By Dr. David O. Volpi

Recently, I was interviewed for a segment on CBS Channel 2 News in New York. The topic was, “What constitutes the best night’s sleep?” How many hours of sleep are needed, and is it better to sleep alone or with a partner?

The answer to both questions is relative to the person asking it, depending on their age and overall health. This is known as a person’s basal sleep need: the amount of sleep an individual needs on a regular basis for optimal performance.

As the founder of Eos Sleep in Manhattan, and an otolaryngology surgeon for more than 20 years, I can tell you that there is no magic number of hours we should all sleep per night—different people need different amounts of sleep to feel their best.

In fact, I see a lot of patients who seem to get a lot accomplished on very little sleep. But even though short sleepers may claim that there are no ill effects, they’re functioning during the day thinking they’re 100 percent, but really they’re probably only functioning at 40 to 50 percent.

Even those who are used to getting by on fewer hours may develop headaches and memory loss, among other symptoms. Often, when we actually improve their sleep they suddenly realize what they’ve been missing all that time.

So, my advice is, even if you think you’re getting enough sleep, try getting more, and see how much better you feel. And if you’re having trouble sleeping, get checked out.

Watch the interview on CBS Channel 2 New York.

By Dr. David O. Volpi

It is common knowledge that untreated sleep apnea can have dire health effects, but researchers in England found out that loss of sleep also increases a person’s risk of nodding asleep at the wheel, and getting in a car accident. That endangers not only the person suffering from the sleep disorder, but any person driving around them at any given time.

The study, which was organized by the European Respiratory Society and the European Sleep Research Society, and presented April 12, 2013 at the Sleep and Breathing Conference in Berlin, determined that people with untreated sleep apnea are more likely to fail a driving simulator test, and report nodding asleep while driving.

Let’s review: What is sleep apnea?

Sleep apnea is a breathing disorder that causes a person’s breathing during sleep to be paused and/or shallow. The pauses generally last 10 to 20 seconds, and in severe cases, can occur hundreds of times a night. With obstructive sleep apnea (OSA), the airway is blocked and/or collapses while sleeping. Air squeezing by the blockage can cause loud snoring and interrupted sleep.

As a result of the paused breathing and/or snoring, many sleep apnea sufferers are woken up throughout the night and spend more time in light sleep, rather than deep, restful REM (rapid eye movement) sleep. This chronic sleep deprivation results in daytime sleepiness, and can negatively affect job performance, mood, reflexes, concentration, and it can lead to hypertension, heart disease, and memory problems.

Testing and results of the study

To determine the effect of untreated sleep apnea on driving, the researchers conducted two separate studies. The first was a driving simulation test where 133 patients with untreated sleep apnea and 89 without sleep apnea were asked to “drive” 90 km—about 55 miles.

Various criteria was recorded, including the participants’ ability to complete the driving distance, their time spent in the middle lane, and any participation in an unprovoked crash or a “veer event” crash.

The results of the driving simulation test showed that:

• Patients with untreated sleep apnea were more likely to fail the driving simulation test—24 percent of the sleep apnea patients failed the test, compared to 12 percent of those without sleep apnea.
• In addition, many patients with untreated sleep apnea were unable to complete the test at all, had more unprovoked crashes, and were unable to follow the clear driving instructions given at the beginning of the simulation test.

In the second study, 118 people with untreated sleep apnea and 69 without sleep apnea completed a questionnaire about their driving behavior, and also took the 90 driving test on the simulator.

The results showed that:

•    35 percent of those with untreated sleep apnea admitted to nodding asleep while at the wheel, and 38 percent of this same group failed the driving simulation test.
•    By comparison, only 11 percent of people without sleep apnea said they have nodded off while driving, and none of this group failed the simulator test.

Key differences in the reasons for failure

While some people in the control group (those without sleep apnea) also failed the driving simulator test, the researchers noted key differences in why they failed the test:

• 13 people with untreated sleep apnea did not finish the test because they fell asleep or veered completely off the road.
• 5 people with untreated sleep apnea failed because they spent more than 5 percent of the study outside the lane they had been instructed to stay in.

But in the control group, no one failed the simulation for either of these reasons. Again, no one in the “without sleep apnea” group failed the driving simulation due to falling asleep, veering completely off the road, or driving outside the lane.

Dan Smyth of Sleep Apnea Europe noted, “The dangers of untreated sleep apnea and driving are highlighted in both studies. These studies give weight to the need for provision of sufficient resources for early diagnosis and treatment.

While further investigation is needed to examine the reasons for failure of the simulator tests, I acknowledge the researchers for bringing light to this very dangerous side effect of untreated sleep apnea. of sleep apnea, where effective treatment ensures a return to acceptable risk levels for road users.”

Are you at risk for sleep apnea?

So how do you know you may have obstructive sleep apnea? Some common symptoms include snoring, paused breathing during sleep and excessive sleepiness during the day. Increased blood pressure is another sign you may have sleep apnea.

While sleep apnea is more common in men, OSA increases in women after age 50. Being overweight may also increase a woman’s risk of having sleep apnea. Menopausal women are three and a half times more likely to get OSA, possible due to reduced amounts of progesterone.

If you experiencing one or more of the above sleep apnea symptoms on a regular basis, see a qualified sleep doctor to get diagnosed and treated properly. There are multiple options and minimally invasive techniques available today to treat your sleep disorder.

By Matthew D. Mingrone, M.D. of eOs Sleep

It has been common scientific knowledge for some time that when people sleep, our brains consolidate the information we subconsciously absorb during the day, and process it into explicit, conscious knowledge.

Both children and adults do this, but an interesting new study out of Germany shows that during sleep, children’s brains convert subconsciously absorbed information—known as implicit learning—into active, useful knowledge even more effectively than adult brains do.

Implicit learning is typically considered subconscious learning; the acquisition of knowledge independent of conscious attempts to learn. For example, a child can say a sentence without understanding the rules of English grammar.

Explicit learning, on the other hand, is deliberate, conscious learning; the active and aware acquisition of skills and/or knowledge. Typically, explicit learning is accompanied by “meta-awareness,” a person can explain how they acquired the skill and/or knowledge.

When we sleep, implicit knowledge becomes explicit memory, making it easier for us to recall and use the information we have previously absorbed.

In a new study conducted by Dr. Ines Wilhelm of the University of Tübingen’s Institute for Medical Psychology and Behavioral Neurobiology in Germany, and colleagues, the researchers studied 35 children between the ages of 8 and 11 years old, as well as 37 adults between 18 and 35.

For the test, the subjects were asked to press a sequence of buttons after they lit up. Half of the subjects did the test before sleep, the other half after sleep. They were then asked to recall the sequence of buttons/lights 10 to 12 hours later. Following a night of sleep or a day awake, the subjects’ memories were tested.

An article explaining the results of the study, entitled, “The sleeping child outplays the adult’s capacity to convert implicit into explicit knowledge,” is published in the February 24, 2013 online edition of Nature Neuroscience.

The authors observed that after a night’s sleep, both age groups—8 to 11 and 18 to 35—remembered a larger sequence of buttons/lights than those who did not sleep. It also showed the children were better at it than the adults—almost all of the children could remember the sequence they had pressed perfectly, while adults experienced smaller gains.

Lead author Dr. Ines Wilhelm wrote, “In children, much more efficient explicit knowledge is generated during sleep from a previously learned implicit task. And the children’s extraordinary ability is linked with the large amount of deep sleep they get at night. The formation of explicit knowledge appears to be a very specific ability of childhood sleep, since children typically benefit as much or less than adults from sleep when it comes to other types of memory tasks.”

Children absorb massive amounts of information every day. They also generally sleep longer and deeper, and experience three times more slow-wave sleep and higher electrical activity in the brain during sleep than adults. This may help them “convert” the information they take in every day into knowledge they can recall and use. This is yet another important reason why parents should ensure their children are getting enough uninterrupted sleep every night.

By Dr. David O. Volpi of eOs Sleep

Over the past three years, I have been writing the Wake Up! You’re Snoring blog with two main objectives: first, to educate you, the public, about sleep disorders, and second, to provide compelling reasons—preferably scientific evidence—why a person who may have a sleep disorder should get diagnosed and, if necessary, properly treated.

There is no shortage of scientific studies being released on a regular basis showing links between obstructive sleep apnea (OSA), insomnia, and other sleep disorders, and myriad negative health conditions, from daytime sleepiness to increased depression.

I wasn’t surprised to see a new study showing a link between insomnia, the loss of hope, and an increased risk of suicide. In a study led by Dr. W. Vaughn McCall, chair of the Medical College of Georgia at Georgia Regents University, researchers studied the mental state of 50 depressed patients between the ages of 20 and 80. More than half of the patients had attempted suicide, and most were taking an antidepressant.

It is established that insomnia and nightmares often go hand-in-hand, and are both known risk factors for suicide. The new study reaffirms that link, but researchers also wanted to find out what effect feelings of hopelessness about sleep had on suicide risk.

In the study, the researchers specifically focused on the relationship between insomnia and suicide risk by asking questions about dysfunctional beliefs about sleep, such as, “Do you think you will ever sleep again?” The scientists used psychometric testing to objectively measure the mental states and personalities of the 50 depressed patients.

Dr. McCall published the results of the study in the Journal of Clinical Sleep Medicine, the journal of the American Academy of Sleep Medicine. In the report, Dr. McCall stated, “It turns out insomnia can lead to a very specific type of hopelessness, and hopelessness by itself is a powerful predictor of suicide.” Dr. McCall also said, “The likelihood of being suicidal at least doubles when insomnia is a symptom.”

McCall and his colleagues have, in effect, discovered a new predictor for suicidal thinking. But why the link between lack of sleep and suicidal thoughts? Dr. McCall explained that, “It turns out insomnia can lead to a very specific type of hopelessness, and hopelessness by itself is a powerful predictor of suicide.” He continued, “If you talk with depressed people, they really feel like they have failed at so many things. It goes something like, ‘My marriage is a mess, I hate my job, I can’t communicate with my kids, I can’t even sleep.’ There is a sense of failure and hopelessness that now runs from top to bottom, and (insomnia) is one more thing. It was this dysfunctional thinking — all these negative thoughts about sleep — that was the mediating factor that explained why insomnia was linked to suicide,” said McCall.

The significance of this study, like many others, is that it not only educates people about the risks associated with insomnia and other sleep disorders, but it challenges the medical community to look at things a little differently when diagnosing and treating.

In this case, examine lack of sleep and insomnia when treating depression and suicidal thinking.  The finding also is a reminder to physicians that depressed patients who report increased sleep problems should be asked if they are having suicidal thoughts, McCall said.

If you’re having trouble sleeping, here are some tips to increase your chances of getting a good night’s sleep.

• Use the bedroom for sleep. With so many electronic distractions in our lives, it’s important to re-claim your bedroom for its intended purpose: rest and sleep. Move the TV and computer out of the bedroom, or at the very least, do not watch TV, work on the computer or check your blackberry close to bedtime.
• Stick to a bedtime routine. Try to go to sleep before 10:00 pm at night, and wake up around the same time every day, even on weekends. Try to keep to within 20 minutes of the same time each morning and night.
• Do activities that will get you ready for bed. Before bed, do activities that will promote sleepiness, such as a taking a warm bath, or reading a book or magazine.
• Maintain a cool temperature in your bedroom. A cool but comfortable temperature is ideal for sleep. Too warm and you will be fitful, too cold however can be uncomfortable and disturb your sleep.
• Exercise regularly but not after the late afternoon. Even though exercise helps regulate sleep, rigorous exercise causes endorphins in the body to circulate which can have a stimulant effect, and keep you awake longer at night.
• Stay away from caffeine at night. The effects of caffeine are different from person to person, and may last hours after your last cup of coffee, so make your last cup of coffee, regular tea or soda earlier in the day.
• Avoid alcohol and medicines that make you drowsy. Even if you think it is helping you fall asleep initially, alcohol and medicines that makes you drowsy may affect your sleep throughout the night.

Remember, people need an average of 7-8 hours of restful sleep to fully take advantage of its restorative power and avoid daytime symptoms of fatigue. If a regular, peaceful routine incorporating the tips above doesn’t help you start sleeping peacefully throughout the night, contact your doctor. You may have a more serious cause of sleeplessness such as snoring, sleep apnea or chronic insomnia. Getting treated could prevent heart disease, hypertension and stroke.  Schedule an appointment today for a sleep test at Eos Sleep Diagnostics, the diagnostic branch of Eos Sleep.

By Dr. David O. Volpi

I read a study recently that I immediately knew I had to make you aware of.

Researchers at Henry Ford Hospital in Detroit found that snoring is a bigger risk factor for heart disease, including stroke and heart attacks, than being overweight, having high cholesterol, and even smoking! Yes, you read that right—snoring is an even bigger risk factor for heart disease.

The study, which was submitted to The Laryngoscope journal, is the first of its kind to show a link between snoring and heart disease, similar to other risk factors, such as sleep apnea, obesity, smoking and high cholesterol are also linked to heart disease.

Snorers showed arterial damage

For the study, Dr. Robert Deeb, MD, and senior study author Karen Yaremchuk, MD, reviewed the data of 913 patients, all between the ages of 18 and 40, who had been evaluated by the Henry Ford sleep center between December 2006 and January 2012.

The researchers noticed that the carotid arteries—the arteries that supply oxygen-rich blood to the brain—had thickened among the snorers, indicating that arterial damage had occurred due to snoring.

The researchers hypothesized that the thickening of the artery walls could have been due to the trauma and inflammation caused by snoring. But previous research on sleep apnea and artery disease has found the opposite: arterial damage comes first, reducing the oxygen level in the blood, leading to interruptions in breathing. The thickening of the arteries may also be contributing to the snoring in the patients.

Even more interesting: The snorers’ arterial walls had thickened, even though none of the patients had been diagnosed with obstructive sleep apnea (OSA). While OSA often develops from snoring and has been known as an indicator of cardiovascular disease, there’s been little evidence until now to prove that arterial damage can actually begin with snoring.

What these results mean

So what are the medical implications of the Henry Ford study? Let’s review coronary artery disease for a moment. Coronary artery disease (CAD), also known as atherosclerosis, occurs when waxy plaque builds up on the inner walls of the arteries.

Over time, the arterial walls thicken and stiffen, restricting blood flow to the heart and/or brain. It is commonly know that CAD is a precursor to conditions such as heart attack, stroke, and heart failure.

The results of the Henry Ford study—that the carotid arteries had thickened among the snorers, is important to pay attention to because it means that snoring, not just OSA, is a high risk factor for coronary artery disease, heart disease, and other related conditions.

Drs. Deeb and Yaremchuk’s research is groundbreaking because arterial blockage and other forms of heart disease are usually detected only after significant permanent damage has been done.

This new research should encourage snorers—and those who love them—to visit a doctor to discuss cardiovascular health and stroke prevention, and get properly diagnosed and treated.

The research is clear that doctors should add snoring to the list of coronary artery disease risk factors, along with high blood pressure, high cholesterol, diabetes, smoking and family history. Perhaps if patients and their doctors considered snoring a serious health threat and treated it accordingly, there would be a great reduction in heart disease.