Are You Sleeping With the Enemy? [draft for comment]

[bookwrm63]

I posted my response to this in a new thread by mistake..lol...anyway...

I agree with Slinky....for it's intended purpose, keep it short and sweet. This should be a paper an average person can pick up and read without nodding off in the middle! (another case for CPAP?) lol..

While I recognize the enormous brain power gathered on this forum, frankly there have been some posts that have been so clinical, so detailed and so lengthy, that I find myself losing interest in the original topic. That is not what we want to do here. So read these thoughts and ideas, make small changes and let 'er rip!

[drbandage]

Now featuring an outstanding quote from a Doctor stating that OSA is like being assaulted every night all night by your own sleep disorder . . . .that if someone tried to smother you with a pillow all night you'd call the police!

just perfect!

Previously, I have posted here that every night, all night long, your subconscious mind is "awakened" to the deafening sound of an Air Raid siren at 120 decibels, and a very bright flashing red strobe light rapidly blinking the word:

SUFFOCATION

over and over. Way worse than the most annoying car alarm going off, at least as far as the body perceives it.

There is no physiologic signal stronger than oxygen deprivation to the brain. The body would and does choose to shunt blood (and the precious oxygen it carries) from any and all organs, including the heart, to be sure the brain gets first dibs. (Obviously, there are certain disorders where the issues get very complicated, but I don't want to stray from the basic facts with too much detail).

It's as if the body arouses with a JOLT, and accompanying that is a tremendous flood of stimulants and stress hormones, such as epinephrine (adrenaline) and cortisol. We all know the "fight or flight" syndrome. It's the Sympathetic Nervous system at work.

Suppose somebody were to sneak up on you in the dark and lunge at you when you least expect it. Your heart races, the endocrine system instantly pumps out inordinately powerful stimulants. During sleep for those with OSA we are incessantly confronted with a similar phenomenon and the accompanying RED ALERT, each time our oxygen levels drop below the "Thresh Hold". (Another cruel twist is to just hover around that critical desaturation level, getting just enough oxygen on board to avoid the arousal, but not enough to provide the oxygenation that the body needs to stay healthy. The desaturation graph is remarkable for a very precipitous drop around the mid to upper eighty percent range for most people).

Repetitive apneic events disrupt the normal physiologic interactions between sleep and the cardiovascular system. Sleep fragmentation, with its accompanying increased sympathetic activation triggers vascular endothelial dysfunction, increased oxidative stress, inflammation, increased platelet aggregability, metabolic dysregulation and undoubtedly helps initiate and accelerate the progression of cardiac and vascular disease. Persuasive data implicate OSA in the development of hypertension, and OSA contribute to cardiac ischemia, congestive heart failure, cardiac arrhythmias, and cerebrovascular disease and stroke.

At least if you have been lunged at and gotten away, you KNOW to avoid ever going down that dark alley again. OSA, conversely, does not tip its hand. Your conscious mind has virtually no recollection of the dozens and dozens of times your Sirens and Alarms have abruptly gone off during your night's sleep. Often times, the only evidence that it occurs at all is grim, and can be found in the obituary column.


Are you sleeping with the Enemy?
SLEEPY can be CREEPY. Know Your SNORE SCORE.

I'd still love to see bumper stickers and eye candy on waiting room pamphlets, etc, that tell the story a little bit differently than what common perception is.


I hope it doesn't seem too repetitive to mention again the subject that I alluded to here:


Tue Jan 23, 2007 8:10 pm
I had a mini brain storm today about how to change public and medical perception to better understand that "sleepy", as cuddly and cute as it can sound, may be a very subtle sign that something more ominous, even deadly, may be brewing.

Sleepy. It sound so innocuous. So dreamy. So, benign. So go have a nap, if you're sleepy. I'll bring your blankie, and maybe some cookies and milk. People seem peaceful when they are getting their refreshing sleep. Just makes me want to layout in a hammock and have a snooze, a siesta. Makes me want to have the luxury of "sleeping in" on the weekend.

Siesta, snooze, a nap. I think Somerset Maughm said the two most beautiful words in the English language were "summer breeze".

Sleep - the Silent Assassin.

Nah, too strong, but we have to be able to bring into the public and medical eye the notion that sleepy may be very fine, but it can also be the ONLY early tipoff to a very deadly disease, a disease that is devastating and often fatal when undetected.

The other notion I think needs to be in the front of the public cranium is that, if sleepy can be creepy, they also need to know that a simple little test can put their mind at ease, or even save their life. I know from personal experience that patients hang on every word awaiting the quantitative results of their labs and their radiographic studies (MRI, CT, x-ray, etc.) Bottom line is that they need to know that something is measurable, and that there is normal (or negative), or it's abnormal (e.g. too high, too low, etc.).

How many patients know that snoring can be evaluated in the same way? If you're sleepy, get more rest. Do you have iron poor blood? Get geritol! Has your get up and go gotten up and went? Lots of people will use the word "tired", or "worn out", when a more accurate description might very well be "sleepy". Maybe you're tired because you're a "restless sleeper", a "light sleeper", or you're "depressed". All fairly vague, hard to measure notions.

If you tell a doctor that you're "tired", it conjures up all sorts of explanations, On the other hand, if you tell a doc that you're "sleepy,"l I believe it conjures up something quite significantly different to most docs. And it's a difference that makes a huge difference. It may seem subtle, but it is a numbers game and any tipoffs that lead the doctor to understand that your chief complaint is "sleepy" (not "tired") are going to payoff in lives saved. It really is that simple.

So, what if people were very well aware that snoring (and it's cousin, sleepiness) were quantifiable, and measurable with reliable results?? You cannot believe how many people come to the doc and say " I want an MRI. I want to know what's going on inside there." Anywhere there is a suspected problem, the MRI is requested. And I can see why.

Why don't people know to request a simple "at home" ovenight sleep study when they have complaints of overwhelming fatigue and sleepiness? 'Tis not my area of expertise, I 'm just learning myself, but I know there are sleep strips, and other fairly cheap, simple tests besides the PSG.

So, without further ado, here's something that people need to know:

Are you sleeping with the Enemy?
SLEEPY can be CREEPY. Know Your SNORE SCORE.

Do you think that is a message with impact, that conveys what is described above? We need some PR, and the right kind, if this is going to get the attention it deserves. BTW, if y'all think the slogan is a non-starter, I can handle that, too. But it kind of grabbed me because it is simple, a little scary and that is the entire extent of my "marketing" expertise.

And so ends another late night ramble . . .

[NightHawkeye]

Just a couple of clarifications for accuracy, SleepGuy.

From:

Sleep apnea is the temporary cessation of breathing during sleep, lasting for ten seconds up to one minute.

To:
Sleep apnea is the temporary cessation of breathing during sleep, lasting for ten seconds up to minutes in length.

From:

In the case of patients with sleep apnea, the airway blocks off due to obstruction and they stop breathing for 10 seconds to a minute, which is repeated hundreds of times in a night.

To:
In the case of patients with sleep apnea, the airway blocks off due to obstruction and so they simply stop breathing, possibly even for several minutes. This sequence can be repeated hundreds of times a night.

Regards,
Bill (who has recorded apneas of several minute duration with both Encore Pro and an oximeter)

[SleepingBeauty]

I haven't read all the responses, so I hope I'm not repeating someone here.

Along with mentioning that it can affect men and women, consider adding something about apnea affecting any age, weight, or sex. My own neurologist admitted she felt I didn't fit "the profile" and that she rarely referred women for sleep studies. People need to know it affects a range of ages and body types.

[shippy]

Very Nice Job !!!!

As an old farm boy I am truly amazed by the word skills and knowledge some folks exhibit here on this forum. I myself graduated from high school and never went to college (went to the school of hard knocks instead) I often say to myself if i had to relive my life i should have gone to college. I have always been smart enough to read and figure things out for myself, example being the computer, i am self taught and can get around pretty good on the old PC making animated safety trainers for work and presentations etc. (although i can't type a lick ha! ha!) I would be interested in knowing the level of education of some of the more knowledged folks here out of curiosity.

knowledge is everything

Dale

[SleepGuy]

Thanks to the good doctor and others for your comments! Take a look at the latest lead in . . . .

[Slinky]

Ahhh, SleepGuy, the tweaking and polishing look GREAT! I'd call it a most satisfying finished product. THANK YOU!

[Mile High Sleeper]

drbandage, I love the slogan. Go for it!

SleepGuy, I appreciate having the sources as part of the article. Gives it credibility and doesn't make it that much harder to read. I like being able to go to the source. For online versions, links would be great.

[kavanaugh1950]

SLEEPGUY, EXCELLENT ARTICLE! THE NAME IS CATCHY AND INTERESTING AND THE ARTICLE IS QUICK READING, SUCCINT AND TO THE POINT. IT IS EASY READING AND VERY INFORMATIVE. YOU DID A GREAT JOB. PAT YOURSELF ON THE BACK. PAT

[bookwrm63]

Great work! I have re-read with revisions and it's terrific. Way to go!


Mary

[drbandage]

drbandage, I love the slogan. Go for it!

Mile High Sleeper, thank you.

I appreciate the encouragement, and most especially from people such as yourself who have given such an enormous gift to this board and the online community. I am not engaging in false modesty when I say that I am certain that you have saved far more lives with your work online than I have in my entire medical career.

[Mile High Sleeper]

drB, wow. Thanks for the praise. I'll take it! Not that I believe it all - I sure hope you have and will save lives in many little and big ways. The articles are OUR collective wisdom. I was the scribe for the wise and caring folks on this forum who contributed their experiences. I'm glad that there seem to be more folks now who will contribute articles to the light bulb and other avenues of information.

And I give thanks to my alert primary care physician who suggested a sleep study. I feel like I owe her my life. Trouble was, my life and symptoms had to get life-threatening before I reported them to the doctor. What I needed: patient information, warning signs of sleep apnea, who it can affect. What my doctors needed before my sleep apnea became severe and life-threatening: awareness to screen for sleep apnea and knowledge of some of the more subtle symptoms. It would have been good if my previous PCPs, cardiologist, eye doctor had been alert to symptoms many years earlier. Many of us have the same story.

I sure look forward to the fruits of our labors in getting sleep apnea information into the hands and heads of doctors and the public.

[Spottymaldoon]

Suggest you say "humanity" - rather than "our nation". We foreigners do breathe the same air, you know!
Best to you,
Spotty

[stoverquill]

All I can say is WOW! and Thank You SleepGuy!

[Sleepy-eyes]

Sleepguy,

Very well written. I truly believe you've gotten the point across to the reader. I'm very anxious to see the finished piece. I want to print it out and give it to a lot of people. I believe the general poplulation has no clue. My Dad has had sleep apnea most of his life. He would just laugh when Mom would have to shake him to get him to breath again, after he'd stopped, at night. He thinks the problem is snoring and the "stop breathing thing". He just doesn't get how dangerous it really is. He's 84 and just doesn't want "incumbrances" for the remaining years of his life. I keep trying to get across to him his life will go on a lot longer with the incumbrances. A copy of this piece you've written just might help convince him. Thanks for writing it.