SLEEP APNEASLEEP APNEA& DIABETES& DIABETES

Juan A. Albino, MD, FCCPJuan A. Albino, MD, FCCP

Village Sleep Lab Village Sleep Lab

751-4955; September, 2006751-4955; September, 2006

Thank You !!!Thank You !!! Jim Smith, Diabetes Support Group Jim Smith, Diabetes Support Group Phillip Ratliff, AWAKE Group (753-8773)Phillip Ratliff, AWAKE Group (753-8773) Lois Brach, AWAKE Group (753-4260)Lois Brach, AWAKE Group (753-4260) Normarie M. Albino M.D., President, WifeNormarie M. Albino M.D., President, Wife Heather Ellington, Office Manager Heather Ellington, Office Manager John Crawford, Technical DirectorJohn Crawford, Technical Director Thomas Chaput, Sleep TechnologistThomas Chaput, Sleep Technologist Tamara Dillon, Sleep TechnologistTamara Dillon, Sleep Technologist Miyoshi Scott, NurseMiyoshi Scott, Nurse Meagin Franey, ReceptionistMeagin Franey, Receptionist

Common Sleep DisordersCommon Sleep Disorders

Insomnia: wants to sleep but cannot Insomnia: wants to sleep but cannot Sleep Deprivation: does not want to Sleep Deprivation: does not want to

sleep but can; problem of sleep quantitysleep but can; problem of sleep quantitySleep apnea: Sleep apnea: sleepy during day, during day, snoressnores

at night because of obstruction in throat; at night because of obstruction in throat; problem of sleep qualityproblem of sleep quality

Restless Legs Syndrome: leg discomfort, Restless Legs Syndrome: leg discomfort, relieved by movement that hinders sleep relieved by movement that hinders sleep

Good Sleep Hygiene: BasicsGood Sleep Hygiene: Basics

Regular times for sleeping and awakeningRegular times for sleeping and awakeningMaintain bedroom dark, quiet, Maintain bedroom dark, quiet,

comfortablecomfortableUse bed only for sleep and sexUse bed only for sleep and sexAvoid late daytime napsAvoid late daytime napsAvoid at night: alcohol, caffeine, nicotineAvoid at night: alcohol, caffeine, nicotineSleep around 8 hours every nightSleep around 8 hours every nightPrudent exercise and eating Prudent exercise and eating Avoid stressful situations at bednightAvoid stressful situations at bednight

Restless Legs SyndromeRestless Legs Syndrome

Leg discomfort, worse at night, relieved Leg discomfort, worse at night, relieved by movement, affects 5% of populationby movement, affects 5% of population

Familial, begins in childhoodFamilial, begins in childhoodAssociated with iron deficiency, drugs, Associated with iron deficiency, drugs,

Periodic Limb Movement of SleepPeriodic Limb Movement of SleepEasily treatable with medicinesEasily treatable with medicinesRestless Legs Syndrome Foundation, Restless Legs Syndrome Foundation,

June K. Wharton (259-0979)June K. Wharton (259-0979)

Sleep DeprivationSleep Deprivation

Disasters: Exxon Valdez, Challenger Disasters: Exxon Valdez, Challenger Space Shuttle, Chernoble Nuclear Plant, Space Shuttle, Chernoble Nuclear Plant, Commuter plane crash in KentuckyCommuter plane crash in Kentucky

33% of fatal truck accidents 33% of fatal truck accidents 10% of fatal car accidents10% of fatal car accidents Impairment the same whether: drunk, Impairment the same whether: drunk,

sleep deprived (<4-6hrs.), sleep apneasleep deprived (<4-6hrs.), sleep apneaMust be taken seriously: sleep 8 hoursMust be taken seriously: sleep 8 hoursLeads to obesity and diabetesLeads to obesity and diabetes

Chronic InsomniaChronic Insomnia

Acute Insomnia (<4 weeks): stress, illnessAcute Insomnia (<4 weeks): stress, illnessChronic Insomnia: >4 weeks, often yearsChronic Insomnia: >4 weeks, often yearsTreat basic problem: 50% psychologicalTreat basic problem: 50% psychologicalTreat primary insomnia, begins childhoodTreat primary insomnia, begins childhoodPsychotherapy and behavioral therapyPsychotherapy and behavioral therapyMedications, new ones coming outMedications, new ones coming outPCP, Psychologists, PsychiatristsPCP, Psychologists, Psychiatrists

Sleep Apnea: Risk FactorsSleep Apnea: Risk Factors

Family historyFamily historyObesity: 80 % of sleep apnea Obesity: 80 % of sleep apnea

patients; central (visceral, apples) patients; central (visceral, apples) obesityobesity

Increasing ageIncreasing ageMale genderMale genderLarge tonsils / adenoidsLarge tonsils / adenoidsSmall mandible, large neckSmall mandible, large neckSmoking, alcohol, sedativesSmoking, alcohol, sedatives

Sleep Apnea: ConsequencesSleep Apnea: Consequences

Social / Psychological: work, familySocial / Psychological: work, familyPersonal: fatigue, tired, depression, Personal: fatigue, tired, depression,

irritability, impotence, memoryirritability, impotence, memoryMore accidents: work home motor vehicleMore accidents: work home motor vehicleHigher death rates with severe apneaHigher death rates with severe apneaHypertension, Congestive Heart FailureHypertension, Congestive Heart FailureAssociated: Heart Attacks, Strokes, A FibAssociated: Heart Attacks, Strokes, A FibPromotes Obesity and DiabetesPromotes Obesity and Diabetes

What is OSA?•Cessation of airflow with ongoing respiratory effort•Normal Snoring

Sleep Apnea

Obstructive Sleep Apnea

Sleep Apnea: Treatment Sleep Apnea: Treatment

Behavioral: Weight Loss, Sleep Position Behavioral: Weight Loss, Sleep Position (Sleep on side, head raised), Oxygen, (Sleep on side, head raised), Oxygen, Avoid sedatives and alcoholAvoid sedatives and alcohol

CPAP: proven therapy, needs CPAP: proven therapy, needs motivation: widely availablemotivation: widely available

Surgery: tracheostomy, tonsillectomy, Surgery: tracheostomy, tonsillectomy, pull forth mandible or tonguepull forth mandible or tongue

Dental appliances: also pull forth Dental appliances: also pull forth mandible or tongue; expertise mandible or tongue; expertise necessarynecessary

Treatment -CPAP treatment– Positive pressure

maintains airway patencey

– Titration– 100% effective

CPAP therapy

Treatment Options

Linkage Linkage

Obesity, sleep, stress, diet, and Obesity, sleep, stress, diet, and exerciseexercise

One study: if not enough sleep wake One study: if not enough sleep wake up with greater hungerup with greater hunger

Proper amounts of sleep and exercise Proper amounts of sleep and exercise decrease appetite and obesitydecrease appetite and obesity

Much easier to obtain proper sleep Much easier to obtain proper sleep and treat sleep apnea than to dietand treat sleep apnea than to diet

Sleep Apnea & Other Sleep Apnea & Other ConditionsConditions

Diabetes worsened by Sleep ApneaDiabetes worsened by Sleep ApneaBetter control of Sleep Apnea leads Better control of Sleep Apnea leads

to better control of Diabetesto better control of DiabetesSleep deprivation in normal young Sleep deprivation in normal young

people leads to a diabetic state people leads to a diabetic state Hypertension caused and worsened Hypertension caused and worsened

by Sleep Apneaby Sleep ApneaFibromyalgia has a strong Fibromyalgia has a strong

component of sleep disordercomponent of sleep disorder

ObesityObesity

Obesity, Sleep Apnea promote each Obesity, Sleep Apnea promote each other other

Hormonal links: Hormonal links: leptinleptin decreases and decreases and ghrelinghrelin increases hunger, while having increases hunger, while having opposite effects on sleepopposite effects on sleep

Unfortunately medical trials with leptin Unfortunately medical trials with leptin have not been fruitfulhave not been fruitful

Body is programmed: if not sleeping Body is programmed: if not sleeping then eat more, in particular CHO and fatthen eat more, in particular CHO and fat

Obesity and Sleep Obesity and Sleep DeprivationDeprivation

Direct link with avoiding sleep and Direct link with avoiding sleep and obesityobesity

Risk of obesity rises with sleep Risk of obesity rises with sleep deprivationdeprivation

Less than 4 hours : 73% riskLess than 4 hours : 73% riskFive hours : 50% riskFive hours : 50% riskSix hours : 23% riskSix hours : 23% riskLess sleep: lower leptin levels Less sleep: lower leptin levels Obese persons sleep less Obese persons sleep less

Obesity & Sleep ApneaObesity & Sleep Apnea

Sleep apnea, obesity promote each Sleep apnea, obesity promote each otherother

BMI: Body Mass IndexBMI: Body Mass IndexUnderweight: <19Underweight: <19Normal : 19 – 24Normal : 19 – 24Overweight : 25 – 29Overweight : 25 – 29Obese : 30 – 39Obese : 30 – 39Morbidly Obese: 40 or aboveMorbidly Obese: 40 or above If obese RISK of Sleep Apnea is the BMIIf obese RISK of Sleep Apnea is the BMI

Approach to Weight LossApproach to Weight Loss

Directly Dieting in long run: 5 to 10%Directly Dieting in long run: 5 to 10%By regular Exercise: 20 to 30%By regular Exercise: 20 to 30%Avoid Sleep Deprivation when Avoid Sleep Deprivation when

associated with obesity: 50 to 70%associated with obesity: 50 to 70%Treatment of Sleep Apnea associated Treatment of Sleep Apnea associated

with obesity: 50 to 70%with obesity: 50 to 70%Treating sleep disorders is a Treating sleep disorders is a

promising approach to obesity controlpromising approach to obesity control

Sleep and DiabetesSleep and Diabetes

Sleep problems: risk factors for Sleep problems: risk factors for DiabetesDiabetes

Sleep problems worsen DiabetesSleep problems worsen DiabetesSleep deprivation worsens insulin Sleep deprivation worsens insulin

resistance and glucose intoleranceresistance and glucose intoleranceSleep apnea does the sameSleep apnea does the sameControl of sleep problems improves DMControl of sleep problems improves DMCPAP improves Diabetes controlCPAP improves Diabetes control

Control Sleep Apnea: Control Sleep Apnea: Better Diabetes ControlBetter Diabetes Control

Improve insulin sensitivity Improve insulin sensitivity Lower blood sugarsLower blood sugarsLower HbA1-cLower HbA1-cLower dosages of oral hypoglycemic Lower dosages of oral hypoglycemic

agents or less medicinesagents or less medicines

Metabolic SydromeMetabolic Sydrome

Early risk factor: cardiovascular diseaseEarly risk factor: cardiovascular diseaseAffects: 50 million AmericansAffects: 50 million AmericansHigh waist: men >40” women >35”High waist: men >40” women >35”High triglycerides: >150 mg/dlHigh triglycerides: >150 mg/dlLow HDL: men <40mg women <50mgLow HDL: men <40mg women <50mgHigh blood pressure: >130/85High blood pressure: >130/85High fasting glucose: >100High fasting glucose: >100Add: sleep deprivation or sleep apneaAdd: sleep deprivation or sleep apnea

WebsitesWebsites

National Sleep Foundation: National Sleep Foundation: sleepfoundation.orgsleepfoundation.org

American Sleep Apnea Association: American Sleep Apnea Association: sleepapnea.orgsleepapnea.org

Restless Legs Syndrome Foundation: Restless Legs Syndrome Foundation: rls.orgrls.org

National Center on Sleep Disorders: National Center on Sleep Disorders: healthfinder.gov/orgs/HR2536.htmhealthfinder.gov/orgs/HR2536.htm

BooksBooks

The Promise of SleepThe Promise of Sleep by William by William DementDement

Sleeping WellSleeping Well by Michael Thorpy by Michael ThorpyNo More Sleepless NightsNo More Sleepless Nights by Peter by Peter

HauriHauriA Woman’s Guide to Sleep DisordersA Woman’s Guide to Sleep Disorders

by Meir H. Krygerby Meir H. Kryger