New data released by CDC on drowsy driving

A couple of weeks ago, the American Academy of Sleep Medicine released an article on its website that I would like to share with you related to the dangers of drowsy drivers. Here’s an excerpt of the AASM report:

The disturbing trend of people driving drowsy continues, according to a new report by The Centers for Disease Control and Prevention (CDC).

The report is based on the largest survey ever to examine the topic of drowsy driving. The CDC found that 4.2 percent of 147,076 respondents reported having fallen asleep while driving at least one time during the previous 30 days.  Men were more likely to report drowsy driving than women.  Statistical analysis found that sleeping for six hours or less per night was related independently to drowsy driving. Self-reported snoring also was an independent risk factor.

“Drowsy driving is a serious risk to personal health and public safety, and snoring is an important warning sign that should not be ignored,” said AASM President Dr. Sam Fleishman. “Loud and frequent snoring is a common symptom of obstructive sleep apnea, a sleep illness that often causes excessive daytime sleepiness.

The CDC analysis involved data from a set of questions about insufficient sleep.  The survey was part of the Behavioral Risk Factor Surveillance System (BRFSS) during 2009–2010. U.S. adults in 19 states and the District of Columbia were surveyed.

The CDC encouraged drivers to seek treatment for sleep disorders. The report also noted that the actual rate of drowsy driving is likely to be higher. Drivers often are unaware that they have fallen asleep behind the wheel. The survey also excluded teens, who have a high risk of drowsy driving.

The public health impact of drowsy driving is clear: The AAA Foundation for Traffic Safety estimates that more than 16 percent of fatal crashes involve a drowsy driver.

The AASM released a free online presentation about drowsy driving. It describes the signs, causes and effects of driver fatigue. It also suggests some strategies to manage it. The SAFE-D: Sleep, Alertness and Fatigue Education for Drivers presentation also is on YouTube and Vimeo to share or embed.

The American Academy of Sleep Medicine (AASM) considers sleep disorders an illness that has reached epidemic proportions. Board-certified sleep medicine physicians in an AASM-accredited sleep center provide effective treatment. AASM encourages patients to talk to their doctors about sleep problems or visit http://www.sleepeducation.com/ for a searchable directory of sleep centers.

Just a reminder, the Capital Health Center for Sleep Medicine is the largest, AASM-accredited sleep center in Mercer and Bucks counties.

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WHEN IT COMES TO SLEEP APNEA, SOME TREATMENT IS BETTER THAN NONE

Even after the best efforts, there are always people who want to consider an option other than CPAP for treatment of sleep apnea. CPAP is the gold standard and nothing is as effective. Having said that, receiving some degree of relief and treatment is better than receiving none at all. As a result, our center offers numerous alternative options. 

A surgical procedure called a UPPP (uvulopalatopharyngoplasty) is an option and involves removing the tonsils and trimming the floppy and redundant tissue in the back of the throat. This surgery is performed by an ENT (ear,nose and throat) physician or an oralmaxillofacial surgeon. Many people also have nasal surgery at the same time to open nasal passages, which can be a source of snoring and make use of CPAP difficult.

An oral appliance can be very helpful to reposition the jaw forward during sleep which gets the tongue out of the back of the throat. A dentist usually makes this type of appliance.

Weight loss is extremely important in the management of snoring and sleep apnea. Although thin people can have sleep apnea, excess weight makes it much worse.

A positional pillow can be very helpful for those who have most of their breathing disruption when sleeping on their backs. A positional pillow will keep you from turning onto your back unknowingly while asleep. 

If you have sleep apnea, a decrease in severity with one of the alternate treatments is far better than no treatment at all. If you have tried CPAP and are looking for an alternative, consider meeting with one of our sleep specialists to discuss your options.

The adage “something is better than nothing” is certainly true when treating sleep apnea.

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IS IMPAIRED SLEEP A NATURAL PART OF AGING?

Excessive daytime sleepiness is a problem for up to one third of older adults. Although patients and physicians often view daytime sleepiness as a normal consequence of aging, excessive daytime sleepiness has also been associated with poor medical outcomes.

Obstructive sleep apnea (OSA) is a frequent cause of excessive daytime sleepiness (a condition known as hypersomnolence). OSA, as defined by an elevated apnea/hypopnea index (AHI) that is found through sleep testing, is twice as common in older adults as compared to those who are younger.

In young adults, the presence of sleep apnea increases risks of heart disease, stroke, and death. In older patients, the medical risks of sleep disordered breathing are less clear. This has raised the question of whether all older patients with an elevated AHI need sleep apnea treatment, or whether some degree of respiratory irregularity may be an expected part of aging.

A recent study published in the journal Sleep helps to define which elderly patients with sleep apnea should be treated. Nearly 300 patients over the age of 65 were followed for an average of nearly 14 years. Patients were divided into two categories based on whether or not they complained of excessive daytime sleepiness. All patients underwent sleep testing, and those with an AHI greater than 20 were classified as having sleep apnea. At the conclusion of the study, overall risk of death was assessed.

After controlling for additional variables such as age and medical history, this study found an increased risk of death only in older patients who experienced excessive sleepiness and demonstrated an AHI greater than 20. Those with an AHI greater than 20 but no complaints of sleepiness, as well as those with complaints of sleepiness but no sleep disordered breathing, did not have a significantly higher risk of death compared to control groups.

As the authors of the study state, “the increased mortality of older adults with excessive daytime somnolence [sleepiness] and sleep disordered breathing emphasizes the importance of obtaining a sleep evaluation.” The common misperception that impaired sleep is a natural part of aging needs to be challenged. This study helps to clarify which patients should be offered treatment.

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CAN CPAP TREATMENT HELP WITH MIGRAINES TOO?

A recent study published in Neurology showed a dramatic decrease in migraine headaches with CPAP treatment of obstructive sleep apnea (OSA). Swedish researchers followed patients newly diagnosed with sleep apnea who also had a history of migraines. Within the first three months after successful treatment of OSA with CPAP, headache frequency decreased from an average of six headaches per month to less than one headache per month. Many patients subsequently became completely headache-free by the end of the first year. This improvement is better than is typically seen with medications used to prevent migraines.

Researchers do not know whether the improvement is due to better oxygen supply at night or better sleep quality overall with control of sleep disordered breathing. It is clear however that headaches and sleep difficulties are very common in the adult population, where they may be expected to frequently overlap. Although this study involved only a small number of patients, the improvement in migraine headache frequency with CPAP treatment for OSA was actually better than is typically seen with commonly used medications for migraine prevention.

Neurology 2011;76:1189-91 “Continuous positive airway pressure therapy is effective for migraines in sleep apnea syndrome”

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ARE PROBLEMS WITH SLEEP EQUIPMENT KEEPING YOU UP AT NIGHT?

OK!! So in my wildest dreams, everyone would choose CPAP and sleep well and live happily ever after.  That is the picture I painted in my last blog entry. There are many people who have difficulty adapting to CPAP or find the interface (mask) annoying. 

If you are a patient at Capital Health, you are in luck because this is “troubleshooting central.” The best technology in the world for sleep apnea treatment is CPAP, but what good is it if you cannot get a good night sleep because you experience annoyances getting used to the mask or pressure?

Capital Health has tremendous resources for support. First of all, this center does not just have technologists at night doing sleep studies which is what many labs provide. We have registered technologists available during the day, Monday through Friday and some Saturdays, to check the machine pressure, brush up your knowledge about how to use the machine to its fullest capacity, refit masks and provide desensitization to make CPAP users more comfortable. Those who suffer from claustrophobia have a longer time adjusting and the desensitization is very helpful.

Our staff is also available several days per week to answer questions over the phone about equipment problems, and we have a CPAP clinic one day each week dedicated to assisting people with any problems.

All of these support services are complimentary with no charge to you or your insurance company.  It’s just part of our commitment to helping you achieve better sleep, and as a result, better overall health outcomes.

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FOLLOWING CPAP INTO THE 21ST CENTURY

I have been fortunate to be associated with the Capital Health Center for Sleep Medicine since the early 1980’s.  My passion and interest in the science of sleep and sleep medicine was conceived during my pulmonary fellowship at Robert Wood Johnson University Medical Center in New Brunswick, NJ.

Research on sleep apnea was beginning to explode looking for acceptable treatment for sleep apnea and clarifying its causes.  CPAP had not yet become commercially available in the 1980s. Treatment options were very limited and only marginally effective at best. Tracheostomy (a surgical procedure to create an opening through the neck into the trachea or windpipe) was the only reliable treatment and most people refused it as an option. 

The commercial availability of CPAP (which stands for Continuous Positive Airway Pressure) provided a non-invasive, highly effective treatment option for everyone regardless of weight, sex or medical conditions.  CPAP is a small lightweight machine which sits on the nightstand. It takes air from the room and delivers it back to you under a set amount of pressure which is customized for your needs based on an assessment in the sleep center. The air pressure is delivered by a small mask over the nose or smaller devices called nasal pillows, and the pressure holds the throat open. 

Many people ask why anyone would want to sleep with a mask on their face? I tell them this is a treatment option which is non-invasive, successful for almost everyone and will eliminate snoring and open the airway so you no longer stop breathing while asleep. Most people sleep sounder (and so do their bedpartners) without the snoring. CPAP treatment of sleep apnea may improve blood pressure, lower blood sugar, make weight loss easier, decrease the risk of heart attacks and strokes and improve alertness during the day—without surgery or medicine. In addition, it is not permanently attached to your body, is covered by insurance and can always be sent back.

As the slang expression goes, “this is a no-brainer!!”

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