. Nina's what you need to know about snoring to improve our sleep, relationships and health:

Why all that noise? A partial obstruction of our breathing passages can cause our respiratory structures to vibrate when we breathe. The vibration results in the harsh sound that we call snoring. To get a better understanding of this, try to create a snoring sound so we can feel the vibration.

What can cause a partial obstruction?

•When we are overweight, extra fatty tissue accumulates not just on our waist and hips, but also along our breathing passages.

•Drinking, smoking and certain medications can cause our airway muscles to relax, making them more likely to vibrate when breathing.

•With age cometh wisdom, narrowing of our throats, and decreased airway muscle tone.

•Nasal deviation and sinus problems can narrow our breathing passages.

•Sleeping flat on our backs can cause our tongue or other fleshy structures to relax and block our airways.

•And some of us are just built with long uvulas (the funny looking dangly thing), large tongues or narrow throats.

Is snoring the same as obstructive sleep apnea (OSA)? No. When we snore, we are breathing but the noise we hear is due to a partial (not total) obstruction; there is movement of air. OSA means that our breathing has stopped temporarily due to complete breathing obstruction and there is no movement of air. This causes us to wake up and is often accompanied by a loud snort or gasping sound. Over time, the repeated sleep interference and drops in oxygen levels can result in a number of ill effects on our health.

What are some ill-effects that can occur from OSA? OSA may be dubbed the "not-so-quiet" culprit of a number of chronic and dangerous health conditions. Studies have shown that it can increase our risk for stroke, heart disease, acid reflux, car accidents and other injuries, mental health issues and weight gain. In other words, we cannot ignore the warning sounds.

What can I do if I snore? Losing weight, quitting smoking and avoiding heavy meals and alcohol at night are some lifestyle changes that can literally put a stop to the noise. For some, sleeping on our sides, performing throat strengthening exercises or "clearing" our nasal passages by humidifying the room or using nasal sprays may do the trick.

When should I see a doctor? When lifestyle changes do not work; we experience daytime drowsiness; or we gasp or choke while sleeping. Our doctors will take a complete history and perform a physical exam. Based on the findings, he or she may order a radiology imaging or sleep study to determine the cause and best treatment. One option is a CPAP (pronounced cee-pap) machine. This device blows pressurized air into a mask that covers our mouth and nose in order to keep our airway open while sleeping. In some cases, a dental appliance may be used to prevent our lower jaw or tongue from blocking airflow. It may be necessary to undergo surgery to remove tissue or correct abnormalities in order to increase the size of our airway.

Although snoring may cause us to sleep alone, we can solve the problem by coming together. I was once told, "Teamwork divides the task but multiplies the success." Dealing with the problem head on will reap rewards to both our relationships and health. So, let's breathe easier and not wait to exhale.

Dr Nina Radcliff, of Galloway Township, is a physician anesthesiologist, television medical contributor and textbook author. Email questions on general medical topics to her at drninaradcliff@aol.com

Putting your kids back on a sleep schedule for school

Home News Tribune 08/26/2014 / By Susanne Cervenka 

Dina Margulies is planning to enjoy every last bit of summer with her three children before they head back to school. 

What’s getting less thought, however, is getting back on a sleep schedule for school. They’ll probably go to bed a little bit earlier, Margulies said.

Key word: probably.

“We have routines, but life just kind of pops up where you have to bend it,” she said.

It’s a common predicament families find themselves in this time of year. Summer brings with it more flexible schedules to take on more leisurely activities as well as more sunlight to enjoy them.

That also can do a number on our sleep routines.

“The problem is sunlight is one of the strongest cues to tell our bodies where it is in the 24hour clock,” said Dr. Carol Ash, medical director for sleep medicine at Meridian Health. “The natural tendency is to go to bed later, get up later and we have the flexibility to do so.”

With fall and the new school year approaching, it can take some time to get back on a normal sleep pattern.

Getting enough sleep can be crucial to students performing well in the classroom. Children of all ages need sleep for the energy and for the ability to focus and concentrate to do well in school, according to the National Sleep Foundation. 

Sleep is critical 

And lack of sleep can make itself known through behavioral problems and learning difficulties. 

“We don’t understand and appreciate how critical sleep is to your health,” Dr. Carol Ash, medical director for sleep medicine at Meridian Health, said. 

Falling off a sleep routine, even if it is common during the summer, isn’t exactly good for us, Ash said. Our bodies still need the same amount of sleep regardless of when the sun goes up and down in the summer. “It really isn’t helpful for them. We think, ‘The kids, they worked so hard, they earned the right to have fun,’ ” Ash said. “It’s like saying, ‘Brushing your teeth is a lot of work. Why worry about brushing your teeth this summer?’ ” Even if families did fall off their normal sleep habits, they can get back to it gradually, Ash said. And now is the time to do it. 

Do it now 

It can be difficult to abruptly move our wake up times an hour or so earlier. Instead, Ash suggests parents start getting their children to bed 15 minutes earlier until they are on track to get up on time for school. Children may need some coaching to get back to waking up at school time. So think about planning a couple of fun early-morning events in the days before school starts to give them a reason to want to get out of bed earlier, Ash said. 

Fair Haven mother Stacey Strandberg said she lets her four children stay up later in the summer, going to bed at 9 p.m. or 10 p.m. compared to 8 p.m. or 8:30 p.m. during the year. But as school approaches, Strandberg said she gradually starts ending activities, such as trips to the beach or the pool, a little bit earlier so the family can start getting ready for bed earlier. Annual activities at the end of summer help signal for her children that school is starting soon and makes it easier for them to get back to the earlier bed time. Fair Haven Fair is the last summer hurrah for the Strandberg children. They typically get their teacher assignments on the first day of the fair, Strandberg said. And, when they see their friends, they get to talk about school in a positive way. “In Fair Haven, there’s a sense of excitement at that time of year,” she said. At home, Strandberg said she and her husband also talk to their children about all of the fun aspects of heading back to the classroom: walking to school, ordering school supplies that will be waiting for them at their desk and getting new backpacks. 

“They know what’s expected of them. If you want to wake up earlier and have a great day at school, you have to go to bed earlier,” she said. 

Diabetes, sleep apnea, obesity and cardiovascular disease: Why not address them together?

Notes from Dr. Norman Blumenstock

Should sleep apnea be considered in the company of obesity, diabetes, and cardiovascular disease? Researcher Salim R. Surani makes the case in a recent article titled “Diabetes, sleep apnea, obesity and cardiovascular disease: Why not address them together?” recently published in the World Journal of Diabetes.

To Read This Article: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4058742/pdf/WJD-5-381.pdf

Prospective multicenter cohort study of obstructive sleep apnea (OSA) patients treated with a custom-made mandibular repositioning device (MRD)

Notes from Dr. Norman Blumenstock
This recent French study shows the benefits of oral appliance therapy.

August 22, 2014 / By Marie-Françoise Vecchierini, MD

Editor's note: Dr. Marie-Françoise Vecchierini is a recent recipient of an American Academy of Dental Sleep Medicine (AADSM) 2014 Clinical Excellence Award.
Obstructive Sleep Apnea (OSA) has numerous and significant comorbidities, so its treatment is essential. Mandibular Repositioning Devices (MRD) are recommended as primary treatment for patients with mild-to-moderate OSA. Because very few studies have specifically assessed the long-term efficacy of MRDs in OSA patients who are noncompliant with continuous positive airway pressure (CPAP), my research team conducted a study on 312 patients (71% men; 53+/-12 years old), offering MRD treatment and determining the long-term efficacy of a custom-made computer aided-design (CAD)/computer-aided manufacturing technology (CAM).
ADDITIONAL READING | 'Captain, permission to come aboard' -- getting the team on-board with OSA therapy
Study participants
The inclusion criteria were severe OSA patients with an apnea-hypopnea index (AHI) >30 or patients with a 5<AHI<30 and severe sleepiness. All patients had no dental or articular contraindications, and no previous MRD treatment. From this criteria, three subgroups were identified according to AHI value (14% of patients with 5<AHI<15, 44% with 15<AHI<30, and 42% with AHI>30).
ADDITIONAL READING | Hidden dental dangers of undiagnosed obstructive sleep apnea
Research parameters
Successful treatment was defined as a decrease of at least 50% of the AHI and complete response was achieved for an AHI<5 or <10. Mean mandibular advancement was 7 +/- 2 cm, 75% of the maximum advancement, after 2+/-1 titration visits.
Results
In the three- to six-month follow-up, AHI decreased significantly from 29+/-15 to 11+/-10, 84% of patients had a ≥ 50% reduction in AHI, and AHI<10 was achieved in 63%. Among the patients with severe OSA, 60% were effectively treated and 40% were completely cured.
Additional results of the study are as follows:

• SpO2 parameters significantly improved in each subgroup of patients
• Epworth Sleepiness Scale decreased significantly from 12+/-5 to 8+/-5
• Clinical symptoms, including loud snoring, nocturnal polyuria, and libido disorders, were all improved
• Quality of life and fatigue scores improved significantly from the baselines scores
• No significant change in sleep duration but a slight improvement in sleep latency, slow wave sleep, and REM sleep duration
• The mean use of MRDs was 6.7 hours per night and 6.6 days per week
• Side effects were reported by 21% of the patients, including gum irritation or pain (9.5%), dental or periodontal pain (8%), and temporomandibular joint pain or stiffness (7%)
• The rate of occlusion change or mobility was low (2%), and 8% of the patients stopped the treatment early as a result of side effects
• By looking for predictive factors of treatment success through univariate and multivariate regression analysis, less abdominal obesity and Class II malocclusion were found among the patients
• Significant predictive factors for complete MRD effectiveness were lower AHI or higher maximal jaw protrusion capability

Conclusion
In conclusion, an MRD offers an excellent compliance rate among patients and provides significant improvement in patients’ OSA symptoms, AHI, and quality of sleep. A custom-made MRD is an effective therapy for patients with mild to severe OSA that can be used successfully in patients who refuse or are not compliant with CPAP.


Marie-Françoise Vecchierini, MD,
is a member of the American Academy of Dental Sleep Medicine (AADSM), the American Academy of Sleep Medicine (AASM), and past president of the French Sleep Medicine and Research Society. Dr. Vecchierini also received two awards at the 2013 AADSM Annual Meeting in Minneapolis for her study on the follow-up of a large cohort of OSA patients intolerant to CPAP and treated by MRD.

In Kids, a Urine Test for Sleep Apnea May Be Viable Alternative to PSG

Notes from Dr. Norman Blumenstock
Early diagnosis of obstructive sleep apnea in children has benefits especially if can be done as simply as a urine test.

Published on August 4, 2014
A sleep apnea test being referred to as “less stressful” for children was presented at the 2014 American Association for Clinical Chemistry (AACC) Annual Meeting & Clinical Lab Expo. The meeting was held July 27 to 31 in Chicago.

Obstructive sleep apnea in children can lead to behavioral difficulties, learning disabilities, pulmonary/systemic hypertension, and decreased growth. However, the current gold standard for diagnosing sleep apnea—the overnight sleep study—is labor intensive, expensive, and limited by availability, in addition to being a potentially traumatic experience for children, says Trevor Pitcher, PhD. At the AACC annual meeting, Pitcher, a clinical chemistry fellow at the University of Louisville in Kentucky, reported the results of research showing that an immunoassay can effectively detect in urine the stress-coping peptide urocortin 3, which is significantly increased in children with sleep apnea. This urine test could serve as a psychologically easier alternative to a child spending a night in a strange bed in a sleep clinic, he says.

Sleep study shows dangers of driving drowsy

Notes from Dr. Norman Blumenstock

In a sleep deprivation study, a hand full of participants stayed up for 24 hours straight and was then monitored in a sleep study room. Dr Chris Hammond from the Ogden Clinic monitored their brain waves to show how sleep deprivation affects how people function.

http://www.good4utah.com/story/d/story/sleep-study-shows-dangers-of-driving-drowsy/20327/E9GIgqGZaU-4_GLJJUPhoA

OGDEN, UTAH (GOOD 4 UTAH) - The Utah Department of Transportation, the Utah Highway Patrol and the Department of Public Safety wants the public to know the dangers of driving drowsy. They say it's one of the top five behaviors killing people on Utah roads.

It’s all part of Utah's first Drowsy Driving Awareness week put together by the Utah Department of Transportation's Zero Fatalities program and participating agencies.

UDOT tells Good 4 Utah already this year there have been 636 drowsy driving related crashes in Utah and they hope by bringing light to drowsy driving it will prevent the problem from growing.

In a sleep deprivation study, a hand full of participants stayed up for 24 hours straight and was then monitored in a sleep study room. Dr Chris Hammond from the Ogden Clinic monitored their brain waves to show how sleep deprivation affects how people function.

“Not only does it affect attention, but it affects memory and executive function, which entails good judgment and good insight. Without those two we don't appreciate how sleepy we may be or how capable we are to safely driving on the road,” said Dr. Chris Hammond.

Right now Utah's has three deaths related to drowsy driving, but still UDOT says it's three too many and encourages drivers to avoid getting behind the wheel without enough sleep.

The Scientific 7-Minute Workout

Exercise science is a fine and intellectually fascinating thing. But sometimes you just want someone to lay out guidelines for how to put the newest fitness research into practice.

An article in the May-June issue of the American College of Sports Medicine’s Health & Fitness Journal does just that. In 12 exercises deploying only body weight, a chair and a wall, it fulfills the latest mandates for high-intensity effort, which essentially combines a long run and a visit to the weight room into about seven minutes of steady discomfort — all of it based on science.

“There’s very good evidence” that high-intensity interval training provides “many of the fitness benefits of prolonged endurance training but in much less time,” says Chris Jordan, the director of exercise physiology at the Human Performance Institute in Orlando, Fla., and co-author of the new article.

Work by scientists at McMaster University in Hamilton, Ontario, and other institutions shows, for instance, that even a few minutes of training at an intensity approaching your maximum capacity produces molecular changes within muscles comparable to those of several hours of running or bike riding.

Interval training, though, requires intervals; the extremely intense activity must be intermingled with brief periods of recovery. In the program outlined by Mr. Jordan and his colleagues, this recovery is provided in part by a 10-second rest between exercises. But even more, he says, it’s accomplished by alternating an exercise that emphasizes the large muscles in the upper body with those in the lower body. During the intermezzo, the unexercised muscles have a moment to, metaphorically, catch their breath, which makes the order of the exercises important.

The exercises should be performed in rapid succession, allowing 30 seconds for each, while, throughout, the intensity hovers at about an 8 on a discomfort scale of 1 to 10, Mr. Jordan says. Those seven minutes should be, in a word, unpleasant. The upside is, after seven minutes, you’re done.

Pledge to Stop the Snore

Notes from Dr. Norman Blumenstock
Why is it so important to stop snoring?

Published on August 14, 2014

The National Healthy Sleep Awareness Project is urging anyone with symptoms of obstructive sleep apnea to pledge to stop the snore and talk to a doctor about sleep apnea. The project is a collaboration launched by the American Academy of Sleep Medicine (AASM), Centers for Disease Control and Prevention (CDC), and the Sleep Research Society (SRS).

“Research shows that the number of sleep apnea sufferers continues to increase–the disease afflicts at least 25 million American adults, and most of them remain untreated, increasing their risk of cardiac disease, hypertension, Type 2 diabetes and obesity,” says Dr Timothy Morgenthaler, AASM president and a national spokesperson for the Healthy Sleep Project, in a release. “Fortunately, many of the damaging effects of sleep apnea can be stopped, and even reversed, through diagnosis and treatment by a board-certified sleep specialist.”

The Healthy Sleep Project provided these 5 warning signs for sleep apnea via a press release:

Snoring. Besides being a nuisance to your bed partner or roommate, loud and frequent snoring is a common symptom of sleep apnea. While not everyone who snores has this sleep illness, snoring is a warning sign that should be taken seriously.

Choking or gasping during sleep. When snoring is paired with choking, gasping or silent breathing pauses during sleep, it’s a strong indicator of sleep apnea.

Fatigue or daytime sleepiness. “Sleep apnea can leave you waking in the morning feeling tired, even after a full night’s sleep,” says Morgenthaler. “Excessive daytime sleepiness often occurs because sleep apnea causes numerous arousals throughout the night, and your body isn’t getting the quality sleep it needs.”

Obesity. An adult with a body mass index (BMI) of 30 or higher is considered to be obese, and the risk of sleep apnea increases with the amount of excess body weight.

High blood pressure. A staggering 67 million Americans have high blood pressure, which is about one in every three adults. Between 30% and 40% of adults with high blood pressure also have sleep apnea, and getting treatment for sleep apnea is a proven means of decreasing blood pressure.

“A common misconception is that sleep apnea only affects older, overweight men,” says Morgenthaler. “This widely-held assumption is wrong: anyone can have sleep apnea, regardless of gender, age, or body type–even if you’re not overweight.”

“Obstructive sleep apnea is a chronic disease that has a negative impact on the health and well-being of millions of people in the US,” says Janet B. Croft, PhD, senior chronic disease epidemiologist in CDC’s Division of Population Health. “It is important to discuss the warning signs for sleep apnea with your doctor to determine if you are at risk.”

How do I know if my partner has sleep apnea?

Notes from Dr. Norman Blumenstock
A sleep test can determine for sure if one has obstructive sleep apnea.

By Courtney Humphries   

| GLOBE STAFF   AUGUST 04, 2014

Q. How do I know if my partner has sleep apnea?

A. Sleep apnea is a common condition in which breathing pauses temporarily during sleep. As you sleep, the muscles that keep your airway open relax, which can narrow the airway. “There’s a spectrum from snoring to shallow breathing to sleep apnea,” says James Mojica, a pulmonologist and sleep specialist at Massachusetts General Hospital. When people develop apnea, Mojica says, they pause at least 10 seconds without breathing, followed by a start that wakens them and restores the muscle tone of the airway. Pauses may happen about five times per hour in mild cases, or more than 30 times per hour in severe cases.

Surprisingly, says Mojica, “even in severe cases, many times patients are completely unaware.” They only discover the problem when their partner brings it to their attention.

Not all snorers have apnea, but all people with apnea snore, says Mojica. Other signs include gasping or choking-like sounds, and irregular breathing. People with apnea may feel excessively sleepy during the day due to lost sleep, and sometimes wake up with a headache in the morning. Obesity is a risk factor for developing apnea, and drinking alcohol can worsen it. It’s more common in men, but women increasingly develop sleep apnea after menopause.

Mojica says that the only way to know for sure if you have sleep apnea is to get a sleep study. It also allows doctors to determine the severity of the problem, which guides the choice of treatment.

Are You at Risk for Heart Failure?

Notes from Dr. Norman Blumenstock
U.S. News & World Report discusses the relationship between sleep apnea and heart failure.

Sleep apnea, pauses in breathing during sleep, doesn’t just leave you tired – it can lead to heart failure if untreated, Curry says. At St. John’s Prairie Heart Institute, “even though patients say they don’t snore or have problems [where] they’re not sleeping at night, we’ll do a sleep study to confirm that,” she says. Patients found to have apnea are put on a CPAP device to make sure they get enough oxygen during sleep.

Why it’s better to protect your pump while it’s healthy.

Heart failure is most prevalent in older adults and affects nearly 5 million Americans.

Heart failure – a weakened heart muscle that can’t pump properly – is every bit as serious as it sounds. You’d expect heart disease and damaging heart attacks to put you at higher risk, and they do. High blood pressure and diabetes are also major contributors. But more surprisingly, sleep apnea has a role in heart failure risk, as do drugs such as amphetamines and cocaine. Here’s what it’s like to live with heart failure and what you can do to prevent it.

Heart Failure: Stage D

Lawrence Lamotte, 70, a Southern California retiree, has advanced heart failure. In 2006, soon after experiencing pressure in his chest “like an accordion squeezing,” he underwent triple bypass surgery, which likely saved his life. But with a heart that was no longer strong enough to sustain circulation on its own, his quality of life plummeted.

"I had special medication with an IV and a computer, and I had to carry it around with me at all times," he recalls. He felt lightheaded and dizzy and kept having falls. He was still very sick and getting progressively worse.

In a healthy heart, the right and left ventricles – the two lower chambers – work together to circulate oxygen-rich blood throughout the body. With heart failure, one or both ventricles can't do their job. It's called "congestive" heart failure as fluid builds up in the lungs, causing a frightening sense of suffocation, or leaks into other parts of the body.

[See: The Facts on Heart Disease.]

Hallmarks of Heart Failure

Rather than coming on all at once, heart failure tends to develop slowly and insidiously. Fatigue is one of the first warning signs.

A drastic change in exercise tolerance is another, says David Friedman, a cardiologist with the North Shore Long Island Jewish Health System. Patients describe "more shortness of breath with the same number of city blocks, or now they’re short of breath after walking just a half block."

Swelling, especially in the legs and feet, is a key complaint, with people sometimes putting on 2 or 3 pounds of fluid weight in a day, or 5 or more pounds in a week. "Their shoes don't fit. Their ankles are swollen," says Sharon Curry, facilitator for heart failure patient care at St. John's Hospital in Springfield, Illinois. "Sometimes they have abdominal swelling."

And then there's the pillow sign. “I ask patients, ‘How many pillows do you need to sleep on to breathe?” Friedman says. If they can’t lie down comfortably without piling on pillows, or they resort to sleeping in a reclining chair instead of bed, it could be due to fluid collecting in their lungs.

[See: U.S. News Best Heart-Healthy Diets.]

Cardiac Causes

Major heart conditions put people at higher risk for heart failure: heart attack, coronary artery disease, cardiomyopathy (heart muscle disease), cardiomegaly (enlarged heart) and inflammatory heart disease, along with heart valve abnormalities and murmurs that can worsen over the years. Some 20 to 30 percent of people with heart murmurs don’t even realize it, Friedman says.

Family history is another risk factor for heart failure, which affects nearly 5 million Americans, according to the Heart Failure Society of America. The prognosis is often grim, with the five-year survival rate after diagnosis less than 50 percent. "Heart failure is the dark side of living longer [with] heart disease," Friedman says. "Now a person's first heart attack isn't their last one."

While age in itself is not necessarily a risk factor, heart failure is more prevalent in older adults. However, people can be diagnosed in their 30s and 40s.

Sleep and Drug Connection

Sleep apnea, pauses in breathing during sleep, doesn't just leave you tired – it can lead to heart failure if untreated, Curry says. At St. John’s Prairie Heart Institute, "even though patients say they don't snore or have problems [where] ​they're not sleeping at night, we'll do a sleep study to confirm that," she says. Patients found to have apnea are put on a CPAP device to make sure they get enough oxygen during sleep.

Even among perfectly healthy people, “anyone who ingests or imbibes cardiac toxins – cocaine, methamphetamines – is at risk for heart failure," says Teresa De Marco, ​director of the Advanced Heart Failure Evaluation and Therapies Program at UCSF Medical Center. And "alcohol is a toxin to the heart."

Certain classes of cancer drugs can also contribute, she says, so oncologists evaluate a patient's heart failure risk before using those treatments.

[Read: Why a Sleep Apnea Diagnosis May Save Your Life.]

Stages of Sickness

Heart failure is classified into four stages. Patient in stage D, like Lamotte, require intensive treatments such as mechanical pumps, continuous IV infusions of cardiac drugs and eventually, heart transplant or hospice care.

Patients in stage B or stage C heart failure have structural heart disease, with or without symptoms. “Some people live long and very well with heart failure,” Curry says, “and other people’s symptoms are so severe that it greatly limits their daily lives."

During hospital readmissions, Curry says, patients often require IV and oral diuretics “to pull all the extra fluid out of their lungs and tissues. We give them medications to help their heart muscle pump and squeeze to the best of its ability. They might need blood pressure support. Some people are so critically ill they have to be admitted into the intensive care unit.”

With some conditions, De Marco says, such as inflammatory or alcohol-induced heart disease, heart function can sometimes be normalized and heart failure reversed, but it’s not usually about a cure. In systolic-type heart failure, she says, “some of the best medicines for disease progression can slow disease progression, reverse some abnormalities, can improve quality of life” and improve life expectancy and side effects.

De Marco, who is also medical director of heart transplantation at UCSF, says it’s at stage A, when patients are only at risk of developing heart failure, where health care providers "can really make a major impact" by closely following and "aggressively attacking" risk factors such as diabetes and high blood pressure.

Protect Your Pump

Anything you do that’s good for your heart will help protect you from heart failure, Curry says. And clearly, making lifestyle changes beats waiting for heart failure to change your whole life.

Because salt causes people to retain fluid, cutting dietary salt is a standard instruction for heart failure patients. In his case, Lamotte says, sodium is even more restricted: "None. Salt-free diet. It was hard in the beginning; I’m used to it now.” That doesn't only apply to people with heart failure – because of its strong link to high blood pressure, healthy adults are strongly encouraged to watch their salt intake.

Smoking is also a thing of the past for Lamotte, who hasn’t had a cigarette since 2006. “You’d be crazy to go back to smoking once they’ve got you together,” he says.

Everyone "should keep their blood pressure under control,” Curry says. “They should maintain a healthy weight. They should follow a 1,500 milligram-per-day sodium diet. They should be screened for possible sleep apnea. That's what you can do to avoid heart failure if you're a young, healthy 40-year-old."

Pump Replacement

In 2012, Lamotte underwent another surgery, this time to implant a left ventricular assist device – a mechanical heart pump. That's helped, but it means going about his day "wearing" the external controller, monitor and battery pack. His outlook remains positive and matter of fact. "I do my church duties," he says, like serving communion to the sick and shut-in. But he had to stop singing in the choir: "You've got to carry those long, long notes sometimes. But I keep cheering them on."

In his case, the LVAD is considered a temporary measure, a bridge, Lamotte says: "I'm on the list – I'm just waiting for a heart transplant."

As De Marco says, “There are an awful lot of people out there with heart failure – and once they have heart failure, they’re on a path which may not be good going forward. So it’s really important to prevent heart failure. It’s important to treat it, but let’s try to prevent it first.”

[Read: Life on an Organ Transplant Waiting List.]

Sleep Deprivation May Increase Susceptibility to False Memories

Notes from Dr. Norman Blumenstock
Researchers at the University of California and Michigan State University found that sleep deprivation may actually create false memories. Physical disorders have long been linked to poor sleep, and the study titled “Sleep Deprivation and False Memories” published in Psychological Science builds on previous work that found a poor/false memory connection to sleep.

Not getting enough sleep may increase the likelihood of forming false memories, according to research published in Psychological Science, a journal of the Association for Psychological Science.

In a study conducted by psychological scientist Steven J. Frenda of the University of California, Irvine and colleagues, sleep-deprived people who viewed photographs of a crime being committed and then read false information about the photos were more likely to report remembering the false details in the photos than were those who got a full night’s sleep.

Research has demonstrated that failing to get your full eight hours interferes with cognitive functioning, but Frenda noticed a gap in the literature when it came to sleep and memory.

“Over the years I noticed that whenever I had a bad night’s sleep, my perception and memory seemed to get fuzzy until I had a good recovery sleep,” explains Frenda. “I was surprised to find that there were so few empirical studies connecting sleep deprivation with memory distortion in an eyewitness context. The studies that do exist look mostly at sleep deprived people’s ability to accurately remember lists of words—not real people, places and events.”

A preliminary study conducted by Frenda and colleagues suggested that getting 5 hours of sleep or less was associated with the formation of false memories. The researchers then designed an experiment to investigate whether pulling an all-nighter would increase the likelihood of forming false memories.

Upon arriving to the lab in the late evening, the 104 college-age participants were assigned to one of four groups. Two groups were presented with a series of photos depicting a crime being committed as soon as they arrived to the lab — one group was then allowed to go to sleep, while the other group had to stay awake all night in the lab. The remaining two groups did things in the reverse order — they either slept or stayed awake all night and then viewed the crime photos in the morning.

In the second part of the experiment, the participants read narratives containing statements that contradicted what the photographs actually showed.  For instance, a text description might say that the thief put a stolen wallet in his pants pocket, whereas the photo shows him putting it in his jacket.

The researchers found that only those students who had been sleep deprived for all parts of the experiment — that is, they viewed the photos, read the narratives, and took the memory test after having stayed up all night — were more likely to report the false details from the text narrative as having been  present in the crime photos.

The students who viewed the photos before staying up all night, however, were no more susceptible to false memories than the students who’d been allowed to sleep.

The researchers believe these findings have important legal applications:

“Recent studies are suggesting that people are getting fewer hours of sleep on average, and chronic sleep deprivation is on the rise,” says Frenda. “Our findings have implications for the reliability of eyewitnesses who may have experienced long periods of restricted or deprived sleep.”

Frenda concludes that more research is necessary before scientists can provide law enforcement with evidence-based guidelines on how to best ensure that eyewitnesses’ memories are accurate:

“We are running new experiments now, in order to better understand the influence of sleep deprivation on processes related to false memory.”

In addition to Frenda, co-authors on the study include Lawrence Patihis and Elizabeth Loftus of the University of California, Irvine, and Holly Lewis and Kimberly Fenn of Michigan State University.

Types of sleep apnea

Notes from Dr. Norman Blumenstock

There are three types  of sleep apnea. 

There are three main types of sleep apnea: 

• Obstructive sleep apnea (OSA)
• Central sleep apnea (CSA)
• Mixed sleep apnea

• Obstructive sleep apnea (OSA)

  Obstructive sleep apnea is the most common type of sleep apnea, making up 84% of sleep apnea diagnoses.¹

  

  In most cases of obstructive sleep apnea, air stops flowing to the lungs because of a blockage (or obstruction) in the upper airway—that is, in the nose or throat.

  The upper airway could become blocked due to:

  • the muscles relaxing too much during sleep, which blocks sufficient air from getting through*
  • the weight of your neck narrowing the airway
  • inflamed tonsils, or other temporary reasons
  • structural reasons, like the shape of the nose, neck or jaw

  * This narrow airway causes a vibration in your throat, which creates the sound of snoring.

  Central sleep apnea (CSA)

  Central sleep apnea (CSA) is the least prevalent type of sleep apnea,¹ and can be caused by heart failure, or a disease or injury involving the brain, such as:

  • stroke
  • brain tumor
  • viral brain infection
  • chronic respiratory disease

  In some cases, the airway is actually open but air stops flowing to the lungs because no effort is made to breathe. This is basically because the communication between the brain and the body has been lost, so the automatic action of breathing stops.

  Those with CSA don’t often snore, so the condition sometimes goes unnoticed.

  Mixed sleep apnea

  This is a mixture of both obstructive sleep apnea OSA (where there is a blockage or obstruction in the upper airway) and CSA (where no effort is made to breathe), and is the least common type of sleep apnea. Your doctor can help you understand more about this if you need to.

  If you have any concerns that you may have any type of sleep apnea, please consult your doctor.

Dr. Norman Blumenstock talks at Sleep Conference

Notes from Dr. Norman Blumenstock

I will be giving two Dental Sleep Medicine talks at Sleep Conference tomorrow which will be held at Monmouth University's MAC Center (gymnasium) in West Long branch, NJ.

How a Lack of Sleep Can Hurt Your Finances

Notes from Dr. Norman Blumenstock

“The fact is that man-made disasters ranging from the explosion of the Space Shuttle Challenger to the spilling of Exxon Valdez, and the chemical disaster in Bhopal, India, all have sleepiness as a primary contributing factor,” Wickwire says.

Proud that you’re awake at all hours and still functioning normally? It may be costing you.

The arguments for a good night’s sleep are well-documented, with studies showing that people who get more sleep get fewer colds, tend to maintain a healthier weight and have a smaller chance of coming down with heart disease and diabetes.

But if you’re uninterested in the health benefits of sleep, you may want to consider what your sketchy sleep patterns are doing to your wallet.

You’re probably sleepwalking through your sleep problem.There are many reasons we don’t get enough sleep. Some people are workaholics or night owls. Others are kept up by chronic stress or insomnia, and still others have a disorder like sleep apnea. According to the National Sleep Foundation, more than 18 million Americans have sleep apnea, a condition that causes troubled breathing during sleep, and 75 percent of people with sleep apnea don’t know they have it.

Related: How Financial Stress Dramatically Lowers Your IQ

What’s unsettling is that the average person may not realize they’re sleep deprived due to the way the body works. ”We habituate to adenosine, a brain chemical that induces sleep. So even though judgment and performance are impaired, we think we’re performing just fine. The reality is, they are depriving their brains of a nutrient just as vital as food or water,” says Emerson Wickwire, sleep medicine program director at Howard County Center for Lung and Sleep Medicine in Columbia, Maryland. He also teaches non-drug treatment approaches to sleep disorders at The Johns Hopkins University School of Medicine and Walter Reed National Military Medical Center.

Wickwire continues: “The effects of sleep loss on cognitive processing, concentration and memory are striking and acute. Processing speed deteriorates dramatically with shortened sleep duration, and you can’t simply ‘catch up’ on the weekends.”

If you aren’t sleeping, you’re putting your career at risk.Nitun Verma, medical director for the Washington Township Center for Sleep Disorders in Fremont, California, sees this a lot. He works with many professionals in Silicon Valley and says there are two typical groups of patients who tend to come into his office.

"The first group is the professional at a larger, more established company, usually in their 40s to 50s," Verma says, adding that these people often feel sleepy at work, which worsens as the afternoon progresses. "They have a fear that some younger, more energetic person is going to take their job or their promotion."

People in their 20s and 30s suffer from sleepless nights, too, Verma says. They have a more active social and professional night life, advancing their lives and careers, and often only sleep four to five hours a night, he says.

"Adrenaline is carrying them during exciting times, but the sleepiness finds them during brainstorming and creative times," Verma says.

Of course, it’s easy to dismiss the problems. Occasionally falling asleep during a meeting, aside from the embarrassment, may not be so bad. But do it enough, and it can destroy your career.