BATESVILLE – “Quality sleep is important overall for your physical and mental health,” Margaret Mary Health sleep medicine supervisor Brooke Coffman emphasized at an April 23 Southeastern Indiana YMCA program.
“There are many different sleep disorders.” Coffman has been asked by friends, family members, patients and co-workers, “’Why am I so tired all the time?’ It is a very difficult question to answer.”
A newborn baby, going on vacation, staying up to watch TV or putting in a couple hours on a hobby can lessen sleep. “How do we know that tiredness is because we're aging, a new medication, nutrition? Getting to the source is very important.”
Sleep disorders are most common in men and women over the age of 65, according to the speaker. A recent University of Michigan study showed older adults are often at a high risk for obstructive sleep apnea, but the illness remains vastly undiagnosed. Fifty-six percent of those 65 and up have a higher risk, but only 8 percent got tested.
Obstructive sleep apnea is “a condition in which a person stops breathing for at least 10 seconds 30 or more times during eight hours of sleep,” according to the American Association for Respiratory Care. “These episodes are usually caused when the tongue or tissue in the back of the throat relaxes during the deepest levels of sleep and blocks the airway. Since your brain will sense that you are not getting oxygen, you will usually wake up or be brought back to a higher level of sleep. This means you will not get the rest that is needed.”
“Complete exhaustion” is how people feel, Coffman reported.
Registered respiratory therapist Dawn Olexey, who works at Christ Hospital, Cincinnati, and the MMH sleep lab, noted due to apnea, “your brain doesn't shut down, your body isn't able to recover.” She explained there is a lot of connection between poor sleep and some illnesses.
According to AARC, “Sleep apnea has been shown to cause or worsen high blood pressure, increase the chance of a heart attack or cause an irregular heartbeat. People with sleep apnea are twice as likely to have a stroke.”
Coffman said once apnea is treated, she has seen the blood pressures of some patients decrease and others with diabetes get off of their medications. Heart conditions also are sometimes lessened.
Olexey observed, “When we deprive ourselves of oxygen, what does our heart do? It has to pump harder ... (causing) wear and tear over the years. What happens ... you start having arrythmias.” She advised, “A lot of times if you correct the underlying issue, you get ahead" of a heart issue.
OSA symptoms range from snoring and waking up with a very dry throat to feeling groggy and unrested. “Your spouse might say you're gasping during the night,” the sleep medicine supervisor observed. It can be hereditary.
Neck size can be a risk factor. Women with a neck greater than 16 inches in circumference and men with one greater than 17 inches means there is excess fat and thickening in the area, which is crowding and narrowing the airway.
She pointed out, “Sleep disorder breathing has gained notoriety in the athletic community. One out of two NFL players has OSA.”
Health conditions can be indicators you are more likely to have the condition: obesity, diabetes, previous heart attack, stroke, high blood pressure.
The Epworth sleepiness scale, developed by a physician in 1992, is the most commonly used tool to pinpoint where one's sleepiness issues lie. The patient answers questions about dozing off while engaged in eight activities.
A family doctor may refer a patient to a sleep specialist, usually a neurologist or pulmonologist who specializes in sleep. Any of them can order sleep study. “An overnight sleep study is necessary to diagnose OSA. It is noninvasive,” according to Coffman, a registered sleep technologist. “We monitor so many different things as well as your heart during the night.”
Margaret Mary Health has a four-bed sleep lab at the main hospital campus. “We are able to offer in-lab sleep testing for patients" and home sleep testing services. Three full-time registered sleep technologists plus two night sleep technicians keep the lab humming.
“We're looking at total sleep time. We try to mimic your exact sleep at home.” Each room has a TV and reading materials. “You're allowed to have your phone, snacks and drinks. You can bring your own pillow if you need to.”
“We also have a sleep clinic at the Margaret Mary Professional Building” on State Road 229 across from the Kroger shopping plaza.
Dr. Karthik Kanagarajan, a pulmonologist and sleep specialist, and nurse practitioner Miranda Miller of Tri-State Pulmonary Associates examine patients on certain Fridays. Two other specialists also help persons who have trouble sleeping.
“Everyone has apnea events throughout the night. It depends how many you have each hour or throughout the night” for treatment to be suggested, Olexey said. In fact, five or fewer apnea events are normal, according to Coffman.
The most common treatment is constant positive airway pressure (CPAP) therapy. A properly fitting mask and whisper quiet machine create white noise – and blissful sleep.
For mild apnea, a 10-pound weight loss might be recommended to solve the problem instead of the machine.
While the ailment can be annoying, it also can be fatal. “If it becomes severe enough and goes untreated for a long time, it can cause breathing failure and even death,” www.aarc.org warned. Olexey recalled, “A few years ago an NFL player who had OSA and been on CPAP therapy for many years” went on a trip and forgot his machine. “He didn't wake up the next day. It was because he had severe sleep apnea.”
Debbie Blank can be contacted at email@example.com or 812-934-4343, Ext. 113.