THE AAA SAYS 16% of FATAL CRASHES CAUSED BY A DROWSY DRIVER

People with sleep apnoea are more likely to fail a driving simulator test and report nodding while driving, according to new research. For the sufferers of sleep apnoea, driving is highly dangerous for all on the roads.

Sleep apnoea may affect as many as 40 per cent of truck drivers, according to recent research in the USA, but a new study suggests they may be underreporting its effects.

The new study, which will be presented at the European Respiratory Society’s Annual Congress this week, shows that commercial vehicle drivers are more likely to understate their daytime sleepiness from the condition than people who don’t work in that field. The Congress was jointly organized by the European Respiratory Society, and the European Sleep Research Society.

Obstructive sleep apnoea is characterized by having pauses in breathing or shallow breathing while sleeping to create disrupted sleep and has previously been linked with an increased chance of being involved in road traffic accidents.

A research team from the University Hospital in Leeds, UK, carried out two separate studies looking at the effect sleep apnoea has on driving during a simulator test, carried out at the University of Leeds.

In the first study, 133 patients with untreated sleep apnoea and 89 people without the condition took part in the test. All participants completed a 90 km motorway driving simulation and were tested on a number of key criteria, including: The ability to complete the distance, time spent in the middle lane, an unprovoked crash or a veer event crash.

The results showed that patients with untreated sleep apnoea were more likely to fail the test. Twenty-four per cent of the sleep apnoea patients failed the test, compared to 12 per cent of the people without the condition. Many patients with sleep apnoea were unable to complete the test, had more unprovoked crashes and could not adhere to the clear driving instructions given at the beginning of the simulator test.

In the second study, 118 patients with untreated sleep apnoea and 69 people without the condition completed a questionnaire about their driving behaviour and undertook the 90 km driving test on the simulator.

Thirty-five per cent of patients with sleep apnoea admitted to nodding at the wheel and subsequently 38 per cent of this group failed the test. This compared to 11 per cent of people without the condition admitting to nodding and none of this group failing the test.

“In the first study, although some people in the control group also failed the test, there were several key differences in the reasons for failure,” said Dr. Mark Elliott, chief investigator. “For example 13 patients were unable to complete the test because they fell asleep, veered completely off the motorway and 5 patients because they spent more than 5 per cent of the study outside of the lane that they had been instructed to remain in. No controls failed for either of these reasons. Further investigation is needed to examine the reasons for failure of the simulator test.”

The public health implications of drowsy driving are clear:  The AAA Foundation for Traffic Safety estimates that more than 16 per cent of fatal crashes involve a drowsy driver.

To promote awareness of drowsy driving, the AASM released a free online presentation describing the signs, causes and effects of driver fatigue and some strategies to manage it.  SAFE-D: Sleep, Alertness and Fatigue Education for Drivers is available at www.aasmnet.org/safed.aspx. The presentation also is on YouTube and Vimeo to share or embed.
By John Redfern


STOP SNORING WEEK • Day 5

Ladies – Do you Snore – or are you actually very ill?

According to the very latest research, one woman for every two men are now diagnosed with sleep disorders. Basically their partner may snore – or it may even be themselves that is snoring. No longer ladies, can you tell your men that snoring is a man thing.

Men are also more likely to seek help for their snoring, outnumbering women eight to one, which could support the argument that men’s snoring is more disruptive than women’s snoring. But there has been a recent growth in women seeking help for their problem.

Mostly help is sought for social reasons – disruption – but if that problem is not just snoring, but obstructive sleep apnoea, then there are some very serious health implications too.

A study found that women who sleep with snorers might get decent sleep just 73 per cent of the time they are in bed; women who do not sleep with snorers get more than 90 per cent. So a woman who gets eight hours of beauty rest is awakened multiple times and might really get only five or six hours. More disturbing is the university’s finding that couples who are plagued by snoring are more likely to divorce, although we doubt that anyone has ever listed it on divorce papers as the reason for the split.

Men, or Women, who complain of persistent sleep disruption should encourage their partner to see their family doctors to rule out underlying problems such as anaemia, depression, fibromyalgia, thyroid disorder, etc. The doctor might also recommend a sleep study to rule out sleep apnoea, which is easily treated with positioning pillows, mouthpieces and CPAP devices. Sleep apnoea occurs when breathing stops because the airway becomes completely blocked.

‘Female First’ reports that over 40% of people say their partners snoring habit has a negative impact on how well they sleep and while a third of people have no idea why they snore, more than half have never done anything to stop themselves doing so.

This blind acceptance by snorers is contributing to some extreme reactions from long-suffering partners. Nearly a third of other halves resort to sleeping in another room while 2 in 5 engage in bedtime tussles, moving their partner from their back to their side to help ease the noise.

And this now applies to both men and women – not men alone – but women are not snoring more – there are just more of them seeking help. As obesity rates continue to rise and extra weight has an influence over snoring for lots of people, it is not unexpected that people are linking it with recent reports that more women are coming to clinics to stop their snoring. Drinking and smoking are additional contributory lifestyle factors.

If it is simply snoring, invest in an NHS recommended oral appliance, a dental mouthpiece, and you will quickly put it right.

If you suffer from obstructive sleep apnoea, you should consult your GP who may decide in consultation that you need a CPAP machine for night-time use. However, in the USA, where snoring problems and OSA have been accepted and treated for many years in advance of the UK, an alternative to a Continuous Positive Airway Pressure (CPAP) machine is becoming a more popular remedy for sleep apnoea.

Sleep Centre Directors in the US are recommending mouthpieces for the problem as they are likely not to deter patients from coming forward and they are also likely to be used much more. Rejection of CPAP has been a problem for many years and for many reasons including extreme dryness of the throat and even claustrophobia.

A relevant comment from a leading Sleep Centre Director, Dr Michael Coats, was made last Thursday on Sleep Apnoea Day:

“What we’re finding is the compliance rates for the oral appliances is higher,” he said. “The efficacy or the success rate of the oral appliance may be a little lower, although, if the patient is not wearing a CPAP at all, the next best thing can be an oral appliance to help them.”

By John Redfern


Heavy Snoring & Sleep Apnea

There is a difference between regular, habitual snoring and sleep apnea. Not all snorers will suffer from sleep apena but it can be a symptom, particularly for the louder snorers among us.

What is Sleep Apnea?

Sleep Apnea is a sleeping disorder characterized by abnormal pauses in breathing or a low intake of oxygen during sleep. Each pause is called an ‘apnea’ which can last anywhere from 10 seconds to a couple of minutes in severe cases.

The gaps in breathing can often occur dozens of times within an hour of sleep. The most common form of apnea is obstructive sleep apnea (OSA) which occurs because of a physical blockage in the throat or nasal passages. This makes snoring a common feature of sleep apnea, as the soft tissue in your throat causes a blockage that prevents oxygen passing freely.

Often the sufferer of the disorder is unaware of the disorder, so it’s often pointed out by a member of the family or sleeping partner.

So if you are heavy snorer it’s worth taking note, that this in turn could be a symptom of sleep apnea. The reason for concern is that sleep apnea is a potentially dangerous disorder causing high blood pressure, cardiovascular problems and even stroke.

If you have a reputation around your house as a noisy snorer it’s worth asking others to look out for the condition if you haven’t spotted it already, look out for pauses in breath intake followed by a gagging or choking sound, often the sleeper inadvertently wakes up without knowing what has transpired.

Treating the problem

The majority of moderate sleep apnea cases can be treated with a stop snoring device, by using one of these devices you can dramatically improve your sleep quality. However in severe cases we do recommend consulting a medical professional first, one of the most highly recommended methods is the continuous positive airway pressure machine (CPAP) which clears the patient’s airway during sleep by pushing pressurized air through the throat.

Sleep Apnea is a serious condition, that may require medical advice sooner rather than later.


Treating Sleep Apnea 

Common treatments for obstructive sleep apnea (OSA) include advice on lifestyle changes, the use of an MAD and the use of breathing apparatus while you are asleep.

Lifestyle changes – Mild cases only

Mild cases of obstructive sleep apnoea (OSA) can usually be treated by making lifestyle changes, if they apply, such as:

  • losing weight if you are overweight or obese
  • stopping smoking
  • limiting your alcohol consumption

It is recommended that men should not regularly drink more than 3 to 4 units of alcohol a day and women should not regularly drink more than 2 to 3 units of alcohol a day. In addition, If you’ve had a heavy drinking session, you should avoid alcohol for the next 48 hours.

‘Regularly’ means drinking these amounts every day or most days of the week.

One unit of alcohol is equal to half a pint of normal-strength beer, a small glass of wine or a pub measure (25ml) of spirits.

Stopping smoking can also help sleep apnoea to resolve

Sleeping on your side, rather than on your back, may also help to relieve the symptoms of OSA, although it will not prevent the condition.

Continuous positive airway pressure (CPAP) – Moderate to Severe cases

Moderate to severe cases of sleep apnoea may need to be treated using a type of treatment called continuous positive airway pressure (CPAP). This involves using breathing apparatus to assist with your breathing while you are asleep. A mask is placed over your nose, which delivers a continuous supply of compressed air. The compressed air prevents the airway in your throat from closing.

Many versions of CPAP equipment cause nasal dryness, nosebleeds and a sore throat. However, some recent versions include a humidifier which helps to reduce these side effects.

CPAP is available on the NHS and it is an effective therapy for treating very severe cases of OSA. It reduces blood pressure and the risk of stroke by 40%, and lowers the risk of heart complications by 20%.

However many patients find it both difficult and uncomfortable as a course of treatment to pursue due to the many possible side effects which include:

  • Mask discomfort
  • Nasal congestion, runny nose or irritation
  • Difficulty breathing through your nose
  • Headaches and ear pain
  • Stomach pain and flatulence (wind)

If you have any of these side effects from COAP, you must discuss them with your sleep specialist who may be able to suggest an alternative treatment.

Mandibular Advancement device (MAD) – Mild & Moderate cases

A mandibular responding splint (MRS) is sometimes referred to as a mandibular advancement device or MAD. It is a dental appliance, similar to a gum shield, and is used to treat mild sleep apnoea and although extremely successful where used It is not recommended for more severe sleep apnoea.

An MRS is worn over your teeth when you are asleep. It is designed to hold your jaw and tongue forward to increase the space at the back of your throat and reduce the narrowing of your airway that causes snoring.

‘Off-the-shelf’ MSRs are available but most experts recommend either a MAD that is adjustable such as the unique sleepPro SFA, or their full Custom mouthpiece that is quickly made to your precise requirements, and at a very affordable price compared with those made by dentists.

Not sure if you have OSA – or just snore heavily?

Check further with The British Lung Foundation and look on their website which offers a simple online checklist that will help to advise you – see how you rank on the same method recommended by the BLF for use by your GP.

Look up the BLF Test that is suggested to GPs – The Epworth Scale
By John Redfern