Chronic Insomnia

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Sleep deprivation is costly physically, mentally, financially and can many times affect others besides the sleep deprived. Sleep is the only time during which the brain’s cerebral cortex – the portion of the brain responsible for memory, attention, perceptual awareness, thought, language, and consciousness – is not in a state of quiet alertness, so only during sleep may the brain properly rest and regenerate for optimal functioning. When a person has chronic insomnia, neurons may begin to malfunction and the person’s behavior will be visibly affected. Their general physical health will suffer, as well.

In the early stages of sleep deprivation, your brain will work harder and less effectively toward even simple tasks. The ability to concentrate will be one of the first noticeable effects. Memory soon becomes impaired, as does the ability to problem solve, make decisions, and generate new ideas.

Short term effects of sleep deprivation are:

• Memory and cognitive impairment – Your ability to think clearly and process thoughts and information will be affected by even the earliest stages of drowsiness.
• Diminished alertness and performance – If your sleep routine is disrupted for one night by as little as 90 minutes, your daytime alertness is reduced by one third.
• Slowed reaction time – In a study published in the journal Occupational and Environmental Medicine in 2000, researchers in New Zealand and Australia revealed that sleep deprivation has some of the same hazardous effects as being intoxicated, carrying serious risk due to its affect on coordination, reaction time, and judgment.
• Risk of automobile or occupational injury – In that same Occupational and Environmental Medicine study of 2000, researchers warned that drivers who have not slept in 17 to 19 hours performed worse behind the wheel than those with a blood alcohol level of .05 percent, the BAC limit for drunk driving in most European countries.
• Poor quality of life – Because of a sleep deprived person’s inability to think clearly, process thoughts, and remain alert, the majority of activities that one may typically enjoy throughout daily life become less enjoyable. Even watching television, going to a movie, engaging in conversation, reading, or outdoor activities are not as enthusiastically appreciated or pursued as when one is not sleep deprived.
• Irritability and moodiness
• Slurred speech
• Lower libido
• Tremors

Long term sleep deprivation and untreated sleep disorders cause even bigger problems, including:

• Obesity – A common effect of sleep deprivation is dramatic weight change. Hormone levels, including leptin and ghrelin which affect feelings of fullness and appetite, are imbalanced by lack of sleep. Leptin falls, encouraging increased hunger. Ghrelin rises, producing a lack of satisfaction from food. Through this imbalance and the sleep deprived body’s confusion regarding when to stop eating and how much to eat, weight is easily gained.
• Psychiatric problems, including depression and other mood disorders – A 2007 Harvard Medical School study in conjunction with the University of California at Berkeley documented that sleep deprivation causes the brain to become incapable of appropriately reacting to emotional events in a controlled, suitable manner.
• Fetal and childhood growth retardation – A 1999 study conducted by researchers at Pennsylvania State University’s College of Medicine’s Sleep Research and Treatment Center found that sleep deprivation suppresses growth hormones.
• Microsleeps – Very similar to blackouts from intoxication, microsleeps occur when the brain is significantly sleep deprived. The brain shuts down and falls into 10 to 60 second sleeps without the person experiencing them even being aware that the microsleeps are occurring and presenting significant driving, occupational, and other dangers.

Other documented long-term health affects from sleep deprivation are:

• Attention Deficit Disorder (ADD)
• Mental impairment
• High blood pressure
• Heart attack
• Heart failure
• Stroke

Regardless of whether you’re sleep deprived for a short period of time or over extended periods, your daily life is vastly affected. Sleep deprivation presents physiological problems, emotional and mental problems, and even occupational risks. Lack of sleep does not have to become an accepted way of life, as there are solutions available after proper diagnosis by a qualified practitioner.

PAP (positive airway pressure) is a technique of respiratory ventilation that is used mainly in the treating of sleep apnea. A CPAP machine (Continuous Positive Airway Pressure)  is a low-pressure portable air generator that is connected to the nose or face by tubing and is worn while resting. This system was developed in Sydney Australia in 1981 by Professor Colin Sullivan and is now used in many intensive care units as a type of ventilation. A CPAP treatment can be very effective in treating of both central and obstructive sleep apnea. Many patients tend to see an improvement in the quality of their sleep and life due to the treatment after just the first night’s use.

A CPAP machine is typically the size of a shoebox but is sometimes even smaller. It works by forcing air in the airway passage at a high enough pressure to prevent apneas. It can be prescribed for use in both central and obstructive sleep apnea. The pressure of the machine is adjusted according to the sleep apnea of the patient. The machine increases the pressure of air in a person’s throat so the airway does not collapse as breathing.

Obstructive sleep apnea begins as the upper airway starts to narrow as muscles relax while sleeping. This causes the reduction of oxygen in the blood which in turn causes a person to awake from sleeping. The CPAP machine stops this from happening by providing compressed air through a hose so breathing becomes possible again, thus reducing or even preventing hypopneas and apneas.

Central sleep apnea is something that occurs much less and is associated with the central nervous system function. The body repeatedly stops breathing while sleeping because the brain stops sending signal temporarily to the muscles that control the body’s breathing. The CPAP machine is the most common treatment for sleep apnea.

It must be understood that the air pressure and not the air movement is responsible for preventing the apneas. Before putting on the mask and while the machine is on, air flow is circulating into the mask. As the mask is placed on the head, it becomes sealed to the face as the air flow stops. From then on it is only the air pressure that provides the needed results. This also tends to help with loud snoring that is many times associated with sleep apnea.

A CPAP machine is simple to use as long as the user completely understands how it works and keeps it very clean. The pressure needed is normally determined by a doctor after thorough review of the patient after having been supervised by a sleep technician overnight. A complete machine will have one of the following:

~a mask covering the nose only, called NCPAP (nasal continuous positive airway pressure)
~a mask covering the mouth and nose
~prongs that slide into the nose

Because a CPAP machine is a medical device, it must have approval from the FDA (Food and Drug Administration) before than can be made available for sale. Because of this, a CPAP machine can only be obtained with a doctor’s prescription.

There are many different CPAP manufacturers that provide several types of machines with various features. Once someone has been diagnosed with sleep apnea and has been prescribed the CPAP as therapy, he or she can choose a machine among the several that are offered. A CPAP machine is usually covered under insurance as a durable medical equipment benefit. It most often bought or purchased with a home health care company.

ABOUT SLEEP APNEA

Apnea is a word that means unable to breathe or without breath. There are three types of sleep apnea with the most common being obstructive apnea. People with untreated sleep apnea stop breathing repeatedly during their sleep, often for a minute or longer. This results in poor sleep quality that makes them tired during the day. Sleep apnea usually is a chronic condition that disrupts your sleep 3 or more nights each week, and is one of the main causes of chronic daytime sleepiness. In our discussion of chronic insomnia, it should be understood that sleep apnea is different than the type of conscious sleeplessness in that the person with apnea does not know that their sleep is being interrupted by lack of oxygen.

According to the National Institutes of Health sleep apnea affects millions of Americans. Risk factors include being male, overweight, and over the age of forty, but sleep apnea can strike anyone at any age, even children. Yet still because of the lack of awareness by the public and healthcare professionals, the vast majority remain undiagnosed and therefore untreated, despite the fact that this serious disorder can have significant consequences.

The most common type of sleep apnea is obstructive sleep apnea. This means that the airway has collapsed or is blocked during sleep. When you try to breathe, any air that squeezes past the blockage can cause loud snoring. Obstructive sleep apnea happens more often in people who are overweight, but it can affect anybody. The blockage may cause shallow breathing or breathing pauses.  You often move out of deep sleep and into light sleep when your breathing pauses or becomes shallow. Breathing pauses can last from a few seconds to over a minute. They often occur 20 or more times per hour. Typically, normal breathing then starts again, sometimes with a loud snort or choking sound.

DIAGNOSIS OF SLEEP APNEA

Generally diagnosis of sleep apnea involves family doctors (general practitioners) determining the primary diagnosis based on various factors including a complete physical and standard sleep studies. If it is determined that sleep apnea may be the cause based on a set of factors determined by the initial exams, the family doctor may refer the patient to a sleep specialist. Sleep specialists are doctors whose specialty is diagnosing and treating people with chronic sleep disorders. Exams, from start to finish may very well be detailed and extensive. Many people find these exams to diagnose sleep apnea invasive and overwhelming to the point that they discontinue them before their sleep disorder treatment can be established with certainty. But for many, finding relief is paramount and if they stay with the initial and specialist exams, they can find relief and begin to live a life with restful sleep.

TREATMENT FOR SLEEP APNEA

Treatment for sleep apnea may be as simple as lifestyle changes and monitoring to procedures as extensive as surgery. Usually, the treatment falls somewhere in between.
A good friend of mine who suffers from sleep apnea who used to snore loudly and all night long was determined to have sleep apnea. His treatment consists of a device called a CPAP )Continuous positive airway pressure) device which consists of a mask that fits over the nose or mouth and nose that gently blows air into the throat. Adjusted properly it keeps the airways from becoming constricted during sleep. With some people there are some mild side effects such as a dry or stuffy nose, or headaches, the vast majority of people using this treatment for sleep apnea report feeling much better and sleeping better.

There are other treatments for sleep apnea that involve simpler treatments such as a mouthpiece that can be made by a dentist and keeps the lower jaw positioned correctly during sleep so that the airways remain open.

SUMMARY

Sleep apnea is a serious, even possibly life threatening condition that should be diagnosed and treated properly to provide the patient with a much improved quality of life through safe, restful sleep.