Sleep Treatments Improve Fatigue, Tiredness

It may seem like common sense, but a good night’s sleep could be the answer to getting energy back, according to a study at the University of Michigan Sleep Disorders Center.

Patients with complaints of fatigue, tiredness or lack of energy improved with nightly use of continuous positive airway pressure (CPAP) or related devices that are often prescribed for those with obstructive sleep apnea, according to the study published in this week’s issue of the Journal of Clinical Sleep Medicine.

“Many physicians and patients assume that while complaints of daytime sleepiness may indicate a sleep disorder, complaints of fatigue, tiredness or lack of energy must be caused by some other medical or psychiatric problem,” says senior author Ronald D. Chervin, M.D., M.S., Director of the U-M Sleep Disorders Center and Michael S. Aldrich Collegiate Professor of Sleep Medicine in the Department of Neurology at the U-M Medical School.

“Our new findings suggest that fatigue, tiredness, and lack of energy, in addition to sleepiness, can also be important, reversible symptoms of sleep apnea,” he says. Chervin says their findings may impact the way doctors evaluate patients with these types of complaints.

When about 300 patients with confirmed obstructive sleep apnea were quizzed about their chief complaints, it was fatigue, tiredness, or lack of energy, rather than sleepiness itself, that emerged as the most worrisome issues. Women, in particular, reported lack of energy more frequently than men.

“If we as physicians ask only ‘Are you sleepy during the day?’ we may miss an opportunity to help patients with serious sleep problems,” Chervin says. “If a patient says ‘I feel tired all day’ or ‘I just have no energy,’ rather than using the word ‘sleepiness,’ it does not rule out the possibility that sleep apnea is the underlying cause.” This would be important to know because sleep apnea is, in most cases, readily treated. The new research findings show that these other complaints – about fatigue, tiredness, and lack of energy – are about as likely to improve as sleepiness is, when sleep apnea is treated.

Sleep apnea describes a group of increasingly common sleep disorders in which a person repeatedly stops breathing during the night. In obstructive sleep apnea, the throat closes completely or partially and interrupts breathing until the person wakes up briefly, only to fall asleep again and repeat the cycle.

The good news is that CPAP or other treatments are effective for the large majority of people who have sleep apnea. A CPAP machine delivers pressurized room air through a mask to keep the throat open. Results can include improved cardiovascular health, in addition to more alertness and energy during the day.

In the U-M study, the percentage of people who reported sleepiness dropped from 39.3 percent to 23.5 percent after regular use of the machine. Tiredness fell from 52.5 percent before treatment to 32.8 percent after adherence to PAP. Patients who used their machines on average for fewer than 5 hours per night did not experience much improvement in their symptoms.

“We found that sleep apnea patients who were able to use their PAP regularly, in comparison to those who used PAP less often, had much greater success in reducing their fatigue, tiredness and sleepiness,” Chervin says. Interestingly, for reasons that remain uncertain, improvement in lack of energy did not depend as clearly on the amount that PAP was used.


Cleveland Clinic Opens Sleep Lab in Willoughby

Cleveland Clinic has opened a new sleep lab in Willoughby as an extension of its Sleep Disorder Center on main campus.

The Willoughby Sleep Lab is located at the Courtyard by Marriott hotel in Willoughby, 35103 Maplegrove Road, and is the fourth sleep lab established by Cleveland Clinic. The new sleep lab will offer sleep studies and consultations by Charles Bae, M.D., a Board Certified Sleep Neurologist at the Cleveland Clinic Willoughby Hills Family Health Center.

“There is no need to suffer with poor quality sleep or daytime sleepiness,” Dr. Bae said. “The first step toward a better night’s sleep is a comprehensive evaluation by a Cleveland Clinic Sleep Medicine Specialist. This new location increases accessibility to our care, benefiting numerous patients and their families.”

The Cleveland Clinic Sleep Disorders Center is a multispecialty comprehensive program dedicated to the diagnosis and treatment of sleep disorders in children and adults. Accredited by the American Academy of Sleep Medicine, the center is comprised of specialists in sleep medicine, adult and pediatric neurology, pulmonary medicine, psychiatry, psychology, otolaryngology and dentistry.

Sleep consultations are available at Cleveland Clinic’s four sleep labs:
Cleveland Clinic Sleep Disorders Center at Fairhill (main campus), a state-of-the-art sleep facility, including a 9-bed sleep laboratory, just one mile east of the Cleveland Clinic main campus downtown. (Adult and Pediatric patients)
The Courtyard by Marriott hotel in Beachwood on Cleveland’s east side (Adult patients)
The Courtyard by Marriott hotel in Willoughby on Cleveland’s east side (Adult patients)
The Courtyard by Marriott Airport/North hotel in North Olmsted on Cleveland’s southwest side (Adult patients)

Fighting Sleep Apnea

Sleep Apnea Treatment

Sleep apnea is a serious medical condition that currently affects approximately eighteen million Americans. Unfortunately, this sleep disorder is often ignored due to the fact that the leading sleep apnea symptom is simply loud snoring, which many people do not consider a concern severe enough to warrant a consultation with a physician. There are two forms of sleep apnea; obstructive sleep apnea and central sleep apnea.

Obstructive sleep apnea is normally seen in people who are overweight or have a narrow throat or enlarged tonsils or adenoids. This disorder is seen more often in men and older people, although anyone of any age or weight can suffer from this condition. Other factors attributed to causing obstructive sleep apnea include heredity and the use of chemicals that relax the throat muscles, such as alcohol or sedatives. This form of sleep apnea is literally caused by the relaxation of the throat muscles, which then prohibits the proper amount of oxygen necessary to supply the body from flowing through the airway.

Central sleep apnea is usually caused by medical conditions that can prohibit the brain from functioning properly in regard to sending signals to various parts of the body that control the breathing rhythm. These medical conditions include, but are not limited to, disorders such as Lou Gehrig’s disease, muscular dystrophy, stroke, injury to the spinal cord, and brain tumors. A non-medical cause would be visiting and sleeping in a high altitude environment, to which your body is unaccustomed.

The result of either form of sleep apnea results in a severe lack of quality sleep. Not only is a person unable to comfortably sleep and dream, one will often wake with sore muscles or a stiff neck. Feeling fatigued throughout the day is also common. Sleep apnea can cause more serious medical complications as well, including cardiovascular conditions and poor or negative responses to medications and even surgical procedures.

Sleep apnea treatment is varied and is dependent on the severity of the individual condition. It could be resolved simply by losing weight and reducing the intake of alcohol and sedatives. Sleeping properly with a comfortable sleep pillow that properly
supports the neck and head is extremely important. Because of this, “memory foam” pillows are commonly being recommended to sleep apnea patients by their doctors. Sleeping on one’s side can also be beneficial. For other people, surgery might be necessary to remove unnecessary tissue from the airway. There are devices that supply increased oxygen pressure which have been found effective for people suffering from sleep apnea, and also dental devices worn at night that assist in opening the airway.

If you are experiencing the symptoms of sleep apnea, be sure to consult with your physician. The disorder can be so severe that a person might find themselves falling asleep at work or while driving. Once treatment has been discussed with a doctor and implemented by the person suffering from the disorder, the individual will usually begin to experience immediate symptom relief and will begin to sleep better and establish a proper sleep pattern.

Dr. Joseph J. Berke, M.D., Ph.D. Copyright 2004
Discover how sleeping on The Better Sleep Pillow can change your life. Visit: Dr. Joseph J. Berke is an author and inventor dedicated to helping people to get a better night rest.

Middle-Aged Men Lose Testosterone and Sleep

As men reach middle-age, they tend to lose their hair, their testosterone levels have already begun to decline, and they experience less deep sleep. A researcher from the University of Montreal believes there is a definite link between the latter two events, and he say his study is the first to uncover a relationship between declining testosterone and less deep sleep.

Experts typically recognize five stages of sleep, with stage 1 being drowsiness, stage 2 as a period of light sleep, stages 3 and 4 as deep sleep, and then stage 5, REM (rapid eye movement) sleep. The two deep sleep stages are known as slow-wave or delta sleep, with stage 4 representing a deeper stage of sleep. Both of these stages shorten dramatically in older people, so they tend to get less total deep sleep than younger individuals do. Older people enter REM sleep faster and stay there longer than younger people.

Deep sleep typically represents 10 to 20 percent of a young man’s total sleep time. Once men are older than 50, stage 3 and stage 4 sleep decreases to 5 to 7 percent, and it can disappear completely after age 60.

Zoran Sekerovic, the author of the study, found a correlation between testosterone levels in men older than 50 and the quality of their deep sleep. This association does not exist in younger men because their neuronal circuits are intact. As men age, however, neurons are lost and synchronization of cerebral activity is not as effective, which results in a loss of deep sleep.

“Deep sleep requires great synchronization,” noted Sekerovic. “Low levels of testosterone intensity the lack of synchronization and can explain 20 percent of men’s inability to experience deep sleep.” Sekerovic believes declining testosterone levels have an effect on sleep, and not the other way around, as other studies have reported.

Testosterone levels begin to decline in men around age 30 at a rate of 1 to 2 percent per year. Correcting deep sleep deprivation may not be as easy as starting testosterone therapy, however. Side effects can include acne, fluid retention, breast enlargement, worsening of sleep apnea, a decrease in testicular size, changes in cholesterol and lipid levels, decline in sperm count, and an increase in PSA (prostate specific antigen), a possible indicator of prostate cancer. Sekerovic notes that “it will be essential to better understand the mechanisms that lead to the loss of deep sleep” before middle-aged men see their doctors about taking testosterone for sleep loss.

Brain Spindles Protect the Brain from Disturbances During Sleep

Everyone knows someone who they say can “sleep through an earthquake”. Scientists are closer to understanding why some people can sleep through the night undisturbed while others wake with even the slightest noise. Researchers from Massachusetts General Hospital and Harvard Medical School in Boston have found specific brain structures that some have that help block out noise, producing a sounder sleep.

Sensory information, including sound, is passed through a structure in the brain called the thalamus before reaching the cortex where communication signals are processed. During the deeper stages of non-REM sleep, brain wave patterns slow down but are interspersed with brief, rapid pulses called spindles. Earlier research suggests that spindles help block sensory information from reaching the thalamus so that sleep is not interrupted.

Read: NC Center Hoping to Make Sleep Studies More Restful

Using electroencephalography (EEG), the researchers observed brain wave rhythms in 12 healthy individuals, ages 20-46, during the different stages of sleep over a three day period. Communication between the thalamus and cortex during sleep were captured by the EEG.

On the first night of the study, the laboratory was kept quiet. On the second and third nights, participants were exposed to 10-second sounds at 40 decibels while sleeping. Those who were able to consistently sleep peacefully through sounds such as a telephone ringing and traffic sounds had higher spindle rates on their EEG’s.

Read: How Long You Sleep Affects Cardiovascular Disease Risk

Dr. Jeffrey Ellenbogen, chief of the division of sleep medicine at Massachusetts General Hospital and lead researcher for the study said, “If a spindle occurs at the same time as a sound, then the sound is likely blocked from perception, keeping the person asleep. More spindles makes it more likely that noises will collide with this sleep-protecting rhythm.”

“Now we want to study behavioral techniques, drugs or devices that may enhance sleep spindles and see if they can help people stay asleep when confronted with noise and maintain otherwise healthy, natural sleep. Understanding the tools and techniques the brain naturally uses could help us harness and expand those responses to help stay asleep in noisy environments.”

According to a 2009 survey by the US Centers for Disease Control and Prevention, about one in 10 Americans report difficulty sleeping. More than 50 million Americans have chronic sleep disorders, such as insomnia. Chronic sleep deficit causes detrimental health effects such as the inability to remain alert and attentive, depression and may contribute to obesity.

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