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| Admin: Good afternoon. Welcome to the Gaylord Hospital Chat Room. Today we have Dr. Carlos Fragoso, a sleep specialist, to discuss sleep disorders. We will be starting in five minutes. Please feel free to e-mail lcrispino@gaylord.org if you have any questions about chatting this afternoon. light: Dear Dr., I feel like a get a good night's sleep but then I often feel sleepy while driving to work in the morning. What's my problem? Dr. Fragoso: It would be important to define first what is a good night's sleep and what is your level of alertness during the course of the day. light: I normally get about 7 hours (10 p.m. to 5 a.m.) and fall asleep easily. Maybe wake up briefly once during the night. During the day I'm alert once I get out of the car, until that 3 p.m. lull. Dr. Fragoso: There is a wide range of what is a normal amount of sleep per night. This may vary from 6.5 to 9 hours of sleep. If on weekends, you are sleeping more than 7 hours, this would be a hint to you that 7 hours is inadequate. Any thoughts ? Nancy: Has entered. light: That may be the problem. On weekends I often sleep 9 hours per night. But that's hard to do during the week when I have to get up so early to get in some exercise. Cindy: Are sleep disorders considered one of those "little known about" conditions that we hear about in the news? bubba: Has entered. Cindy: Welcome, Nancy. Hello, Bubba. Iinda: Has entered. Dr. Fragoso: Light, one alternative is to ask your employer to allow you a 30-minute nap in the early afternoon but prior to 3 p.m. This is not the best solution but will serve to improve your daytime alertness. bubba: Dr. Fragoso, I have had many sinus infections over the past few years. I have noticed that I have started to snore more often and louder much to my wife’s dismay. Can snoring be related to sinus infections? Admin: Thanks for your patience, everyone. Typing responses can take a bit of time, so we appreciate your understanding. Dr. Fragoso: Cindy, we have often ignored sleep-related complaints. This is not a topic at most doctor's visits or among families. However, when we hear of industrial accidents related to sleepiness or the recent tragedy in Texas (18-year-old driver fell asleep while driving and then allegedly killed 6 people), it becomes a cause for alarm. Our daytime well being is heavily influenced by our sleep quality. bubba: Is there a way that I can reduce my snoring and thus have a positive effect on my wife’s sleep habits? Dr. Fragoso: Hi bubba. Yes, nasal congestion predisposes to snoring by increasing upper airway instability and predisposing individuals to breath through their mouth while asleep. Do you wake up with a dry mouth? In addition, if you are a sleepy snorer you may need treatment beyond the nasal congestion. Cindy: Dr. Fragoso, what do you mean by a "sleepy snorer" as in your response to Bubba? bubba: What do you mean by a sleepy snorer? I do snore fairly regularly. Do those nasal strips work on snoring? Dr. Fragoso: Bubba, raising the head of the bed by 30 degrees, avoiding sleeping on your back, keeping pets out of the bed room, and avoiding alcohol within 2-4 hours of bedtime, etc. There are also a variety of medications that may assist you. bubba: Thanks. I will give some of those suggestions a try. Dr. Fragoso: Hi Bubba: you must type faster than I do. If you are sleepy at times during the day, have high blood pressure, are overweight, and have abnormal breathing spells while asleep, you need to be evaluated for sleep apnea. light: What's sleep apnea? Dr. Fragoso: Light, sleep quality can be severely disrupted without the affected individual being aware by abnormal breathing during sleep. The latter is due to collapse of the upper airway (throat) but only during sleep. This results in sleep deprivation and daytime sleepiness or fatigue. It can also result in memory problems, sexual dysfunction, and predisposes the individual to future strokes or heart disease. Cindy: Dr. Fragoso, could you explain "abnormal breathing spells?" Dr. Fragoso: Cindy, this may be characterized by an awakening with gasping, snorting, or sputtering sounds. A significant other may also observe a sudden stoppage in snoring followed by a loud snorting during which the person may have body jerking movements. Cindy: In your experience, is the topic of sleep disorders a difficult one for spouses to discuss? light: Especially if one spouse always seems tired and grumpy? fred: Aren't they usually? Dr. Fragoso: Hi Cindy. Yes, often a sleep problem affects the whole family resulting in poor sleep quality for all. Sleep deprivation can make people irritable. In addition, the individual with the sleep disorder has often no direct observation of the sleep problem and may be annoyed by others who are blaming them for the family being sleep deprived. There is often much denial. Cindy: So, does the mate have to resort to videotaping? fred: Only kidding, my wife has difficulty falling asleep. During this period she often twitches. I always assumed this is normal. It does not continue through the night. Is there anything that we should be aware of? Cindy: I mean...how do you lead a person to seek consultation with a physician such as yourself? Dr. Fragoso: Hi fred. Twitching is nonspecific but may reflect restless legs syndrome. This describes a disorder with perceived irritable sensations in the legs, feet, and less frequently in the arms. Affected people instinctively move/rub/massage to seek relief. This is often precipitated by inactivity such as lying down in bed. It leads to difficulties in falling asleep and may contribute to depression or anxiety. light: I don't think that my doctor has every asked me if I feel sleepy during the day. Dr. Fragoso: Cindy, the first step is to talk with your primary care provider. Doctors often require their patients to emphasize the symptoms which are most bothersome. The Internet also has a web site by the American sleep Disorders Association and another by the National Sleep Foundation. Gaylord Hospital also has a telephone-based infoline. Dr. Fragoso: Hi light. It's a shame that sleep medicine is not yet a high priority item in preventive health care. It is tragic to enumerate the countless motor vehicle accidents and the untreated risk factors that contribute to our nation's high rate of cardiovascular and cerebrovascular disease. Cindy: Is it possible that a child under the age of 5 could have sleep apnea? Dr. Fragoso: Yes. The preschool age group of 4-6 year olds have an increased prevalence of sleep apnea primarily due to large tonsils. Sleep apnea may be a cause of attention deficit hyperactivity disorder, behavioral problems, and poor learning at school. Sleep apnea is also one of the causes of sudden infant death syndrome. debby: Has entered. Admin: Hello, Debby. light: My brother often wakes up at 3:00 a.m. and can't go back to sleep. He usually spends the rest of the night tossing and turning. Does he have a sleep apnea problem? Dr. Fragoso: Early morning awakenings have many causes. In general, it could be due to environmental factors (garbage trucks, airports, etc.), depression, anxiety, and abnormal biological rhythms (morning lark). It does not necessarily imply sleep apnea. light: Do you have any tips for better sleeping? Cindy: OK, so my husband snores loudly, seems to stop breathing then gasps for air, and sometimes twitches drastically. Is that enough info to bring to his primary care provider...or am I being a worry-wart? debby: My 5-year-old daughter grinds her teeth sometimes. Is this normal? Admin: Attention, folks, we have five minutes left in the chat. Dr. Fragoso: Light, it is important that we maintain a regular wake-up time; avoid non-sleep related activities in the bedroom; make the bedroom environmentally friendly (noise, temperature, mattress, significant other, pets, etc.); go to bed only when you are drowsy (within reason); and have at least 30 minutes of direct exposure to sunlight each day. For the morning larks, this should be after 4 p.m. For the night owls, this should be between 6-9 a.m. A warm bath at 2 hours prior to bedtime is helpful. Exercise, but not within 3 hours of bedtime, is also very helpful. Dr. Fragoso: Cindy, you are a good person! Your husband needs to be seen and educated on issues related to sleep apnea. We can help him tremendously. Cindy: Thank you, Dr. Fragoso! Admin: One minute to go! Dr. Fragoso: Debby, grinding of the teeth is frequent in childhood and children will outgrow it. However you should check with your dentist if there is any underlying dental problems such as a malocclusion or wear and tear on the teeth. Stress related issues may also need to be pursued. debby: Thanks very much! Admin: Thanks everybody for joining us for today's chat. Special thanks to Dr. Fragoso for taking the time to be with us. If anyone would like to ask further questions, please send e-mail to lcrispino@gaylord.org. |
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