Progress 2022: Sleep disorders affect overall health

Apr. 2—ASHLAND — Fitness conjures images of intense exercise, water drinking and high-protein diets.

But something that's just as important to good health is good sleep. That's not as easy to get as you might think.

As many as 70 million U.S. citizens have some form of sleep disorder. The most common in eastern Kentucky is obstructive sleep apnea, which means a structural problem in the airways causes breathing interruptions during sleep, according to Dr. Sabrina Roberts, at King's Daughters Medical Center. Roberts is a pulmonologist who works with the hospital's sleep center.

"Obstructive sleep apnea may cause snoring, difficulty breathing, daytime fatigue, memory impairment," Roberts said, noting there are other sleep disorders, but the sleep center focuses on the ones involving breathing issues.

Those with sleep apnea don't get enough oxygen during sleep. They wake often because their breathing stops. However, the patient might not be conscious of those activities, pulmonologist Scott Nelson, also with KDMC, said.

"It's often the bed partner who realizes there's a problem," Nelson said. "The bed partner is the one who hears the snoring and gasping for air and the stopping of breathing."

It's not just about being a pleasant person with whom to share a bed. Roberts said a low oxygen level in the bloodstream can be life-threatening and puts the sufferer at risk for heart attack and stroke.

Nelson pointed out studies show it's not unusual for heart attack or stroke-related death to occur between 2 and 4 p.m. and it's thought to be related to sleep apnea. It also can lead to infertility, diabetes and heart disease.

Symptoms of sleep apnea include low energy, fatigue, napping at inappropriate times, waking frequently at night, teeth grinding during sleep and difficulty focusing. Nelson said in extreme cases, blood work can reveal a high red blood cell count because of a lack of oxygen.

Obesity is often blamed for sleep apnea, but it's not always the cause.

"Obesity is not necessarily the common variable here," Nelson said. "There are lots of individuals who are quite thin and still have it."

Apnea is more common in men, but Roberts said women tend to be diagnosed too late, and they often don't meet the threshhold of waking five times in an hour, but still live with the symptoms.

"There is going to be a lot of conversation going forward about how we're going to measure it," Roberts said. "We're missing those patients who don't qualify."

An accurate measure of the number of waking episodes a patient has is measured at the sleep center in a typical bedroom setting. Heart rate, oxygen levels and limb movements are monitored. An electroencephalogram detects abnormalities in brain waves; the patient wears electrodes on the scalp to track sleep events to help with the diagnosis.

"Sleep apnea patients don't have problems falling asleep with all the monitoring equipment," Nelson said. "Those who are face or stomach sleepers might have some difficulty adjusting to the monitoring equipment, but all they have to do is sit there, maybe watch a little TV and at your regular sleep time, turn the lights out and go to sleep."

The most common treatment for sleep apnea is the use of a CPAP machine, which delivers continuous air pressure to keep the airways open and puts an end to stops in breathing while asleep. Patients wear a mask over their mouth and nose to direct the air pressure into the throat.

Roberts said some patients are candidates for surgery and some dentists in the area can make an apparatus to wear during sleep to open the airways.

"Weight loss is an option," Nelson said. "We encourage them to get to their ideal body weight and, for some, that works."

A BiPAP, which provides pressure for inhalation and exhalation, may be used with patients who have respiratory failure complicated by apnea, but, Nelson said, the CPAP is the gold standard for apnea patients.

Roberts encourages those who suspect they have a sleep disorder such as apnea to seek help.

"Although we don't know why we sleep, we do know that deprivation contributes to many chronic medical conditions," she said. "I encourage a consistent sleep schedule and get ample amounts and, if you recognize a problem, seek help."

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