Sleep Apnea

Sleep Apnea is becoming an epidemic - maybe at a rate of 24% in men and 9% in women.It looks as if the rise in Sleep Anea is tracking the spread of obesity. According to an article in the Lancet, severe Sleep Apnea is correlated with a three-fold increase in the risk of a heart attack (or similar cardiac incident).

The rise of Sleep Apnea as an important health issue motivated the ACSM (American College of Sports Medicine) to devote the whole of its October-December 2007 Certified News to the topic of Sleep Apnea. The issue was headlined as "Obstructive Sleep Apnea: An Elephant in the Closet of Importance to the Exercise Professional."

So what can be done ? The answer :

• lose weight - maybe as little as 12 pounds and 10% of body weight should make a big difference
• use a sleep aid such as a CPAP.

Is there a problem ? Well yes, because Sleep Apnea makes exercise more difficult:

• heart rate does not increase the way it should in a healthy body
• blood pressure goes up more than it should during exercise.
• wearing a CPAP every night is no bed of roses and hence long-term, every night use of a CPAP is unlikely. The peaceful image of a CPAP in use at the head of this blog is just a tad idealized. Read this forum to get an idea of what it's really like.
  

Can a Personal Trainer help ?
Is there an exercise prescription for Sleep Apnea ?
At the moment the ACSM does not have any specific exercise recommendations for Sleep Apnea but the issue of Certified News referred to above is the start of defining such a prescription.

One major problem standing in the way of a simple exercise prescription is the possibility, even likelihood, that anyone with severe obstructive sleep apnea is going to have other health issues such as obesity, Type 2 Diabetes, hypertension and a variety of heart issues such as congestive heart failure, cardiac arhythmias and perhaps a stroke risk.

The bottom line is to try for 45 to 60 minutes of low intensity exercise every day (or at least 5 days) a week. Low intensity is defined by the ACSM for this purpose as being 40%to 60% of maximum heart rate. This is longer than ACSM recommendations for hypertension, Type 2 diabetes and CV diseases but at a lower intensity.

The ACSM emphasizes that exercise for anyone with severe sleep apnea should be concluded gradually with an extended cool down period of at least 15 minutes. One additional ACSM recommendation is to closely monitor blood pressure and in particular to measure blood pressure 5 to 15 minutes after the end of exercise cool down. This is to check that blood pressure has returned to baseline value. If it has not then either the exercise intensity was too high or the cool down was too short.

Prescription Sleep Aids

The Mayo Clinic Health Letter for January 2008 has a good summary of prescription drugs to aid sleep. Mayo makes the distinction between finding it difficult to get off to sleep as contrasted with the problem of staying asleep (sleep-maintenance insomnia). Older adults more commonly have sleep-maintenance insomnia.

The Health Letter has a useful summary of drugs used for helping getting off to sleep and for those that help one stay asleep.

The newest class of sleep drug are the melatonin agonists. These are related to the natural hormone melatonin. Rozerem is the brand name and it seems somewhat weak in its affect but not habit forming.

Another group of sleep aids currently being heavily promoted are from the class called non-benzodiazepine hypnotics. This includes brands such as Ambien, Ambien CR, Lunesta and Sonata. It appears that older adults can take these fairly well with little residual drowsiness. However Mayo say that there are some reports of amnesia after taking them. That said this new class of non-benzodiazepine hypnotics is much better than their predecessors, the benzodiazepine which have been used for the last 40 years.

Sonata (one of the non-benzodiazepine hypnotics) is short acting and wears off quickly.

Mayo is fairly dismissive about non-prescription medication sleep aids such as Benadryl, Somine and Unisom saying they have minimal effectiveness.

The Mayo summary is:

• Ambien - Useful for initiating sleep, sleep onset 7 to 27 minutes, low risk for dependency
• Ambien CR - Useful for initiating sleep, sleep onset 30 minutes, more chance of morning drowsiness than with Ambien
• Lunesta - Good for both initiating sleep and sleep maintence, sleep onset 10 minutes, low risk dependency.
  
• Sonata - Good for night awakening and for sleep initiation, sleep onset 30 minutes, short acting so you can take it middle of night and be OK in morning.

Remember that these are all on prescription, so listen to your doctor, take exactly as prescribed and read all the warnings.

Difficulty sleeping can reach an extreme in sleep apnea. This topic is worthy of a blog all on its own.