Waking Up Rested

• By Bill Lozon, Pamela Friedman
• Jul 01, 2001

Research on sleep began in 1953 after rapid eye movement (REM) was discovered. Two types of brain wave activities during sleep were discovered-non-REM and REM sleep. This discovery ushered in a new era of sleep research.

Sleep has become a valuable commodity in today's society. Americans have accumulated a national sleep deficit of 105 billion hours. Currently, researchers are studying the effect of sleep deprivation and sleeping disorders on human performance-at work and in the home. People increasingly borrow against their sleep to complete daily tasks, resulting in difficulty concentrating, a loss of productivity and sometimes dangerous situations. Millions of people struggle to stay alert at home, in school, on the job and on the road. Fatigue contributes to more than 100,000 highway crashes, causing 71,000 injuries and 1,500 deaths each year in the United States alone, according to the National Sleep Foundation, Washington, D.C.

The consequences of lack of sleep can cause daytime tiredness, poor work performance, poor concentration, reduced memory consolidation, depression, decreased libido and a general lack of energy to enjoy life and perform productive work.

Sleeping disorders are a primary cause of sleep deprivation.

Americans have accumulated a national sleep deficit of 105 billion hours.

"Sleep deprivation affects every part of our daily lives whether we are the sleep deprived or the other driver on the road, facing a drowsy driver," said Joseph Anderson, RPFT, RPSGT, CRRT and sleep product manager of SensorMedics Corp., Yorba Linda, Calif.

"There are literally dozens of research papers showing the significant consequences that sleep deprivation can bring to an otherwise loving family or enjoyable work environment. The sleep deprived show dramatic increases in conflict and a decrease in productivity," Anderson said.

SensorMedics manufactures several diagnostic and therapeutic products to assist consumers and health care providers in diagnosing and treating sleep disorders.

"Additional sleep diagnostic and therapy products seem to arrive almost daily. Digital acquisition and scoring of sleep studies has all but eliminated paper. The few paper labs that are left, decrease every year," Anderson said.

Sleep Apnea and CPAPS

Sleep apnea is the most common sleeping disorder. Some people estimate that it is more common than diabetes mellitus. Sleep apnea refers to episodes of partial or complete blockage of airflow during sleep that last 10 seconds or longer. People with sleep apnea generally snore between episodes, and then gasp, snort or choke when they start breathing again. Because their slumber is constantly disrupted, they are deprived of sleep.

There are three types of sleep apnea: central, obstructive and mixed. Central sleep apnea-which tends to be less common-occurs when the brain fails to send the appropriate signals to the breathing muscles to initiate respirations. Obstructive sleep apnea is far more common. Many people snore because their upper airway is obstructed. The body arouses itself to abort this obstruction so the body is not deprived of oxygen. If the body does not succeed in arousing itself in time, it is deprived of oxygen to various degrees with serious consequences on the blood pressure, heart and the brain. These obstructive events can occur from 40 to 500 times in an eight-hour sleeping regiment. Mixed sleep apnea is a combination of both.

Many people do not realize they have sleep apnea. Those at risk include all age groups and both sexes, although it is more common in men than women. As many as 20 million Americans have sleep apnea and less than five percent of sleep apnea sufferers have currently been diagnosed, according to Sleep Solutions Inc., Palo Alto, Calif.

While sleep apnea often goes undiagnosed, the level of awareness has risen in the last five years, according to Ron Richard, vice president of marketing for the Americas for Resmed Corp., San Diego. "We've seen a 20 percent jump in the number of diagnoses and sales," Richard said. "This can be attributed to information on the Internet and several studies and articles published on the subject matter of sleeping disorders," he said.

Many people do not realize they have sleep apnea.

Treatment of sleep apnea can be prescribed by primary care physicians, ear-nose-and-throat specialists, pulmonologists, neurologists and other physicians with specialty training in sleep disorders. Behavior modifications may be recommended or reconstructive surgery, including new techniques such as minimally invasive radio-frequency tissue ablation. The most common treatment is continuous positive airway pressure (CPAP) therapy. Dental appliances that reposition the lower jaw and the tongue have been helpful to some patients with mild sleep apnea or who snore but do not have apnea.

CPAP treatment requires patients to wear a mask over the nose during sleep. Connected by tubing to a small pump, the mask delivers constant air pressure through the nasal passages. The air pressure works like a stent and is adjusted so that it is just enough to prevent the airway from collapsing during sleep. However, many patients often are not compliant with their CPAP due to the design and fit of the nasal mask.

Resmed specializes in CPAP devices and manufactures a full line of nasal masks and humidifers. "The biggest issue we face is trying to find masks that reduce the inventory issue with the dealer, as well as fit a wide range of patient faces," said Richard.

Currently, Resmed's nasal mask product line consists of three sizes but fits over 90 percent of patients. While properly fitting a nasal mask to a patient is important-and makes patients more compliant-convenience and comfort also are important issues. Patients want masks that are easy to put on and take off and that are comfortable to wear throughout the night. Pliable, supple and soft masks seem to be where the trend is in the design and manufacturing of nasal masks.

"A lot of it is proprietary patented technology. We use a double-layer cushion design made with high-quality silicone," Richard said. "Adjustable forehead pads also are added features as well as quick release clips, which makes the head gear easier to remove."

Sleeping disorders can be difficult to diagnose and physicians sometimes have difficulties getting insurance companies to pay for sleep study equipment or CPAP devices.

Market Trends

Sleep Solutions Inc. has a new technology that allows sleep studies to be conducted at home. The Internet-enabled Bedbugg At-Home Diagnostic Service uses a comfortable, cost-effective, easy-to-use system for monitoring sleep-disordered breathing in the patient's home. It consists of a bedside unit containing the signal processing and memory circuitry, a portable processing unit and three sensors for measuring respiration airflow, respiratory effort and oxygen saturation and pulse rate. The multi-channel system detects and records apneas and hypopneas as well as monitoring nasal and oral airflow, oxygen saturation, heart rate, respiration effort and snoring sounds intensity.

There are other products on the market designed to aid in sleeping disorders. The Chin-Up Strip Co., Dacula, Ga. manufactures u-shaped strips of medical tape that are applied under the bottom lip. Typically used as an accessory to CPAP devices, the strips are designed to limit abnormal mouth breathing and directs breathing airflow through nasal mucosa.

Latex also is becoming a popular product-in the form of pillows and mattresses. It is inherently anti-microbial, anti-bacterial and dust mite resistant, preventing potential breathing problems throughout the night. Latex International Inc., Ansonia, Conn., manufactures latex mattress and pillows, designed to offer patients a better night's sleep. "Comfort is the most important consideration when it comes to getting a good night's sleep. An improperly designed mattress can create high pressure levels on the body that inhibits circulation," said Will Veitch, vice president, sales and marketing for Latex Foam Products Inc., Bedding Division. "A latex bedding system is designed to promote healthful, revitalizing sleep," Veitch said.

Mattresses constructed of latex are intended to help people rest more soundly by conforming to the natural contours of the body-providing better and more congruous support for the back. The mattresses eliminate pressure points, which decrease capillary blood flow, significantly reducing tossing and turning.

"Buying a new mattress is one of the ways that consumers can help improve their sleep. One of the first culprits of poor sleep can be an old mattress that is no longer comfortable. Especially as our bodies age, we need more support and a mattress purchased a few years ago may need to be replaced with a more supportive, comfortable surface. The easiest, most effective way to get a good night's sleep without disturbances is to sleep on a latex mattress," Veitch said.

Latex mattresses allow air to flow through myriad interconnected cells in the mattress. The result is that the mattress breathes as air circulates within it to maintain a comfortable sleeping climate. It stays cooler and drier in warm weather, while in colder conditions, blankets hold in warmth.

While there are several products available to treat sleeping disorders, the real treatment is education. Getting the word out about sleep apnea and other disorders will encourage patients to ask questions about any symptoms they may be having. Once diagnosed, those patients also will need products to help treat their specific disorder. Educating consumers should be the first priority of not only medical personnel, but of home medical equipment dealers as well as manufacturers of sleep therapy products.

HME dealers can help by learning about sleep disorders and posting information within their store so consumers and patients are aware that their particular issues, such as snoring or interrupted sleep, may be a result of a particular condition. Manufacturers can help HME dealers by providing not only point-of-purchase materials, but educational information, such as pamphlets and brochures as well.

The average person could sleep 24 hours a day for three weeks continuously and still never catch up on their sleep. With our fast-paced and high-tech society, typical lifestyles are becoming more hectic and lack of sleep only adds to the pressure of everyday activities. Through education and appropriate treatment, consumers and patients may be able to solve one of the nation's biggest problems-sleep deprivation.

Sleeping and Living Better

The following information was provided by Latex Foam Products Inc., Bedding Division, Ansonia, Conn. Visit their Web site at www.latexfoam.com.

1. Avoid caffeine, nicotine and alcohol in the late afternoon and evening. Both can delay your sleep and alcohol can interrupt sleep later in the night.

2. Establish a regular relaxing bedtime routine that will allow you to unwind and send a signal to your brain that it is time to sleep. Build seven to eight hours of sleep into your routine and maintain the routine as much as possible--even on the weekends.

3. Create a comfortable sleeping environment and check your mattress twice a year. If you wake up feeling stiff or sore, the mattress has visible signs of tear, your lifestyle has changed since you last purchase a mattress or your sleep has declined in the past year, it is time to for a new mattress. Sleeping with a partner on a bed smaller than a queen can result in interrupted sleep from a partner's tossing and turning. People with larger sleep debts develop more illnesses and recover from them more slowly. Most healing and recovery from illness occurs during sleep.

4. Avoid making getting to sleep work. If you don't fall asleep within 30 minutes of tossing and turning, get up and involve yourself in a relaxing activity or mundane chore until you feel sleepy. Remember to clear your mind and don't use bedtime as a time to solve your daily problems.

5. Don't use your bed for anything other than sleep or sex. Your bed should be associated with sleep, not used as an office or as a home theater.

6. Exercise regularly, but do so at least three hours before bedtime. A workout too close to bedtime may actually keep you awake because your body had not had a chance to unwind.

7. Avoid large, heavy meals an hour or two before bedtime. The digestive process can interrupt sleep.

This article originally appeared in the July 2001 issue of HME Business.