Sleep Apnea: Why You Feel Tired After a Full Night of Sleep

CNET’s guide goes over the different types of sleep apnea, causes, risk factors, and symptoms to help people understand sleep apnea.

The most common symptom of sleep apnea is snoring, but snoring on its own isn’t always indicative of sleep apnea. Snoring followed by silent pauses, gasping or choking sounds is likely a sign of sleep apnea.

Because sleep apnea wakes you up frequently throughout the night (even if you don’t notice it), you can suffer from symptoms of sleep deprivation, such as daytime fatigue, difficulty concentrating, unintentional napping and irritability or mood swings.

from Sleep Review…

Opioids Are Not Sleep Aids—They Can Actually Worsen Sleep

Evidence that taking opioids will help people with chronic pain to sleep better is limited and of poor quality, according to an interdisciplinary team of psychologists and medics from the University of Warwick in partnership with Lausanne University Hospital, Switzerland.

Many people suffering from long-term chronic pain use opioids as a sleep aid to take away pain and stop their sleep being disrupted. However, a new study led by the Department of Psychology at the University of Warwick with Warwick Medical School suggests that not enough research has been done to assess the benefits and risks of using painkillers for the purpose of improving sleep quality.

Their study, a systematic review of existing research on the effects of opioids on sleep, has been published in Sleep Medicine Reviews.

Sleep disruption is a particularly frequent issue for patients with chronic pain, with a vicious cycle building between bad nights and increased pain. Patients with chronic pain are often empirically prescribed opioids to reduce their pain enough to get a good night’s sleep, but there has been little investigation of whether this is a safe and effective intervention.

The researchers conducted a comprehensive systematic review of existing literature that examined the effects of opioids on sleep quality. As part of this, they conducted a meta-analysis of data from these studies, combining the results of 18 studies which were then narrowed down to 5 with comparable data.

They found that research on opioid effects on sleep quality was limited and of poor quality, often with potential publication bias and conflicts of interest, and rarely testing patients for sleep apnea prior to and during the study.

Patients reported a small improvement in sleep quality when using opioids but that was not consistent with results derived from sleep assessment technologies, such as the total time and the percentage of time in deep sleep, which did not show an improvement.

Certain studies reported calmer sleep with less movement but the examined articles frequently did not examine the wider effects of opioid therapy such as subsequent functioning during the day. Where they did, reports of sedation

Study Links Sleep-disordered Breathing to Age Acceleration

Increasing severity of sleep-disordered breathing and sleep disruption are associated with epigenetic age acceleration, according to preliminary results of a new study.

Results show that each standard deviation increase in the apnea-hypopnea index, a measure of sleep-disordered breathing severity, was associated with the equivalent of 215 days of biological age acceleration. Similarly, each standard deviation increase in the arousal index, a measure of sleep disruption, was associated with the equivalent of 321 days of age acceleration.

“People’s biological age might not be the same as their chronological age,” said lead author Xiaoyu Li, ScD, a postdoctoral research fellow in the Division of Sleep and Circadian Disorders in the Department of Medicine at Brigham and Women’s Hospital and the Department of Social and Behavioral Sciences at the Harvard T.H. Chan School of Public Health in Boston, Massachusetts. “Individuals whose biological age is higher than their chronological age exhibit age acceleration or fast aging. In our study, we found that more severe sleep-disordered breathing is associated with epigenetic age acceleration. Our data provide biological evidence supporting adverse physiological and health effects of untreated sleep-disordered breathing.”

Sleep-disordered breathing, such as obstructive sleep apnea, is characterized by abnormalities of respiration during sleep. Episodes often result in reductions in blood oxygen saturation and are usually terminated by brief arousals from sleep. Nearly 30 million adults in the U.S. have obstructive sleep apnea. Common warning signs include snoring and excessive daytime sleepiness.

According to the authors, epigenetic age acceleration is a DNA methylation-based marker of fast biological aging, and it is associated with modifiable lifestyle factors. Although sleep-disordered breathing is associated with multiple age-related health disorders, its relationship with epigenetic aging has not been well studied.

The study involved 622 adults with a mean age of 69 years; 53.2% were women. Participants were measured for blood DNA methylation, and their sleep was evaluated at home by polysomnography. Age acceleration measures were calculated as residuals from the regression of each epigenetic age on chronological age. The association of each sleep-disordered breathing trait with age acceleration was estimated using linear regression, controlling for socio-demographics, health behaviors, body

Andrew Varga, MD: How Sleep Apnea Affects Elderly Spatial Orientation

In an interview with MD Magazine, Andrew Varga, MD,  explains the most cognitively-affected OSA patient population, and expanded on the association between sleep apnea and psychiatric conditions.

Varga: This was a group of older people, average age was around 68 years old. One of the really interesting things is that these were people that were recruited from the community and didn’t intrinsically have any sleep complaints. So they were not necessarily complaining that they had  snoring or any other breathing issues with sleep apnea. They were not complaining of any cognitive complaints, were not complaining of any sleepiness.

from Sleep Review…

A Reference for Referrals [Editor’s Message]

What makes a clinician-friendly medical referral form? An engineer publishes tested recommendations to close the communication loop.

You’ve likely heard the advice before: Provide user-friendly consultation order forms to your referring providers. Be sure the referral forms promote the transmittal of clear, complete, and correct data to your sleep or dental sleep practice.

But what exactly makes for a clinician-friendly referral template? Recommendations have been published before, but recently a human factors engineer went a step further. April Savoy, PhD, a research scientist with the VA Center for Health Information and Communication at the Richard L. Roudebush Veterans Affairs Medical Center, and colleagues implemented several recommendations into a scenario-based simulation experiment. They tested a control electronic referral form and their recommendation-incorporating prototyped form with primary care clinicians who were referring patients to a variety of specialists.

Some of the communication problems that Savoy’s team hoped to resolve included unclear goals in referral, specialists rejecting a consultation pending more information, missing details that needed to be provided by the patient, and phone tag between busy professionals. The researchers found that implementing a few recommendations from the referral communication literature significantly improved clinicians’ satisfaction, workload, and efficiency. You could implement several of the successful features immediately into your own referral templates.

Include a checklist of “urgency” options. The prototype form allowed for “routine (30 days),” “stat,” or “specific time,” as well as a free-text field for comments. “Referrers, who are most familiar with their patients’ typical health, are best equipped to gauge urgency, not consultants or schedulers,” the authors note.

Remind referring providers of your expectations at a glance. Include an “About Us” section with a few bullet points, such as “Individuals with sleep irregularities manifested by daytime sleepiness, snoring, witnessed apneas, morning headaches, insomnia, or abnormal nocturnal movements or behaviors would benefit from a sleep evaluation.” Bulleted information on how to avoid cancelled consults is also appreciated. For example, a dental sleep medicine practice may want to include verbiage such as, “Interpreted sleep study results, from a home or in-lab study done in the past 12 months, must

Therapy Update: Implanted Neurostimulators for Sleep Apnea

Inspire Medical, Respicardia, LivaNova, and Nyxoah share the latest data on their devices.


Inspire Medical Systems Inc Inspire Upper Airway Stimulation


Inspire Stimulator

Information source: Howard Green, vice president of marketing

FDA status: FDA approved in April 2014.

Size: 15 cc

Implant location: Inserted just under the skin of the neck and chest through 3 incisions.

Lead location: The sensing lead is placed in the intercostal muscle area; the stimulation lead is wrapped around the hypoglossal nerve (which controls the muscles and movements of the tongue).

How it works: As a patient sleeps, Inspire senses when they breathe in and delivers mild stimulation nudging the tongue forward, opening the airway. The patient uses a sleep remote to turn Inspire on when they go to sleep and off when they wake up.

Treats: Moderate-to-severe obstructive sleep apnea. AHI between 15 and 65.

Titration: Inspire is turned on about a month after it’s implanted. The patient is given a sleep remote and initial settings are established. The patient uses Inspire at home for 2-3 months and adjusts the amplitude using the remote to find a level that gives them comfortable, restful sleep. After this, the patient has an overnight sleep study where stimulation levels can be adjusted to optimize patient outcomes.

Future titrations: The vast majority of patients find stable settings after one lab titration. Inspire is customizable so any adjustments can be made simply in the physician’s office.

Overall efficacy: A recent peer-reviewed publication on the ADHERE Registry concluded that: median patient AHI was reduced from 34.0 to 7.0 events/hour; quality of life: ESS was reduced from 12 to 7; after 12 months, patients used Inspire 5.7 hours per night; 94% of physicians rated improvement in patients after Inspire implant. Patient-reported response to therapy experience: 94% stating they would undergo Inspire implant again; 96% of patients reported they would recommend Inspire to family and friends; 94% of patients reported they were overall satisfied with Inspire therapy.

Efficacy by demographic: Men and women within the FDA-approved AHI range (15-65) benefit equally from Inspire therapy. The ADHERE registry concluded:

Women with Sleep Apnea More Likely to Be Diagnosed with Cancer Than Men with Sleep Apnea

A study of more than 19,000 people has found that women with obstructive sleep apnea (OSA) are more likely to be diagnosed with cancer than men with the condition, according to research published in the European Respiratory Journal.

OSA, where the airways close completely or partially many times during sleep, reduces the levels of oxygen in the blood, and common symptoms include snoring, disrupted sleep, and feeling excessively tired. The new study suggests that people who experience more closures of the airways during sleep and whose blood oxygen saturation levels drop below 90% more frequently are more likely to be diagnosed with cancer than people without OSA.

The study also found that cancer was more prevalent among women with OSA than men, even after factors such as age, body mass index (BMI), smoking status, and alcohol consumption were taken into account, suggesting women with OSA may be at greater risk of being diagnosed with cancer than men with OSA.

The study was led by Athanasia Pataka, assistant professor of respiratory medicine at Aristotle University and who works at the George Papanikolaou General Hospital of Thessaloniki, Greece. “Recent studies have shown that low blood oxygen levels during the night and disrupted sleep, which are both common in OSA, may play an important role in the biology of different types of cancers. But this area of research is very new, and the effects of gender on the link between OSA and cancer have not been studied in detail before,” she says in a release.

The researchers analyzed data from 19,556 people included in the European Sleep Apnoea Database (ESADA), an international multi-centre study that includes patients with OSA, to explore the link between OSA severity, low blood oxygen levels, and cancer development. The participants included 5,789 women and 13,767 men in total, who were also assessed for their age, BMI, smoking status, and level of alcohol use, as these factors can impact the risk of developing cancer.

To assess OSA severity and the link with developing cancer, the researchers looked at how many times the participants experienced partial or complete airways

Making Sleep Medicine a Priority in Your Dental Practice

How to get your whole team on board with dental sleep medicine.

The prevalence and under-treatment of obstructive sleep apnea (OSA) in the general population is alarming. To begin, an estimated 30 million Americans suffer from the disorder, yet 80% of those cases remain undiagnosed.1 Couple that with the fact that the population of Americans age 65 and older—an age group at high risk for OSA—is projected to more than double from 46 million to over 98 million by the year 2060.2

For those who have been diagnosed with OSA, continuous positive airway pressure (CPAP) is the accepted gold standard for treating the condition. However, low adherence rates mean many patients remain ineffectively treated, leaving them at risk for a host of associated comorbidities and in need of an alternative option. The convergence of these realities provides dentists a golden opportunity to help address this public health epidemic by incorporating dental sleep medicine (DSM) and the administration of oral appliance therapy (OAT) into their dental practices.

When implemented correctly and strategically, DSM can be exciting and rewarding—financially and otherwise. In addition to providing a profit center, DSM has the potential to save lives and save relationships. For me personally, the reward comes in the form of patients who are happy to see me when I walk into an appointment. As dentists know, that’s frequently not the case when walking into a dental operatory.

In this article, I will offer advice about how to get the whole team on board so that DSM is a bona fide profit center—not just a hobby.

Staffing a DSM Practice

It doesn’t take many team members to get sleep going in a dental practice. The key roles in any successful DSM practice are going to be: the dentist, a sleep assistant, a patient coordinator, and a medical insurance coordinator. For practices just starting out, one person may even be able to take on two or three of the roles, until patient load requires further separation of responsibilities.


Sleep Dallas sleep assistant, April Fields, demonstrates to

A Life with Sleep Apnea

A woman’s life changes *dramatically* after discovering she had a sleep disorder, reports WPSD.

Krafton was scared. In 2014 she was diagnosed with sleep apnea. Five years later, she’s checking in with Dr. Lisa Buford regularly at the Midtown sleep Center. “She came to me with symptoms of snoring and increased daytime somnolence. Also a BMI body max index of 30 or greater is a risk factor of sleep apnea,” said Dr. Buford.

from Sleep Review…

Sleep Apnea Being Diagnosed More Often as Awareness Spreads

Srinivasan Devanathan, medical director of Parkview Health Sleep Centers, said that sleep apnea is a prevalent disorder and is getting diagnosed more and more each year because people are more aware of it, reports KPC News.

“People are often told that they snore, their bed partner may be concerned that they are holding their breath, snoring loudly, they may wake up with headaches in the morning, they can wake up with the sensation of having acid reflux, their chest could be pounding with the heart beating faster, waking up often to use the restroom and have excessive daytime sleepiness,” Devanathan said.

Get the full story at

from Sleep Review…