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He may be man’s best friend, but if you have problems sleeping Dr. Mary Rose, a sleep expert at Baylor College of Medicine says you should find pets a bed of their own.
“Many times when you tell someone that they need to sleep without their pet, they get very protective,” said Dr. Rose, assistant professor of pulmonary, critical care and sleep medicine at Baylor. “So it’s important to determine what works best for them to optimize their lifestyle with a pet.”
Possible disruptions
Rose said a lack of training for pets like dogs can cause disruptions to your sleep. If the pet is not well trained and wakes the owner in the middle of the night, it would be disrupting to have the pet in the room.
Cat owners face issues with their feline’s nocturnal schedule that can cause disruptions, as cats tend to walk around more during the night.
Rose also points out that owners who struggle with allergies should check with their doctor to make sure it’s safe to sleep with their pet.
Benefits to bunking up
Rose noted sharing your bed with a pet has benefits. For example:
They can create a sense of security
Their rhythmic heartbeat and release of bonding hormones, like oxytocin, may aid in owner’s sleep
Trained assistance dogs can help keep owners who struggle with sleep walking safe
They can comfort children who have night fears or nightmares
“At the end of the day, use common sense to determine what is best for you and your pet,” said Rose.
Research from Canada demonstrated that a neck-to-waist ratio of >0.41 has sufficient sensitivity and specificity to be considered a predictor of obstructive sleep apnea.
Neck-to-waist ratio can help predict pediatric OSA
Adults are not the only ones who develop sleep apnea. The condition occurs frequently in children as well. The statistics are quite staggering -- up to 66% of obese children are diagnosed with apnea compared with 5.7% of non-obese children. This is another reason to keep children active and help them make better food choices.
Just as with adults, the consequences of sleep apneacan lead to other health issues. In children, learning and behavioral problems can be the first symptoms that suggest there is something happening in their sleep.
In adults, obstructive sleep apnea is the collapse of the pharyngeal tissue which causes obstruction of breathing during sleep. Children often develop sleep apnea because of large tonsils and adenoids. When a child is not sleeping well, ask his or her parents about snoring or if they can hear their child breathing from across the room. These are indications that tonsils and adenoids are hypertrophic.
As a provider, keep a measuring tape in your drawer can be helpful in determining whether your pediatric patient has obstructive sleep apnea. Research from Canada suggests that a neck-to-waist ratio of >0.41 has sufficient sensitivity and specificity to be considered a predictor of obstructive sleep apnea. The neck circumference is measured at the most prominent part of the thyroid cartilage and the waist circumference equidistant between the iliac crest and the lowest rib.
Of course, if you believe a child has obstructive sleep apnea it is important to order a polysomnogram to confirm the diagnosis. As it is often a concern, assure your patient that sleep labs have rooms set up for parents to stay with their child. Treatment may be as simple as removal of tonsils and adenoids, however, some children may need continuous positive airway pressure (CPAP) therapy.
Children are not able to always put into words what they are feeling physically. As adults, we can say we are tired or fatigued, while children might not be able to do so. Ask parents how the child is interacting with other children or siblings. Are they falling asleep if not active? How are they doing in school? How is their behavior at home?
On your pediatric patient's next visit, remember to measure their neck and waist to see if they might need to a sleep study to assess for obstructive sleep apnea.
A new FAA policy on obstructive sleep apnea that addresses many of the concerns raised by AOPA is scheduled to take effect March 2.
The new policy closely follows draft guidelines released in April 2014 and will not disqualify pilots from receiving a medical certificate based solely on body mass index (BMI). Pilots believed to be at significant risk for the condition will receive a regular medical certificate and be required to undergo a follow-up assessment. Those who are diagnosed with the condition must receive treatment to continue flying.
The issue of sleep apnea came to the forefront in 2013 when the federal air surgeon described a planned policy change in an FAA medical bulletin. Under the original FAA proposal, pilots with a BMI of 40 or greater would have been required to undergo testing for sleep apnea by a board certified sleep specialist. The FAA said it planned to expand the policy to include all pilots with a BMI of 30 or greater.
But AOPA strongly objected to requiring thousands of pilots to go through expensive and intrusive testing based exclusively on BMI. The association and other aviation groups turned to Congress for assistance, and the House passed a bill that would have required the FAA to go through the rulemaking process before introducing any new policy on sleep disorders.
In December 2013, the FAA stepped back from its initial policy announcement and began working with stakeholders, including AOPA, to address concerns about sleep apnea.
Under the new policy, announced Jan. 23, the risk of obstructive sleep apnea will be determined through an integrated assessment of the pilot’s medical history and symptoms as well as physical and clinical findings. Aviation medical examiners will be provided with guidance from the American Academy of Sleep Medicine to assist them in determining each pilot’s risk.
Pilots who are determined to be at significant risk will receive a regular medical certificate and undergo a sleep apnea evaluation. That evaluation can be performed by any physician, including the AME, and does not require a sleep study unless the physician believes one is needed. Pilots will have 90 days to complete the evaluation and forward the results to the FAA’s Aerospace Medical Certification Division (AMCD), the regional flight surgeon’s office, or the AME. Thirty-day extensions will be available to pilots who need more time to complete the process.
If the evaluation does not lead to a diagnosis of obstructive sleep apnea, no further action will be required. Pilots who are diagnosed with the condition can send documentation of effective treatment to the AMCD or regional flight surgeon to arrange for a special issuance medical certificate to replace the regular medical certificate issued previously.
“The effectiveness of the new policy will depend on how aviation medical examiners implement it,” said Rob Hackman, AOPA vice president of regulatory affairs. “We continue to be engaged in this issue and we encourage AOPA members to tell us about their experiences once the policy takes effect.”
If you snore, you might have a serious condition called sleep apnea
BY LYNNE SNIERSON
If you’ve ever longed to be wrapped in the arms of Morpheus, you’re hardly alone among seniors who would welcome nightly communion with the mythological Greek God granting restful sleep and sweet dreams.
Sleep disorders can plague people at any life stage, but they worsen and become more perilous as we age.
“It was awful. I was snoring like crazy every night. My wife was always yelling at me and didn’t want to sleep with me. It was so bad even the cat wouldn’t sleep in the same room,” says George “Sonny” Tylus, the owner of a promotional marketing company in Salem. “I would toss and turn all night and wake up still tired every morning. I knew I wasn’t sleeping right, but I didn’t know what was wrong with me.”
Tylus was diagnosed six years ago with obstructive sleep apnea (OSA), the most common type of sleep apnea, which can be life-threatening if left untreated. It is marked by brief but repeated interruptions in breathing while sleeping.
“The [sleep disorder] condition that has the most severity and the most wide-ranging adverse health effects is obstructive sleep apnea, which is often associated with the occurrence of other medical conditions or may increase the possibility of other medical conditions that are diverse and many,” says Dr. George Neal, the medical director of the New England Sleep Center at Catholic Medical Center in Manchester. “If severe enough, it can cause or contribute to heart failure or serious cardiac rhythm problems. Statistically, people with apnea have a shorter life span. Overall, there is a higher risk of stroke, heart attack, diabetes and hypertension in individuals with apnea. It can exacerbate a number of those [existing] medical conditions.”
Although it is unknown how many Americans suffer from OSA because many cases go undiagnosed, Dr. Elizabeth Lynch says that studies estimate three to seven percent of the population is afflicted. Nevertheless, numbers can be deceiving.
“When you start breaking it down into different age groups and different sexes, you can start to say that there is a little bit of disparity. Women tend to have it a little less than men and for those over the age of 65, it’s usually a little bit more prevalent, maybe upwards of 15 percent,” says Lynch, the director of the Sleep Institute of New England, which is headquartered in Kingston with satellite offices in Portsmouth and Derry.
Although OSA is more common in men overall, as women grow older they become increasingly more at risk.
“What I say to my [female] patients is this is one more ‘fun’ thing about menopause,” says Dr. Anne Magauran, director of the Center for Sleep Disorders at Exeter Hospital. “It is absolutely true that OSA is more prevalent in men, but as women become menopausal it evens out. The hormonal changes do change the incidence. Older men still have it a little more than women but they are almost equal. It’s almost a three-to-one men-to-women ratio prior to menopause.”
Often when seniors tell their family, friends, or even in some cases their physicians, that they are experiencing problems with falling asleep, staying asleep and suffering with other symptoms, they are told that it is just a normal part of the aging process.
“The problem is more widespread than people thought but the awareness of it is increasing. More and more research is being conducted. People who suffered often took this as that’s just the way it is, but it doesn’t have to be that way anymore,” says Magauran.
FYI If you suffer from obstructive sleep apnea (OSA), your bed partner will most likely become aware of it before you do. After all, you’re asleep and don’t know how loud you’re snoring and that you are making choking or gasping sounds after you stop breathing intermittently. Although not everyone who snores suffers from sleep apnea, it’s one of the most common symptoms of the condition, according to the National Institutes of Health.
Other well-documented symptoms include: *Fighting the urge to fall asleep during the day, at work or while driving *Morning headaches *Memory or learning *Problems and not being able to concentrate *Feeling irritable, depressed, or having mood swings or personality changes *Waking up frequently to urinate *Dry mouth or sore throat when you wake up
According to the documentary, Sleepless in America, coproduced by the National Geographic Channel, 40 percent of Americans are sleep deprived. Many get less than five hours of sleep per night. Percentage-wise, adolescents are among the most sleep deprived.
The consequences are dire, not just for the individual who isn’t getting enough rest, but for those around them as well. While most people don’t give lack of sleep much thought, there are in fact life-threatening consequences.
Notably, “experts now believe that sleep deprivation may have played a role in the Exxon Valdez oil spill, the Staten Island ferry crash, and the Three-Mile Island nuclear meltdown,” the film states. Countless people have also lost their lives to tired drivers who simply dozed off behind the wheel.
It’s important to realize that getting less than six hours of sleep each night leaves you cognitively impaired. Sleep deprivation has also been linked to health effects such as obesity, diabetes, cardiovascular disease, Alzheimer’s,1and cancer. Depression and anxiety disorders are also adversely impacted by lack of sleep.
The Importance of Staying in Sync with Nature
Maintaining a natural rhythm of exposure to sunlight during the day and darkness at night is one crucial foundational component of sleeping well.
This was addressed in a previous interview with researcher Dan Pardi. In it, he explains how exposure to bright daylight serves as the major synchronizer of your master clock—a group of cells in your brain called the suprachiasmatic nuclei (SCN).
These nuclei synchronize to the light-dark cycle of your environment when light enters your eye. You also have other biological clocks throughout your body that are synchronized to your master clock.
One reason why so many people get so little sleep, and/or such poor sleep, can be traced back to a master clock disruption. In short, most people spend their days indoors, shielded from bright daylight, and then spend their evenings in too-bright artificial light.
As a result, their body clocks get out of sync with the natural rhythm of daylight and nighttime darkness, and when that happens, restorative sleep becomes elusive.
An estimated 15 million Americans also work the night shift, and the adverse health effects of working nights are well documented. As just one example, three years of periodical night shift work can increase your risk for diabetes by 20 percent, and this risk continues to rise with time.
What Happens When You’re Sleep Deprived?
What makes sleep deprivation so detrimental is that it doesn’t just impact oneaspect of your health… it impacts many. Among them are five major risks to your mental and physical well-being:
Reaction time slows: When you’re sleep-deprived, you’re not going to react as quickly as you normally would, making driving or other potentially dangerous activities, like using power tools, risky. One study even found that sleepiness behind the wheel was nearly as dangerous as drinking and driving.2
Your cognition suffers—both short- and long-term: A single night of sleeping only four to six hours can impact your ability to think clearly the next day. In one animal study,3 sleep deprived mice lost 25 percent of the neurons located in their locus coeruleus, a nucleus in the brainstem associated with cognitive processes.
Hence, if you’re sleep-deprived you will have trouble processing information and making decisions. This is why it’s so important to get a good night’s sleep prior to important events at work or home.
For example, research discussed in the film found that diagnostic mistakes shot up by 400 percent among doctors who had worked for 24 consecutive hours.
Sleep deprived medical residents also reported a 73 percent increase in self-inflicted needle sticks and scalpel stabs, and when driving home from work, they had a 170 percent increased risk of having a serious motor vehicle accident.
Research4 also suggests that people with chronic sleep problems may develop Alzheimer’s disease sooner than those who sleep well. One of the reasons for this is because sleep is critical for brain detoxification—a process during which harmful proteins linked to Alzheimer's are cleared out.
Memory and learning declines: The process of brain growth, orneuroplasticity, is believed to underlie your brain's capacity to control behavior, including learning and memory. However, sleep and sleep loss modify the expression of several genes and gene products that may be important for synaptic plasticity.
Furthermore, certain forms of long-term potentiation, a neural process associated with the laying down of learning and memory can be elicited in sleep, suggesting synaptic connections are strengthened while you slumber.
Emotions are heightened: As your reaction time and cognition slows, your emotions will be kicked into high gear. This means that arguments with co-workers or your spouse are likely, and you’re probably going to be at fault for blowing things out of proportion.
The amygdala controls basic emotions like fear and anger. As discussed in the film, another area of your brain called your frontal cortex, plays a key role in the regulation of emotions, and sleep is vital for its function.
When you’re well rested, your frontal cortex is nicely connected to your amygdala—that deep emotional center—and works almost like “a break to your emotional gas pedal.”
Sleep deprivation causes a disconnect between these two brain centers, allowing your emotions to run amok. Sleep deprivation also plays an important role in mental illness, and tends to result in more adverse psychiatric outcomes.
Immune function and health deteriorates: Sleep deprivation has the same effect on your immune system as physical stress or illness,5 which may help explain why lack of sleep is tied to an increased risk of numerous chronic diseases.
For example, research shows that sleeping less than six hours per night more than triples your risk of high blood pressure, and women who get less than four hours of shut-eye per night double their chances of dying from heart disease.6
You Need Around Eight Hours of Sleep Every Night
The studies are quite clear and most experts agree, you are seriously fooling yourself if you think you can do fine on less than eight hours of sleep. But eight hours of sleep is not eight hours in bed. If you go to bed at 10 pm and get out of bed at 6 am, you might say you’ve slept for eight hours. In reality, you probably spent at least 15-30 minutes falling asleep and may have woken during the night one or more times.
With the advent of fitness-tracking devices such as Jawbone’s UP, however, we now have access to actual sleep data (and more) from wristband users. The data is quite useful on a personal level and they helped me understand that I need to start getting to sleep around 9.30 PM if I hope to get a full eight hours of sleep, which I now typically do.
Newer devices, like Jawbone’s UP3 that should be released in early 2015, can even tell you what activities led to your best sleep and what factors resulted in poor sleep. It’s also fascinating on a larger scale, as the data reveal insights into sleep patterns from around the world.
The Glorification of Sleep Deprivation
According to the 2013 International Bedroom Poll by the National Sleep Foundation,7 25 percent of Americans report having to cut down on sleep due to long workdays. On average, Americans get only 6.5 hours of sleep on weeknights, but report needing 7.25 hours in order to function optimally. As noted in a previous article in The Atlantic:8
“For some, sleep loss is a badge of honor, a sign that they don’t require the eight-hour biological reset that the rest of us softies do. Others feel that keeping up with peers requires sacrifice at the personal level—and at least in the short-term, sleep is an invisible sacrifice.”
Modern man’s penchant for equating sleep with unproductiveness (if not outright laziness) can be traced back to the heyday of Thomas Edison, who was known for working around the clock. According to the featured article:9
“Edison spent considerable amounts of his own and his staff’s energy on in publicizing the idea that success depended in no small part in staying awake to stay ahead of the technological and economic competition.” No one... did more to frame the issue as a simple choice between productive work and unproductive rest ...
Over time, children’s books and magazines began to promote this type of Edisonian asceticism... Edison encouraged all Americans to follow his lead, claiming that sleeping eight hours a night was a waste and even harmful. “There is really no reason why men should go to bed at all,” he said in 1914.”
This culture of sleep deprivation started with the invention of the light bulb, and has only gotten worse with the proliferation of light-emitting electronics, which disrupt your natural waking-sleeping cycle. The following infographic, created by BigBrandBeds.co.uk, illustrates how your electronic gadgets wreak havoc on your sleep when used before bedtime.10
People who snore may think that their partners or roommates are the ones most affected by their nightly symphonies -- after all, they're the ones who are kept awake while the noise-maker remains, for the most part, blissfully unaware.
But snoring can be more than just an annoyance to anyone else in the room; it can also be a symptom of a serious health condition, and has been linked to dangers like heart disease and falling asleep behind the wheel.
Of course, there are many reasons why people snore and not all of them are chronic or hazardous to your health. If you sleep alone, you may not even be aware that you're "sawing logs" on a regular basis. Here's how to know if you or a loved one is at risk for snoring-related health problems and what you can do about it.
Why We Snore Middle-of-the-night wheezing, snorting and snuffling can happen for a variety of reasons, but they all have to do with obstruction of a person's airways. Most often, muscles in the roof of the mouth (known as the soft palate) or the back of the throat relax and partially block the flow of air.
"If you blow air through a floppy tube, it's going to vibrate and make noise," explains Michael Grandner, Ph.D., professor of psychiatry and a member of the Center for Sleep and Circadian Neurobiology at the University of Pennsylvania's Perelman School of Medicine. "And at night, for a lot of people, your airways become a floppy tube."
This can occur when people sleep on their backs instead of their sides, when they've had a few drinks before bed (because alcohol relaxes muscles) or when they have nasal congestion due to allergies or a cold. In fact, about half of adults snore at least some of the time, says Grandner, and it's usually not dangerous. "Most of the time, we can still get enough air to keep things functioning normally."
But other snoring triggers can be harder to fix. For example, having an enlarged uvula (that ball of tissue hanging in the back of your mouth), a large tongue, or being overweight -- especially for men, since they tend to gain weight around their necks -- all raise your risk for obstructive sleep apnea, a condition in which the heart isn't able to get enough oxygen to function properly.
Spotting The Sleep Apnea Symptoms Between 5 and 15 percent of middle-aged adults probably suffer from sleep apnea, Grandner says, although it often goes undiagnosed and untreated. And that's bad news, since studies have shown strong associations between sleep apnea and high blood pressure, high cholesterol, heart attacks and other cardiovascular conditions.
For people with sleep apnea, airway obstruction is so severe that breathing slows to a trickle. It may even stop for seconds at a time. These episodes are called apneas, at which point the brain sends alert signals to the body, forcing a gasp, a gag or an extra powerful snore.
"A lot of people think sleep apnea will cause them to suffocate, but it won't," says Grandner. "You're still getting enough air to breathe -- and if not, your brain will wake you up." (Note though that according to the Mayo Clinic, for those with underlying heart disease, sleep apnea can lead to sudden death due to cardiac arrest.) The bigger risk, he says, is the long-term damage it can do.
Fluctuating oxygen levels throughout the night causes stress and oxidative damage to cells within your body. They also force the brain to be on high-alert all night and to deliver a shot of adrenaline to the heart every time an apnea occurs, when the body and brain are ideally supposed to be resting and recovering.
"It's much more of a cardiovascular problem than a respiratory one," he says. "People with untreated sleep apnea tend to develop these conditions years before they normally would."
When to Take Snoring Seriously So how do you know whether you have run-of-the-mill snoring or a more serious problem? If someone hears you sleep on a regular basis and notices that you periodically stop breathing for several seconds at a time, that's a red flag.
So is the volume of your snoring. "If you can hear it pretty clearly through a closed door, that's a sign that your body is probably working too hard to get sufficient oxygen," says Grandner.
If you don't have a live-in partner or roommate, you can still watch out for daytime symptoms. Because the condition doesn't allow people to get the deep sleep they need, about two thirds of people with sleep apnea experience excessive daytime sleepiness. "If you can stop whatever you doing, just about any place and any time of day, and sit down and immediately fall asleep, that's a problem," says Grandner.
Waking up feeling exhausted is also a sign, especially if that feeling doesn't go away within 10 to 15 minutes of getting out of bed. People with untreated sleep apnea may also have trouble getting high blood pressure under control, even with the help of medication.
How To Treat Sleep Apnea The good news is that sleep apnea is very treatable and easily diagnosed through an overnight sleep study done either in your own home or at a sleep clinic.
Lifestyle changes, like losing weight or not sleeping on your back, may help some people. And if not, almost all cases can be treated by using a device called a continuous positive-air pressure, or CPAP, machine. The device sends air through a tube and a mask, into a patient's nose and mouth while they sleep, keeping the airway open.
"It may take a few weeks of getting used to, but once they get over that hurdle most patients say it literally changes their life," says Grandner. "It gives them more energy during the day, so a lot of them are finally able to exercise, eat better, and really get healthier overall."
Question: My dog snores louder than my husband. How can I make him stop?!
Answer: Many dogs snore and it can keep their owners up at night! Certain breeds of dog are genetically more likely to snore because of the shape of their head and nose. The brachiocephalic breeds ( dogs with a short nose and pushed in faces) tend to have very tiny nostrils, excess tissue in their throats, and elongated soft palates. This combination can cause breathing difficulties and snoring. Surgery can sometimes be done to help improve the breathing for these dogs. Examples of brachiocephalic breeds include bulldogs, pugs, and Boston terriers.
If your dog is not a short-nosed breed and he did not snore until recently, he may have something else going on. Common things that can cause snoring are: weight gain (obesity), allergies, old age, second hand cigarette smoke, dental disease, nasal or upper respiratory infections, foreign body inhalation (grass or stickers), laryngeal paralysis, polyps and tumors. You will need a trip to your veterinarian to help sort through these possibilities.
Most snoring is caused by the nose and throat tissues getting swollen and narrowing the area for air to pass. There are things that you can do to help soothe the airway and make breathing easier.
1. Keep your pets bedding clean and dry. Replace the top sheet daily. Wash bedding in hypoallergenic laundry soap.
2. Vacuum frequently to keep your floor sniffing dog from inhaling dust and dirt.
3. Decrease pollen in the home by using a HEPA filter and dusting with a microfiber cloth to trap the dust.
4. Keep the air clean! Do not smoke inside your home or near your pet. Don’t burn real candles or use air fresheners.
5. Get fit and healthy! Get your dog at a healthy weight and exercise him daily.
6. Brush your dog’s teeth daily! Dental disease is a main component in inflammation and infections. Schedule a complete dental cleaning at least once a year with your veterinarian.
7. Put your dog in a hot steamy bathroom twice a day to help hydrate and soothe the nasal passages. Try a vaporizer in the bedroom at night.
8. Avoid exercising your dog in the middle of the day when it is very hot and humid.
9. Clean and change the water dish at least twice a day. Add water to your dog’s food. Drinking more water can help keep sensitive nasal tissues moist and comfortable.
10. Give your dog a pillow for his head or use a cuddler dog bed that has raised padded sides where he can rest his head. Elevating the head can sometimes improve airflow and reduce snoring.
11. Video your dog snoring and show it to your veterinarian, it may help to determine a treatment plan for your dog.
should find pets a bed of their own. 
