History of Sleep – The Beginning

In the age of information, it can be difficult to find a comprehensive article about almost anything. Not many people are able to find the time to read about topics that interest and effect them, so the demand for easily digestable material is high.  Recently, an article appeared in the New Yorker by a person clearly interested in the history and study of sleep, Jerome Groopman.

His article discusses many fascinating aspects of sleep, ranging from the medical industry’s lack of knowledge about sleep to what happens to a person when they do sleep.  The theme of his article is much like what we’ve discussed on our blog – the necessity of sleep, and how it’s lack can be a severe detriment to a person’s daily life. At PDSM, we wanted to take a further look at the items discussed in Mr. Groopman’s article.  Gleaning information from his article and other sources, we were inspired to create this series in hopes of offering a more comprehensive look at sleep in general, and the things that can happen because – and in spite – of it.

 

“No one has been able to declare with certainty why all life forms need sleep”

-Meir Kryger

 

Though we now know that sleep is a very necessary part of a healthy lifestyle, it’s not always been a focus in the medical world.  Mr. Groopman states “in medical school, the subject [of sleep] had been covered in only the most cursory way.” In addition to the fact that sleep specialtiy is a relative newcomer to the medical world, there is also the shift work typical of medical residents.  It makes sense that new doctors have to work long hours to get used to the pressures of being a full-time doctor. However, it is also a scary idea – being the patient of a doctor that’s been awake for 24+ hours. Although it is well known that lack of sleep causes us to be ineffective, there is some interestingly contradicting cultural and historical information to discuss regarding what exactly may be considered proper sleep.

 

In the coming months, we will take you on the informative adventure.  We will learn more from Dr. Kryger, Mr. Benjamin Reiss and Mr. A.Roger Ekirch – three gentlemen that have quite a lot to say about sleep. We will discuss what we know, what we don’t know, theories surrounding what we don’t know, how our understanding has changed through the years, and what the future may hold.  

 

“Even God needed a seventh day to rest from all that he created.”

-Jerome Groopman

Wearable Technology as A Health Solution?

“Roughly 24% of men and 9% of women have sleep-disordered breathing, and 80% of people with diagnosable sleep apnea don’t realize they have it.” – Brandon Ballinger, co-founder at Cardiogram

Last year, Pittsburgh Dental Sleep Medicine took a closer look at the role sleep trackers play in a good night’s sleep. Though there has been some controversy of how sleep trackers can affect an individual’s sleep, there have been new advances in that arena. Since the individual purchase of wearable technology has been mainly geared towards sport and recreation, healthcare has not been a key focus of wearable technology – until now.

“Consumers rely on [fitness trackers] and the ecosystem of associated apps to meet fitness goals.  And yet, these devices often fall short of identifying actionable health insights, such as risk factors for diabetes and heart disease..”

Peter Daisyme

Converging recreation and health, some investors have found a new niche for fitness and sleep trackers. Brandon Ballinger dares to ask“What if we could transform wearables people already own – Apple Watches, Android Wears, Garmins and Fitbits – into inexpensive, everyday screening tools using artificial intelligence?” His article mentions hypertension and sleep apnea as two conditions most suited to be diagnosed with wearable technology and the assistance of his app.  He mentions that the rate of detection can be staggeringly accurate via consumer wearables and the DeepHeart app.

While Cardiogram promotes the DeepHeart app that they’ve developed to work with existing wearables, many technology companies are gearing their next generation devices to be more health-conscious.  Jawbone is focusing on interpreting the heart rate metrics gleaned from the device’s daily use; iBeat has a device that links it’s wearer to an emergency response center via a help button; Diabetes Sentry “tracks a patient’s skin temperature and perspiration levels to detect signs of a drop in blood glucose levels.”  

Perhaps the most exciting of all – for sleep apnea sufferers – is the Go2Sleep ring.  

“Go2Sleep monitors wearers’ heart rate, blood oxygen saturation levels, perfusion index (your pulse strength), and the amount that you’re tossing and turning during your sleep in order to provide you with a sleep report.”Lulu Chang

While it is appealing (and cost-effective) for an individual to use the fitness tracker that they already have to detect life-threatening health issues, it is also exciting to keep an eye on the new devices that are on the horizon of this new industry.  Morphing a recreational consumer item into a potentially life-saving device is very exciting indeed.

So what is the role that wearable technology plays on a good night of sleep?  It still remains to be seen, and we are looking forward to learning more as the developments come.

When Sleep Apnea Turns Deadly

If you have come to see us at Pittsburgh Dental Sleep Medicine, chances are good that you understand and recognize the severity of sleep apnea.  Unfortunately, the dangers of sleep apnea have a history of going undetected in many professions – most notably, in the mass transit industry. Recent train crashes have called to light some glaring inconsistencies in the regulations for mass transit.

According to an article from Sleep Review, a couple of recent railway accidents were possibly caused by “undiagnosed severe obstructive sleep apnea.”  The two accidents combined injured just under 250 people.  A closer look at these incidents reveals that undiagnosed sleep apnea seems to be a concern in transit workers. Additionally, the National Transportation Safety Board (NTSB) drew focus to the safety issues at these terminals. While an automatic-stop option seems a good idea in case of emergency, the article suggests there are “no mechanisms installed in the United States that will automatically stop a train at the end of the track if the engineer is incapacitated, inattentive, or disengaged.”

The lack of safety regulation is alarming.  A quick Google search of “subway safety regulations” brings up an article from the Baltimore Sun discussing the deteriorated safety standards of the Baltimore Metro rail system – for more than a year prior to shutdown.  While these system safety concerns are disheartening, perhaps a more serious point of contention is the operator of these mass transit vehicles.

As a community, we are coming to understand the significance of sleep in an individual’s lifestyle. More sleep research is bringing unknown circumstances to light – such as a person’s inability to recognize symptoms of sleep deprivation in his or herself.  This research must be taken into consideration when safety regulations are discussed and reviewed. Sleepapnea.org estimates “22 million Americans suffer from sleep apnea, with 80 percent of the cases of moderate and severe obstructive sleep apnea undiagnosed.”  

What this evidence suggests is that an individual cannot be the only determining factor regarding his or her capabilities – especially if hundreds of citizens rely on him or her for their daily commute.This is a perfect example of what government regulation should be all about.  When the greater good must trump an individual’s shortsightedness, we must be able to trust in our government and safety systems.

If you or someone you know struggles with any sleep issues, please have a sleep study done.  If your sleep habits concern you, please schedule an appointment.  Pittsburgh Dental Sleep Medicine can help to bring some closure to an issue that doesn’t have to be dangerous, if monitored and treated properly.

Sleep and Diet – The Information We Ignore

 

The American culture is fast-paced, and lack of sleep can be brushed off as a humorous rite of passage into adulthood.  New parenthood and work weeks of 50-80 hours are two examples of common ways our society justifies lack of sleep. As sufferers of sleep apnea know, the importance of sleep is often minimized even though it affects many aspects of an individuals well being.  When dealing with matters of weight loss, it is easy to overlook something as seemingly insignificant as sleep.  This article will pull together some old and new research that suggests that it’s all interrelated.

 

Sugar and Sleep

A recent article on news-medical.net suggest some interesting points regarding lack of sleep and its impact on an individual’s sugar cravings.  Dr. Ananya Mandal summarizes the findings of a study done with a sample group of under 50 healthy adults. Split into two groups, each one was given separate tasks. The first group was not to do anything differently than usual.  The second group was told to get an additional hour and a half of sleep a night.  They were also given directives regarding caffeine and food intake and a relaxation routine prior to bed time.  

Unsurprisingly, the second group got more sleep and were also found to have reduced their sugar intake the following day.  

She also confirmed with another sleep professional that “only raising total bed time duration by an hour or so was necessary to making better and healthier food choices….it has already been studied previously that poor sleep meant poor diets.”  

This one small study led to further investigation regarding sleep and its correlation to diet. Our findings went from a micro to a macro level quickly.

 

Looking at Our Health as a Whole

Sleep is a common answer to most of our health-related questions.  We all know that rest is a key factor for curing common malaise.  Why is it then so hard for us to consider that more rest may help us with other health-related concerns?  Looking at weight-gain in a similar fashion (as our body’s way of indicating that we are doing something wrong – like a cold), it stands to reason that more rest can play a significant role.

An interesting article from the National Sleep Foundation offers several examples of studies that bring relevancy to this discussion.  The article mentions that “an estimated 18 million Americans have sleep apnea” – which is something Dr. Rogers has studied in great detail.  Unfortunately, obesity can be a commonality with sleep apnea sufferers.  Since sleep apnea often leads to lack of sleep, these individuals are less likely to diet and exercise.  Further, even with proper diet and exercise, lack of sleep can still be a weight-loss inhibitor.  The study referenced showed a tie between minimal sleep levels and hormone characteristics of diabetics.  

If an individual has issues with accomplishing weight loss even with proper diet and exercise, it’s recommended to evaluate the time of day exercise takes place.  Exercise is recommended between morning and late afternoons, and no later than 3 hours prior to bedtime.  The interesting reason for limiting later workouts is that the body needs a cool down before bed.

One final piece to ponder – “people who don’t get enough sleep are more likely to have bigger appetites due to the fact that their leptin levels (leptin is an appetite regulating hormone) fall, promoting appetite increase.”  Additionally, “the psychological manifestations of fatigue, sleep and hunger are similar.”  The answer seems easy – sleep more to eat less.

Although sleep is crucial, exactly how and why may not be known.  But a good night’s rest is something we all need for our overall health.  If you or someone you know struggles with sleep deprivation or weight troubles, suggest a sleep study.  If you or someone you know struggles with sleep apnea, suggest that they come see us at Pittsburgh Dental Sleep Medicine.  We are here to help them!

 

Squabbles at Home? Are Your Sleep Patterns Making You Fight?

A recent article in Sleep Review Magazine suggests some interesting correlations among partners’ sleep patterns and their abilities for conflict resolution.  The article cites researchers involved with a study at the Ohio University Institute for Behavioral Medicine Research.  The main topic of this discussion was stress-related inflammation, which “is associated with higher risk of cardiovascular disease, diabetes, arthritis, and other diseases.”  These finding are not that surprising, and a regular topic in the sleep world.  Because of the fairly common knowledge of how sleep can change a person’s physiological well-being, the researchers wanted to take things a step further.  They wanted to find out the effects of partners’ sleep patterns on their mates.

They invited 43 couples in for two visits.  Both times, blood samples were taken and the previous two nights’ sleep amount was recorded per partner.  By inciting a known source of contention amongst the couple, the researchers recorded their conflict resolution throughout the process.  They concluded the visit by taking blood samples for a second time.  

A researcher on the study, Dr. Stephanie Wilson, stated “We found that people who slept less in the past few nights didn’t wake up with higher inflammation, but they had a greater inflammatory response to the conflict.  So that tells us less sleep increased vulnerability to a stressor.”  In other words, someone that has had less sleep is more prone to react poorly to a conflict.

“If both partners got less than 7 hours of sleep the previous two nights, the couple was more likely to argue or become hostile.  For every hour of sleep lost, the researchers noted that levels of two known inflammatory markers rose 6%.” Another interesting note – the inflammatory response almost doubled when the couples employed unhealthy discussion tactics.  

With findings such as these, it is concerning to also hear from Dr. Wilson that “About half of our study couples had slept less than the recommended 7 hours in recent nights.”  

Perhaps the most crucial part of the study was mentioned by Dr. Janice Kiecolt-Glaser, who stated “Part of the issue in a marriage is that sleep patterns often track together.” Anyone that has shared a bed with another person can relate to having a troubled sleeper next to them. If one person in the bed sleeps poorly, the risk is greater that both will sleep poorly.  

There was one hopeful area of the study, though; it was noted that there was a “protective effect” between a couple with a well-rested and sleep-deprived partner.  The partner with better rest employed better conflict resolution mechanisms to pull the other out of the disagreement.   

As it is continually shown, a good night’s rest is crucial to our physical and emotional well-being as people.  If tensions at home are high, try getting a better night’s sleep.  If you are having trouble sleeping, find out why by scheduling a sleep study.  Pittsburgh Dental Sleep Medicine can help you find some answers.

The Prevention of Sleep Apnea starts with Breastfeeding

Over 22 million Americans suffer from sleep apnea. Currently, the disorder is addressed with a variety of treatments, from Continuous Positive Airway Pressure (CPAP machines), to Oral Appliances (OA) and surgical options. But what if you could take steps to possibly prevent or minimize the disorder?

The evolution of the human upper airway has resulted in a size and shape which functions differently than other mammals within the animal kingdom. Mammals can swallow while breathing but humans are unable to. Let’s take a look at why this is and then move onto what we can do with our infants to possibly prevent them from the future suffering of sleep apnea.

human pharyngeal airway diagram

The human pharyngeal airway differs from that of other mammals in how the human epiglottis and the soft palate are separate, but in other mammals, overlapped. This causes the human upper airway to be longer and more flexible, which in turn allows the tongue to reside partially within the pharynx. This chamber allows for the refined vocalizations that separate humans from other mammals. Yet another change to our physiology is due to facial migration, or klinorhynchy, which is caused by our erect posture that moved our facial skeleton below the frontal region of the braincase, rather than in front of it.

Evolutionary changes in the human upper airway caused the human oropharynx, or space between the uvula and the epiglottis, to develop without specific musculature to dilate and maintain patency of the pharynx, unlike other mammals that have the musculature to exclusively maintain dilation of the pharynx.

pharyngeal anatomy chart chimp to human infant to human

When born, humans have the pharyngeal anatomy that most closely resembles the anatomy of the upper airway of non-human mammals. Human newborns do not yet have an oropharynx, and the epiglottis and soft palate overlap with the tongue anterior to the airway. This allows for newborns to simultaneously suckle milk and breathe. By the time a newborn is 18 months of age, the anatomy of the pharyngeal airway changes to more resemble that of an adult human, which gives them the ability to vocalize, but begins to inhibit their ability to suckle and breathe at the same time.

The development of the pharyngeal airway from the time of birth until 18 months later is the best time to possibly prevent or minimize sleep apnea in later years. Newborns do arrive with some genetic predisposition that affects their upper airway anatomy. However, environmental and functional forces also influence their morphologic development. There lies the window of opportunity parents have to help prevent sleep disordered breathing for that baby later on in life. 

natural breast feeding image

Breast-feeding encourages the proper development of the swallowing action of the tongue; promotes good teeth alignment and proper shaping of the hard palate. Studies have shown that bottle-feeding and pacifiers encourage the formation of a high palate and narrow arch, characteristics that are good predictors of sleep apnea. Broad palates and wide, U-shaped, uncrowded dental arches do not predispose to sleep apnea. Preventative measures can be taken to decrease the odds that your child suffers from sleep apnea. So consider the benefits of breast-feeding over bottle-feeding when possible, limit the use of commercial pacifiers, and control finger habits.

Let’s prevent sleep apnea, instead of just treating it. Share this article with moms who are expecting and new moms so they know how they can help prevent sleep apnea for their children.

Read the full article by Dr. Rogers titled, ‘Sleep, Breathing, and Orthodontics’ on the Pittsburgh Dental Sleep Medicine Website for more information and sources.

Is it Okay for Professional Drivers to be Drowsy on the Job?

Drowsy driving is detrimental for all drivers in general. No one should ever drive when they are at risk of falling asleep at the wheel. But what about when your income depends on it? What if you were tired much of the time, but your paycheck relied on you getting behind the wheel of a vehicle anyway? Is it okay for professional drivers to be drowsy on the job? The answer is simple -No.

Lets take a closer look at what drowsy driving does. We are all well aware of the dangers of drunk driving. However most people fail to realize that those much of those dangers carry over to drowsy driving as well. Like alcohol, drowsiness slows reaction time, impairs judgment, decreases awareness, and increasing your chance of getting in an accident.

Drowsy Drivers Should Not Drive Warning Sign Image

Drowsy driving as relating to professional drivers has been a topic of discussion for several years. In December of last year, the Metro North Railroad was derailed. The crash killed 4, and injured over 64 passengers on board. The train driver had become ‘dazed’ as the train went 82 mph around a 30 mph curve. The National Transportation Safety Board investigators faulted the train driver’s shifting work schedule for exacerbating his “undiagnosed severe obstructive sleep apnea (OSA).” Should train drivers have sleep disorders and still be trusted with the lives of everyone who rides the train? If riders knew that they would be traveling with a driver whose mental condition was equivalent to that of a drunk person, would anyone ride that train?

A recent article by Sleep Review Magazine explains who this issue effects; this should not be very surprising, but it effects everyone. “Obstructive sleep apnea has, is, and will continue to be an important issue for the commercial transportation industry, particularly trucking. Stakeholders include physicians, dentists, other healthcare providers, sleep testing and treatment facilities, equipment manufacturers, employers, payers, regulators, attorneys, society in general, and, most importantly, the drivers.”

According to the National Sleep Foundation, “Several states are considering legislation that would allow police to charge drowsy drivers with criminal negligence if they injure or kill someone while driving if they have not had adequate sleep.” But this does nothing about preventing the problem. According to Truck Driver Advocate Allen Smith, The FMCSA and the National Sleep Foundation have initiated an awareness campaign called “Get on the Road to Better Health: Recognizing the Dangers of Sleep Apnea. Currently, the FMCSA is only giving ‘recommendations’ and no legal procedures or mandates requiring sleep apnea testing for professional drivers. Expectantly, this will soon change.

 

Will the Popularity of Sleep Apnea Rise as the Baby Boomer Generation Grows Older?

Image of Baby Boomer Generation

The Prevalence of Sleep Apnea increases with the obese and aging populations.

With that being said, the American population of adults 65+ will increase from 13.5 million in 1991 to 21.8 million by 2020. This increases the 65+ age segment of the United States by about 61%. According to the variations of definitions for the Apnea Hypopnea Index (AHI), which is the number of apneas and hypopneas experienced by an individual per hour, 62% to 81% of the population will then suffer from Sleep Apnea. That means that about three quarters of the population will get insufficient sleep causing them to be more irritable, drive drowsy, and suffer from high blood pressure. Even worse, the condition of Sleep Apnea untreated, brings with it dire consequences such as; Diabetes, Stroke, Coronary heart disease and others.

In the recent article published by Dental Sleep Practice, Oral Appliance Therapy for the Edentulous PAP Intolerant Patient, John H. Tucker, D.M.D., discusses this issue in detail, and delves into the process of dentures and sleep apnea as he makes dentures to combat the issue of Sleep Apnea in the denture using population.

However, do not wait until you witness the dire consequences of sleep apnea in your parents and/or grandparents. Inform your loved ones about Sleep Apnea now, and get them help before the disease goes untreated and more problems occur. Take a step ahead and get your loved ones checked out with a sleep test, especially if they show side effects of Sleep Apnea already, such as snoring or fatigue.

 

I think I have Sleep Apnea: What should I do?

The best way to find out if you suffer from sleep apnea, is to complete a sleep study. A sleep study is just like it sounds, a test recording the activity of the body during sleep. For sleep apnea, Polysomnography sleep study records your brain waves, the oxygen level in your blood, heart rate and breathing, as well as eye, leg, chest and belly movements. Sleep studies can be conducted in a sleep lab, or even from home.

If you are not ready to conduct a sleep study just yet, you can also conduct some of your own tests to learn about your quality of sleep. Try answering the questionnaires below and see how you do to find out if you might want to complete a sleep study and start getting a good nights rest.

 

How does your Snore Score? 

1. Are you a loud and/or regular snorer?
2. Have you been observed to gasp or stop breathing during sleep?
3. Do you feel tired or groggy upon awakening, or do you awaken with a headache?
4. Are you often tired or fatigued during the wake time hours?
5. Do you fall asleep sitting, reading, watching TV or driving?
6. Do you often have problems with memory or concentration?

If you have one or more of these symptoms you are at higher risk for having obstructive sleep apnea. If you are also overweight, have a large neck, and/or have high blood pressure the risk increases even further.

If you or someone close to you answers “yes” to any of the above questions, you should discuss your symptoms with your physician or a sleep specialist. Or ask the American Sleep Apnea Association for more information on the diagnosis and treatment of sleep apnea. Different treatment options exist; which is right for you depends upon the severity of your apnea and other aspects of the disorder. Talk to your doctor about choices. Untreated, obstructive sleep apnea can be extremely serious and cannot be ignored.

 

 Epworth Sleepiness Scale
How likely are you to doze off or fall asleep in the following situations, in contrast to feeling just tired?

0 = would never doze off
1 = slight chance of dozing off
2 = moderate chance of dozing off
3 = high chance of dozing off

Situation:
Sitting and Reading:____
Watching TV: ____
Sitting inactively in a public place (movies, theater, meeting):____
Sitting in a car as a passenger for over an hour (no break):____
Sitting and talking to someone:____
Sitting quietly after lunch (no alcohol):____
In a car, stopped in traffic for a few minutes:____

If you answered these with scores of 1 or more, give Pittsburgh Dental Sleep Medicine a call and find out if you should get a sleep study.

An Overview of Sleep Medicine, an instructional CD by Jonathan Parker great resource for lecturers of Dental Sleep Medicine

Post is written By Dr. Rogers, D.M.D.

 

 

A good friend of mine, Dr. Jonathan Parker, has produced an incredible instructional CD entitled An Overview of Sleep Medicine. For all of us who lecture often about dental sleep medicine, this wonderful CD offers us a resource to present the nuts and bolts of sleep medicine in a whimsical yet very effective manner. I use it on a regular basis when I lecture and was flattered to be able to write a review/testimonial touting its merits. This CD is also very useful for the traditional dental office wishing to educate themselves and staff regarding the basics of sleep medicine which affects us and our patients. The format of the CD is the trendy, effective style consisting of narration on top of an animated hand penning graphic representations of the concepts presented. Dr. Parker begins with an explanation of normal sleep and its importance to us all. Sleep is a complicated physiological process which forms the basis of our overall health and well-being. Healthy sleep is much like a roller coaster for your brain during the night. Following a short wakeful period the brain relaxes and falls into stage one sleep which should occupy roughly 5% of the night. Shortly thereafter the brain should slip a little deeper into stage two sleep which should comprise roughly 50% of the night. Stages one and two sleep are considered “light” sleep and are necessary components of healthy sleep but not necessarily refreshing or regenerative. A little while later on the brain will slip into stage three sleep which is considered “deep” sleep and the most refreshing stage of sleep.  This deep sleep should occupy approximately 20% of the night. Throughout the night, the brain should cycle in and out of REM sleep (rapid eye movement sleep) 4 or 5 times and comprise 25% of the night. REM sleep is where dreaming takes place. Normally, the brain cycles through all this sleep stages over and over givingrise to the term “sleep architecture”. When the proportions of sleep staging is interrupted by snoring or obstructive sleep apnea, our health and well-being can be negatively affected.

 

Check out a clip from the CD here.