Did you forget? – The clocks went forward one hour Sunday

This month we’ve seen lots of attention put on sleep, from it being celebrated as ‘National Bed Month’ to many countries celebrating a special World Sleep Day on Friday 17th March, with this year’s official slogan being “Sleep soundly, nurture life.” Now we’re going to change the clocks.

Funny couple in bed

Spring will officially be here. The nights will become lighter, the temperatures will start getting (slightly) warmer, and during this Sunday night, 26 March 2017 we will see the UK move to British Summer Time: at 1am to be precise.

Daylight saving time (DST) or summer time is the practice of advancing clocks during summer months by one hour so that in the evening daylight is experienced for an hour longer, and normal sunrise times are sacrificed. Regions with summer time adjust clocks forward by one hour close to the start of spring and adjust them backward in the autumn to standard time.

‘Spring forward, fall back’ is usually the only way that anyone can ever remember if the clocks go forward or backward. Except it’s ‘Autumn’ for us in the UK, not ‘Fall’, obviously.

So the clocks are about to go forward, which is somewhat of a double-edged sword. It is obviously a good thing and something we’ve all looked forward to, but it also means that we lose an hour in bed, which is definitely a very bad thing. You might only be missing an hour of sleep, but it can have a negative effect on your body clock, and it can take up to a week to re-adjust and get back into your normal routine.

Sleep deprivation often hits the headlines and we are frequently told we need 8 hours a night. But how much sleep do we really need? Are we sleeping less than we used to and is today’s society really sleep deprived?

A recent meeting at the Royal Society of Medicine aimed to answer these questions. They reminded us that while we have every reason to think our sleep has never been better, we seem to have increasing complaints of fatigue and insomnia, and heavily disturbed sleep for many reasons, but particular sleep disorders such as obstructive sleep anoea, or the noise of our bedfellows snoring loudly.

Many of us have disturbed nights that leave us tired and irritable the next day. The rest of us may be sleeping for the recommended 8 hours – but is it quality sleep? It is increasingly being realised that poor sleep, both in terms of quality and quantity, has negative consequences for physical, mental and performance risk.

Sleep deprivation and sleep disorders are dangerous, costly, and impact our health and overall well-being. New research puts forth sleep as a major public health concern, and shows that the effects of a good night’s sleep are as beneficial for our happiness and well-being as winning the lottery might be.

In the USA insufficient sleep has been recognized by the Centers for Disease Control and Prevention (CDC) as a major public health concern. It is currently estimated that between 50 and 70 million people in the United States have a sleep disorder, and one analysis revealed that over a third of adults do not get enough sleep.

Sleep deprivation leads to traffic accidents and occupational errors that can, in turn, cause industrial or environmental disasters and has many adverse health effects. According to the CDC, not getting enough sleep may lead to a range of chronic diseases such as diabetes, obesity, or cancer, as well as generally increasing the risk of dying prematurely. A lack of sleep simply makes us unhappy and may even lead to depression.

Australia recognises the same problem and describes it as an epidemic. Research by the Australian Sleep Health Foundation has found between 33 and 45 per cent of Aussies have poor sleep patterns that lead to fatigue and irritability, and it’s putting them at risk of low productivity, damage to their mental health and unsafe behavioural patterns. The Official Sleep Day Ambassador has been offering tips to support sleep and help sustain health and wellbeing in the country, where they state that over 30% of adults now average less than 6 hours of sleep per day.

The message is the same everywhere – if you’re not sleeping well do something about it before really serious damage is done.

John Redfern.


New Guidelines for treating Obstructive Sleep Apnoea (OSA)

If you already suffer from sleep apnoea, or think that you or your partner may have this dangerous problem, and it remains undiagnosed for whatever reason, then the new rules that have been issued in the United States will have some real meaning for you.

The American College of Physicians (ACP) has published new clinical practice guidelines regarding the management and treatment of OSA in adults. It deals with the known detrimental effects of the problem, and discusses the limitations of the various available treatments. These findings endorse those of the AASM – the American Academy of Sleep Medicine but take recommendations further.

As ever, the USA is ahead of the UK in dealing with this huge problem, partly because it is so much more widespread in the community there. Much of this can be linked to obesity, a major problem in the USA, and which is rapidly becoming so here due to changes in our diet, lower exercise levels in youth, and sedentary occupations now being the largest group by far versus manual workers. Alcohol also often plays a significant role in the equation – mostly due to the high calorific intake and the effect that alcohol can have on sleep hygiene.

What is OSA?

OSA disrupts breathing during sleep, and this is usually as a result of the muscles and soft tissues in the throat relaxing and collapsing to block the airway. It can last for about 10 seconds or even more. It affects people of all ages, but particularly those of us in middle age, and particularly the elderly.

However, we believe that around 80% of cases remain undiagnosed. OSA is easy to treat but when left undiagnosed and untreated, is linked with a range of serious health concerns that include heart disease and stroke, diabetes and high blood pressure, called hypertension. Fatigue becomes a huge problem too.

Current approved treatments for OSA and sleep disordered breathing

OSA is a chronic medical disorder that requires immediate action, but also requires long term, and often lifelong. therapy. Obviously a healthier lifestyle will come high on the list from any GP but this will not stop the problem of your snoring immediately, and sometimes does not succeed at all.

As well as recommending weight loss in overweight and obese patients, it recommends and approves the following treatments as it is recognised that weight-loss intervention alone will not achieve the desired objectives.

Medical Treatments and Clinical Recommendations for OSA

CPAP Mask wearer

  • Continuous Positive Airway Pressure (CPAP) is recommended for more serious sufferers but it is readily identified that many patients reject this treatment for various reasons, particularly having to wear a mask for such long periods of time, claustrophobia, having a dry mouth, or the associated discomfort of the mask amongst others.
  • It is still however strongly recommended for chronic sufferers if acceptable.

Sweet dreams

  • Mandibular Advancement Devices (MAD’s or Splints) are fully recommended as a primary treatment route and a strong option in many cases versus CPAP. They are more readily accepted than masks and have many distinct advantages over them including, ease of wear, instant results, high rates of effectiveness and also being inexpensive by comparison – even bespoke mouthpieces or the now available self-fit versions which are highly adjustable compared to the standard oral appliance – although this may be the best starting point.
  • Strongly recommended by ACP for less severe versions of OSA.

Snoring Surgery

  • Surgery however is not listed in the ACP’s summarized recommendations, but the guideline does specifically discuss its role as a treatment for OSA. It highlights that surgical procedures, which are intended for sleep-disordered breathing, are not as effective as either CPAP or using MAD’s. Currently success rates vary greatly and can be as low as 20%, as well as it sometimes requiring several procedures.
  • Not currently recommended by ACP to American Physicians.

More and more clinics, doctors and hospitals in the USA now recommend using oral appliance technology in the form of a mouthpiece to be used when sleeping and this is now becoming more accepted as a route here in the UK, particularly now that higher quality MAD’s are NHS Approved.

By John Redfern

 

 

 

 

 

 

 

 

 

 

 


Snoring mothers-to-be are linked to low birth weight babies

The British Press have covered this subject extensively this week based on the results of a new research study that has just been completed in the United States. The research was published in the journal ‘Sleep’.

Snoring can be more than just an annoyance to others who are trying to sleep in the same room. For pregnant women, snoring could indicate certain higher risks. Experts say that snoring may be a sign of breathing problems that could deprive an unborn baby of oxygen.

Snoring is often a key sign of obstructive sleep apnoea, which results in the airway becoming partially blocked, said the researchers, whose findings appear in the journal Sleep. This can reduce blood oxygen levels during the night and is associated with serious health problems, including high blood pressure and heart attacks. The experts stress sleep apnoea can of course be easily treated.

The study found that chronic snorers, who snored both before and during pregnancy, were two thirds more likely to have a baby whose weight was in the bottom 10%.

Newborn baby girl sleeping

They were also more than twice as likely to need an elective Caesarean delivery, or C-section, compared with non-snorers.

Dr Louise O’Brien, from the University of Michigan’s Sleep Disorders Centre, said: “There has been great interest in the implications of snoring during pregnancy and how it affects maternal health but there is little data on how it may impact the health of the baby.

“We’ve found that chronic snoring is associated with both smaller babies and C-sections, even after we accounted for other risk factors. This suggests that we have a window of opportunity to screen pregnant women for breathing problems during sleep that may put them at risk of poor delivery outcomes.”

Previous research has already shown that women who start to snore during pregnancy are at risk from high blood pressure and the potentially dangerous pregnancy condition pre-eclampsia.

More than a third of the 1,673 pregnant women recruited for the new US study reported habitual snoring. They were also more than twice as likely to need an elective Caesarean delivery, or C-section, compared with non-snorers.

Scientists found that women who snored in their sleep three or more nights per week had a higher risk of poor delivery outcomes, including smaller babies and Caesarean births.

The very worst cases of sleep apnoea can be treated with CPAP (continuous positive airway pressure), which involves wearing a mask attached to a machine during sleep, which pumps oxygen to keep the airways open. Most other forms of sleep apnoea can be treated with the wearing of a simple snoring mouthpiece, similar to a gumshield that is worn for sports.

Dr O’Brien added: “If we can identify risks during pregnancy that can be treated, such as obstructive sleep apnoea, we can reduce the incidence of small babies, C-sections and possibly NICU (neo-natal intensive care unit) admission that not only improve long-term health benefits for the newly born but also help keep costs down.”

By John Redfern


Sleep disorders vary regionally – and so does support and diagnosis

Recent research carried out by the British Lung Foundation, in conjunction with both Guys and St Thomas’ Hospital in London, has highlighted that the provision of services to diagnose obstructive sleep apnoea, or OSA, varies a great deal across the UK, and it doesn’t match the worst areas for the problem.

OSA is linked to serious ill health, and the figures for the problem have continued to rise steeply across the last few years. This is partly due to the higher numbers of the population reaching middle age, at which time OSA becomes much more prevalent, and also because of certain lifestyle factors. Increased weight is a major contributory factor in the problem, due to our vastly changed pattern of eating and drinking across the last decade.

The population’s average age and girth has increased, both of which are risk factors for obstructive sleep apnoea. These increases are forecast to continue.

Sleep Apnoea infographic

Disturbed unsatisfactory sleep

OSA is a condition that disrupts breathing during sleep, usually as a result of the muscles and soft tissues in the throat relaxing and collapsing to block the airway. This usually lasts for 10 or more seconds. It affects people of all ages, including up to 4% of middle-aged men, 2% of middle-aged women and 20% of those aged over 70. However, it is estimated that around 80% of cases remain undiagnosed. In real terms we estimate about four million people in the UK to be sufferers.

Although it’s relatively easy to treat OSA, when it is left undiagnosed and untreated, it has been closely linked with a range of serious health concerns including stroke, heart disease, depression, diabetes, and high blood pressure. More recently, Alzheimer’s disease, glaucoma, and certain forms of cancer have also been related to it. OSA can also significantly affect one’s quality of life and ability to work, as well as increasing the chances of road accidents due to fatigue.

Regional differences

Wales, large parts of East Anglia, East Yorkshire, Lincolnshire and the North-East were found to be areas with the highest predicted rates of OSA. Larger urban areas in England and Scotland and the counties to the west of London were amongst the areas with the lowest predicted prevalence.

This pattern contrasted considerably with the availability of local sleep services for diagnosing and treating the condition, with large urban areas being better served despite the lower risk of OSA, and parts of mid-Wales, the North-West and East Anglia having much lower numbers of identified sleep centres, of which there are 289 in total, each one being required to serve an average of 1.25 million people.

Diagnosis of OSA

Professor Adrian Williams, Medical Advisor at the British Lung Foundation, Professor of Sleep Medicine at Guys and St Thomas’ Hospital, and co-author of the study says in a press statement: “Too often, a lack of awareness leads to the symptoms of OSA being not recognised or dismissed simply as an irritation for anyone who shares a room with someone affected. However, OSA can have a severe impact on quality of life and is associated with a range of serious health problems including heart disease, stroke, diabetes and depression.

“In most cases, OSA is easily treatable in a way that can successfully minimise the associated risks.

Self-diagnosis is therefore often a key requirement for OSA, and fortunately, by using easily accessible NHS approved products, such as an oral appliance, or mouthpiece which keeps open the airway whilst sleeping, the majority of serious cases can be prevented and better health attained.

By John Redfern


Snoring, sleep apnoea, and sleep loss in women

Snoring, and sleep apnoea in particular, were both generally considered to be conditions predominantly affecting men but we now know this not to be the case, with the ration of men to women estimated at approximately 2:1. Since sleep apnoea is mainly a problem that is self-reported , men were more likely to seek help for this and heavy snoring, even if prompted to do so by their partner.

Approximately 50% of women snorers are believed not to report their symptoms to their GP, mostly due to being embarrassed. Some studies show that as many as 90% of more severe cases go undiagnosed in women, and women have a tendency not to report apnoea events, choking or restless sleep, whereas most men did report these matters.

Treatment however can be both simple and inexpensive and it can prevent major health problems in later life. Sufferers are often put off by the thought that the treatment most used historically was CPAP, where air is forced via a mask into the lungs throughout the whole night. More recent thinking is to recommend the use of an oral appliance for mild and moderate cases of sleep apnoea.

Sleep apnea in womenComparison showing Continuous Positive Airway Pressure (CPAP and an Oral Appliance (MAD)

The contrast is shown in the photography above where one patient is using a mask

for CPAP and the other an oral appliance – just distinguishable in the inset, with the result that this method is now much more appealing to those who suffer – both men and women. This treatment, although not quite so effective, works very well.

Snoring often results in a disturbed night and it is very common to hear a comment such as – “I barely slept last night. I just couldn’t get comfortable” – or – “I tried to fall asleep, but my mind kept racing.”

Sleep, and the lack of it, is a common talking point, and disturbed sleep generally is much more common in women than men. A woman’s experience of sleep loss is different and sometimes feminine factors are involved that may cause and maintain sleep difficulties. However, focusing on quality sleep is important to help prevent many aspects of both physical and mental health.

Disruption of sleep leads not only to daytime sleepiness, but memory lapses, weight gain, headaches, irritability and poor work performance overall. It can also contribute to psychological disorders such as depression and for the more severe cases, there’s an increased risk of high blood pressure, premature heart disease and stroke.

It’s not an area to neglect.

The best solution is an approach on several fronts including exercise, reduced alcohol consumption, healthy eating and treatment for the sleep apnoea or heavy snoring which will stop the snoring immediately whilst other things take time.

There are several treatment solutions including surgery, CPAP (Continuous Positive Airways Pressure) a full-face mask which works by stopping the airways from collapsing, or a mandibular advancement device, like a sports mouth-guard, that holds the lower jaw slightly forward, making more space to breathe.

Many women now opt for the mouthpiece. It’s easy to wear, quite comfortable, non-claustrophobic unlike the mask, and doesn’t create dryness of the mouth, which CPAP has a tendency to do. Mouthpieces are easily acquired as they are non-prescription, but some are NHS Approved, which is preferable, and they will bring you immediate results.

SleepPro now have a special product in their range dedicated to women only – the only oral appliance technology company to do so.

By John Redfern


Orthodontists have a big role to play in stopping children snoring

Many more people are now aware of the serious health dangers for both adults and children that are signaled by snoring. It’s not just a matter of sleepless nights and poor rest for your children but also poor behavior and learning difficulties are also likely.

A recent Conference held in New Zealand featured strongly on this subject and the key role that the family orthodontist can play. One of the main topics was the problem of obstructive sleep apnoea, especially in children, and the role of orthodontists in helping to diagnose and treat the problem.

The statistics are similar in Australia and New Zealand to those for the United Kingdom. We are aware that approximately one in 25 men, and one in 50 women, are affected, but that significant numbers of others remain totally undiagnosed and therefore receive no treatment – a dangerous situation.

The main objective was to better educate the medical profession as far as snoring and sleep apnoea is concerned, an area where Australasia, and also the UK, lags far behind the USA and Canada in recognition and advice.

Sleep Apnoea - Children and Sleep Disorders

It is generally believed that about 35 per cent of children who snored more than three times a week have obstructive sleep apnoea, and that weight and environmental factors like allergies could increase the risk.

“If a child is snoring more than three nights a week then parents should be concerned.”

It was stated that if sleep apnoea went untreated, as well as behavioural and learning problems, it could cause other problems in the muscle and skeletal structure of the face.

A speaker from from the leading New Zealand Children’s Hospital said that often parents weren’t too concerned about snoring, but it could be a sign of bigger problems and it was important to have it diagnosed and treated.

“If parents feel that their child is having difficulty breathing while asleep, or are worried they are not getting enough air, then those are worrying signs that the child might have obstructive sleep apnoea. Because the breathing problem leads to sleep disturbance, children often have difficulty concentrating during the day and are more likely to have behaviour problems, temper tantrums and moodiness.”

The belief is that in many cases it is being picked up far too late, and because of that, problems like behavioural issues remain after treatment because they had become so entrenched over time.

It is in this area that the Conference believed that orthodontists have a key role to play.

Children with nasal obstruction, leading to snoring, sleep apnoea and daytime mouth breathing, can develop changes in the shape of the face that results in problems with the alignment of teeth. In some cases parents might not be aware that breathing is an issue and the first profession they might see could be an orthodontist.

Conference said “Orthodontists have an important role in asking about snoring and breathing problems during sleep and referring children to their doctor for tests and treatment where there is concern.”

By John Redfern


New Report: Half of women may have Sleep Apnoea

Sleep is a big topic these days. Turn on the TV or radio and you’ll probably hear someone discussing sleep medicine. There have been broadcast several conversations about sleep recently on topics ranging from surgical options to sleep-inducing drinks. And books are being written everyday on sleep topics, as well as ongoing articles in national magazines – particularly on the subject of snoring

For many years this has been regarded as strictly a male preserve but the emphasis has started to shift recently. In fact half of all the women given overnight sleep tests for a new study were found to have mild-to-severe sleep apnoea – a staggering percentage.

Obstructive sleep apnoea is a serious snoring disorder in which the sufferer stops breathing during sleep for at least 10 seconds. It’s generally associated with men, but researchers in Sweden recently set out to determine the frequency of the problem in women. The results were surprising. Half of the women in the study experienced obstructive sleep apnoea, with 20 percent having moderate and 6 percent having severe symptoms.

The report has been published in the European Respiratory Journal and was based on women between the ages of 20 and 70 from a large population sample of 10,000.

The participants of the study were monitored during sleep for heart rate, eye and leg movements, blood oxygen levels, airflow and brain waves. Half experienced at least five episodes an hour when they stopped breathing for longer than 10 seconds. And for women with hypertension or who were obese, the numbers reached as high as 80 to 84 percent.

The results were very clear cut and seem to have started many alarm bells ringing – it was important enough to have been picked up and covered by the UK National Press including the Daily Telegraph and the Daily Mail.

Age played a big part and the disorder was found to be more prevalent in older women: Among women aged 20-44, one quarter had sleep apnea, compared to 56 percent of women aged 45-54 and 75 percent of women aged 55-70.

Occasional cessation in breathing during sleep may happen to everyone from time to time, but in obstructive sleep apnea there are at least five times when breathing stops, for at least 10 seconds each time, within an hour. Patients with really severe symptoms may stop breathing hundreds of times in one sleeping session.

Sleep apnoea is a serious health problem and is tied to a higher risk of depression, stroke, heart attack, cancer and early death. Importantly it can be minimized or even eliminated by simple anti-snoring devices such as Mouthpieces worn at night.

Many patients are not aware of their sleep disorder, and knowing these symptoms can often help:

  • Excessive daytime sleepiness
  • Loud snoring, which is usually more prominent in obstructive sleep apnoea
  • Episodes of breathing cessation during sleep that is witnessed by another person
  • Abrupt awakenings accompanied by shortness of breath, which more likely indicates central sleep apnoea
  • Awakening with a very dry mouth or a sore throat
  • Morning headache
  • Difficulty staying asleep
  • Attention problems during the day

In some occupations, particularly when driving or being in charge of any machinery, sleep apnoea is extremely dangerous due to the possible lack of attention or even from falling asleep briefly.

Another recent study also found that women who have sleep apnoea are more likely to develop memory problems and dementia.

One piece of important advice – Do not Ignore it.

If you suspect problems take advice from your GP who may even ask you to attend a specialist NHS Sleep Centre for further tests and confirmation of the symptoms.

Act now – because it will not go away – it will simply get worse.

By John Redfern

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