Putting Sleep Apnea to Bed

An estimated 50 to 70 million Americans suffer from serious chronic or intermittent sleep disorders that undermine the quality of their sleep and, more importantly, their health. Sleep apnea, the most common disturbance, is also potentially the most serious, raising the risk of high blood pressure, arrhythmias, diabetes, heart failure, heart attack and stroke. At its most severe, it can even cause death.

Fortunately, modern medicine can diagnose and treat obstructive sleep apnea before it ever reaches such dangerous stages. Key to our success was the development of the continuous positive airway pressure device known as CPAP. The front-line therapy for nearly 30 years now, CPAP is a safe, non-invasive and highly effective treatment for the disorder, when used as directed. However, compliance can be a problem.

Tune in to the full podcast with Dr. Stanley Chia.  

Why?  

Some people find the devices noisy and uncomfortable. Those with claustrophobia have problems adjusting to a mask that covers the nose and, with some models, also the mouth.  And restless sleepers have trouble keeping them on.  

As a result, only between 30 and 60 percent of patients with the devices actually use them regularly and for the prescribed amount of time each night.  

So clinicians and researchers have come up with new methods to tackle the problem. 

Understanding Obstructive Sleep Apnea

First, it helps to understand the mechanics behind sleep apnea, which is marked by pauses in breathing called apnea episodes, or shallow breathing called hypopnea episodes, during sleep. When you sleep, the throat muscles that normally keep your airway stiff and open relax, narrowing the passageway. That’s normal.  However, certain conditions or even the physical structure of your mouth can momentarily prevent enough air from getting to your lungs. A partial blockage produces loud snoring or irregular breathing, while a complete obstruction usually results in a sudden snort or gasp as the oxygen-starved brain startles the body awake.

These breaks in breathing can last from a few seconds to minutes, and have been recorded over 100 times an hour.  

Among the causes of sleep apnea are age, sex (with males at a higher risk) and, increasingly, obesity as excess fatty tissue can thicken the wall of the windpipe, narrowing the opening.  

Finding the Right Fix

Beyond lifestyle changes and CPAP, specialists have a range of other approaches to treat sleep apnea. Choosing the right therapy depends upon determining the source of the problem and on patient preference. We start with a careful and thorough evaluation, including physical examination, a detailed medical history, an overnight sleep study and an endoscopy to look at the airways and arrive at the correct diagnosis.  

For patients with large tonsils or an elongated soft palate, treatment can include removing the tonsils and shortening the palate. Another approach, especially when patients have excess or enlarged tissue at the back of the tongue, is transoral robotic surgery to remove the excess tissue, or radio frequency ablation which shrinks the tongue or soft palate.

In other cases, the very structure of the upper or lower jaw is the culprit. To eliminate the condition, oral surgeons can actually advance the upper and lower jaws to open up the airway.  These procedures have a high success rate, sometimes accompanied by an unintended consequence: a better-looking jaw line!

But a newer approach is proving to be even better for some individuals.   

Novel Approach Offers Improved Solution

Approximately two years ago, the FDA approved a promising new technology to treat sleep apnea called the hypoglossal nerve stimulator. (Full disclosure:  I sat on the final FDA review board.) Basically, the technology acts like a pacemaker, helping to synchronize the intake of air with the action of the tongue.  The pacemaker apparatus is implanted in your right chest, and connected to a wire that is wrapped around the nerve that controls tongue movement. A second wire implanted in the side of the right chest senses when you breathe in, causing the pacemaker to signal to the tongue to move forward and out of the way, opening the airway. The device is turned on and off by the patient, so daytime breathing is not affected.  

To date, the stimulator has been used in hundreds of patients with very good success. I’ve personally used it on about 15 patients with an 85% success rate. However, not everyone is a candidate for the approach.  Patients must have moderate to severe sleep apnea, as indicated by a sleep apnea severity score (Apnea Hypopnea Index or AHI) between 20 and 65, and a body mass index (BMI) less than 32. The latter, in particular, rules out many who could benefit from the procedure. As a result, I often refer my obese patients for consideration of bariatric surgery to help lose weight instead.

But for those who fit the criteria, the hypoglossal nerve stimulator is an important breakthrough. And for specialists, it’s a nice complement to the range of other treatments available and yet another tool to give patients what they need to put sleep apnea to bed.   

Listen to the full podcast with Dr. Chia.

 

The surprising heart risks of too much sleep and exercise

You’ve probably heard a lot about how getting exercise and sleep can help you avoid heart troubles in the future. But getting too much of either can actually increase your risk of heart disease.

It seems counterintuitive. After all, we’re constantly told that exercising regularly and getting enough sleep are vital to staving off obesity, high blood pressure, stroke and, of course, heart disease. And it’s true. Exercise and sleep are important components of a healthy lifestyle. So, wouldn’t exercising even more and getting lots of sleep make us healthier and less prone to heart disease?

Surprisingly, the answer is no. Excessive sleep and over-exercising can increase your risk for heart disease, just like not getting enough sleep or exercise can. In many disciplines, from economics to communication, this phenomenon is known as the “Goldilocks effect,” referring to the children’s story of “Goldilocks and the Three Bears.”

Here’s how can you balance your sleep and exercise to find the amount that isn’t too much or too little, but instead “just right” for your heart health.     

How sleep affects the heart

There is still some debate about the exact amount of sleep that’s ideal for adults. However, researchers have reached a consensus on the optimum range. Almost everyone needs between seven and nine hours of sleep every day. And no, you can’t “catch up” on the weekends. It’s much better for your body’s circadian rhythm–the natural sleeping and waking cycle–to go to bed and wake up at a relatively consistent time each day.

Some people are naturally long sleepers, about two percent of the population. These people need 10 to 12 hours of sleep, or they feel tired and groggy throughout the day. However, most people should not be sleeping more than nine hours per day.  

Oversleeping has been linked to increased inflammation–in which the body’s immune system attacks healthy tissue. Chronic inflammation, or inflammation that occurs over months or even years, can put you at greater risk for cancer, diabetes, heart disease and many other health problems.

Getting too little sleep or too much sleep can increase inflammation levels. But considering that fewer people are aware of the dangers of oversleeping compared to undersleeping, it’s important to emphasize that both can lead to heart problems in the future. A study of the National Health and Nutrition Examination Survey found that, compared to people who get six to eight hours of sleep, those who slept:

  • Less than six hours: Had a doubled risk of stroke or heart attack
  • More than eight hours: Had a doubled risk of angina – chest pain due to reduced blood flow – and 10 percent higher risk of coronary artery disease

If you’re having trouble getting between seven and nine hours of sleep each night, bring it up to your doctor at your next physical. While short-term sleep problems aren’t likely to cause lasting damage, developing poor sleep habits can put you at higher risk for heart trouble as well as other problems later in life.

How exercise affects the heart

On the whole, Americans don’t exercise nearly enough. About half of U.S. adults don’t get enough aerobic physical activity – the heart-strengthening exercises known as “cardio.” Aerobic exercise is one of the best ways to safeguard against future heart disease and improve your overall health. However, too much vigorous aerobic exercise can also be detrimental to your heart health.

Like a few days of getting too little sleep, brief bouts of high-intensity cardio followed by periods of rest won’t do lasting damage. In fact, it can make your heart stronger. Problems arise when extreme athletes – such as long-distance runners, rowers, swimmers and cyclists – perform vigorous exercise regularly.

Intense aerobic physical activity puts a strain on your heart. Over time, repeated strain changes the very structure of the heart, enlarging the arteries and right ventricle and causing thick scar tissue to form in the heart’s two atria. These adaptations have been linked to heart problems in some people, though more research is needed for us to draw definitive conclusions.

There are many misconceptions about how intense exercise needs to be to achieve the best results. I find that many people believe they have to be totally out of breath and drenched in sweat to get a “good workout,” but the reality is that, as far as your heart is concerned, you’ll maximize your exercise benefits with regular moderate exercise, like a brisk walk. What defines “moderate” exercise? You should sweat a little and be able to carry on a conversation with someone without too much difficulty.

The American Heart Association recommends 150 minutes of moderate physical activity per week, or 75 minutes of vigorous exercise, or some combination of both. I suggest doing 30 to 60 minutes of moderate exercise on most days of the week. That’s a healthy habit that you can continue through your whole life. 

This doesn’t mean you shouldn’t give that marathon or triathlon you’ve always wanted to do a try. I’ve finished 11 marathons and a 50-mile race, so I know the allure of such events. The positives of endurance training are many: fitness, strength, even psychological. But we need to remember that more isn’t always better. Talk to your doctor before beginning to train for such endurance events. As for me, I still enjoy running and believe strongly in the benefits of exercise, although I’ve moderated my distance over the years, opting for a morning jog on the C&O canal as my favorite run!

Most people don’t have to worry about exercising too much or oversleeping. In fact, they should be concerned about too little exercise and sleep! But for extreme athletes and chronic sleepers, these issues can lead to heart problems in the future. The trick to the Goldilocks effect of sleep and exercise is finding a balance that makes you feel “just right.”

 

Request an appointment online or call 202-877-3627 to talk to a doctor about how your sleep and exercise routine affects your heart.