NYU School of Medicine Debunks Common Sleep Myths

People often say they can get by on 5 or fewer hours of sleep, that snoring is harmless, and that having a drink helps you to fall asleep.

These are, in fact, among the most widely held myths about sleeping that not only shape poor habits, but may also pose a significant public health threat, according to a new study publishing online in Sleep Health on April 16.

Researchers from NYU School of Medicine reviewed more than 8,000 websites to identify the 20 most common assumptions about sleep. With a team of sleep medicine experts, they ranked them based on whether each could be dispelled as a myth or supported by scientific evidence, and on the harm that the myth could cause.

“Sleep is a vital part of life that affects our productivity, mood, and general health and well-being,” says study lead investigator, Rebecca Robbins, PhD, a postdoctoral research fellow in the Department of Population Health at NYU Langone Health, in a release. “Dispelling myths about sleep promotes healthier sleep habits which, in turn, promote overall better health.”

The claim by some people that they can get by on 5 hours of sleep was among the top myths researchers were able to dispel based on scientific evidence. They say this myth also poses the most serious risk to health from long-term sleep deficits. To avoid the effects of this falsehood and others identified in this study, such as the value of taking naps when you routinely have difficulty sleeping overnight, Robbins and her colleagues suggest creating a consistent sleep schedule and spending more time, at least 7 hours, asleep.

Another common myth relates to snoring. And while Robbins says snoring can be harmless, it can also be a sign of sleep apnea, a potentially serious sleep disorder in which breathing starts and stops over the course of the night. The authors encourage patients not to dismiss loud snoring, but rather to see a doctor since this sleep behavior may lead to heart stoppages or other illnesses.

The study authors also found sufficient evidence in published studies that, despite beliefs to

Stop Snoring With This One Easy Device

Men’s Journal covers how an oral appliance can reduce snoring.

The Zyppah Anti-Snoring MouthpieceOpens a New Window. ($100) is an FDA-cleared, self-molded, boil-and-bite oral appliance that is effective, safe, and easy to use. What makes Zyppah different is its patent-pending tongue strap that gently holds and stabilizes your tongue. The revolutionary Zyppah tongue strap holds the tongue in place, preventing it from falling back into the throat. Meanwhile, Mandibular Advancement moves the jaw forward. Working together, these two solutions open your airway during sleep, allowing you to breathe freely—and allowing the person next to you a night of peaceful, relaxing sleep.

Clinical studies have shown Zyppah to have a 91 percent effectiveness. Over 800 reviewers have tried Zyppah, and no one—that’s ZERO—reviewers have given the device less than four (out of five) stars.

Get the full story at www.mensjournal.com

from Sleep Review http://www.sleepreviewmag.com/2019/04/stop-snoring/…

Why Clinicians May Miss Identifying Patients Who Could Benefit from Positional Sleep Apnea Therapies

Split-night studies that don’t necessarily allow patients the time to change postures and a lack of reliable reimbursement can lead to position-dependent sleep apnea being missed.

Clinicians face several obstacles in identifying positional sleep apnea (POSA), which can hinder their ability to treat the condition.

Positional sleep apnea can affect as many as 49.5% of patients with mild sleep apnea and 19.4% of those with moderate sleep apnea. In people of Asian decent, these numbers are higher with as many as 75% of all obstructive sleep apnea patients having a positional component.1 “Many physicians working in sleep medicine really underappreciate the prevalence overall of positional sleep apnea,” says Samuel Krachman, DO, a pulmonologist and professor of thoracic medicine and surgery at Temple University’s Lewis Katz School of Medicine.

Positional sleep apnea refers to sleep-breathing difficulties associated with the supine position, which promotes a downward gravitational pull and causes the muscles in the airways to fall straight back. While there is currently a plethora of devices on the market to help people keep off their backs when asleep, identifying positional sleep apnea is not always easy.

In recent years, third-party payors have become stricter in their criteria for who qualifies for an in-lab sleep test. And those who are approved for in-lab studies are often only approved for a split-night study (instead of a two-night study, when a patient is diagnosed one night and then titrated the second night). During split-night studies, patients might not have time to assume all positions, says Krachman.

According to research, published in the journal CHEST, positional sleep apnea cannot usually be properly assessed during a split-night study.2

“The biggest issue, in many cases, is how we diagnose patients in the United States leaves a gap in knowledge,” explains Daniel Levendowski, president and co-founder of Advanced Brain Monitoring, which produces the FDA-approved Night Shift positional sleep apnea therapy device.

“[Sleep technologists] only need two hours of sleep time to know whether to move that patient to CPAP and in that two-hour window it is very difficult to get a good

Zyppah Gets FDA Over-The-Counter 510k Nod Allowing It to Sell Its Anti-Snoring Oral Appliance via Third-Party Retail Marketplaces

After six years on the market, Zyppah has been granted US Food and Drug Administration (FDA) clearances to be made available over-the-counter (OTC) via third-party retail marketplaces.

“As a Class 2 medical device, which we were, you can sell it on your website directly to consumers BUT you cannot sell through a third party (such as Amazon or any retail store as in Costco, Target, WalMart, pharmacies, supermarkets, etc),” explains creator Jonathan Greenburg, DDS, via email to Sleep Review. “With the OTC approval, we can now sell everywhere in retail.”

As noted in the FDA #K182312, “The Zyppah Anti-Snoring Appliance is intended for use by adults (18 years or older) as an aid to reduce snoring. Biocompatibility testing results demonstrated that Zyppah is biocompatible under ISO 10993, including cytotoxicity, sensitization, and irritation testing. The device was shown to meet the requirements of the ISO 10993 guidelines for each of these tests. All materials used in the device are certified USP Class VI and used in many other currently marketed medical devices.”

Zyppah is a patented dual-action mouthpiece featuring both a mandible advancer and a “seat belt for the tongue” to keep the tongue from blocking the airway. NBA Hall of Famer Shaquille O’Neal serves as a global ambassador for the product. It retails for $99.95.

from Sleep Review http://www.sleepreviewmag.com/2019/04/zyppah-gets-fda-counter-510k-nod-allowing-sell-anti-snoring-oral-appliance-via-third-party-retail-marketplaces/…

Why Nasal Breathing Is Best

Sleep physicians can identify and correct mouth breathing in their patients.

Sometimes we do not think about a disease until it becomes overwhelming. This is especially true when the symptoms are relatively mild, have an unclear origin, or a very gradual onset. Obstructive sleep apnea (OSA) is a good example of this sort of disease; people will often live with OSA symptoms for years before seeking medical attention.

It is important to identify risk factors for diseases like OSA; some will be causal factors, and they may be crucial to effective treatments and even cures. Obesity is probably the most well-known OSA risk factor, but others clearly exist, such as hypertension and smoking.

Less well recognized is how nasal obstruction is a risk factor for OSA. And unlike other contributors to OSA, nasal obstruction is often amenable to treatment. Even when not contributing to OSA, nasal congestion can worsen subjective sleep quality in our patients. What’s more, nasal obstruction can be a major challenge for the treatment of OSA, so it is important to recognize and manage it in all of sleep-disordered breathing patients.

In this article, I will discuss nasal obstruction as a risk factor for OSA, as a barrier to the treatment of OSA, and how sleep medicine specialists can best address it for OSA patients. By treating our patient’s nasal obstruction, we can improve their sleep, adherence to positive airway pressure (PAP) therapy, and improve their quality of life.

Why Nasal Congestion Is Important

The nose performs several functions during breathing. It humidifies and warms the air and filters out large particles—protecting the lower airway. While we are all capable of oral breathing, the oral mucosa is not capable of an adequate amount of humidification. In fact, an easy way to determine if someone is mouth breathing in their sleep is to ask if their mouth is dry in the morning or if they need water at their bedside.

For patients with obstructive sleep apnea, especially those using positive airway pressure devices, nasal breathing is crucial. If there is complete or near-complete

A Patient’s Guide to Pregnancy Insomnia

U.S. News & World Report on what to know about symptoms, causes of and treatments for sleeplessness during pregnancy.

Dimitriu says there’s “some evidence that sleep apnea might also get worse in pregnancy,” and this may be related to weight gain associated with the developing baby. Sleep apnea is a condition in which you stop breathing momentarily multiple times during the night. This can cause you to wake up frequently, and you might not even know it’s happening. Sleep apnea can be a serious condition, so “that’s something to watch out for,” Dimitriu says. If you start snoring while you’re pregnant, snoring worsens or you develop any sort of breathing issue, talk with your doctor.

from Sleep Review http://www.sleepreviewmag.com/2019/04/a-patients-guide-to-pregnancy-insomnia/…

AADSM Develops Educational Standards for Dental Sleep Medicine

As more patients turn to their dentists for help with obstructive sleep apnea (OSA), the American Academy of Dental Sleep Medicine (AADSM) releases its educational standards for the dentists who practice dental sleep medicine.

“It is about ensuring those dentists who desire to treat patients with OSA or snoring are properly trained, so their patients are safely and effectively treated,” says David Schwartz, DDS, D.ABDSM, AADSM president-elect, in a release. His editorial explaining the organization’s position appears in the most recent issue of the Journal of Dental Sleep Medicine.

The AADSM launched the AADSM Mastery Program to provide standardized education to dentists who want to provide oral appliance therapy for OSA and snoring. The program consists of three levels of training comprising 65 hours of continuing education.

The AADSM has reached out to all US dental schools, inviting them to offer an accredited AADSM Mastery Program. The AADSM recently approved the first dental school to receive this designation.

“The inherent risk to the patient coupled with the professional liability risk the dentist is assuming is far too great to be fooled into thinking that no additional training is needed,” says Schwartz. “High-quality care is an absolute must, and proper education and training are the only pathways to ensure quality care.”

The AADSM states that standardized education based on a core curriculum is essential for the growth of the field. “I firmly believe that dentists will play an increasingly larger role in preventing medical diseases and treating illnesses such as OSA, snoring, type 2 diabetes, and hypertension. There simply are not enough physicians, but to do so, we need to demonstrate that we are competent to provide optimal care,” says Schwartz.

Establishing educational standards addresses a topic that was not covered in the recent American Dental Association (ADA) Proposed Policy on the Role of Dentistry in the Treatment of Sleep-Related Breathing Disorders. That policy does not specify educational requirements for dentists to provide oral appliance therapy. It is in this context that the AADSM has taken on the responsibility of defining and providing the education necessary for dentists who

Withings Launches Breathing Disturbance Detection for Sleep Tracking Mat, Plans to Add Sleep Apnea Detection by End of 2019

Withings has added new capabilities to its sleep sensor mat, the Withings Sleep, that it says will track and provide detailed information about breathing disturbances experienced during the night. Available to all current Sleep owners after performing an app update, the new feature charts their breathing disturbances over time and provides educational content to help users recognize the signs of sleep apnea.

The new feature acts as a first step towards Withings’ strategy to introduce even more advanced sleep diagnostics including sleep apnea detection. Withings aims to add these capabilities by the end of 2019, subject to FDA and CE clearances.

According to the company, the new Withings Sleep breathing feature provides users with an early warning system to allow them to identify hard to diagnose potential issues and where appropriate, seek medical advice.

Breathing disturbances is a free upgrade for Withings Sleep and was developed and extensively tested by sleep physician Dr Pierre Escourrou within the Paris-Béclère hospital sleep lab using polysomnography (PSG) analysis.

Withings Sleep is a mat that fits under the mattress and after a onetime setup automatically provides a look at users’ nights by monitoring sleep cycles, tracking heart rate, and detecting snoring. The new feature monitors vital signs such as respiration and heart rate, as well as motion and snoring to track and chart the intensity of breathing disturbances throughout the night. The Health Mate App rates the intensity of those disturbances from low to high and provides monthly charts where people can visualize occurrences and take any necessary actions, such as seeking medical care.

The app also provides educational content around breathing disturbances and their impact on sleep quality and overall health issues such as blood pressure, fitness, and weight. It also provides information on sleep apnea, its signs and correlation to more chronic conditions.

“Despite its prevalence and serious consequences, sleep apnea goes largely undetected as current tests are confined to the clinical and sleep lab environment,” says Eric Carreel, president of Withings, in a release. “By allowing people to track the intensity of breathing disturbances, we are helping them identify warning signs

Engineer Uses Biological Fluid Dynamics to Better Understand Sleep Apnea

Sleep apnea can cause a range of health risks and problems, from heart disease and type 2 diabetes to drowsy driving and metabolic disruptions affecting performance. Even children between 2 and 8 can develop sleep apnea, which can affect normal development, learning and behavior.

“Treatments often fail because there is a knowledge gap of the fundamental science behind the reasons for this health issue,” says Haibo Dong, PhD, a University of Virginia associate professor of mechanical and aerospace engineering who specializes in fluid dynamics research, in a release.

Dong and PhD students Junshi Wang and Pan Han are gaining new understanding of the fundamental science behind sleep apnea by using CT scans and MRIs to image the mouth and nose and the full airway during snoring and apnea, and then computer-modeling the actions that cause vibrations of the uvula and obstructions. They are looking for the changes in the shape of the airway during sleep that cause perturbations in airflow. Those perturbations are the vibrations of snoring and the often-resulting breathing difficulties.

sleep_apnea_fluid_dynamics

The three images here represent vortices, streamlines, and velocity contours of snoring flows in the human pharyngeal airway.

If Dong’s team and his research colleagues, including James Daniero, MD, a head and neck surgeon in UVA’s Department of Otolaryngology, can understand the basic mechanics of sound produced during normal breathing, then perhaps better treatments and longer-term solutions for abnormalities may be possible.

“This work is highly interdisciplinary and involves scientific problems in the fields of biology, physics, physiology and engineering,” Dong says. “By studying biological fluid dynamics, we are trying to predict and eventually control sleep apnea and snoring.”

Dong has now modeled both normal breathing and the breathing conditions of sleep apnea for people from 8 months to 80 years old. He is identifying the “force reduction,” the point when normal breathing does not provide enough air volume to keep the front and back of the airway open, resulting in collapse.

“With a normal airway, we see a very smooth channel that doesn’t vibrate much, and where there is not much force difference on the airway walls

Aging and Sleep: Making Changes for Brain Health

Neurobiological processes that occur during sleep have a profound impact on brain health, especially as we get older, writes neuropsychologist Margaret O’Connor, PhD, ABPP.

Numerous studies have shown that structural and physiological changes that occur in the brain during sleep affect capacity for new learning, as well as the strength of memories formed during the day. Sleep promotes the consolidation of experiences and ideas; it plays a pivotal role in memory, and has been shown to enhance attention, problem solving, and creativity.

When we get older, we tend to feel sleepy earlier in the evening. This may result in waking up early in the morning as our sleeping hours shift. Older people have less REM and less slow wave sleep. Less slow wave sleep may impede memory consolidation in older adults.In addition to changes in sleep cycles, older people are increasingly vulnerable to sleep disturbances that cause poor sleep and low brain oxygen such as sleep apnea, a medical condition characterized by loud snoring, breathing pauses during sleep, and daytime fatigue.

from Sleep Review http://www.sleepreviewmag.com/2019/03/aging-sleep/…