Snoring and Sleep Apnea

ZZZZzzzzzzzZZZZZZZ ...

In 1910 the average amount of sleep was nine hours a night. Today, it’s just seven. Over 100 million Americans snore. The record snore came from Melvin Switzer who topped 92 decibels, according to Guinness. (Heavy traffic is 80dB!)

Seriously, though, sometimes snoring is associated with sleep apnea (AP-knee-ah). That means breathing stops, sometimes for minutes. As the body uses up remaining oxygen, the chemistry of the blood can change, and pretty soon the heart beats irregularly.  And at least 12 million people have frank apnea.  Others simply experience high upper airway resistance and compromised breathing.

People with sleep apnea have stiffer arteries and are subject to high blood pressure. 

Next stop: heart attack.

Nice video on Obstructive Sleep Apnea from Dr. Bill Hang.  No, surgery and orthodontics are not the only way to manage this very serious problem, but it's nice to have them in our armamentarium!

CLICK HERE FOR APNEA VIDEO

New research at UCLA also notes that, when people strain to breathe and break the logjam in their throat, blood pressure goes way up. This, in turn, damages the inside of the lining of the vessels in the neck.

CPAP machines can be lifesaving if you have compromised breathing when you sleep...but...

Sick of wearing the cumbersome CPAP device every night?

Prevent closure of the breathing passages with a simple oral appliance.

The next thing we know these people have little sores on the inside of their arteries. This is where things stick and build up the clog that stops up blood flow inside the arteries.

This can lead to strokes. Interestingly, people who have sleep apnea have ten times the amount of clogged arteries in their necks.

We can often help with special appliances designed to keep the airway open.

Snoring--You May Need Evaluation

Here are just SOME of the things we look at when we do an evaluation for possible sleep apnea:

• reports of snoring or stopping breating while asleep
• reports or evidence of acid coming up into the throat or mouth (GRD)
• a neck size over 17"
• a recessive jaw
• deep overbite
• scalloping on the side of the tongue
• enlarged tonsils
• a high, arched palate (roof of the mouth)
• allergies
• high blood pressure
• high body mass index--over 30
         calculate your own BMI: http://www.nhlbisupport.com/bmi/
• a closed posterior of the mouth
• space under your chin less than about a half inch
                  
• ...and more...

But...you may very well need proper analysis by a physician for this potentially life-threatening condition.  This could involve a POLYSOMNOGRAM, a testing procedure that can really analyze what goes on when you're sleeping.

NOTE: the damage from sleep apnea is NOT just seen in people with ongoing health problems.  Apnea increases risk of death even in the apparently healthy.

Sleep Apnea and GRD

A surprising number of people stop breathing while they sleep.  this can happen hundreds of times a night.  It interrupts rejuvenating deep sleep and can lead to changes in the blood.

These changes can lead to heart damage or even heart attack.

And, when the victim awakens to the restriction in breathing, it brings them into the lighter levels of sleep where clenching and grinding can go on big time.

And think of what goes on when your throat is closed off and you are trying to suck in air.  That results in a big negative pressure--suction-- in the chest cavity.  This can, in turn, draw the contents of the stomach up into the esophagus and lead to heartburn.

This is often labeled GRD, gastric reflux disease.

Bring up acid into the esophagus long enough and the next thing you know, you have a cancer going there.

What's more, if the acid comes up into the mouth, it can literally MELT the teeth.

And sometimes it all works backwards.  First, someone has acid come up into the esophagus and then into the throat.  Next, their airway closes down in an attempt to protect itself.  And, of course, at this point they're awake enough to do more damage by clenching and grinding.

If you suspect you have either GRD or Sleep Apnea, it is imperative that you contact your physian!  Most responsible docs will then order a sleep study.  We have a great sleep center nearby at the Pomona Valley Hospital.

What is a polysomnogram?  Click here

Good news: we now have a service that will send a technician to your home to perform the sleep study, rather than having to go into the strange surroundings of a sleep center.

What's more, there are a number of new, portable home sleep recorders coming on the market.  You simply hook yourself up to a few sensors and go to sleep.  Meanwhile, the system records how often you stop breathing, how much oxygen your system is taking in, and whether you are snoring.

Thanks to colleague Kent Smith for his good counsel in this field.

Life Threatening

A recent fourteen-year study of moderate sleep apnea victims showed that a third had died by the end of the study. 

Those diagnosed as only mild apneics showed a much smaller death rate: 6 percent.

Sleepiness and Car Accidents

People with sleep apnea have at least TWO TIMES the risk of car accidents and three to five times the risk of a SERIOUS car crash involving personal injury:

http://sleepwellandlive.wordpress.com/2008/02/14/people-with-sleep-apnea-at-increased-risk-for-auto-accidents/

Take the Epworth Sleepiness Test: click here

What does it mean?

You MIGHT have sleep apnea.

NOTE: It's NOT just about preventing life-threatening apneas.  Your dentist can frequently help cut down on snoring and improve the over-all QUALITY of your body-restoring rest.  And that can go a long way to improving the quality of life.

Women Who Snore

Snoring is considered by many to be a man's problem, or at least more prominent and dangerous for men. Not so. An estimated 19% of women also snore, and are just as prone to developing snoring related complications as are men. Sleep apnea, closely allied to snoring, can strike people of either sex.

Women, however, have their own complications with which to cope. A news story dated April 27, 1999 reports that snoring is also associated with high blood pressure in pregnancy, and high blood pressure leads to a more serious problem known as pre-eclampsia.

There are indications that partial obstruction of upper airway passages may be the cause of the night time increase in blood pressure that causes the more serious pre-eclampsia. If not controlled, it may be necessary to hospitalize the patient to protect mother and child.

In a recent study, a group of women suffering from pre-eclampsia were put on CPAP(positive pressure ventilator), with the majority experiencing a marked reduction in blood pressure levels.

Several things contribute to snoring, such as smoking, weight, high cholesterol and sleeping on the back. Hormones and oral contraceptives also play a part in this dangerous mix.

Women who snore have a higher risk of hypertension and heart disease. The probable cause of these complications is a reduction in blood oxygen. Women who snore, therefore, should seek medical advice, and, if deemed necessary, take part in a sleep study. this is even more urgent during pregnancy.

 Dentists: contact us for a comprehensive continuing  education video program on sleep apnea.                

Review a sleep questionnaire:

1) What time do you typically go to bed? ______________   When do you typically wake up to start your day? ___________

2) Do you have difficulty falling asleep at the beginning of the night?                                                                                     Yes    No

      If yes, on average how long does it take to fall asleep?   _________

3) Do you have difficulty staying asleep throughout the night?                                                                                                  Yes    No

       If yes, how many times do you wake up during the night? _______

             How long does it take you to fall back to sleep?   ________

4)  Do you experience an unsettled, restless sensation in your legs while lying in bed?                                       Yes    No

         If yes, how frequently?   Occasionally,  About 50% of the time,  Almost every night. 

5) Have you been told that you make kicking and twitching movements while asleep?                                                        Yes    No

6) Do you snore at night?                                                                                                                                                     Yes    No

       If yes, how would you rate the severity?   Mild      Moderate    Severe

7) Have you been told that you have pauses in your breathing while asleep?                                                                          Yes    No

8) Does your bed partner frequently sleep in another room because of how you sleep?                                                     Yes    No

9) Circle those statements that apply to you:

     Do you frequently wake up with    -a dry mouth   -headaches   -excessive sweating  

        -Choking or gasping    -nasal congestion   -chest pain   -heart burn   - drooling on the pillow 

10) Are you sleepy during the day?                                                                                                                                     Yes    No

11) Do you take naps often, and if so for how long?             _______________________                                                  Yes    No

12) How many caffeinated beverages do you consume each day? ____________________

13)  Do you occasionally awaken feeling paralyzed?                                                                                                  Yes    No

14) Do you experience sudden loss of strength in your legs or arms during the day?                                         Yes    No

           If yes, are these brought on by a sudden frightening event or laughter?                                                     Yes    No

-----------------------------------------------------------------------------------------------------------------------------------------------------------------

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

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

             Situation                                                                                                                            Chance of dozing

Sitting and reading                                                                                                                                0                1                2                3

Watching TV                                                                                                                           0                1                2                3

Sitting, inactive in a public place (i.e. theater)                                                              0                1                2                3

As a passenger in a car for an hour without a break                                                  0                1                2                3               

Lying down to rest in the afternoon when circumstances permit                            0                1                2                3   

Sitting and talking to someone                                                                                         0                1                2                3

Sitting quietly after lunch without alcohol                                                                    0                1                2                3

In a car, while stopped for a few minutes in the traffic                                              0                1                2                3               

Please list your MEDICATIONS in the space below:                                                                                                                        

Please list your MEDICAL CONDTIONS PAST and PRESENT and any sleep problem not covered with the questions above.

Berlin Questionnaire (for sleep apnea)

Height (m) ________ Weight (kg)________ Age______ Male / Female

(used to computer body mass index)

Please choose the correct response to each question.
CATEGORY 1
1. Do you snore?

a. Yes

b. No

c. Don’t know
If you snore:
2. Your snoring is:

a. Slightly louder than breathing

b. As loud as talking

c. Louder than talking

d. Very loud – can be heard in adjacent
rooms
3. How often do you snore

a. Nearly every day

b. 3-4 times a week

c. 1-2 times a week

d. 1-2 times a month

e. Never or nearly never
4. Has your snoring ever bothered other
people?

a. Yes

b. No

c. Don’t Know
5. Has anyone noticed that you quit
breathing during your sleep?

a. Nearly every day

b. 3-4 times a week

c. 1-2 times a week

d. 1-2 times a month

e. Never or nearly never

CATEGORY 2
6. How often do you feel tired or fatigued
after your sleep?

a. Nearly every day

b. 3-4 times a week

c. 1-2 times a week

d. 1-2 times a month

e. Never or nearly never
7. During your waking time, do you feel
tired, fatigued or not up to par?

a. Nearly every day

b. 3-4 times a week

c. 1-2 times a week

d. 1-2 times a month

e. Never or nearly never
8. Have you ever nodded off or fallen asleep
while driving a vehicle?

a. Yes

b. No
If yes:
9. How often does this occur?

a. Nearly every day

b. 3-4 times a week

c. 1-2 times a week

d. 1-2 times a month

e. Never or nearly never

CATEGORY 3
10. Do you have high blood pressure?

Yes

No

Don’t know

Scoring Berlin questionnaire

Categories and scoring:
Category 1: items 1, 2, 3, 4, 5.
Item 1: if ‘Yes’, assign 1 point
Item 2: if ‘c’ or ‘d’ is the response, assign 1 point
Item 3: if ‘a’ or ‘b’ is the response, assign 1 point
Item 4: if ‘a’ is the response, assign 1 point
Item 5: if ‘a’ or ‘b’ is the response, assign 2 points
Add points. Category 1 is positive if the total score is 2 or more points
Category 2: items 6, 7, 8 (item 9 should be noted separately).
Item 6: if ‘a’ or ‘b’ is the response, assign 1 point
Item 7: if ‘a’ or ‘b’ is the response, assign 1 point
Item 8: if ‘a’ is the response, assign 1 point
Add points. Category 2 is positive if the total score is 2 or more points
Category 3 is positive if the answer to item 10 is ‘Yes’ OR if the BMI of the
patient is greater than 30kg/m2.
(BMI must be calculated. BMI is defined as weight (kg) divided by height (m)
squared, i.e., kg/m2).
High Risk: if there are 2 or more Categories where the score is positive
Low Risk: if there is only 1 or no Categories where the score is positive
Additional question: item 9 should be noted separately.

Listen to Need for Sleep Radio:

http://www.need4sleepradio.com/staff.htm

Sleep problems are reported by:

• 82% of those diagnosed with depression
• 81% who have suffered a stroke
• 76% being treated for heart disease
• 75% diagnosed with lung disease
• 72% being treated for diabetes or arthritis
• 71% of those diagnosed with hypertension

We are lucky to have some physician resources in our area:

Click here- The Snoring and Apnea Center of California is a medical practice dedicated to the evaluation and treatment of snoring and sleep apnea. Visit www.snoring911.com (what a great name!)

   ---------------

New Millennium Diagnostics can actually send someone to your home, so you can get your testing done while sleeping in your own bed, in a much more private setting: 949-813-5805

   ---------------

Local polysomnogram sleep study: Sleep Disorders Center 1011 N Euclid Ave, Upland    call 866 753 3762  

See www.SleepDisordersCenterInc.com.

We are a proud member:

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Do you think I'm sexy?

  MSNBC.com

Apnea aid raises doubts Hoses, masks and whirring noises make CPAP romance a little challenging

By JoNel Aleccia
Health writer
MSNBC
updated 9:39 p.m. ET, Thurs., March. 20, 2008
Babbett Peterson thought there was nothing less sexy than her husband's snoring - until he brought home the cure.

The 47-year-old Trabuco Canyon, Calif., woman took one look at the plastic face mask, the long tubing and the whirring motor that ran all night and decided there were worse things than a few snuffles and snorts.

As far as she was concerned, the Continuous Positive Airway Pressure machine - known as a CPAP - was a threat to her 22-year marriage.

"Things were great in the bedroom," Peterson said. "Then there was this thing strapped to his head."

Peterson and her husband, Chris, a 47-year-old engineer, are among growing numbers of couples whose romantic lives have been derailed by sleep problems - or their solutions.

Bedtime troubles send three in 10 couples to separate rooms, according to a poll by the National Sleep Foundation, a nonprofit agency. About a quarter of people with partners and 10 percent of singles said sleep problems left them too tired for sex.

Snoring is the most obvious interference, sleep experts say, but some users contend that the most commonly prescribed cure - the CPAP machine - can put an even bigger damper on libido.

"It's a huge emotional loss," said Peterson, who works as an executive assistant. "I am a cuddler. I felt like I couldn't touch him."

Peterson's opinion isn't the most popular view in the online support group at www.sleepapnea.org, the Web site aimed at people who suffer from the serious sleep disorder that advocates say involves so much more than snoring.

People with obstructive sleep apnea have a problem that causes their airways to collapse during sleep, cutting off breathing sometimes dozens - or even hundreds - of time a night. Because they awake over and over, they're never fully rested and often wind up with the chronic, life-threatening consequences of extended sleep deprivation.

Compared to the possibility of high blood pressure, heart disease and stroke, looking less sexy at bedtime is a minor concern, said Barbara Ruggiero, who coordinates the southern Nevada chapter of the AWAKE support group run by the American Sleep Apnea Association.

"I couldn't have cared less," said Ruggiero, 49, a married mother of two from Las Vegas who started using a CPAP nearly three years ago. "It's not just the snoring; people do die from sleep apnea."

But while CPAP users are grateful for the treatment, dozens of posts on the popular apea Web sites reveal some also are worried about the social consequences of the cure.


"I am having a hard time seeing an educated, attractive man looking for an over-weight single mother (2 year old girl) who also has the joy of wearing a full face mask to bed," one 27-year-old woman wrote.

"It's a very big thing," acknowledges Edward Grandi, executive director of the sleep apnea association that counts 10,000 registered members in its ranks. "We hear that a big challenge is having somebody that's coming to bed with all these accoutrements as opposed to just their jammies."

Like sleeping with Darth Vader And the challenge is growing with the number of sleep apnea sufferers. An estimated 4 percent of men and 2 percent of women between the ages
of 30 and 60 in the United States suffer from severe sleep apnea, Grandi said.

That's at least 18 million Americans who shuffle through life in a sleep-deprived haze. Only about 10 percent of sufferers are diagnosed, but the most common prescription is a CPAP.

Still, less than half of those sent home with a CPAP wind up using it, experts said. It's easy to see why. The machine works by blowing a stream of air down a plastic tube and through a plastic mask, using the pressure to keep airways open.

Even the most streamlined models can't hide the Darth Vader-like effect of slipping on the device and flipping the switch, acknowledged Dr. William Orr, a sleep expert and president of the Lynn Health Science Institute at the Oklahoma University Health Sciences Center.

"It's like sleeping with a vacuum cleaner strapped to your nose," he said. "You wouldn't go around dating somebody and put this thing on and say, 'Hey, look what I've got.'"

While CPAP wearers complain about claustrophobia, inconvenience and the weird effect of being plugged into the wall all night, their partners have other issues.

The noise of the motor can be annoying, like leaving a blow-dryer on for hours, although some users insist the new models are no louder than a large fan or a refrigerator. The CPAP's steady stream of exhaled air also can bother partners who suddenly feel like they're sleeping in a wind tunnel.

After 46 years of marriage, Jim and Ann Hurd of Colorado Springs, Colo., had to stop cuddling because of her CPAP machine.

"My husband and I were snugglers all night long," said Ann Hurd, 66. "But he doesn't like the cold air blowing on him."

And there's no question it's hard to feel seductive while wearing the thing. Vern Hulse, 66, of Ririe, Idaho, has worn a CPAP for seven years, so when his wife, Betty, 63, got one last fall, she didn't mind.

"But if I wore one and he didn't, I might have been a little vain," said Betty Hulse. "If I were a young woman in my 20s and I was alone, I would wear it, but if I had an overnight visitor, there's no way."

Despite those obstacles, CPAP users and sleep experts said the benefits of the machine far outweigh the impositions on intimacy.

'Most unromantic device ever'

Sleep-deprived people are not good partners, noted Rosalind
Cartwright, chairman of the of the psychology department at Rush University and founder of the school's sleep disorders center. She calls the CPAP "the most unromantic device ever," but says using the machine or an oral applicance can rescue a troubled marriage.

"You don't want somebody to go untreated," she said. "When people are sleepy, they can keep up their work role, but their husband role, their parenting role, their love role, they can't keep it up."

That's often true in a sexual sense as well. In addition to
life-threatening health problems and psychological symptoms, people with untreated sleep apnea often suffer from impotence and other disorders.


Unexpected perks

For Reid Johnson, a 28-year-old salesman from Charleston, S.C., using  the CPAP caused some funny moments with college girlfriends, but also some unexpected benefits.

"The relief of being able to sleep and have energy again was so great that I did not care what anyone thought," Johnson said. "And, after the mask my libido unquestionably went up. I had energy again and was not always sick."

Now married, Johnson said his CPAP doesn't hamper his sex life. His wife, Christina, even nicknamed the device Snuffalufagus," he said.

Most CPAP users say they're as matter-of-fact about the device as anyone who needs crutches, prosthetics or other aid for a serious medical condition - and that they expect romantic partners to be the same.

"I've never been self-conscious about it," said Vicki Thon, a
50-year-old single mom who has balanced CPAP use and an active social life for 11 years. "I say, 'This is what I need to be healthy.'"

For couples who can't tolerate the device, there are a few options.  Chris Peterson, for instance, lost 20 pounds, decreased his snoring - and ditched the machine, much to his wife's delight.

"We got our life back," Babbett Peterson said.

When that's not possible, CPAP users have to cultivate a sense of humor - and a practical view, said Grandi, the apnea association director.

"No, it's not sexy, but I don't think snoring is sexy," he said. "And, you know, you don't have to do it with the mask on."

© 2008 MSNBC Interactive
URL: http://www.msnbc.msn.com/id/23731731/

The Snore Relief Wrist Band from Hammacher listens to your snoring to 'gently' shock you to stop.  They claim that 80% in their study experienced some reduction in snoring within two weeks and had 'better sleep quality'.   Well, we're skeptical...

ScienceDaily (Aug. 4, 2008) — Moderate to
severe obstructive sleep apnea (OSA) is an
independent risk factor for all-cause
mortality, according to a study in the August
1 issue of the journal Sleep.

Fourteen years after initial data were
collected, about 33 percent of participants
with moderate to severe sleep apnea had died
(six of 18 individuals), compared with 6.5
percent of people with mild OSA (five of 77)
and 7.7 percent of people with no OSA (22 of
285). The association between moderate to
severe OSA and mortality remained significant
after statistical adjustment for other risk
factors, producing a fully adjusted hazard
ratio of 6.24 for all-cause mortality; mild
OSA was not a risk factor for mortality.

"This is the first study to demonstrate an
independent association between all-cause
mortality and sleep apnea in a
community-based study," said lead author
Nathaniel Marshall, PhD, a postdoctoral
fellow at the Woolcock Institute of Medical
Research in Sydney, Australia. "The size of
the increased mortality risk was surprisingly
large. In our particular study a six-fold
increase means that having significant sleep
apnea at age 40 gives you about the same
mortality risk as somebody aged 57 who
doesn't have sleep apnea."

According to Marshall, previous studies that
have linked OSA to mortality as an
independent risk factor have involved
patients referred to sleep clinics rather
than community-based samples; the association
between OSA and mortality in the community
was unknown.

The study involved 380 men and women between
the ages of 40 and 65 who were already
involved in the Busselton Health Study, an
ongoing survey of residents in the rural town
of Busselton in the state of Western
Australia. From November to December 1990,
each participant used a portable
home-monitoring device for one night to
assess his or her level of sleep-disordered
breathing.

Individuals were categorized according to the
frequency of recorded respiratory
disturbance. Only three participants had
severe OSA with an average of 30 or more
respiratory disturbances per estimated hour
of sleep, while 18 individuals (about 4.7
percent) had moderate to severe OSA with 15
or more respiratory disturbances per hour.
Seventy-seven participants (about 20.3
percent) had mild OSA with five to 14
respiratory disturbances per hour, and 285
people (75 percent) had no OSA.

State and national death records were
reviewed through 2004 to identify
participants who had died and to note the
cause of death listed on the death
certificates. From the records of the 33
study participants who died, no predominant
cause of death could be linked to OSA.

Initial results were adjusted for other
mortality risk factors such as age, sex, body
mass index, smoking status, blood pressure,
cholesterol and diabetes. All statistical
models produced a significant relationship
between sleep apnea and mortality. No
information was gathered about participants'
use of any sleep apnea treatment.

According to Marshall, the results of this
study indicate that OSA is a potentially
life-threatening condition that demands
increased medical attention.

"Our findings, along with those from the
Wisconsin Cohort, remove any reasonable doubt
that sleep apnea is a fatal disease," he
said. "People who have, or suspect that they
have, sleep apnea should consult their
physicians about diagnosis and treatment
options."

The study was supported by grants from the
Australian National Health and Medical
Research Council.

According to the American Academy of Sleep
Medicine, most people with OSA snore loudly
and frequently, with periods of silence when
airflow is reduced or blocked. They then make
choking, snorting or gasping sounds when
their airway reopens. About 80 percent to 90
percent of adults with OSA remain undiagnosed.

The most common treatment for OSA is
continuous positive airway pressure (CPAP)
therapy, which provides a steady stream of
air through a mask that is worn during sleep.
This airflow keeps the airway open to prevent
pauses in breathing and restore normal oxygen
levels.

A media fact sheet about obstructive sleep
apnea is available from the AASM at
http://www.aasmnet.org/Resources/FactSheets/SleepApnea.pdf.
Information from the AASM for patients and
the public is available about OSA at
http://www.sleepeducation.com/Disorder.aspx?id=7
and about CPAP at
http://www.sleepeducation.com/CPAPCentral/.

How sleep affects your weight
Nutrition Action Healthletter,  July-August, 2005
by David Schardt

Are the sleepless counting doughnuts and pies instead of sheep? "Americans sleep less than they used to, and this could be part of the reason why more of us are now overweight," says David Dinges, Chief of the Division of Sleep and Chronobiology at the University of Pennsylvania School of Medicine. Over the past 40 years, Americans have cut their snooze time by one to two hours a night. We now sleep less than people in any other industrialized country. And researchers are discovering that sleep affects hormones that regulate satiety, hunger, and how efficiently you burn calories. Too little sleep may make you hungry, especially for calorie-dense foods, and may prime your body to try to hold on to the calories you eat. It may also boost your insulin levels, which increases the risk of heart disease and diabetes.

The Sleep-Weight Link
"Obesity is obviously a very complex issue, and no one is suggesting that lack of sleep is the cause of the obesity epidemic," says Carl Hunt, director of the National Center on Sleep Disorders Research at the National Institutes of Health in Bethesda, Maryland.
"But new research certainly supports the idea that sleeping less may be a previously unknown but important contributor to the obesity epidemic in the U.S." The link between sleep and weight was first noticed in the 1990s, when European researchers were puzzling over why so many children were getting heavier. "They were surprised to discover that it wasn't how much TV a child watched, but how much sleep the child got, that best predicted whether he or she was overweight," says Dinges. "The less children slept, the heavier they were." Researchers in the U.S. are finding the same link in adults.

In the Wisconsin Sleep Cohort Study, which tracks the sleep habits of nearly 3,000 middle-aged state government employees, those who reported that they typically slept less than eight hours a night were more likely to be overweight. (1) And researchers at Columbia University in New York City found that people who slept six hours a night were 23 percent more likely to be obese than people who slept between seven and nine hours. Those who slept five hours were 50 percent more likely--while those who slept four hours or less were 73 percent more likely--to be obese. The connection between hours slept and weight wasn't significant for people 60 and older, says James Gangwisch, a psychiatric epidemiologist at Columbia, "probably because the sleep problems that are so common in older people obscure the link." (The analysis hasn't yet been published.)

Leapin' Leptin
Why would people who sleep less weigh more? "The results are somewhat counterintuitive," says Gangwisch, since people burn more calories when they're awake. "We think it has more to do with what happens to your body when you deprive it of sleep, as opposed to the amount of physical activity you get." What happens involves two hormones: Leptin, which is released by fat cells, signals the brain to stop eating. Ghrelin (pronounced GRELL-lin), which is made in the stomach, is a signal to keep eating. The two influence whether you go for a second helping or push yourself away from the table.
"Studies have shown that leptin levels are lower and ghrelin levels are higher in people who sleep fewer hours," says Gangwisch.

In the Wisconsin Sleep Cohort Study, those who slept for five hours had 15 percent lower leptin levels and 15 percent higher ghrelin levels than those who slept for eight hours. (1)
While the study wasn't designed to prove whether sleep deprivation causes changes in leptin and ghrelin levels, new research at the University of Chicago suggests that it does.
When Eve Van Cauter and co-workers limited 12 healthy young men to just four hours of sleep for two consecutive nights, their leptin levels were 18 percent lower and their ghrelin levels were 28 percent higher than after two nights of sleeping for ten hours. (2)
"The combination of low leptin and high ghrelin is likely to increase appetite," says Wisconsin Sleep Cohort Study researcher Emmanuel Mignot of Stanford University (though "short sleepers may also have more time to overeat," he points out).

In fact, the men in Van Cauter's study said that they were more hungry--and that they'd be more likely to eat salty foods like chips and nuts; sweets like cake, candy, and ice cream; and starchy foods like bread, cereal, and potatoes--after four hours of sleep than after ten hours. Compounding the problem: the brain interprets a drop in leptin as a sign of starvation. So it responds not only by boosting hunger, but by burning fewer calories. That means you put on more weight even if you don't eat any more food.

Sleep Dreams
Sleep deprivation may stimulate more than your appetite. "It also affects insulin resistance and blood glucose levels, which are two important components of the metabolic syndrome," says Carl Hunt of the National Center on Sleep Disorders Research. The metabolic syndrome, also called insulin resistance syndrome, is a cluster of symptoms that increases the risk of heart attack, stroke, and diabetes. Signs of the syndrome are abdominal obesity, low HDL ("good") cholesterol, and elevated (though not necessarily high) triglycerides, blood pressure, and blood sugar. When the University of Chicago's Eve Van Cauter and her colleagues limited 11 healthy men in their 20s to four hours of sleep for six straight nights, "it brought them to a nearly prediabetic state."

Their bodies were 40 percent less able to clear glucose from their blood and 30 percent slower in releasing insulin than when they were allowed to sleep for twelve hours. (3) In fact, four hours of sleep for six consecutive nights gave the young men the insulin sensitivity of 70- or 80-year-olds. "We didn't expect to see a change of that magnitude," says Van Cauter. (Insulin is a hormone that lets glucose, or blood sugar, enter the body's cells, where the sugar is burned for energy. When people are insulin insensitive, or insulin resistant, their insulin doesn't work efficiently.) "The consensus that prevailed until recently was that sleep is for the brain, not for the rest of the body," says Van Cauter. "But sleep really affects everything. We are not wired biologically for sleep deprivation. We're the only animal that intentionally sleeps less than we need to."
(1) PLoS Med. 1:e62 2004 (Epub.).
(2) Ann. Intern. Med. 141: 846, 2004
(3) Lancet 354: 1435, 1999
RELATED ARTICLE: Sleepus interruptus.

Sleep less, weigh more. If true, that's not good news for the estimated 15 million Americans with sleep apnea

Sleep apnea (pronounced APP-knee-uh) typically occurs when the soft tissue in the rear of the throat relaxes too much during sleep, partially blocking the passage and cutting off the flow of air. The result: loud snoring and labored breathing. If the passage closes entirely, no air can get through and breathing stops until the brain rouses the person enough to gasp for air. According to the American Sleep Apnea Association in Washington, D.C., some people with untreated apnea stop breathing hundreds of times during the night, often for a minute or longer. When they do fall back to sleep, it's generally to a lighter, fragmented, less-restful stage that leaves them drowsy the next day.

It's not a minor problem: the number of Americans who have sleep apnea equals the number who have diabetes. And, like those with diabetes, "the majority don't know it or aren't being properly treated," says Sleep Apnea Association president Rochelle Goldberg. What's more, apnea "increases your risk for developing high blood pressure, coronary heart disease, and diabetes, for suffering strokes, and for having accidents during the day." How? "Obstructed breathing produces an arousal response that revs up the body into a 'fight-or-flight' stance," she explains. To divert blood to high-priority sites, the blood vessels constrict and the heart rate increases. "Since the oxygen supply is cut off at the same time, the circulatory system can be damaged, especially if it happens again and again every night."

And it's not just the blood vessels that pay. People with severe sleep apnea--that means at least 15 breathing disruptions an hour--suffer a loss of motor skills, attention, and concentration that's equal to an additional five years of aging/"Men are twice as likely as women to have sleep apnea," says Goldberg, "because the tissues in their throats are usually larger and thus more likely to cause obstruction." Ditto for people who are overweight. Even so, "you can be thin as a rail and still have the airway characteristics that cause apnea," says Goldberg. It's a Snore. People with sleep apnea are more likely to snore ... and to snore loudly. "If someone snores and wonders whether they have sleep apnea, they should answer a few questions," says Goldberg.

* If the snoring is pretty much every night, is there any irregular breathing or pauses between the snores?
* Do you wake with some frequency at night, even if just to go to the bathroom?
* Do you still feel tired the next day after what seemed like a good night's sleep?
* Do you have trouble concentrating and working through simple tasks during the day?
* Do you have headaches while you sleep or when you wake up?
"The most effective treatment for sleep apnea is CPAP, or continuous positive airway pressure," says Goldberg. It's a machine with a mask that attaches over the face and keeps the air passage open by forcing air through the nose and mouth throughout the night. Not everyone can tolerate it.
Dental appliances and surgery work about half the time, while drugs and supplements don't work at all, says Goldberg.
(1) Amer. J. Respir. Crit. Care Med. 156: 1813, 1997.
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