Sleeping nightmare: How snoring meant my child was naughty and only surgery could help

Notes from Dr. Norman Blumenstock

My advice to parents is if you have a child who snores and whose behaviour is out-of-control, have a sleep test.

Katrina Creer with her son Mitchel, 4, battled sleep aponea for years.

WE used to think it was a blessing our youngest child was a terrible snorer. Exhausted after a morning of meltdowns it was never a problem putting him down for his nap. And his snoring was so loud I didn’t even have to walk down the corridor to check on him.

But when he was awake, things were different. While most two-year-olds have tantrums our toddler’s were in the extreme. While other children amused themselves at the local playgroup, my son was trying to escape out the door.

SIGNS OF SLEEP APONEA

• Snoring in children with sleep aponea normally starts around two years

• It can also occur in seven to nine year olds, usually as a result of allergy or obesity

• Children tend to sleep with their neck and head stretched back

• They are fussy eaters preferring soft foods like cheese and yoghurts over hard to swallow foods

• They are often restless and sweaty sleepers

• They can be cranky during the start and end of the day, but will often appear hyperactive

• Take a video of your child sleeping and see your GP

• Other signs are blocked nose, dry lips and dark rings around eyes. They can also have a cross bite

Whenever possible, I needed someone to help me put him in his car seat as he would lie down on the floor kicking and waving his arms. This went on for two years.

Not surprisingly, there were very few offers to babysit. Friends and family didn’t always see the same loving and cuddly little boy we knew, which always reassured us there was probably nothing seriously wrong.

But by his third birthday, Mitchell barely slept through the night and his behaviour was wearing thin. Dinnertime was a struggle but by chance, one day I noticed a huge set of tonsils.

I sounded desperate but luckily our GP agreed and sent us to an Ear, Nose and Throat specialist.

While we had sought medical help before for his behaviour, we were told he would most likely outgrow it. In our sleep-deprived fog, we don’t remember anyone asking us “does your son snore?”

The specialist immediately suspected sleep aponea.

The condition causes a loss of airflow during rest often due to enlarged tonsils or adenoids.

It can also make young children naughty, despite being very tired they appear hyped-up. According to doctors, it mimics the symptoms ADHD.

The only way to make a definite diagnosis was a sleep study. The cost was covered by our private health insurance. Mitchell was wired up and eventually dosed off during our overnight stay in hospital.

Katrina Creer with her son Mitchel, 4, now enjoy a more soothing night’s sleep.

As I lay in the same room, I could hear him noisily sucking in the air. Occasionally it would go quiet and then restart. He never fully woke and if we were at home, we would have thought it was a good night.

The test showed Mitchell had a moderate sleep aponea waking on average 26 times every hour with his oxygen levels dipping to 80 per cent. It is likely he had never been in a deep enough sleep to ever dream.

I felt relief when told the results. Over the years I’d been given plenty of parenting advice, but deep down I always felt like he just couldn’t help it.

Three months after surgery and a much calmer little boy had emerged. And now, almost a year after surgery, he has become an absolute joy.

My advice to parents is if you have a child who snores and whose behaviour is out-of-control, have their sleep checked.

For further information contact the Woolcock Institute on (02) 9114 0000 or www. woolcock.org.au

Bronx Train Tragedy Continues to Resonate

Tragedy often sparks change, and last year’s Bronx train derailment may ultimately lead to more and better sleep disorder screening for New York transit employees. In addition, new procedures will make it harder for sleep deprived employees to allow trains to get back into service.

According to Gannett’s news, Metro-North in the Bronx plans to ask the Metropolitan Transportation Authority in December to approve hiring a company to provide sleep apnea screening in a pilot program. The train conductor presiding over last year’s derailment (which killed four and injured dozens) had “severe sleep apnea.”

Ken Valenti writes that the Federal Railroad Administration is writing rules to address sleep disorders and reduce fatigue in train engineers and other employees. “Our goal is to reduce the likelihood of accidents, injuries, and fatalities caused by fatigue,” FRA spokesman Michael England said in an email. He did not know when the rules would be completed or implemented.

Among the additional proposed changes was a system to protect workers put in place after track foreman Robert Luden was killed by a train on a track that had been taken out of service. The new system reportedly blocks a rail traffic controller from allowing trains back on an out-of-service track without entering a computer code given only to a supervisor at the work site.

Source: Gannett Company Inc

Sleep Duration Affects Risk for Ulcerative Colitis

Notes from Dr. Norman Blumenstock

Another important reason to get the right amount of quantity and quality of sleep

Published on October 22, 2014

If you are not getting the recommended 7 to 8 hours of sleep each night, you may be at increased risk of developing ulcerative colitis. This is according to a new study1 in Clinical Gastroenterology and Hepatology, the official clinical practice journal of the American Gastroenterological Association.

“Both short and long durations of sleep have important health implications and are associated with increased overall mortality, cardiovascular disease and cancer,” says lead study author Ashwin N. Ananthakrishnan, MD, MPH, Massachusetts General Hospital, in a release. “Our findings indicate that ulcerative colitis may potentially be added to this list. We found that less than 6 hours of sleep per day and more than 9 hours of sleep per day are each associated with an increased risk of ulcerative colitis.”

Researchers conducted a prospective study of women who were enrolled in the Nurses’ Health Study (NHS) I since 1976 and NHS II since 1989 and followed through detailed biennial questionnaires with greater than 90%  follow-up. The large size of the cohorts, prospective design, and prolonged duration of follow-up provide a unique opportunity to examine the association between sleep duration and incident disease with sufficient power to adjust for potential confounders.

The results demonstrated that there is a “U-shaped” relationship between sleep duration and risk of ulcerative colitis, with both short and long duration of sleep being associated with an increased risk of disease. These observed associations were independent of other known environmental risk factors.

In a previous study, 2 also published in Clinical Gastroenterology and Hepatology last year, Ananthakrishnan and colleagues had reported that poor sleep quality, even while in remission, resulted in a twofold increase in risk of Crohn’s disease flares at 6 months. “All these data together support a growing recognition of the impact of sleep disruption on the immune system, and the need for providers to frequently inquire about sleep duration and quality as an important parameter of health in patients with inflammatory bowel diseases,” Ananthakrishnan says.

The authors acknowledge several study limitations. First, the study population consisted predominantly of white female nurses and is thus not representative of the gender and ethnic distribution in the general population. Sleep duration was also self-reported. However, the size of the study and quality of data substantiate these findings.

Future studies are warranted to better understand mechanisms by which sleep may influence intestinal inflammation.

REFERENCES

1 Ananthakrishnan AN. Sleep duration affects risk for ulcerative colitis: a prospective cohort study. Clinical Gastroenterology and Hepatology. 2014:12(11):1879-1886.

2 Ananthakrishnan AN. Sleep disturbance and risk of active disease in patients with Crohn’s disease and ulcerative colitis. Clinical Gastroenterology and Hepatology. 2013:11(8):965-971.

NTSB: Engineer’s Sleepiness Caused Deadly Bronx Metro-North Train Derailment

October 28, 2014 5:35 PM

NEW YORK (CBSNewYork/AP) — Another stinging report was issued on the Metro-North Railroad Tuesday, concluding this time that a sleep-deprived engineer nodded off at the controls of a Metro-North train just before taking a 30 mph curve at 82 mph, causing a derailment that killed four people and injured more than 70 in the Bronx.

As CBS 2’s Don Champion reported, the National Transportation Safety Board report also announced the findings into the investigation of four other Metro-North accidents that occurred in New York and Connecticut in 2013 and 2014, and concluded that the railroad blew off safety concerns as a matter of habit.

EXTRA: Click Here For The Full NTSB Report

U.S. Sens. Charles Schumer (D-N.Y.) and Richard Blumenthal (D-Conn.) were furious about the findings.

“The MTA has blood on its hands,” Blumenthal said.

“The NTSB report represents a horror-house of negligence resulting in injury, mayhem and death,” added Schumer.

And as if the reaction from lawmakers did not sting enough, the findings alone by the NTSB also paint a nasty picture of the culture inside that nation’s second largest commuter rail line.

“Two accidents on one railroad in a short period of time may be a coincidence,” Hart said. “Five accidents in one railroad in less than a year begged the question — how important was safety at Metro-North?”

The NTSB concluded that safety was not important at the Metro-North. In fact, the report found the railroad often failed to keep up with regular track maintenance — opting to put it off.

The lack of detailed, visual track inspections were pinpointed in two of the accidents investigated.

“Maintenance and other ongoing efforts to address known safety issues should not have to wait for accidents in order to be implemented, but instead should be preventive measures and be completed before an accident occurs,” said Acting NTSB Chairman Christopher Hart.

The NTSB also found that the railroad was seven years’ behind schedule in replacing some track parts.

And as for the Bronx derailment near the Spuyten Duyvil station on the Hudson Line, the NTSB said engineer William Rockefeller’s sleepiness was due to a combination of an undiagnosed disorder — sleep apnea — and a drastic shift in his work schedule, the NTSB said in the report.

“We determined that the cause of this tragic accident was the engineer’s non-compliance with the 30 mph speed restriction because he had fallen asleep due to undiagnosed, severe obstructive sleep apnea,” Hart said.

The agency said the railroad lacked a policy to screen engineers for sleep disorders, which also contributed to the Dec. 1, 2013 crash. It also said a system that would have automatically applied the brakes would have prevented the crash.The NTSB also took issue with the lack of a federal rule requiring railroads screen engineers for sleep disorders. Metro-North plans to start screening in December.

For its part, in the past year, Metro-North said it has already invested millions of dollars into new safety programs and infrastructure.

“This would be almost a comedy of errors if it weren’t so tragic,” Schumer said. “It’s clear these mistakes were avoidable.”

The NTSB had reported Rockefeller’s sleep apnea in April, saying tests revealed it interrupted his sleep dozens of times each night.

Investigators said Rockefeller told them he had felt strangely “dazed” right before the crash. But until Tuesday it had refrained from declaring his sleepiness as the cause of the crash.

It said that less than two weeks before the crash, Rockefeller had switched from a work day that began in late afternoon to one that began early in the morning. The board said that probably compounded his sleep problem.

It also noted that the technology known as positive train control was not in use at the time of the crash. Positive train control can automatically bring a train to a stop if it’s exceeding a speed limit. Metro-North has said it is working to install the technology.

On the other accidents, the NTSB found:

- A May 17, 2013, derailment and collision in Bridgeport, Connecticut was caused by broken joint bars, which are used to join rails of different sizes. At least 65 people were injured. The board said Metro-North had deferred scheduled track maintenance and lacked “a comprehensive track maintenance program.”

- A track foreman who was fatally struck by a train in West Haven, Connecticut on May 28, 2013 was probably due to a mistake by a student rail traffic controller. The controller misunderstood some instructions and canceled the signals protecting the section of track the man was on, the NTSB said.

- In a similar accident in Manhattan on March 10, 2014, a Metro-North worker was killed by a train while trying to re-energize tracks that had been out of service for maintenance. The NTSB blamed the accident of briefings that poorly communicated which part of the track would be safe.

- The derailment of a freight train on Metro-North tracks in the Bronx on July 18, 2013, which caused no injuries, was caused by deteriorated concrete ties and other problems compounded by deferred maintenance, the NTSB said.

“Seeing this pattern of safety issues in a single railroad is troubling,” Hart said. “The NTSB has made numerous recommendations to the railroad and the regulator that could have prevented or mitigated these accidents. But recommendations can only make a difference if the recipients of our recommendations act on them.”

On Tuesday, the railroad’s newly-hired president admitted Metro-North lost focus by putting on-time performance above everything else.

“It’s been a continuous process to get this railroad back up where it belongs and keep the safety on it,” said Metro-North President Joe Giulietti.

Giulietti said the report will be taken very seriously.

“We truly take to heart all the issues that have been stated,”Giulietti said. As an example, he said the railroad already has begun a test project on engineer sleep apnea that will be expanded.

In March, the Federal Railroad Administration issued a stinging report on Metro-North, saying the railroad let safety concerns slip while pushing to keep trains on time. Railroad executives pledged to make safety their top priority.

Since the incidents, the MTA has also hired David Mayer as the chief safety officer. His job is to work with Metro-North to keep a close eye on equipment and crews and make sure these crashes don’t keep happening.

The NTSB said it will also issue safety recommendations designed to “improve railroad safety on Metro-North and other railroads.”

Riders welcome changes.

“You have to have faith that the system work and that they’re going to fix those things,” said rider Gerald Watford.

The NTSB in the report also put blame in its report on the Federal Railroad Administration, for essentially failing to regulate Metro-North.

Snoring, heart disease and sudden death

Notes from Dr. Norman Blumenstock

Despite CPAP good efficacy, it fails approximately 50% of the time due to lack of compliance.

Philippine Daily Inquirer 4:08 AM | Saturday, October 25th, 2014

So now we know better. Snoring, as a symptom of obstructive sleep apnea (OSA), is definitely not a benign disorder which carries no serious implications. It is linked with the development of difficult-to-treat high blood pressure, heart enlargement, heart failure, diabetes, accidents due to daytime sleepiness, memory lapses, irregular heartbeat and even sudden cardiac death (SCD).

Mayo Clinic researchers in the United States studied the sleep characteristics of close to 11,000 adults in an overnight sleep laboratory, and found that OSA can cause low nighttime oxygen saturation in the blood, and this may be a triggering risk factor for SCD, due to a fatal irregularity of the heart beat called ventricular fibrillation.

Some of these unfortunate patients may die suddenly in their sleep. Many cases of what we attribute to bangungot may actually be related to OSA.

In the Mayo Clinic study, OSA was one of two  factors that contributed to the highest risk of SCD. OSA has been implicated in SCD, and the study is the first large study to rigorously test the hypothesis and offer some hard evidence to support it.

Frequently overlooked

Physicians should always watch out for OSA in their heart patients and treat it promptly when present. This is a frequently overlooked problem in clinical practice.

Various treatment options are used in patients with OSA. Lifestyle measures like weight reduction in overweight individuals,  and avoiding alcohol and smoking can help and might be sufficient to treat mild cases of OSA. Medications that relax the central nervous system like sedatives and muscle relaxants should also be avoided.

A change in sleeping position can also do the trick. Many people may snore less when sleeping at a 30-degree elevation or higher of the upper body, as if sleeping on a recliner. This prevents the collapse of the airway, in the usual supine sleeping position. Sleeping on one’s side instead of sleeping on the back may also help.

For moderate to severe cases of OSA, a CPAP (continuous positive airway pressure) device can be a life-changer. An OSA patient puts on a well-fitted nasal or facial mask which is connected to the CPAP device and this helps keep the airway open when asleep.

The CPAP device is the most commonly used device for OSA, but other, newer modalities may also be used. These include the VPAP (variable positive airway pressure), also known as bilevel or BiPAP device. It monitors the patient’s breathing, and provides two different pressures, a higher one during inhalation and a lower pressure during exhalation. The VPAP or BiPAP is more expensive, and is sometimes used in patients who have other coexisting respiratory problems.

One can also read about appliances, splints or mouth guards that are being advertised in the Internet and in various health publications. All of them are designed to hold the lower jaw slightly down and forward relative to the natural, relaxed position. This position holds the tongue farther away from the back of the airway, and may be enough to help relieve apnea and improve one’s breathing during sleep. However, none of them has been shown to be more effective than the CPAP or BiPAP devices.

Premarket approval
A few months back, the United States Food and Drug Administration granted premarket approval for an upper airway stimulation system that senses respiration, and delivers mild electrical stimulation to the hypoglossal nerve in order to increase muscle tone at the back of the tongue so it will not collapse and obstruct the airway. It is powered by an implantable pulse generator, similar to a heart pacemaker device implanted in patients with heart blocks and very slow heart rates. Although the device is promising and has been shown to be effective, I think it’s a lot simpler, more convenient and economical to just use a CPAP device.

In more severe cases wherein an anatomical problem in the airway is identified, surgery may be considered to modify airway anatomy. This is still controversial and should only be considered as a final resort.

Other surgical procedures to relieve airway obstruction like straightening of the nasal septum, tonsillectomy and/or adenoidectomy, removal or reduction of parts of the soft palate, and tracheostomy (incising a hole in the anterior part of the neck to the windpipe)  may have to be done in more extreme cases.

Obstructive sleep apnea is more common than previously thought. It can become serious if undetected and untreated. It can be a stealthy killer; it comes figuratively and literally like a thief in the night. Make sure you’re not one of its victims.

Sleep Apnea Increases Risk of Atrial Fibrillation After Bypass Surgery

MedicalResearch.com Interview with:
Adrian Baranchuk MD FACC FRCPC
Associate Professor of Medicine
Director, EP Training Program Queen’s University
Kingston, Ontario, Canada



Medical Research: What are the main findings of the study?

Dr. Baranchuk: In this study, we investigated whether obstructive sleep apnea increases the risk of atrial fibrillation after coronary artery bypass surgery. We found the risk to increase by approximately two-fold for patients with obstructive sleep apnea, suggesting that this disease is a strong predictor of atrial fibrillation after coronary artery bypass surgery.

We also found that the risk increases in patients with more severe obstructive sleep apnea.

This is an important association to explore since atrial fibrillation after coronary artery bypass surgery increases patient mortality, the risk of stroke, hospital stay, healthcare costs, and has substantial burden on patients and their families. It is also a common complication of the surgery, occurring in up to half of the patients. Knowing which factors increase its risk gives us a better understanding of how to manage it and mitigate its negative consequences.

Medical Research: What was most surprising about the results?

Dr. Baranchuk: Factors like age, obesity, and many others can influence the risk of atrial fibrillation after coronary artery bypass surgery. Some studies we investigated in our systematic review controlled for these factors, and obstructive sleep apnea became a stronger risk factor when these study results were pooled.

This suggests that obstructive sleep apnea independently predicts which patients are more likely to have atrial fibrillation after coronary artery bypass surgery.

Medical Research: What should clinicians and patients take away from your report?

Dr. Baranchuk: Healthcare specialists of multiple disciplines, including cardiologists, anesthesiologists, and cardiac surgeons should equip themselves with the necessary knowledge and tools to both recognize and optimally manage obstructive sleep apnea. This can include screening patients for obstructive sleep apnea using questionnaires, as well as following up to date guidelines and using the best available evidence to manage it.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Baranchuk: We were not able to identify any studies that investigated the effectiveness of obstructive sleep apnea management strategies on reducing the risk and negative consequences of atrial fibrillation following coronary artery bypass surgery. This is an appealing research topic to explore, since it can inform whether managing obstructive sleep apnea, such as using continuous positive airway pressure, has a positive impact for outcomes in this patient population.

Citation:

Obstructive Sleep Apnea as a Predictor of Post Coronary Artery Bypass Graft Atrial Fibrillation: A Systematic Review and Meta-analysis
Qaddoura, Amro et al.

Canadian Journal of Cardiology

Received: September 23, 2014; Received in revised form: October 10, 2014; Accepted: October 13, 2014; Published Online: October 14, 2014

DOI: http://dx.doi.org/10.1016/j.cjca.2014.10.014

Your Brain May Get Smaller if You Don't Sleep Enough

Notes from Dr. Norman Blumenstock

EmpowerHER reports that a portion of the brain may shrink when individuals do not get an adequate amount of sleep.

The cerebral cortex is the site of complex functions of the brain, and controls how we think and interact with the world. According to the study, lack of sleep may shrink part of the frontal cortex, which deals with problem-solving, self-control, planning and logic. Lack of sleep also accelerates the rate of brain loss in regions that process sound, language and spatial orientation.

Monkey Business Images/PhotoSpin

Getting a good night’s sleep has all sorts of health benefits, while a bad night’s sleep can lead to health issues, from aging skin to weight gain. But these effects seem less drastic in light of a study published last month in the journal Neurology. It showed that poor quality sleep is actually linked with wasting away of the brain, especially in those over 60 years old.

Researchers from University of Oxford and University of Oslo sampled 147 adults. The subjects ranged from 20-84 years old and encompassed a variety of physical activity levels, body mass index (BMI) and blood pressure levels.

Each subject completed a questionnaire that measured sleep quality. The questionnaire assessed three main things: sleep latency (how long it takes to fall asleep), sleep duration (how many hours of sleep per night) and sleep efficiency (the percentage of time spent actually sleeping).

Two MRI scans were done for each subject, an average of 3.5 years apart, to see how different sleep habits affected the brain. After comparing brain volumes from the two scans, the researchers found that physical activity, BMI and blood pressure were not related to brain volume.

However, poor sleep quality was related to reduced brain volume, specifically in the cerebral cortex.

The cerebral cortex is the site of complex functions of the brain, and controls how we think and interact with the world. According to the study, lack of sleep may shrink part of the frontal cortex, which deals with problem-solving, self-control, planning and logic. Lack of sleep also accelerates the rate of brain loss in regions that process sound, language and spatial orientation.

The correlation between lack of sleep and reduced brain size was strongest for subjects over 60 years old, a period in life that is often characterized by poorer sleep. Generally, people older than 60 sleep less, take longer to fall asleep and wake up more often in the middle of the night, according to a New York Times article.

The researchers of the Neurology study emphasized that they didn’t know for sure whether poor sleep causes brain shrinkage or whether it's the other way around. Perhaps brains naturally decay somewhat as we age, which leads to worse quality of sleep, the study said.

Other people have suggested that poorer quality of sleep in older people doesn’t come from their age, but rather their illnesses or medications. “The more disorders older adults have, the worse they sleep,” Sonia Ancoli-Israel, a sleep researcher at the University of California, San Diego, told New York Times.

It turns out that sleeping well is just as important for the over-60 crowd as for 20 year olds, although what defines sleeping well could be different for the two age groups.

Regardless, there seems to be a consensus that getting a good night’s sleep is important, no matter the age. And for those over 60 years old, good sleep may be essential to slowing down brain loss.

Sources:

The Elderly Always Sleep Worse, and Other Myths of Aging. New York Times.com. Retrieved October 5, 2014.
http://www.nytimes.com/2007/10/23/health/23age.html?_r=0

Human Brain: Facts, Anatomy & Mapping Project. LiveScience.com. Retrieved October 5, 2014.
http://www.livescience.com/29365-human-brain.html

Lack of sleep may shrink your brain. CNN.com. Retrieved October 3, 2014.
http://www.cnn.com/2014/09/04/health/no-sleep-brain-size/index.html?hpt=...

Poor sleep quality is associated with increased cortical atrophy in community-dwelling adults. Neurology. Retrieved September 28, 2014.
http://www.neurology.org/content/early/2014/09/03/WNL.0000000000000774

Reviewed October 8, 2014
by Michele Blacksberg RN

The Worst Sleep Disorder of Them All

Notes from Dr. Norman Blumenstock

Stanford Doctor Names The #1 Worst Sleep Disorder

Posted: 05/02/2014 5:14 pm EDT Updated: 07/02/2014 5:59 am EDT

As a kid I used to love watching the G.I. Joe cartoon series, and still can remember one of their catchphrases: "Knowing is half the battle!" Now, over 25 years later, it occurs to me that this quote is relevant to the field of sleep as well.

Researchers estimate that more than 80 percent of people with clinical sleep issues remain undiagnosed, and so it seems that awareness around sleep disorders could use a little boost. With that intention, let's see if we can shed some light on a few things.

Dr. William Dement is known as the father of sleep medicine, and for good reason. He started the world's first sleep clinic at Stanford University in 1970, has worked tirelessly to promote sleep health, and was among the first to draw attention to the fact that sleep is as important, if not more so, than diet and exercise when it comes to well-being. He helped discover REM sleep, defined the stages of sleep, and created the index that sleep doctors use to this day to determine the severity of sleep apnea. But perhaps his most eye-opening contribution to the advancement of sleep health is identifying the granddaddy of all sleep disorders.

Ignorance.

"Ignorance is the worst sleep disorder of them all," writes Dr. Dement in his book The Promise of Sleep. What he means is that if people are unaware of the existence of sleep disorders, it is unlikely that they will seek or receive the help they need to improve their sleep. Part of the problem is that doctors do not receive much training on sleep in medical school. In fact, based on the most recent data available, doctors receive less than 3 hours of formal education on sleep during their 4 years of medical school. Three hours. Unsurprisingly, therefore, they tend not to address the sleep of their patients in their practices - has your doctor asked about your sleep in any detail? If you ask your friends the same question, I'm willing to bet that most of them would say "no."

Which brings us back to G.I. Joe. Knowing, or awareness, is half the battle - and we as patients can take some responsibility for ourselves by knowing the basics. In that spirit, here are some things to consider:

1. Approximately 70 million Americans have a sleep disorder.
2. There are over 80 recognized sleep disorders. Apnea, insomnia, and restless legs syndrome are some of the common ones, but there are many others that can interfere with sleep quality.
3. Well over 50 percent of Type II diabetes patients have a sleep disorder, which may in turn worsen the diabetes.
4. Sleep disruption may increase the growth of cancer cells.
5. Fitness trackers, while great for raising awareness, may provide a false sense of security for those with sleep disorders as they are not built to provide diagnoses.
6. Sleep duration is important, but sleep quality is just as important. What if you get eight hours, but are snoring like a chainsaw, or tossing and turning all night?
7. Sleep problems impact workplace productivity and safety.
8. Sleep is directly related to most of your body's major systems, including the immune, metabolic, and endocrine systems.
9. Most sleep disorders are treatable.

Here's the point. Sleep "hacks," tips and tricks are all well and good. But if you are one of the 70 million Americans (or hundreds of millions of people globally) that has an actual, medically-recognizable sleep disorder, then you're probably going to want to address that with a sleep-savvy physician if you truly want to optimize your sleep.

And congratulations, by the way. Now that you've read this article, the worst sleep disorder of them all is hopefully not an issue for you!

Undiagnosed Sleep Apnea among women on rise: Study

Yahoo!7 Pty Ltd October 21, 2014, 7:38 pm

Sleep Apnea is now being detected in nearly as many Australian women as men. Emily Angwin reports.

https://au.news.yahoo.com/video/watch/25314697/undiagnosed-sleep-apnea-among-women-on-rise-study/

Snoring likely to be in your genes

Notes from Dr. Norman Blumenstock

Children whose parents suffer from obstructive sleep apnea have a much higher chance of having the condition, reports The New Zealand Herald.

There’s bad news for the children whose parents keep them awake at night snoring – they are more likely to follow in their parents’ footsteps and be noisy sleepers too.

5:00 AM Thursday Oct 9, 2014

Study shows 5 to 10 per cent of adults have severe sleep apnoea and the majority of them are overweight.

Children whose parents suffer from obstructive sleep apnoea - of which snoring is a major symptom - have a much higher chance of having the condition. Photo / Thinkstock

There's bad news for the children whose parents keep them awake at night snoring - they are more likely to follow in their parents' footsteps and be noisy sleepers too.

Children whose parents suffer from obstructive sleep apnoea - of which snoring is a major symptom - have a much higher chance of having the condition than children whose parents do not, according to new research from Otago University which has found a genetic link.

Obstructive sleep apnoea is a sleep breathing disorder that occurs when the muscles in the back of the throat close off the airway during sleep.

But as well as keeping the family awake all night, sleep apnoea can affect a child's learning at school by hindering their ability to retain information, making them more sleepy during the day and more prone to developing cardiovascular issues such as hypertension later in life.

Otago University in Wellington senior lecturer and co-researcher of the study Dr Angela Campbell said the consequences could be serious, so it was important problems were picked up early.

The study involved asking 25 children whose parents had obstructive sleep apnoea (OSA) and 25 whose parents were low risk questions about symptoms related to snoring and sleep apnoea. It found a significantly larger number of the children whose parents had sleep apnoea appeared to exhibit the related symptoms such as snoring, restlessness at night, breathing through the mouth, sweating in the night and hyperactivity during the day.

The children whose parents had sleep apnoea were more likely to snore loudly and to have crowded or small airways.

Factors that contributed to sleep apnoea included facial structure, which could be genetic, and being overweight.

Dr Michael Hlavac, NZ Branch Committee chairman of the Australasian Sleep Association and director of the sleep unit at Christchurch Hospital, said about 20 per cent of adults had sleep apnoea. It was twice as common in men. Between 5 and 10 per cent of adults had severe sleep apnoea. Most were overweight.

NZ Respiratory and Sleep Institute clinical director Dr Andrew Veale said it was not surprising there was a link between parents who had sleep apnoea and their children because certain bone structures and tongue sizes made it more likely. He said it was effectively treated in children by removing their tonsils.

 Mask solves sleeping problem

After years of sleeping badly, Jill Hammonds, 61, was diagnosed with sleep apnoea about 10 years ago.

The Paraparaumu  woman said she initially became aware of the problem because she was constantly overtired.

Once diagnosed, she was given a mask connected to a machine that helped her airways remain open while she slept.

Though it took her a while to get used to wearing the mask, she has had no health problem related to the condition since.

"It took me a long time to get to the stage where my sleep was better," she said, but now she was not overtired at all.

Ms Hammonds said it was important that people with the condition got support to deal with it, which was why she was part of the Sleep Apnea Association of New Zealand, which held support group meetings around the country.

Ms Hammonds said she had two grown sons and four grandkids, but luckily none of them suffered from the condition. She hoped more research would be done.

- Susan Strongman

5 ways to sleep better

1 Have a regular sleep pattern
2 Spend the right amount of time in bed
3 Bed is for sleeping, not entertainment
4 Wind down and relax before going to bed
5 Have a comfy bedroom.

Why It's Harder To Sleep As We Get Older

• ERIN BRODWIN
 / OCT. 7, 2014, 2:33 PM

She makes it look so easy.

Sleeping helps us process memories, learn new skills, and stabilize our mood. Yet as we get older, a good night's sleep becomes a rare commodity. 

Scientists have struggled for years to find out what makes sleep more elusive as we age. As it turns out, there are a number of factors that change how — and when — we sleep, from shifts in brain activity to a loss of special brain cells that tell us when it's time to rest. And not getting enough shuteye, no matter our age, can have dangerous repercussions.

Here's what happens to our bedtimes as we age.

Goodbye, Deep Sleep

As we get older, we tend to get slightly less sleep, and the quality of that sleep is poorer, with more awakenings throughout the night. Our brains also spend fewer hours in deep sleep mode, that precious time when the frantic chaos of brain activity grinds to a slow burn. During deep sleep, or slow wave sleep, our brain waves stretch out and get less frenetic.

A typical 25-year-old plunges half a dozen times into several hours of sustained deep sleep throughout the night. In contrast, the average 70-year-old brain shuffles quickly in and out of moderate-level sleep, spending only a few minutes in the deepest phase of rest and far more time in shallow sleep or complete wakefulness. The transition between being asleep and awake also becomes far more abrupt as we age. This is probably why older people are generally more likely to call themselves "light sleepers."

Unfortunately, our changing sleep patterns have some pretty stark effects on our health and cognitive functioning.

For starters, not getting enough deep sleep messes with our memory. When we hit deep sleep, our slowed-down brain waves help transfer short-term memories stored in the hippocampus to our prefrontal cortex, where they are recorded as long-term memories. But when we don't spend much time in deep sleep, a recent study study suggests, our newest memories can get stuck in the hippocampus, where they are soon overwritten with new memories.

Hello, Afternoon Nap

In the 1990s, scientists identified a tiny section of the brain that acts as an on/off switch for sleep in mice. Earlier this year, the same team of researchers discovered that humans have a sleep section of the brain, too, and that as we age, we lose the special type of brain cells that live there.

After making this initial discovery, the researchers took a look at the data from a long-term sleep study of more than 1,000 people who joined at age 65 and agreed to be monitored until their deaths. The scientists found that people who lost a larger number of these brain cells had more fragmented sleep patterns — they woke up more and slept for shorter periods. The relationship between the cells and sleep patterns was surprisingly precise: The fewer cells someone had, the more disrupted her sleep. The more disrupted someone's sleep, the worse their memory. 

Our answer to our broken-up cycle of unsatisfying sleep? Naps.

Typically, naps still don't allow us to reach deep sleep, but they do help make up for the decreases in alertness and increases in stress that can result from too little shuteye.

A Lifelong Trend

You might not remember it, but your parents sure do: From the moment they brought you home from the hospital as a newborn, you never slept for more than a few hours at a time.

Yet even after managing to wake them up throughout the night, your infant self clocked in up to 20 hours of sleep each day. By the time you celebrated your fourth birthday, you cut back your daily shuteye to 12 hours, and as a teenager, you slept a conservative 9 hours each night.

In keeping with this gradual trend, the average 35-year-old gets about 8 hours of shut-eye each night. By the time we hit 70, most of us need only about 7 hours. Older people also get far less REM sleep.

The difference between a 70-year-old's sleep schedule and a 35-year-old's, however, is that older people rarely get all that sleep in one solid block, leaving them groggier after waking. Hence the afternoon nap.

Lost Sleep Is Not Always Due To Age

In the elderly, difficulty sleeping could also be a side effect of other problems like muscle spasms, depression, anxiety, and respiratory disorders like sleep apnea, which becomes more common as we age. 

These are often treatable conditions that can go undiagnosed when people assume sleeping problems are simply a natural byproduct of old age. Other chronic conditions, such as arthritis, can disrupt sleep, so it's important to make sure these issues are not simply dismissed as run-of-the-mill insomnia.