Nasal cannula may be a treatment for sufferers of sleep apnea
04 Feb 2011 Leave a Comment
in Sleep apnea Tags: sleep apnea, sleep apnea treatment
Sleep apnea treatment
Researchers at Johns Hopkins University have found that symptoms in patients with obstructive sleep apnea and hypopnea can be significantly reduced through treatment with nasal insufflation (TNI), using a nasal cannula to deliver warm, humidified air at a high flow rate.
“Our findings provide evidence that TNI may offer a viable treatment alternative to patients with obstructive hypopneas and apneas,” said lead researcher Hartmut Schneider, M.D., of Johns Hopkins Asthma and Allergy Center.
The research was reported in the second issue for July 2007 of the American Journal of Respiratory and Critical Care Medicine published by the American Thoracic Society.
The proof of concept study included 11 patients with mild to severe apnea-hypopnea disorders, who were selected to provide a balanced range of disease severity. Apnea was defined as complete cessation of airflow for more than 10 seconds. Hypopnea was defined as a greater than 30 percent reduction of airflow.
After baseline data were established for each patient while undergoing TNI at 0, 10 and 20L/minute, subjects were randomized to receive either no treatment or treatment with TNI at 20L/minute on separate nights. Researchers then measured airflow and superglottic pressure and monitored body position, sleep arousals and respiratory events.
At TNI of 10L/minute, some indications of disordered breathing showed improvement, but airflow limitations and snoring persisted. However, at TNI of 20L/minute, all patients showed a marked improvement. “When TNI was administered, sleep and breathing patterns stabilized,” said Dr. Schneider.
Furthermore, the results showed that even patients with more severe disorders gained significantly from TNI. “Although we expected marked improvements in the apnea-plus-hypopnea index (AHI) primarily in patients with hypopneas rather than obstructive apneas, TNI lowered the AHI in all subjects,” the researchers wrote.
These findings suggest that TNI may be a more viable treatment option for patients with hypopnea and sleep apnea. “Current treatment options… are often intrusive or invasive and not well-tolerated, leaving a vast number of patients untreated,” said Dr. Schneider. “Improved therapeutic strategies are required to treat sleep apneas and hypopneas and their associated morbidity and mortality.”
Sleep apnea affects more than 12 million Americans, according to the National Institutes of Health, and is especially prevalent in overweight or obese individuals. Many more have the milder form of sleep-associated respiratory disorders, hypopnea. Untreated sleep apnea can increase the chance of having high blood pressure and risk of heart attack, stroke and diabetes, as well as putting patients at risk for work-related accidents and driving accidents.
“At present, CPAP [continuous positive airway pressure] is most effective at eliminating apneas and hypopneas, [but] long-term effectiveness is compromised by low adherence,” wrote the researchers. “We developed a simplified method for increasing pharyngeal pressure by delivering warm and humidified air at a continuous high flow rate through the open nasal cannula.”
While patients with severe sleep apneas may be more highly motivated to adhere to treatment with CPAP or surgery, younger, thinner and healthier patients with milder disorders may find the TNI approach appealing, according to Dr. Safwan Badr, chief of pulmonary, critical care and sleep medicine at Haper University Hospital in Detroit and chair of the American Thoracic Society’s Assembly on Respiratory Neurobiology and Sleep.
The authors noted that the minimally intrusive nasal interface of TNI may improve patient adherence, and may ultimately prove more effective at managing long-term morbidity and mortality of sleep apnea. Furthermore, the fact that one flow rate and one cannula size were sufficient to stabilize breathing patterns in the majority of subjects suggests that titration of TNI may be unnecessary, streamlining the initiation of treatment.
The present study is a proof of concept, the authors wrote, and will require replication in clinical trials. However, the study represents the first step in developing a new potential alternative to current sleep apnea treatments that may lower the barrier for care in patients with sleep-associated breathing disorders.
Reduce Stress Hormones To Beat Sleep Problems
18 Jan 2011 Leave a Comment
in Sleep Problems Tags: sleep problems, stress hormones
Stress can ruin your whole day … and your whole night, too. According to NIH estimates, at least 60 million Americans annually suffer from occasional sleeplessness, and the stress of modern living can play a major role.
“Stress and sleep are not comfortable bed partners,” explains Cheryl Myers, Vice President of Health Sciences for Enzymatic Therapy (ETI). “But many people don’t recognize that stress may be the reason they’re counting sheep at night.”
“If you’re running at high rev and the body’s stress hormones remain elevated, it can be difficult to unwind and fall asleep. These stress hormones can short circuit the usual biorhythms that occur as the body prepares for sleep.”
Enzymatic Therapy has just introduced a valerian-free, stress-reducing sleep aid to promote overall relaxation and support a healthy sleep cycle with the use of non-habit forming ingredients.
A recent 28-day trial conducted by ETI found that the Sleep Tonight! formula produced a dramatic reduction in stress during the course of the study. Cortisol, a stress-related hormone, can interfere with healthy sleep. Salivary cortisol levels decreased by more than 60% after the first dose of Sleep Tonight! The effect continued throughout the duration of the study, averaging a 75-83% reduction in cortisol. The valerian-free formula presented no side effects and was shown to be well tolerated by participants.
Keeping cortisol in check is also a good prescription for overall health. Associated with the fight-flight stress response, cortisol can impact blood sugar, bone density, muscle tissue, blood pressure and immunity. Cholesterol researcher Dennis Goodman, MD, FACC, explains, “Elevated cortisol hits you in the gut and then in your heart. It manifests as increased abdominal fat, which can have a negative impact on heart health, including lowering levels of ‘good’ cholesterol (HDL).” Goodman, former Chief of Cardiology at Scripps Memorial Hospital is currently at Scripps Center for Integrative Medicine and Clinical Associate Professor at U.C., San Diego.
Anesthesia More Similar to Coma than Sleep
12 Jan 2011 Leave a Comment
in Coma than Sleep Tags: anesthesia, anesthesia and analgesia, coma, coma white, sa coma
When explaining the process for general anesthesia, physicians often correlate the process with deep sleep. However, a review written this week for the New England Journal of Medicine finds that the brain is in a state more similar to a reversible coma than sleep. While this may sound scary, the findings could lead to positive results such as new approaches to general anesthesia, improved diagnosis and treatment for sleep abnormalities, and helping patients emerge from a coma.
General Anesthesia is Essentially a Reversible Coma
Study authors Dr. Nicholas D. Schiff, Dr. Emery Brown, and Dr. Ralph Lydic reviewed previous studies plus work of their own over the course of three years and conclude that activity in the fully anesthetized brain is closer to the deeply unconscious, low-activity state seen in coma patients than that of a person who is asleep. There is only a slight overlap between the deepest states of sleep and the very lightest phases of anesthesia.
Also, while sleeping involves moving through a series of phases, patients under general anesthesia are taken to a specific phase or state and kept there during surgery, more closely resembling coma.
Read: Nurse Anesthetists Salary Outpacing Primary Care Doctors
While the brain activity pattern is more similar to a coma, because it is drug-induced, it is reversible. Also, the states differ on time scales. Recovery from general anesthesia takes minutes to hours while recovery from coma takes hours to months – or even years.
The understanding of how these two states are more common than different “is very exciting, because it gives us new ways to understand each of these states,” Says Dr. Schiff, who is a professor of neurology and neuroscience at Weill Cornell Medical College and a neurologist at New York-Presbyterian Hospital/Weill Cornell Medical Center. Dr. Schiff also specializes in recovery from coma.
He hopes the findings can make general anesthesia even safer, especially for the elderly who can experience effects such as slower recovery time and impaired cognitive function afterwards.
Read: Sleep Deprived Doctors Should Tell Patients Before Surgery
Dr. Emery Brown, of Massachusetts General Hospital, the Massachusetts Institute of Technology and Harvard Medical School, hope that the findings will also give new insights into how the brain works in order to develop new sleep aids. The drug zolpidem (Ambien) for example is used to treat insomnia by slowing brain activity in order to allow sleep. But it has also been shown to be useful in restoring communication and behavioral responsiveness in some severely brain injured patients.
“Consciousness is a very dynamic process,” says Dr. Schiff, “and now we have a good way of studying it.”
Many Americans Not Getting Enough Sleep
08 Jan 2011 Leave a Comment
in Sleep Tags: sleep, sleep number bed, sleep country, enough, eight is enough
Approximately 50 to 70 million American adults suffer from sleep disorders, and a new report issued in this week’s Morbidity and Mortality Weekly Report, a publication by the Centers of Disease Control and Prevention, found that one in nine American adults claim lack of sleep on a regular basis.
In a telephone survey of over 400,000 Americans throughout the United States, only one-third say they got adequate sleep, quantified as at least seven hours per night, during the previous month. 11% responded that they did not get the minimum recommended amount of sleep at any time during the past 30 days.
The survey was part of the Behavioral Risk Factor Surveillance System project of the CDC and includes all 50 states, the District of Columbia, and three island territories.
There were some notable trends in the survey among gender, ethnicity, and education levels. Women were more likely than men to suffer from sleep disorders, and blacks were less likely to get enough sleep compared to other ethnic groups. Those with less education tend to sleep less than those who were college graduates. Those over 65 were more likely to be satisfied with their sleeping patterns than those who were younger – those between the ages of 25 to 34 reporting the least amount of sleep.
Geographical differences in sleep patterns were also noted. Southeastern states were most typically noted to have less sleep, with West Virginia residents receiving the least – 19.3 percent indicating difficulties. North Dakota residents were among those who reported adequate sleep in 93% of survey respondents from that state. The CDC researchers identified several other factors predicting poor sleep: unemployment, inability to work, rotating or extended shifts, lack of college education, and a terminated spousal relationship (by divorce, separation, or death). There were also links to medical comorbidities, such as depression and obesity, known to affect sleep.
Getting at least seven hours of sleep each night results in greater alertness, better work performance and better quality of life. Lack of sleep has been tied to mental distress, depression, anxiety, obesity, hypertension, diabetes, high cholesterol and work problems, such as performance issues and reduced productivity. The main causes of sleep loss reported in the study included lifestyle, occupation, and specific sleep disorders, such as insomnia.
According to the CDC, if you are having trouble sleeping, seek the help of a physician or sleep specialist. Other methods for getting better quality sleep, include:
· Keep a regular sleep schedule.
· Avoid stimulating activities for two hours before bedtime.
· Avoid caffeine, nicotine and alcohol in the evening.
· Sleep in a dark, quiet, well-ventilated room.
· Avoid going to bed hungry.
· Sleep medications can be helpful for some
Sources Include: Centers for Disease Control and National Center on Sleep Disorders and Research
Sleep-related Breathing Problems Linked with Asthma
24 Dec 2010 Leave a Comment
in Uncategorized Tags: asthma, asthma symptoms, asthma treatment, breathing problems, linked
Breathing disorders during sleep are common among asthmatics, may help predict severe asthma.Asthma and Breathing Disorders
When asthmatics are awake, they can turn to their inhalers to open their airways. But when they sleep, many of them continue to struggle with breathing, and an understanding of their sleep-related problems may help doctors better diagnose and treat their patients’ asthma, according to new University of Michigan Health System research.
Symptoms of sleep apnea and other breathing problems during sleep are common among people with asthma, according to the research, which is being presented today at the American Thoracic Society’s 2005 International Conference in San Diego.
Given this preliminary finding from an ongoing study, researchers say doctors should examine their asthma patients’ sleep patterns more often, especially when the patients continue to have trouble even with regular use of inhalers and other common asthma treatments.
“The more you look for sleep apnea in patients with asthma, the more you find it,” says William F. Bria II, M.D., medical co-director of the UMHS Asthma Airways Program and associate professor of internal medicine in the U-M Medical School.
“This tells us that a lot more people with asthma need to have sleep studies,” Bria says. “When patients are having problems with asthma, their doctors need to look at more than whether they are taking enough puffs from their inhalers.”
Researchers examined the connection between sleep-related breathing disorders by giving questionnaires to patients with asthma. Of the 115 subjects included in the study so far, most were in one of the most severe stages of asthma.
Most participants were being treated for asthma with inhalers and other medications, but they were still symptomatic, says Mihaela Teodorescu, M.D., a pulmonary medicine specialist, research fellow in sleep medicine and a lecturer at UMHS, who is presenting the findings at the ATS meeting and who is leading the study.
Large percentages of the people included in the study, 33 percent of men and 49 percent of women, were found to be at risk for obstructive sleep apnea, a condition in which people stop breathing for periods of time during sleep.
Those numbers are based on the symptoms of sleep apnea reported by the subjects, including 86 percent who said they snored with any frequency, 38 percent who snored regularly and 31 percent who said a family member had witnessed their pauses in breathing during sleep. The symptoms of sleep apnea were related to the severity of asthma, independent of other conditions that could influence asthma. In addition, 55 percent of these people said they experienced excessive daytime sleepiness.
Although the study is still ongoing, Teodorescu says the early findings should encourage doctors to consider sleep apnea as a possible aggravating condition in their asthma patients.
“We hope that eventually, by addressing this earlier, we’ll be able to help sooner with patients’ asthma control,” Teodorescu says.
These early findings offer one more reason people should be tested for sleep disorders, a vast majority of which are under-diagnosed, says Ronald Chervin, M.D ., M.S., director of the Sleep Disorders Center and Michael S. Aldrich Sleep Disorders Laboratory at UMHS. Some 80 percent of men and 90 percent of women who have sleep apnea don’t know it, he says.
“We might be able to control some of these patients’ asthma better if we could identify and treat their apnea,” says Chervin, associate professor of neurology at the U-M Medical School.
He also notes that many asthmatics complain of daytime sleepiness, which is often assumed to be a result of the asthma itself. Instead, the study is finding that apnea symptoms rather than asthma severity best predict daytime sleepiness. The investigators hope that attention to the overlap of sleep apnea and asthma might one day lead to better nighttime sleep and daytime alertness for asthmatics.
In addition to Teodorescu, Bria and Chervin, the authors are Flavia Consens, M.D., clinical assistant professor of neurology; Michael Coffey, M.D., associate professor of internal medicine; Ann Durance, R.N., a clinical nurse at UMHS; Kevin Weatherwax, a project associate in the Department of Neurology; John Palmisano, clinical coordinator in the Department of Neurology; Peter Mancuso, Ph.D., assistant professor at the School of Public Health; and Jesica Pedroza, all from the University of Michigan; and Srinivas Bhadriraju, M.D., of Emory University and formerly of the University of Michigan.
The research is funded by the National Institutes of Health, through the support of the U-M General Clinical Research Center and a UMHS neurology training grant.
For more information about the UMHS Asthma Airways Program, visit www.med.umich.edu/intmed/allergy/asthma.htm For more information about the UMHS Sleep Disorders Center and Michael S. Aldrich Sleep Disorders Laboratory, visit www.med.umich.edu/neuro/sleeplab/
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24 Dec 2010 1 Comment
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