Better Sleep Better Health

The obesity epidemic sweeping our nation has dramatic effects on health. Exercising is not only a key component in losing weight, but it may also affect the severity of Obstructive Sleep Apnea and help you sleep at night.

Researchers enrolled forty-three sedentary and overweight adults aged 18-55 years with at least moderate untreated OSA in a 12-week study to evaluate the efficacy of exercise as a treatment for sleep apnea. The participants were divided into two groups: One met 4 times per week and performed 150 minutes per week of moderate-intensity aerobic activity, followed by resistance training twice a week. The other group was the control and met twice weekly to perform low-intensity exercises designed to increase whole-body flexibility. Both groups underwent sleep studies before and after the exercise trial to determine severity of apnea. The results of the trial, published in the journal SLEEP, showed that the group that exercised weekly experienced a moderate reduction in their Apnea-Hypopnea Index (AHI), the measurement of the average number of breathing events per hour of sleep. The group that was limited to stretching did not experience this reduction.

Interestingly, the exercise group members did not experience any weight loss as a result of the exercise, suggesting the benefit of a reduced AHI was not in relation to losing weight. The researchers point out that further studies need to be done on this subject but speculate that “possible mechanisms of improvement in OSA following exercise training include a general strengthening and fatigue resistance of the ventilatory and upper airway dilator muscles, attenuation of respiratory instability from reduced sleep fragmentation, decreased nasal resistance, and prevention of lower-extremity fluid accumulation.”

Exercise is not a replacement for effective treatment such as CPAP or an oral appliance but a regular exercise program may help reduce your apnea severity.

For over twenty years Positive Airway Pressure therapy has been the gold standard treatment for Obstructive Sleep Apnea. Although modern CPAP machines are comfortable, quiet and compact, what is the solution for those who cannot or will not use the therapy? Luckily, there are alternative treatments.

One of the most common CPAP alternatives for sleep disordered breathing is called a mandibular repositioning appliance (MRA), or oral appliance. These devices resemble orthodontic retainers and work by repositioning the lower jaw forward during sleep, thereby anchoring obstructive tissue out of the airway and preventing apneas. The devices usually have some sort of adjustment screw or tensioner that allows for minute advancements. A health professional preforms these advancements over time until the breathing is corrected. The devices have been shown to be effective in treating some forms of sleep disordered breathing such as snoring and mild to moderate apnea. Patients with severe sleep apnea might see a reduction in intensity of their apneas, but the problem is likely to remain. For this reason, an MRA is not recommended for severe sleep apnea.

You may have seen the commercials on television for so-called “boil and bite” mouth guards that help to treat snoring. These devices are generally not beneficial. To be truly effective, oral appliance therapy must be custom fit to each patient and a qualified dentist must supervise the advancement of the device. Advancing the jaw too far forward too quickly can lead to complications including temporomandibular joint (TMJ) pain.

It is also very important that there be an objective measurement of the treatment’s efficacy after initiation. Patients may subjectively feel some relief after using an oral appliance, yet they can still have significant sleep disruptions. An overnight sleep study should be performed to confirm or refute the efficacy of the oral device.

When correctly fit and titrated, oral appliances may provide a convenient way of treating mild sleep disordered breathing. They can be also be used in conjunction with PAP therapy to allow for reduced pressures. Oregon Sleep Associates has longstanding relationships with several dental providers in the area who specialize in oral appliance therapy. If you are interested in an alternative to CPAP or are seeking treatment for the first time, contact our sleep specialists for more information at 503-288-5201.

The backbone of our economic infrastructure is based on open access to readily available goods. To keep this system working properly, we rely upon an extensive network of freight transportation, including the trucking industry. In fact, trucking accounts for 70 percent of all freight transported annually in the U.S., $671 billion worth of manufactured and retail goods. Truckers work hard to stay on schedule, sometimes to the detriment of their health.

Drowsy driving is a constant danger for truck drivers. The long hours and monotonous routes lend themselves to fatigue. Coupled with a lack of exercise and unhealthy truck stop dining, the risk for both obesity and sleep-related health risks is high.

Chief amongst those risks is sleep disordered breathing, or sleep apnea. Sleep apnea is closely related to obesity and its symptoms include snoring, hypertension, and excessive daytime sleepiness. It also increases risks for heart attack, stroke, and insulin resistance. Many truck drivers may not know they have the condition. In fact, in a recent Australian research study of 517 commercial vehicle drivers, only 4% believed they had sleep apnea. However, when the group was tested 41% were positive for the condition.

One barrier in treating truckers for sleep disorders is the unfortunate perpetuation of the myth that getting a diagnosis of sleep apnea will lead to loss of a driver’s commercial license. Over the past decade, this groundless rumor has spread through the trucking industry as companies have begun to include sleep screenings in annual physicals. Some drivers discourage peers from revealing information to their doctors about their sleep habits and level of fatigue. This is a disturbing trend as truckers who may truly need treatment for sleep disorders are afraid of being honest with their physician based on the unfounded risk of losing their jobs. “We’re not in the business of pulling people’s licenses or jeopardizing their livelihood,” says Dr Daniel Root, Medical Director at Oregon Sleep Associates, “We’re here to provide commercial drivers with access to proper screening and treatment options that keep them safe and alert on the roads.”

Despite government regulations to limit the amount of hours spent behind the wheel, many truck drivers are pushed to work long hours and meet deadlines. Also, late-night shift work is common for drivers and can lead to excessive fatigue. When one considers that a vehicle moving at 55 mph travels almost 81 feet per second, it is evident that even a momentary lapse in attention or quick nod-off can result in fatal consequences. It is very important to pull over and rest if you feel fatigued when driving. If this happens frequently or if you have other symptoms of a sleep disorder such as snoring or apnea, be honest with your physician about your fatigue or seek treatment directly at Oregon Sleep Associates.