Sleep Apnea

What is sleep apnea?
Sleep apnea can be a serious sleep disorder. People who have sleep apnea
stop breathing for 10 to 30 seconds at a time while they are sleeping. These
short stops in breathing can happen up to 400 times every night. If you have
sleep apnea, the periods of not breathing may make you wake up from deep
sleep. If you are waking up all night long, you aren't getting enough rest
from your sleep.
There are 2 kinds of sleep apnea: obstructive apnea and central apnea.
Obstructive sleep apnea is the most common type. Nine out of 10 people with
sleep apnea have this type of apnea. If you have obstructive apnea,
something is blocking the passage or windpipe (called the trachea) that
brings air into your body. When you try to breathe, you can't get enough air
because of the blockage. Your windpipe might be blocked by your tongue,
tonsils or uvula (the little piece of flesh that hangs down in the back of
your throat). It might also be blocked by a large amount of fatty tissue in
the throat or even by relaxed throat muscles.
Central sleep apnea is rare. This type of sleep apnea is related to the
function of the central nervous system. If you have this type of apnea, the
muscles you use to breathe don't get the "go-ahead" signal from your brain.
Either the brain doesn't send the signal, or the signal gets interrupted.

Is sleep apnea common?
Doctors estimate that millions of people have sleep apnea. Men, people who
are overweight, or over 40 years old are more likely to have sleep apnea,
but it can affect anyone at any age.

How do I know if I have sleep apnea?
Because some of the symptoms of sleep apnea occur while you're sleeping, the
person you sleep with may notice it first. You, or that person, may notice
heavy snoring or long pauses in your breathing during sleep. Even if you
don't remember waking up during the night, you may notice daytime sleepiness
(such as falling asleep at work, while driving or when talking),
irritability or fatigue. You may also experience morning headaches,
forgetfulness, mood changes and a decreased interest in sex.
Your family doctor can diagnose sleep apnea. He or she may ask you if you
feel tired or sleepy during the day. Your family doctor may also want to
know about your bedtime habits and how well you sleep. Your family doctor
may ask you to go to a sleep center for a sleep study. Tests done at the
sleep center may reveal which kind of sleep apnea you have. You may also
need to take some equipment home with you to do a sleep study there.

Is sleep apnea dangerous?
Sleep apnea can cause serious problems if it isn't treated. Your risk of
heart disease and stroke is higher if serious sleep apnea goes untreated.
You are also more likely to have traffic accidents if you drive while you're
sleepy. If you have sleep apnea, it is very important to get treatment.

Is there anything I can do to help my sleep apnea?
Yes. The following steps help many people who have sleep apnea sleep better:
* Stop all use of alcohol or sleep medicines. These relax the muscles in the
back of your throat, making it harder for you to breathe.
* If you smoke, quit smoking.
* If you are overweight, lose weight.
* Sleep on your side instead of on your back.

How is sleep apnea treated?
Certain dental devices can be used to treat mild cases of obstructive sleep
apnea. These devices move your jaw forward to make breathing easier.
A common treatment for sleep apnea is called "continuous positive airway
pressure," or CPAP. In this treatment, you wear a special mask over your
nose and mouth while you are sleeping. The mask will keep your airway open
by adding pressure to the air you breathe. It helps most people who have
sleep apnea.
In very few cases, surgery is necessary to remove tonsils or extra tissue
from the throat.

Will this problem change my life?
Actually, sleep apnea may already have affected you more than you know.
Chances are things will improve for you once the diagnosis is made and you
start treatment. Whatever your treatment, remember that you are not alone
and help is available. [AAFP]

Pregnancy Problems Tied to Caffeine

Too much caffeine during pregnancy may increase the risk of miscarriage, a
new study says, and the authors suggest that pregnant women may want to
reduce their intake or cut it out entirely.
Many obstetricians already advise women to limit caffeine, though the
subject has long been contentious, with conflicting studies, fuzzy data and
various recommendations given over the years.
The new study, being published Monday in the Journal of Obstetrics and
Gynecology, finds that pregnant women who consume 200 milligrams or more of
caffeine a day - the amount in 10 ounces of coffee or 25 ounces of tea - may
double their risk of miscarriage.
Pregnant women should try to give up caffeine for at least the first three
or four months, said the lead author of the study, Dr. De-Kun Li, a
reproductive and perinatal epidemiologist at the Kaiser Permanente Division
of Research in Oakland, Calif.
"If, for whatever reason, they really can't do it, think of cutting to one
cup or switching to decaf," Dr. Li said. "Stopping caffeine really doesn't
have any downside."
Professional groups like the American College of Obstetricians and
Gynecologists and the American Society for Reproductive Medicine have not
taken official positions on caffeine, representatives said.
On Friday, the March of Dimes Web site said most experts agreed that the
amount of caffeine found in 8 to 16 ounces of coffee a day was safe. It
noted that some studies had linked higher amounts to miscarriage and low
birth weight, but stated: "However, there is no solid proof that caffeine
causes these problems. Until more is known, women should limit their
caffeine intake during pregnancy."
Now, having reviewed the new study, the March of Dimes plans to change its
message, to advise women who are pregnant or trying to conceive to limit
their daily caffeine intake to 200 milligrams or less, said Janis Biermann,
its senior vice president of education and health promotion.
"Women do need good guidance," she said.
Dr. Li's study included 1,063 pregnant women who were interviewed once about
their caffeine intake. At the time of the interview, their median length of
pregnancy was 71 days. But 102 had already miscarried - not surprising,
because most miscarriages occur very early in pregnancy. Later, 70 more
women miscarried, for a miscarriage rate of 16 percent for the group - a
typical rate.
Of 264 women who said they had used no caffeine, 12.5 percent had
miscarriages. But the miscarriage rate was 24.5 percent in the 164 women who
consumed 200 milligrams or more per day. The increased risk was associated
with caffeine itself and not with other known risk factors like the mother's
age or smoking habits, the researchers said.
Dr. Li said the study answered an important question that previous research
had left unresolved. Women who have morning sickness are less likely to
miscarry than those who do not, possibly because the same hormonal changes
that cause nausea and vomiting contribute to a healthy pregnancy. But some
researchers said morning sickness could lead to confusing results in
caffeine studies. These researchers argued that because they feel ill, some
women may consume less caffeine. That tendency may make it appear that they
are less likely to miscarry because they avoid caffeine, when the reason is
actually that they began with healthier pregnancies.
Dr. Li said he and his colleagues had determined that the risk from caffeine
was real and could not be explained away by different rates of morning
sickness.
Dr. Carolyn Westhoff, a professor of obstetrics and gynecology, and
epidemiology, at Columbia University Medical Center, had reservations about
the study, noting that miscarriage is difficult to study or explain. Dr.
Westhoff said most miscarriages resulted from chromosomal abnormalities, and
there was no evidence that caffeine could cause those problems.
"Just interviewing women, over half of whom had already had their
miscarriage, does not strike me as the best way to get at the real
scientific question here," she said. "But it is an excellent way to scare
women."
She said that smoking, chlamidial infections and increasing maternal age
were stronger risk factors for miscarriage, and ones that women could do
something about.
"Moderation in all things is still an excellent rule," Dr. Westhoff said. "I
think we tend to go overboard on saying expose your body to zero anything
when pregnant. The human race wouldn't have succeeded if the early pregnancy
was so vulnerable to a little bit of anything. We're more robust than that."
[NYT]

Health Myths Revealed

Reading in dim light won't damage your eyes, you don't need eight glasses of
water a day to stay healthy and shaving your legs won't make the hair grow
back faster.
These well-worn theories are among seven "medical myths" exposed in a paper
published in the British Medical Journal. Two researchers took seven common
beliefs and searched the archives for evidence to support them.
Despite frequent mentions in the popular press of the need to drink eight
glasses of water, they found no scientific basis for the claim.
The complete lack of evidence has been recorded in a study published the
American Journal of Psychology, they said.
The other six "myths" are:
* Reading in dim light ruins your eyesight
The majority of eye experts believe it is unlikely to do any permanent
damage, but it may make you squint, blink more and have trouble focusing,
the researchers said.

* Shaving makes hair grow back faster or coarser
It has no effect on the thickness or rate of hair regrowth, studies say. But
stubble lacks the finer taper of unshaven hair, giving the impression of
coarseness.

* Eating turkey makes you drowsy
It does contain an amino acid called tryptophan that is involved in sleep
and mood control. But turkey has no more of the acid than chicken or minced
beef. Eating lots of food and drink at Christmas is probably the real cause
of sleepiness.

* We use only 10 per cent of our brains
This myth arose as early as 1907 but imaging shows no area of the brain is
silent or completely inactive.

* Hair and fingernails continue to grow after death
This idea may stem from ghoulish novels. The researchers said the skin dries
out and retracts after death, giving the appearance of longer hair or nails.

* Mobile phones are dangerous in hospitals
Despite widespread concerns, studies have found minimal interference with
medical equipment. [RT]

Obesity Linked to Quantity of Sleep

People who sleep fewer than six hours a night - or more than nine - are more
likely to be obese, according to a study that is one of the largest to show
a link between irregular sleep and big bellies.
The study also linked light sleepers to higher smoking rates, less physical
activity and more alcohol use.
The research adds weight to a stream of studies that have found obesity and
other health problems in those who don't get proper shuteye, said Dr Ron
Kramer, a physician and a spokesman for the Academy of Sleep Medicine.
"The data is all coming together that short sleepers and long sleepers don't
do so well," Kramer said. The study is based on door-to-door surveys of
87,000 adults from 2004 through 2006 conducted by the NCHS.
Such surveys can't prove cause-effect relationships, so - for example - it's
not clear if smoking causes sleeplessness or if sleeplessness prompts
smoking, said Charlotte Schoenborn, the study's lead author.
It also did not account for the influence of other factors, such as
depression, which can contribute to heavy eating, smoking, sleeplessness and
other problems.
Smoking was highest for people who got under six hours of sleep, with 31 per
cent saying they were current smokers. Those who got nine or more hours also
were big puffers, with 26 per cent smoking.
The overall smoking rate is about 21 per cent. For those in the study who
sleep seven to eight hours, the rate was lower, at 18 per cent.
Results were similar, though a bit less dramatic, for obesity: About 33 per
cent of those who slept less than six hours were obese, and 26 per cent for
those who got nine or more. Normal sleepers were the thinnest group, with
obesity at 22 per cent.
For alcohol use, those who slept the least were the biggest drinkers.
However, alcohol use for those who slept seven to eight hours and those who
slept nine hours or more was similar.
In another measure, nearly half of those who slept nine hours or more each
night were physically inactive in their leisure time, which was worse even
than the lightest sleepers and the proper sleepers. Many of those who sleep
nine hours or more may have serious health problems that make exercise
difficult.
Many elderly people are in the group who get the least sleep, which would
help explain why physical activity rates are low. Those skimpy sleepers who
are younger may still feel too tired to exercise, experts said.
Stress or psychological problems may explain what's going on with some of
the lighter sleepers, experts said.
Other studies have found inadequate sleep is tied to appetite-influencing
hormone imbalances and a higher incidence of diabetes and high blood
pressure, noted James Gangwisch, a respected sleep researcher.
"We're getting to the point that they may start recommending getting enough
sleep as a standard approach to weight loss and the prevention of obesity,"
said Gangwisch, who was not involved in the study. [SMH]

High Blood Pressure Runs in Families

A 54-year study has solidified the link between parents' high blood pressure
and the chances their children will develop this significant risk factor for
cardiovascular disease.
A family history of hypertension is well-established as a warning sign --
researchers estimate that 35 percent to 65 percent of high blood pressure is
inherited.
However, "there are a couple of unique features about our study," said
Nae-Yuh Wang, an assistant professor of medicine at Johns Hopkins University
and lead author of a report in Archives of Internal Medicine.
"One is that we have an incredible amount of data," Wang said. His group
followed 1,160 men in a study that started in 1947, when the participants
were medical students, and made annual measurements of their blood pressure
over the next five decades.
"And we did not just recall the usual data," Wang added. "We were able to
classify the potential risk a lot better."
At the start, 264 participants reported at least one parent with high blood
pressure, while only 20 had two parents with high blood pressure. By the end
of the study, 583 new cases of parental hypertension were diagnosed, so that
701 (60 percent) of the group had at least one parent with high blood
pressure, and 166 (14 percent) had two.
The age at which high blood pressure was detected in the parents was
important, Wang said.
"What we found was that if parents have hypertension early, their children
have a significantly higher risk of developing hypertension at an early
age," he said. "If the parents develop hypertension at the age of 55 or
earlier, the lifetime risk for the children is seven-fold higher than
normal."
The lesson for young adults is that they should pay attention to their
parents' blood pressure, Wang said. "They should tell themselves that if
their parents develop high blood pressure early, they should pay more
attention to their health," he noted.
The finding reinforces the standing advice to consider family history when
assessing the risk of high blood pressure, said Dr. Barry Davis, a professor
of biostatistics at the Coordinating Center for Clinical Trials at the
University of Texas School of Public Health in Houston.
"Everyone should have their blood pressure checked early," he said. "If they
have a family history of hypertension I would check it more often, and at an
earlier age."
While high blood pressure has many potential causes, "I would expect it to
have a genetic factor," Davis said. "Potentially many genes are involved in
the regulation of blood pressure. We're trying to find out what they are and
how they operate."
Regardless of the exact cause, medication, careful attention to diet and
exercise can help keep blood pressure under control, Wang and Davis said.
Another study in the same issue of the journal looked at 48 medical papers
on the effect of diet and medication on high blood pressure. The study,
conducted by researchers at the Medical University of Graz in Austria,
concluded that a diet that reduced weight by about 9 pounds would bring
blood pressure down 6 points, and that use of the weight-loss medication
Orlistat also reduced blood pressure. [WP]

Aggression on Job More Harmful Than Sexual Harassment

Persistent criticism, belittling comments, bullying and other forms of
workplace aggression may inflict more harm on employees than sexual
harassment, according to a study.
"As sexual harassment becomes less acceptable in society, organizations may
be more attuned to helping victims, who may therefore find it easier to
cope. In contrast, non-violent forms of workplace aggression such as
incivility and bullying are not illegal, leaving victims to fend for
themselves," lead author M. Sandy Hershcovis, of the University of Manitoba,
said in a prepared statement.
In their work, the researchers reviewed 110 studies conducted over 21 years.
They found that both workplace aggression and sexual harassment create
negative work environments and unhealthy consequences for workers, but
aggression has more severe consequences.
Workers faced with bullying, incivility or interpersonal conflict were more
likely to quit their jobs, have a lower level of well-being, be less
satisfied with their jobs, and have less satisfying relationships with their
bosses than workers who were sexually harassed, the researchers concluded.
In addition, bullied employees reported more job stress, less job commitment
and higher levels of anger and anxiety.
"Bullying is often more subtle and may include behaviors that do not appear
obvious to others," Hershcovis said. "For instance, how does an employee
report to their boss that they have been excluded from lunch? Or that they
are being ignored by a co-worker? The insidious nature of these behaviors
makes them difficult to deal with and sanction."
The study was to be presented at the International Conference on Work,
Stress and Health, co-sponsored by the American Psychological Association,
the U.S. National Institute of Occupational Safety and Health, and the
Society for Occupational Health Psychology. [WP]

How Not to Get Baby to Sleep

Every new parent knows how difficult it can be to get a fussy baby to sleep,
but new research suggests that a parent's best efforts may only be
exacerbating the problem - and that inadequate sleep in childhood can have
long-lasting health effects. "It is very hard to let your child cry it out
when they are toddlers," says Dr. Elsie Taveras of Harvard Medical School,
referring to parents' tendency to pick up their children or bring them into
the family bed to help them sleep. "But if you approach it differently - 'I
am not even going to start my child making these sleep associations' - it's
much easier to prevent [future problems]."
That point is central to a new study by Valérie Simard of Hôpital de
Sacré-Coeur in Montréal, which examines the link between parents' bedtime
behavior and sleep disturbances in children during infancy and early
childhood. Simard administered yearly questionnaires to 987 parents, whose
children were 5 months old at the start of the study. She found that certain
"maladaptive" parental habits - such as the mother staying with the child
until he or she fell asleep, or the parent giving a child food or drink upon
nighttime awakening - appeared to develop in response to babies' early sleep
difficulties, at 5 to 17 months of age. In turn, however, some of those
calming strategies, which parents reported continuing to practice at 29 to
41 months, led to disrupted sleep - bad dreams, short sleep time and delays
in falling asleep - in children of preschool age.
The findings, published in Archives of Pediatrics & Adolescent Medicine,
suggest that bedtime behaviors that soothe infants don't always benefit
older children. "Giving food or drink to the child may be an appropriate
answer when he awakes at night during the first months of life," Simard
says, "However, most often, children at 29 to 41 months do not wake up
because they are hungry." According to Simard's study, children whose
parents fed them when they woke up in the middle of the night at age three
were more likely to have nightmares and short sleep times at age four.
Babies who grew accustomed to falling asleep with a parent in the room,
being held until they fell asleep, or being taken into a parent's bed when
they couldn't sleep were also more likely as older children to have trouble
falling asleep and to sleep fewer hours during the night. "Co-sleeping with
the child does not seem to be a good solution for comforting a child after
night awakenings," Simard says. But that doesn't mean that children should
be left to wail endlessly, or that parents should never console them. "It
might be appropriate to be present in the room, comforting the child for a
short time," Simard says. But it's most important "to let the child develop
a capacity to comfort himself on his own."
The benefits of adequate sleep in infancy and childhood extend far beyond
any single night of rest. According to a burgeoning body of research,
children who don't sleep enough may be at risk for health problems later in
life. Two additional reports, also appearing in the current issue of
Archives of Pediatric and Adolescent Medicine, suggest that children's
sleeplessness may be associated with an increased risk of being overweight
and having emotional and behavioral difficulties in adolescence and
adulthood.
In one study of 915 children from 6 months to age 3, Harvard's Taveras found
that infants who slept fewer than 12 hours per day - including naps - were
nearly twice as likely as their peers to be overweight by age 3, potentially
laying the foundation for childhood obesity. The risk for obesity was
exacerbated by TV watching: 17% of children who slept fewer than 12 hours
per night and watched two or more hours of television a day before age 2
were obese by age 3, compared with 9% of the study participants overall.
"This is a perfect storm. Not sleeping enough and watching too much TV is a
particularly hazardous combination in the toddler years," Taveras says.
"There's room for prevention even in the first month of life," she says.
In another study of 2,076 children, psychologist Alice Gregory at the
University of London followed participants for 14 years, starting when the
kids were between 4 and 16 years old. She found that those who slept "less
than others" - roughly fewer than 10 hours a night - according to their
parents, were more likely than their peers to self-report high levels of
anxiety, depression and aggression later, between the ages of 18 and 32. The
implication, Gregory suggests, is that children who don't sleep enough may
struggle to perform during the day, resulting in lowered self-esteem, along
with other emotional consequences.
These findings are the latest in a growing field of study dedicated to
understanding how sleep affects health, particularly in childhood.
Increasingly, research suggests that long-term sleep-related problems may
start as early as infancy, and that both pediatricians and parents need to
do more to ensure that children develop healthy sleeping habits. "The most
important message is that there's a lot we can do to prevent problems from
starting - in sleep," says Taveras. "Parents and pediatricians should keep
in mind that children have to develop the capacity to regulate their own
sleep early in life and self-soothe themselves during the night."
To that end, Taveras offers a few simple steps for parents: "Go to sleep at
the same time every night. Remove things that will create a lot of
stimulation before sleep - don't put a TV in the child's room. These are
proven sleep hygiene techniques that will hopefully translate to more hours
of sleep." [TM]