Sleep as a Vital Sign

The Institute of Medicine estimates that as many as 70 million adults in the United States have a sleep disorder. Many remain undiagnosed, in part because physicians do not routinely ask them about the quality and quantity of their sleep. Talking to your physician about this important topic could mean better sleep — it may also yield important clues about possible underlying health issues, from hypertension and congestive heart failure to depression and Parkinson’s disease.

Patients may not mention sleep problems unless they are asked, perhaps because they are unaware of treatment options or think poor sleep is just a normal part of aging, menopause, parenting teenagers, having a stressful job, etc. Any of these diagnostic questions could get them talking:
• Does it take you more than 20-30 minutes to fall asleep at night?
• If you wake up in the middle of the night, can you fall back asleep?
• Do you wake up at night gasping for air?
• Do you feel fatigued throughout the day or become sleepy while driving?
• Have you been told you snore loudly or stop breathing while sleeping?
• Do you have headaches when you wake up?
• Do you have a dry mouth when you wake up?

Underlying issues
Kettering Health Network Sleep Centers specialize in treating sleep disorders, including obstructive sleep apnea (OSA), narcolepsy, abnormal movements during sleep, and others. Many of these are associated with other medical problems. For example, OSA is an independent risk factor for the development of hypertension, because it produces surges in systolic and diastolic pressure that keep mean blood pressure levels elevated at night. In many patients, blood pressure remains elevated during the daytime, when breathing is normal. Because even small decreases in arterial pressure can contribute to reducing cardiovascular risk, screening for OSA is an essential element of evaluating patients with hypertension. OSA is associated with a number of other cardiovascular health problems. For example, 50% of heart failure patients have sleep apnea. OSA increases the risk for atrial fibrillation (AFib) by a factor of two to four—in fact, patients with OSA have a higher reoccurrence of AFib after electrical conversion or catheter ablation compared to patients who do not have OSA. Treatment with continuous positive airway pressure (CPAP) can reduce the risk by 42%. CPAP also is effective in reducing the risk of recurrent stroke for patients with OSA and a history of stroke.

Sleep problems can be associated with many non-cardiovascular health problems as well. For example:
• People with poor sleep are at increased risk for depression and anxiety, and vice versa. In many cases, improving sleep can aid in the treatment of depression and anxiety.
• Menopausal women may have poor sleep related to insomnia, and double the risk of OSA, likely due to loss of progesterone.
• Abnormal behaviors during sleep (such as acting out dreams) can be a precursor to degenerative neurological diseases such as Parkinson’s.

Specialized treatment
Many sleep disorders can be diagnosed and treated by a primary care physician, but sometimes more specialized care is needed. The network’s sleep centers offer sleep studies and other diagnostic tests, as well as the full spectrum of treatment options, including continuous positive air pressure therapy, short-term hypnotic medications, and cognitive behavior therapy, which can be very effective for treating insomnia.

By Dr. Kevin Carter  

Adapted from Kettering Physician Quarterly, First Quarter, 2019

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