Risky Combo Sleep Apnea and Daytime Sleepiness

Older adults who have sleep apnea and who are excessively sleepy in the daytime may have more than twice the risk of death as people who do not have both conditions, new research suggests. In a study of 289 adults over age 65 without depression or dementia, the risk of death was not Increased for people with sleep apnea without excessive daytime sleepiness or for those who reported only excessive daytime sleepiness without having sleep apnea, the researchers say.

Older adults who sleep apnea and are chronically tired during the day could be at more than double the risk of death as individuals who do not have these conditions indicate new findings. In a survey of 289 adults over the age of 65 without depression or dementia, there was no rise in the risk of death for people with sleep apnea without excessive daytime sleepiness or for those who indicated excessive Daytime sleeplessness, the researchers claim, without sleep apnea.


"Excessive daytime sleepiness, when associated with sleep apnea, can significantly increase the risk of death in older adults," study researcher Nalaka S. Gooneratne, MD, MSc, of the University of Pennsylvania Health System in Philadelphia, says in a news release. "We did not find that being sleepy in and of itself was a risk. Instead, the risk of increased mortality only seemed to occur when sleep apnea was also present."

"Excessive daytime sleepiness can dramatically increase the risk of death in older adults when combined with sleep apnea," Study Researcher Nalaka S. Gooneratne, MD, MSc, Philadelphia University of Pennsylvania Health System, says in a news release. "We didn't think it was a concern to be sleepy in and of itself. Rather, the concern of increased mortality only occurred while sleeping Apnea was there, too.


*Sleep Apnea and Excessive

Daytime Sleepiness*

* Apnea and Excessive Sleep

Sleepiness for the day *


Both sleep apnea and excessive daytime sleepiness are common problems, with sleep apnea affecting up to 20% of older adults. Excessive daytime sleepiness affects 10% to 33% of the elderly, the researchers write, and this problem often is viewed as a normal result of getting older. But previous studies have shown that people who are overly sleepy in the daytime have an increased incidence of falls, functional impairment, and cognitive deficits.

Both sleep apnea and prolonged daytime sleepiness are common issues, with up to 20 percent of older adults suffering from sleep apnea. Excessive daytime sleepiness affects 10% to 33% of the elderly, researchers note, and this problem is mostly seen as a natural product of growing older. Yet previous research found that people who are excessively tired during the day had an increased rate of falls, Functional disability, and cognitive deficiency.


The most common form of sleep apnea is obstructive sleep apnea, which occurs when soft tissue in the back of the throat collapses, blocking the upper airway during sleep.

The most common type of sleep apnea is obstructive sleep apnea that occurs when soft tissue collapses in the back of the throat and blocks the upper airway while sleeping.


Older people are also at risk for a condition called central sleep apnea, which involves a repetitive absencenof breathing effort during sleep that is caused by a problem in the brain.

Older people also face a disorder called central sleep apnea, which includes a repeated absence of breathing activity during sleep caused by a brain malfunction.


Researchers say only 4% of participants in the study had this condition, and there was no meaningful changenin study results when this information was excluded from the analysis.

Researchers state only 4 percent of study participants had this disorder, so when this knowledge was omitted from the research, there were no significant findings of the changenin sample.


Looking for Clues on Sleep Apnea Risks

In the study, 74% of participantsnwere female. The mean age of participants at the start of the study was 78.

Search for Sleep Apnea Risks Clues

74 per cent of participants are female in the sample. At the start of the study the mean age of the participants was 78.


About half of participants had significant levels of excessive daytime sleepiness and reported that they felt sleepy or struggled to stay awake during daylight hours at least three tonfour times per week.

Around half of the participants had moderate levels of extreme daytime sleepiness and reported feeling exhausted or struggling to stay awake at least three ton-four days a week during daylight hours.


Sleep apnea testing was performed at night in a sleep lab.

Sleep apnea monitoring was conducted in a sleep lab at night.


Participants in the study were recruited between 1993 and 1998. Survival status was determined bynsearching the Social Security death index, ending Sept. 1, 2009.

The study participants were recruited in the period from 1993 to 1998. The state of survival was determined by checking the Death Index of Social Security, ending Sept. 1, 2009.


The study says 160 people, or 55% of the participants, died during an average follow-up period of 14 years.

The study says that 160 men, or 55 percent of participants, died during an average 14-year follow-up.


Those participants who had both sleep apnea and excessive daytime sleepiness had a risk of death that was more than two times higher than those who did not have the combination of these conditions.

Those participants who had both sleep apnea and extreme daytime sleepiness had a chance of death which was more than twice as high as those who did not have these conditions combined.


The researchers say It's unclear just why sleep apnea combined withnexcessive daytime sleepiness may increase the death risk of older adults.

The researchers conclude why sleep apnea coupled with prolonged daytime sleepiness can increase the risk of death for older adults is unclear.


Obstructive sleep apnea generally is treated with a device that provides a steady stream of alr through a mask that is worn at night during sleep. This is known as CPAP therapy.

Obstructive sleep apnea is usually handled with an device that delivers a continuous stream of alr through a mask that is worn during sleep at night. It is called CPAP treatme


The study is published April 1 in the

journal SLEEP.

*Clues You Might Have

Obstructive Sleep Apnea*

The report will be released in April 1

SLEEP Journal.

* Clues You Might Have

Obstructive Apnea to Sleep *


Do you wake up in the morning with a headache, feeling Just as tired as when you went to sleep? Has your spouse moved to the room next door, exhausted by listening to you snore, gasp, and choke every night?

Wake up with a headache in the morning, feeling as exhausted as you went to sleep? Has your spouse moved to the next door space tired from listening every night to you snore, sigh and choke?


If so, you may have obstructive sleep apnea (OSA) - a condition where the upper passages of your airway close off, interrupting your breathing and depriving you of oxygen until you wake up and start breathing again. Sleep apnea affects more than 18 million American adults.

If so, you may have an obstructive sleep apnea (OSA)-a disorder in which your airway 's upper passages close, disrupt your breathing and deprive you of oxygen before you wake up and start breathing again. More than 18 million American adults are affected by Sleep apnea.


How can you tell if you have sleep apnea? The only real way is to have a sleep study, a test that records what happens while you sleep. But there are some common signs of sleep apnea, experts say,

What do you say if apnea sleeps? The only other way to do this is to do a sleep analysis, a test this tracks what's going on when you sleep. Yet, experts note, there are some common symptoms of sleep apnea,expert say,


Sleep Apnea Signs:

Snoring. Gasping, Sleepiness

The three main warning signs of obstructive sleep apnea are:

• Loud, persistent snoring

• Pauses in breathing, accompanied with gasping episodes when sleeping

•Excessive sleepiness during waking hours

Should everyone who snores see a sleep specialist? No, say the experts.


The signs of Sleep Apnea:

Rumming. Gasped, Exhausted

The three primary signs of obstructive sleep apnea are:

• Strong, persistent snoring

• Breathing delays followed by gasping episodes during sleep

•Overly tired during waking hours

Anybody who snores should see a sleep specialist? No, the Experts say.


"Most people who snore don't have obstructive sleep apnea, but most people who have apnea snore," says Robert L. Owens, MD, of the Sleep Disorders Research Program at Brigham and Women's Hospital in Boston. If you have chronic snoring that is loud enough to wake a bed partner, talk to your doctor.

"Many people who snore don't have obstructive sleep apnea but even people who have apnea snore," says Robert L. Owens, MD of the Brigham and Women's Hospital's Sleep Disorders Research Program in Boston. Speak to the doctor if you have constant snoring that is loud enough to wake a friend in bed.


Like snoring, the most definitive sign of sleep apnea - waking up to breathe - is often witnessed by a bed partner. People with sleep apnea frequently wake up for a few seconds to gasp for air. This can happen hundreds of times a night in people with severe sleep apnea, Owens says.

Much like snoring, a bed partner also experiences the most obvious symptom of sleep apnea-waking up to breathe. People who have sleep apnea sometimes wake up to gasp for air for a few seconds. This can happen in people with serious sleep apnea hundreds of times a night, Owens says.


"If someone witnesses you waking up repeatedly at night, it's very suggestive of obstructive sleep apnea." he tells WebMD. "Increasingly, I get wives who come in with little movies on their cell phones that show what their husband looks like at night. That's very convincing."

"When someone sees you waking up repeatedly at night, the obstructive sleep apnea is rather suggestive," he tells WebMD. "I'm constantly having wives who come in on their mobile phones with little videos of what their husband looks like at night. That's really compelling."


If you don't have a bed partner to catch your gasping or snoring on camera, the only signs of sleep apnea you may notice are morning headaches or extreme sleepiness during the day, says Lisa Shives, MD, medical director of Northshore Sleep Medicine in Evanston, |||.

When you don't have a bed buddy to catch your gasping or snoring on tape, the only symptoms of sleep apnea you may find are headaches in the morning or intense daytime sleepiness, says Lisa Shives, MD, Northshore Sleep Medicine Medical Manager in Evanston,.


Sleep specialists use the Epsworth Sleepiness Scale to measure daytime sleepiness. People with extreme sleep apnea are likely to doze off in the middle of meals or conversations, Shives tells WebMD. Moderate daytime sleepiness, such as the desire to take an afternoon nap, doesn't necessarily mean you have obstructive sleep apnea,

Sleep specialists assess daytime sleepiness with the Epsworth Sleepiness Scale. Individuals with serious sleep apnea would typically linger in the middle of meals or interactions, Shives tells WebMD. Moderate daytime sleepiness, such as an afternoon nap, doesn't automatically mean you have an obstructive apnea for sleep,


Other Signs of Sleep Apnea: Mouth Breathing and Excessive Urination If you wake up with a very dry mouth and gummy front teeth, it may also be a sign of sleep apnea, Shives says. “My little phrase is, 'It's very hard to gasp through your nose.' People who have obstructive sleep apnea tend to sleep with their mouths open."

Some Sleep Apnea Signs: Mouth Breathing and Excessive Urination When you wake up with a really dry mouth and gummy front teeth, that may also be a symptom of sleep apnea, Shives notes. "My little saying is, 'The nose is very hard to breathe.' People with obstructive sleep apnea prefer to sleep with their mouths open."


After treatment with continuous positive airway pressure (CPAP) devices - the gold standard for treating sleep apnea - patients keep their mouths closed at night, Shives says.

After continuous positive airway pressure ( CPAP) monitoring systems-the gold standard for sleep apnea care-patients keep their mouths closed at night, Shives says.


A less common symptom of sleep apnea is waking up frequently with a desperate need to urinate. When a person's breathing is disrupted, it puts pressure on the heart.

A less common sleep apnea symptom often awakens with a urgent urinating need. If it disrupts a person's breathing, it puts pressure on the heart.


This, in turn, affects a hormone that normally controls urine production in the kidneys, says Vishesh K. Kapur, MD, MPH, medical director of the Sleep Institute at the University of Washington in Seattle. "This tends to occur when obstructive sleep apnea is really extreme," Kapur tells WebMD.

This, in effect, affects a hormone that usually regulates urine output in the kidneys, says Seattle University of Washington's Vishesh K. Kapur, MD, MPH, medical director of the Sleep Institute. "It appears to happen when there is very serious obstructive sleep apnea," Kapur tells WebMD.


Once you treat the apnea. Shives says, "This problem is immediately eradicated."

If you get the apnea diagnosed. Shives says "This problem is being eradicated immediately."


Some other symptoms – such as lower pain threshold, mood changes or irritability, depression, or problems concentrating - often show up in people with obstructive sleep apnea. But they aren't particularly good diagnostic hints, Kapur says, because they are associated with so many other problems and conditions.

Many other symptoms-such as lower pain threshold, changes in mood or irritability , fatigue, or attention issues-also occur in people with obstructive sleep apnea. But they aren't especially strong diagnostic indicators, says Kapur, since they are correlated with so many other problems and conditions.


Obstructive Sleep Apnea: 5 SelfCare Strategies

Here are the five self-care strategies most often recommended by experts for coping with sleep apnea.

Sleep Apnea Tip 1: Lose Weight if You Need to

Obstructive Sleep Apnea: 5 Techniques on SelfCare

Below are the five self-care approaches that doctors most often prescribe for dealing with sleep apnea.

Apnea Sleep Tip 1: Lose Weight If You Need


Obesity is considered the most important risk factor for obstructive sleep apnea. Research has shown that weight loss - even a modest amount can improve sleep apnea. Not all people with sleep apnea are overweight or obese, but many are.

Obesity is known as the most important risk factor for obstructive sleep apnea. Research has shown weight loss-only a small amount of sleep apnea will improve. Not every person with sleep apnea is overweight or obese but there are many.


In a Finnish study published in 2010, 71 people with sleep apnea were given lifestyle counseling or participated in a lifestyle modification program that included a 12-week low-calorie diet. On average, those in the weight loss group shed 16 pounds. After two years, their sleep apnea was much less severe than the sleep apnea in then lifestyle counseling group.

In a Finnish study published in 2010, lifestyle therapy was provided to 71 people with sleep apnea, who enrolled in a lifestyle change plan that included a low-calorie diet for 12 weeks. An average those shed 16 pounds in the weight loss category. In the then lifestyle therapy community, their sleep apnea was much less extreme after two years than the sleep apnea.


AU.S. study published in 2009 looked at the effect of weight loss on obstructive sleep apnea among obese people with type 2 diabetes. The people in then study were assigned to either a weight loss group or a diabetes management group over a one-year period. On average, those in the weight loss group lost nearly 24 pounds, while those in the second group lost just 1.3 pounds.

U.S. The 2009 research investigated the impact of weight loss on obstructive sleep apnea among obese subjects with type 2 diabetes. The participants in the then study were allocated over a one-year cycle either to a weight loss group or to a diabetes management group. People in the weight loss category lost an total of almost 24 pounds, while those in the second group lost only 1.3 pounds.


The effects of losing weight were even more dramatic in this study. Three times as many people in the weight loss group wound up with no symptoms of sleep apnea at all. And among the people in that group who still had sleep apnea, it was much less severe after losing weight.

For this research , the results of weight-loss were much more drastic. Three times as many people ended up in the weight loss category, with no sleep apnea symptoms at all. And among the people in that category who still had sleep apnea after losing weight, it was much less serious.


Sleep Apnea Tip 2: Limit Alcohol

and Stop Smoking

You already know that smoking and drinking too much alcohol are hazardous to your health. Did you know they can also make your sleep apnea symptoms worse? Cigarette smoking makes the swelling in your upper airway worse. That can aggravate symptoms such as snoring and pauses in breathing. Alcohol decreases the muscle tone in the back of the throat, which can interfere with breathing - the last thing you need when you already have breathing problems.

Sleep Apnea Tip 3: Eat Healthy

Apnea Sleep Tip 2: Limit Alcohol

Just Don't Smoke

Smoking and drinking too much alcohol are both proven to be dangerous to your health. Do you know that they can make the symptoms of sleep apnea worse too? Smoking cigarettes worsens the swelling of the upper airway. This may intensify complaints including snoring and breathing delays. Alcohol decreases muscle tone at the back of the throat,This can mess with the breathing-the last thing you need if you have breathing issues already.

Apnea Sleep Tip 3: Stay Good


 Like everyone else, people with sleep apnea should eat a healthy diet. But people with sleep apnea may be more likely to eat unhealthy foods, some research suggests.

Those with sleep apnea should eat a balanced diet just like anyone else. Yet people with sleep apnea may have greater risk of consuming unhealthy foods, some research suggests.


Sleep deprivation may lead to increased cravings for carbohydrates. Sleep deprivation and fatigue have also been linked with changes in the appetite regulators leptin and ghrelin, which control feelings of hunger and fullness. When you don't sleep, you may want to eat more and feel less satisfied when you do.

Sleep deprivation may result in increased carbohydrate cravings. Sleep deprivation and tiredness were also related to changes in the leptin and ghrelin appetite regulators, which regulate feelings of hunger and fullness. You may want to eat more when you don't sleep, and feel less relaxed when you do.


You don't need to be overweight to have an unhealthy diet. In a 2008 study of 320 adults, those with more severe sleep apnea ate more protein, fat, and saturated fatty acids than those with the less severe sleep apnea, regardless of how much they weighed.

You don't have to be overweight in order to get a healthy diet. Those with more extreme sleep apnea ate more protein , fat, and saturated fatty acids in a 2008 study of 320 adults than those with the less severe sleep apnea, regardless of how much they weighed.


Sleep Apnea Tip 4: Tend to Your Allergies

Apnea Sleep Tip 4: Control The Allergies


Not surprisingly, being stuffed up from nasal allergies can complicate sleep apnea and make sleep more difficult. To understand why, picture your airway as a long, muscular tube running from your nose to your windpipe. If your allergies are not under control, the tissues of the upper throat swell and narrow the airway. And that can make breathing more difficult.

Not surprisingly, being filled up with nasal allergies will complicate sleep apnea and make it harder to sleep. Imagine your airway as a long, muscular tube stretching from your nose up to your windpipe to understand why. When the allergies are not managed, the upper throat tissues swell, and the airway narrow. And that can make it harder to breathe.


If you have sleep apnea and nasal allergies, be sure your allergies are under control. A saline nasal spray before bed may also help.

If you have sleep apnea and allergies to the nasal system , make sure the allergies are under control. A saline nasal spray in front of bed will help too.


Sleep Apnea Tip 5: Develop a Good Sleep Routine
Getting enough sleep is important to staying healthy with obstructive sleep apnea.

Tip 5 Sleep Apnea: Build a Healthy Sleep Routine
Having enough sleep with obstructive sleep apnea is critical for staying healthy.


The catch, of course, is that sleep apnea makes it diMcult to get good sleep. A variety of devices designed to improve breathing for people with sleep apnea - including a CPAP or continuous positive airway pressure machine - can help. About half of the people with apnea have most of their breathing abnormalities while sleeping on their backs, sleep experts have found. So most doctors encourage people with sleep apnea to try to sleep in other positions.

The catch, of course, is that sleep apnea makes healthy sleeping a diMcult. A range of equipment designed to improve breathing for people with sleep apnea-like a CPAP or continuous positive airway pressure machine-can be of assistance. Approximately half of people with apnea experience much of their breathing problems while lying on their backs, sleep experts report. But most doctors cheer on Persons with sleep apnea trying to sleep in various places.