Entries in Sleep Apnea (9)


Provigil: Sleep Deprivation Drug the Secret to Success?

JB Reed/Bloomberg via Getty Images(NEW YORK) -- They are all around us, a secret society of the successful. They say what gives them an advantage, though, isn't just purposefulness or perseverance but a little secret weapon -- a pill called Provigil.

There is the lobbyist, who wakes up at 5 a.m. to complete two full workouts before heading to work.

"I could not do this without Provigil. You know, it just wouldn't be the same," she told ABC News, asking that ABC News not identify her. "It's amazing. ...I just don't get...why more people don't know about it."

John Withers, a computer programmer, can write code for 12 hours at a time.

"It helps you focus up for exceptionally long periods of time," he said.

And then there is the brain researcher who can find connections no one else is seeing. She also asked that ABC News not name her.

"It's just a clear day," she said. "The fog isn't there."

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Provigil is approved only for narcolepsy, sleep apnea or for people who work irregular hours, but hidden among those who take it are pockets of healthy Americans taking it just to boost energy and enhance focus. It excites the mind so much that Provigil has been nicknamed "Viagra for the brain."

Prescription sales for this class of drugs has increased by 73 percent in four years, from $832,687,000 in 2007 to more than $1.4 million in 2011, according to IMS Health.

Online there are hundreds of sites campaigning for Provigil that explain how to get a doctor to write a prescription or how to get the drug without one.

Many Provigil users are secretive, but not Dave Asprey, a successful executive of a billion-dollar Internet security firm who often starts his day at 4:45 a.m. by popping a pill.

"[It] can be the difference between [me] just making it through the day to I had the best day of my life," Asprey told ABC News.

Asprey says he once flew 20 hours to Australia with almost no sleep, got off the plane, took Provigil and delivered a series of speeches that were so good they made the local papers.

As a kind of an experiment ABC News asked Asprey to stop taking the drug for three days. Off the drug, he said he felt off.

"I've noticed that my speech is very slightly altered," he said.

After three days, Asprey popped a Provigil and he says it took only 17 minutes for him to snap back. He said the world suddenly seemed brighter. Asprey compared it to the scene in The Wizard of Oz where everything goes from black and white to color.

ABC News had Asprey take some cognitive tests, and there was a pronounced improvement over the day before when he was not on Provigil.

So, should we all be on Provigil?

Doctors warn that you are really rolling the dice with this drug. There have been no long-term studies of Provigil and its effects on healthy brains have never been studied. Doctors also warn that possible side effects include sleep deprivation and potentially lethal rashes and worse.

Provigil is a wake-promoting agent, but doctors admit they don't really know how it works.

"Provigil is not a substitute for sleep. Sleep deprivation can cause and worsen heart disease, diabetes and high blood pressure," said Dr. Joanne Getsy, chief of the Sleep Medicine Section at the Drexel University College of Medicine in Philadelphia.

And there have been no studies proving that performance actually improves with Provigil. "Sleep deprivation can actually worsen performance," said Getsy.

"It's very tempting, but I think long-term it's a bad idea," said Dr. Martha Farah, a cognitive neuroscientist at the University of Pennsylvania. "We actually know very little about the long term effects."

Astonishingly, Asprey says even if it were to turn out that Provigil could shorten his life he wouldn't give it up and neither would the lobbyist or brain researcher who take it. They told ABC News they aren't worried and aren't about to stop using Provigil.

"I would like to really live during those years when I'm alive. I'd like to be fully alert, fully focused and fully present all the time" Asprey said. "Provigil helps me do that."

Copyright 2012 ABC News Radio


Sleep Apnea Treatment May Prevent Hypertension

Hemera/Thinkstock(NEW YORK) -- Sleep apnea may prove to be a treatable cause of high blood pressure, according to research released Tuesday that suggests wearing a special breathing mask at night may protect apnea patients from the hypertension.

Most people think of obstructive sleep apnea as a snoring disorder. Although many sufferers snore, apnea is characterized by short episodes in which the patient's upper airway narrows or closes, reducing the flow of oxygen to the body and brain. Those episodes, which can number hundreds in a night, not only disrupt nighttime sleep but may reduce daytime alertness and over time stress the body. For the past 15 to 20 years, doctors have thought that these episodes send blood pressure upward and put patients at risk of heart attack and stroke.

Doctors most often treat sleep apnea by having their patients use devices that employ a technique called continuous positive airway pressure, or CPAP, which delivers mild air pressure through a nasal mask, to keep their airways open throughout sleep.

Two studies released Tuesday in JAMA suggest that CPAP may reduce the risk of hypertension among apnea patients.

Dr. Ferran Barbe and his colleagues at the Institut de Biomedia Recerca in Lleida, Spain, studied the effects of CPAP treatment on hypertension and risk of heart attack and stroke among 723 apnea sufferers who didn't have daytime sleepiness. They divided the patients into two groups, one that wore CPAP masks while sleeping and an observation-only group. In the course of more than two years, patients who used CPAP machines at least 4 hours a night did better, but the study didn't show a statistically significant reduction in cardiovascular problems.

However, a related study in the same issue found a stronger benefit. Dr. Jose M. Marin, a respiratory specialist, led an observational study that followed 1,889 patients without hypertension who underwent evaluations for abnormal nighttime breathing at a sleep center in Zaragoza, Spain. They subsequently came in for annual blood pressure checks.

With more than 12 years of follow-up, Marin's study suggested that apnea patients who used a CPAP didn't develop hypertension as much as patients with untreated OSA, those who refused treatment or those who don't wear a CPAP as prescribed. The greater the adherence to prescribed nightly CPAP use, the more protective the treatment.

Dr. Viren Somers, a sleep apnea and heart disease researcher at the Mayo Clinic in Rochester, Minn., cautioned that the results of the two studies are suggestive "but not definitive that CPAP is protective of the cardiovascular system."

He said the conclusion that better adherence to CPAP use is protective also "has to be taken with a pinch of salt -- because the fact that someone uses CPAP more frequently and more conscientiously may mean they do other things, maybe take their medicines or do other things we don't measure that will improve their cardiovascular risk," said Somers, a professor of cardiovascular diseases.

Barbe's finding that those patients who adhered to therapy had a decreased incidence of hypertension "is in my opinion quite powerful and supports the relationship found in the Marin study," said Dr. James Rowley, medical director of the Sleep Disorders Center at the Detroit Receiving Hospital in Detroit and faculty member at Wayne State University. "The Marin study in particular was a more 'real-world' study and had a longer follow-up period so is in my opinion strongly supports the statement that OSA is associated with increased risk of hypertension."

The two studies provide more evidence for the benefits of CPAP therapy in reducing hypertension and its potential in preventing it among people with obstructive sleep apnea, Drs. Vishesh Kapur and Edward Weaver, both of the University of Washington in Seattle, wrote in an accompanying editorial.

"Treatment may not only reduce blood pressure (although modestly on average), but if confirmed by future studies, also may prevent hypertension in at-risk patients. Thus, OSA deserves attention in patients with or at risk of developing hypertension as a potentially treatable cause of hypertension as well as other clinically important outcomes."

However, they said additional clinical trials were needed to determine the amount of CPAP therapy necessary to achieve a beneficial effect, and to evaluate other sleep apnea treatments.

Because so many apnea patients complain that they cannot tolerate wearing a mask throughout the night, Somers said that industry is "trying to develop new ways of delivering positive airway pressure that are more tolerable." He said the idea is for the machines to deliver constant air flow throughout the night, increasing the pressure when it's needed. That way, the treatment "will be primarily instituted" when breathing is blocked, "and when you're breathing quietly and happily, you don't need it."

The sleep apnea pipeline includes new technology being developed to address some of the neurologic issues that underlie disrupted breathing to reduce apnea episodes. One approach now being tested involves stimulating nerves that control how the body keeps the airways open, Somers said.

Rowley said that for now, none of the other treatments used for OSA, including surgery, some oral appliances that reposition the jaw, CPAP masks, or even devices in the pipeline "have been studied for long-term outcomes of OSA, particularly cardiovascular disease. Most of the data is short-term and relates to subjective symptoms such as sleepiness and quality of life."

Copyright 2012 ABC News Radio


Provent: A New Option for Sleep Apnea

Erik Snyder/Photodisc/Thinkstock(NEW YORK) -- An estimated 18 million Americans have obstructive sleep apnea, according to the National Sleep Foundation.  But now, they have a new treatment option: a device called Provent.

Provent is a small patch that fits over the nose with two small plugs in each nostril.  During inhalation, a valve opens, allowing air to flow in freely.  During exhalation, the valve closes.  Air is directed out through two small channels, increasing the pressure in the airway and helping to keep it open.

Provent is a welcome rival to Continuous Positive Airway Pressure (CPAP), a machine with a cumbersome mask that pumps air through a patient's nostrils, which has long been the gold standard for treating sleep apnea.  More than half of patients who try using CPAP stop using it.

But Provent has its drawbacks, too.  At $2 per night, it’s expensive, not covered by insurance and it only works in about half the people who try it.

“The main complaint has been the inability to tolerate having the plugs in their nose,” said Dr. Nanci Yuan, medical director of the pediatric sleep center at Stanford University.  “They complain of feeling like they are suffocating as they are unable to generate enough air pressure or movement.”

Yuan added that patients with nasal congestion have found Provent to be useful.

“It may be effective, more so in patients with snoring alone and those with mild-moderate sleep apnea,” said Dr. Donald Greenblatt, director of the University of Rochester Sleep Disorders Center.  “It also may be useful for travel in patients using CPAP at home.”

Copyright 2012 ABC News Radio


Sleep Apnea Linked to Depression, CDC Study Finds

Erik Snyder/Photodisc(WASHINGTON) -- Gasping for air and stopping breathing while sleeping has been linked to depression, according to a new study from the Centers for Disease Control and Prevention.

The condition, known as sleep apnea, occurs when a person's breathing is paused or interrupted while sleeping.  The pauses, which can last a couple seconds to a minute, can cut off oxygen from the brain and the rest of the body.  Symptoms of the condition include snoring, daytime fatigue and restless sleep.

"When a person stops breathing like this, they are momentarily brought out of deeper levels of sleep," said Anne G Wheaton, a CDC epidemiologist and lead author of the study.  "They may not fully wake up, but they will not get the proper amount of rest."

The study, published in the journal Sleep, analyzed nearly 10,000 American adults.  Researchers found that the likelihood of depression in study participants increased along with the self-reported rate of gasping and stopping breathing while sleeping.

About six percent of men and three percent of women enrolled in the study reported having been diagnosed with obstructive sleep apnea.  Otherwise, participants had not been diagnosed with the disorder, but described symptoms of gasping, snorting, restlessness while sleeping and daytime fatigue.

"Mental health professionals often ask patients with depression about their sleeping habits, and there is a known link between depression and insomnia, but less about depression and this specific sleep disorder," said Wheaton.

While there have been small studies with smaller study populations that have examined the link in the past, this is the first study to look at the link between sleep apnea and depression in the general population, said Wheaton.

Cells need oxygen to "perform whatever tasks there are for the brain to perform and if they're not getting enough, a person's physical and mental health seems to suffer," said Wheaton.

Men are more at risk of sleep apnea than women.  Obesity puts people at greater risk of apnea because the extra weight around the neck can cut off breathing.  Being older than 40 and having a large neck size also puts people at greater risk for the sleep disorder.

Despite the potential health issues associated with the disorder, most people are unaware of the difficulty they have breathing while sleeping.  It is usually only after a bed partner notices the breathing problems that a diagnosis is revealed.

While the research adds an important element to understanding depression and sleep disorders, the findings should be taken with caution because of the study's self-reporting nature.

"People are poor reporters of their sleep symptoms in general," said Dr. Rosalind Cartwright, chairman of psychology at Rush University Medical Center.  "The authors make up for this with large numbers to wash out error but [did] better if they asked the bed partner for these data."

Copyright 2012 ABC News Radio


Sleep Apnea: Hidden Illness for Women Can Lead to Real Dangers

Jupiterimages/Thinkstock(PHILADELPHIA) -- Cathy Rossi, 57, had never had never had trouble sleeping, but when she started experiencing mental blank outs on her morning drive to work she knew something was wrong.

“I was on my way to work and I was on one interstate and next thing I knew I was on another road and I had no idea where I was,” she said.

After a barrage of medical tests Rossi was diagnosed with sleep apnea, a diagnosis she initially had trouble accepting.

“I didn’t snore, I didn’t have any of the typical symptoms of sleep apnea,” she told ABC.  "Anytime you see anything on television…it’s always some big guy sawing logs.”

These are common misconceptions, according to Dr. Grace Pien, assistant professor at the Sleep Medicine Division of the Perelman School of Medicine. She told ABC News that sleep apnea was initially believed to be a disease that almost exclusively affected men, only rarely showing up in women. However, newer findings have refuted this, showing that for every two or three men who have the condition, roughly one woman is also affected.

According to Pien, the consequences of this misconception are evident. “The symptoms we think about with sleep apnea (such as snoring and daytime sleepiness) are those that were first described in men.”

Woman may have far subtler symptoms, such as headaches and fatigue, which lead to frequent misdiagnoses. "Women oftentimes are worked up for other things, for hyperthyroidism, for inactive thyroid, or for depression or other types of medical conditions before somebody says oh, you know maybe this woman does have sleep apnea,” Pien said.

This is especially the case for menopausal woman. They are not only one of the most at-risk groups of women for developing sleep apnea, but they often write off the symptoms to the changes going on in their bodies. "A woman might just think…it’s normal and maybe once I get through menopause this will get better and her doctor might actually think the same thing,” Pien said.

So what are the signs that a woman may have sleep apnea?  Pien can point out a few. “During the day she might just feel run down, tired, fatigued, if she has a few minutes to herself she wants to doze off even if she did get a good night’s sleep the night before.” Other women “may notice that they wake themselves up feeling as if they are gasping for air or choking,” and they may, “report that they wakened, but they’re not entirely sure what awakened them.”

Sleep apnea is associated with long-term health problems. According to Pien “We know that sleep apnea especially if it’s severe can increase the risk for having various types of heart disease including heart attacks and even dying from a heart related condition.  There also appears to be an association with stroke.”

If you think you may be suffering from sleep apnea “get it checked out,” advises Rossi, who after treatment tells ABC that she feels “like a whole new person.” “It doesn’t take that much to have a test done” she said. “Everybody owes it to themselves to have it checked out.”

Copyright 2012 ABC News Radio


CPAP Mask Treats Sleep Apnea, Heart Problems

Siri Stafford/Digital Vision/Thinkstock(NEW YORK) -- Joan Siegel reached the tipping point of husband Alan's snoring on their trip to China.

For the past three years, Siegel could bear her husband's snoring and waking in the middle of the night. It was simple: just sleep peacefully in another bedroom.

But when she found herself stuck in the same hotel room on their big trip, there was no escape.

"She told me she'd never go on vacation with me again unless I got help," said Siegel, 61 of Jericho, N.Y. "She really meant it and that did it for me."

Siegel suffered from obstructive sleep apnea, a condition in which Siegel's blocked airways caused him to stop breathing in the middle of the night. For many patients with sleep apnea, each pause in breathing typically lasts 10 to 20 seconds or more, and the pauses can occur 20 to 30 times or more an hour, according to the American Sleep Association.

If left untreated, sleep apnea can lead to high blood pressure, heart disease, obesity and stroke. "I was getting tired during the day," Siegel said. "Let's just say I needed a lot of coffee."

After his diagnosis, Siegel's specialist, Dr. Lisa Liberatore, recommended a continuous positive airway pressure mask (CPAP), a device worn while sleeping to open the airways and keeps the oxygen flowing.

It's considered the gold-standard treatment for sleep apnea, but the mask can be a source of disdain for many patients who are advised to wear it. It can be irritating, itchy, loud and, for some, can lead to headaches.

But there's a reason it's the first-line treatment for sleep apnea. A new study suggests only three months of CPAP therapy can dramatically lower blood pressure and decrease the risk and even treat signs that can lead to metabolic disorders such as heart disease and diabetes.

Eighty-six patients with moderate to severe sleep apnea were randomly assigned to undergo standard CPAP therapy or a sham CPAP therapy, according to the study that was published Wednesday in the New England Journal of Medicine. Eighty-seven percent of the group already had signs of a metabolic disorder at the start of the study.

After three months, 20 percent of patients who completed CPAP therapy for the first time were more likely to have lower blood pressure, lower cholesterol and a lower body mass index (BMI), compared to those on the false therapy. A lower BMI and smaller waistline may have been the result of participants' being less likely to fall asleep during the daytime and therefore more physically active, the researchers said.

Patients who wore the CPAP mask for five or more hours a night were also more likely to see the most improvement in their overall health.

Still, the stigma of sleeping with a large ventilated mask holds many patients back from even trying the treatment. "It's not the most attractive for couples," said Liberatore, otolaryngoloist at Lenox Hill Hospital in New York. "Sometimes, they feel like they're choking."

But there are many models of the mask. And Siegel chose one he said was smaller and less intrusive.

The initial fitting trial with CPAP offers some the best sleep they've had in a long time, and that will win them over, Liberatore said.

Alternatives to CPAP therapy include surgery to clear the obstructive airways. But Liberatore says surgery is the last resort, and some patients, depending on the reasons causing their sleep apnea, might not qualify.

The overall goal for many patients is to lose the weight that might be bringing on the sleep apnea, Liberatore said. Sleep disruption caused by sleep apnea and the lack of oxygen to vital organs can cause changes in hormones involved in appetite regulation and fat retention.

Siegel, who exercises regularly and is not considered overweight, says other parts of his health have improved dramatically. After two months, Siegel no longer snores, sleeps through the night, and feels more energized during the day. What's better, he says, is that is wife is happy.

Copyright 2011 ABC News Radio


Scientists ID ‘Morning Person’ Gene

iStockPhoto/Thinkstock(MUNICH) -- History is full of names of famous figures who accomplished historical feats on reportedly few hours of sleep. Now, new research suggests they may have had a certain genetic advantage.

Scientists at Germany’s Ludwig Maximalians University of Munich have found that one gene, called ABCC9, influences sleep duration and could explain why certain people seem able to operate on limited amounts of shut-eye. The researchers studied responses to a sleep survey from more than 4,000 Europeans in seven different countries and also scanned their genomes. They found that people who had two copies of a particular variant of the ABCC9 gene generally reported sleeping for shorter periods than those who had two copies of a different version of the gene.

The ABCC9 gene has been previously linked to heart disease and diabetes. These latest findings on the genetic factor’s role in sleep duration add to a growing body of evidence suggesting a connection between sleep and cardiovascular health. A 2008 study found a connection between lack of sleep and a dangerous build-up of calcium in the arteries. Sleep apnea, a sleep disorder marked by abnormal pauses in breathing, has also been associated with high blood pressure and heart attacks.

“Apparently, the relationships of sleep duration with other conditions, such as heart disease and diabetes, can be in part explained by an underlying common molecular mechanism,” study author Karla Allebrandt told the U.K.’s Daily Mail.

The scientists also found that the ABCC9 gene controls sleep duration in fruit flies, providing a clue to the gene’s evolutionary age, Allebrandt said.

Copyright 2011 ABC News Radio


Obesity, Sleep Apnea, Cognitive Problems Linked in Children

Boy Yawning (iStockphoto/Thinkstock)(CHICAGO) -- Obesity, sleep apnea, and behavior and learning difficulties can cause significant dysfunction in children, but a new study suggests these three problems interact with one another, exacerbating the effects of each individual problem.

Researchers at the University of Chicago's Comer Children's Hospital and Pritzker School of Medicine performed sleep, cognitive, and body weight tests on more than 350 healthy, normally developing children aged 6 to 10, and found a complex relationship between the three factors.

"Cognitive functioning in children is adversely affected by frequent health-related problems, such as obesity and sleep-disordered breathing," the authors wrote.  "Furthermore, poorer integrative mental processing may place a child at a bigger risk for adverse health outcomes."

On the other hand, "good cognitive abilities may be protective against increased body weight and sleep-disordered breathing," said Karen Spruyt, the study's lead author.  "If the brain can function optimally, it can help protect against the clinical manifestation of disease."

The study, she said, published this week in the American Journal of Respiratory and Critical Care Medicine, is one of the only ones to evaluate the relationship between obesity, sleep apnea and cognitive ability at the same time in either children or adults.

Past research has looked at them separately.  For example, studies have found that the mental functioning of obese people with sleep apnea is impaired, but these studies didn't look at the reverse relationship.  Other research has found a link between both body weight and sleep disorders, and a study published in January found a link between a lack of sleep and childhood obesity.

The new study's findings suggest, Spruyt explained, that when targeting obesity in children, clinicians should also screen for sleep apnea and cognitive impairment, because improving one of these variables could also lead to improvement in the others.

Copyright 2011 ABC News Radio


Sleep Apnea Linked to Sexual Dysfunction

Stockbyte/Thinkstock(NEW YORK) -- Sleep apnea cuts into sleep quality for more than 12 million Americans every year, but shut-eye isn’t the only bedroom activity disrupted by this nighttime breathing disorder.

Several studies have shown that sleep apnea sufferers have higher rates of sexual dysfunction as well. Most recently, a study published in The Journal of Sexual Medicine of women aged 28 to 64 found that those with sleep apnea were significantly more likely to suffer from loss of libido and experience sexual dysfunction.

Past studies in men have shown a similar spike in erectile dysfunction (ED) among men who suffer from the sleep disorder, such as a 2009 study done in Germany that reported that 70 percent of men referred seeking sleep apnea treatment also suffered from ED.

A 2008 experimental study in male mice found that sexual dysfunction arose almost immediately after inducing the kind of oxygen deprivation experienced by sleep apnea sufferers. This University of Louisville study showed that just a week of induced sleep apnea led to a 55 percent decline in daily spontaneous erections. After five weeks of sleep apnea, there was a 60-fold decrease in the frequency of mating attempts in the mice.

“Even relatively short periods of CIH, [the oxygen deprivation experienced during sleep apnea] are associated with significant effects on sexual activity and erectile function,” wrote Dr. David Gozal, professor of pediatrics at the University of Louisville, in the article.

Sleep apnea is characterized by disruptions in breathing during sleep that lead to lower oxygen levels and repeated waking throughout the night.

Sleep experts believe that the link may be due to the body’s levels of the sex hormone testosterone, which naturally rise while we sleep. Because sleep apnea causes repeated nighttime waking, this chronic sleep deprivation may inhibit the body’s ability to produce and process testosterone, which is partially responsible for libido in men and women.

Copyright 2011 ABC News Radio

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