Latest Sleep News

Read the latest Sleep news and find your Adelaide sleep specialist here!

Here you’ll find the latest sleep news about Sleep Disorders, and innovations in Sleep medicine.

Our blog and news feed is ever increasing, and now covers :

•  Obstructive Sleep Apnoea (OSA) and it’s effects on your body
•  OSA contributes to Hypertension / high blood pressure
•  Sleep Apnea and Glaucoma, erectile dysfunction, memory loss, strokes / CVAs
•  OSA and cardiovascular disease (including Atrial Fibrillation, AF)
•  Sleepwalking, sleeptalking and REM Behavior Disorder (RBD) 
•  Sleep Apnea can worsen your diabetes
•  Untreated Sleep Apnoea is costing you financially
•  Fixing sleep in Teenagers and Adolescents
•  RLS and Gambling, Impulsive Behaviours
•  Memory loss and poor concentration
•  CPAP prevents Atrial Fibrillation recurrence in those with OSA 
•  Blue light and body clocks
•  Worldwide recall of ASV machines
•  OSA and depression
•  Congenital Long QT Syndrome
•  45% of those with heart disease have OSA
•  Cancer incidence and OSA
•  CPAP and lowering car accident risk
•  REM-OSA and Hypertension

… AND MORE!

There is a whole world of other sleep disorders, including Narcolepsy, Idiopathic Hypersomnolence, Restless Legs Syndrome (RLS), Delayed Sleep Phase and Free Running Rhythm, other Circadian Rhythm Disturbances, Insomnia, and so much more.

You’ll also be able to read about the treatments available – from machines such as Continuous Positive Airways Pressure (CPAP) and Bilevel PAP (BiPAP), to medications such as Modafinil, Dexamphetamine, Sodium Oxybate (Xyrem), Pramipexole (Sifrol) and so much more.

Our Sleep doctors are experts in all of these conditions, and all of these treatments. We also see Teenagers and Adolescents, not just Adults. We hope you’ll find our blog useful.


The treatment of Narcolepsy including Sodium Oxybate (Xyrem) and Modafinil

Narcolepsy is one of the most complex of non-respiratory Sleep Disorders, consisting of a tetrad was Excessive Daytime Sleepiness, Cataplexy, Sleep Paralysis and Hypnagogic Hallucinations. Once we've diagnosed Narcolepsy, treatment for your Narcolepsy comes in many forms including :

Behavioral Therapy

Good sleep hygiene is crucial in managing Narcolepsy symptoms in the long term. Adequate sleep at night is important, daytime timed-naps can be useful.

Medications

Many medications can be used to treat Narcolepsy, each with their own pros and cons.

CNS stimulants such as Methylphenidate (Ritalin, Concerta) and dextroamphetamine (dexamphetamine, dexamfetamine) work well but have long term complications. Pemoline is less commonly used due to the potential side effects.

Modafinil and Armodafinil (Modavigil, Nuvigil) are generally better-tolerated than amphetamine-based medications, and with less side effects. These still however require longterm vigilance.

Sodium oxybate (Xyrem, metabolite of gamma-aminobutyric acid) has been used in the USA since 2002, and has been used by our clinic since it’s Australian approval in late 2014. We have the largest known group of patients in South Australia on treatment, with impressive symptomatic results. We provide continuous regular clinical monitoring in conjunction with patients’ General Practitioners, to ensure optimal titration of treatment modalities based on the patient’s current clinical status.

At Adelaide Sleep, we routinely counsel, diagnose, and treat all aspects of Narcolepsy and Idiopathic Hypersomnia. We have experience in all medications used for Narcolepsy and Narcolepsy-like conditions. If you’d like to know more, contact us now.

© APSS 2018

The Diagnosis of Narcolepsy and the MSLT

Narcolepsy is one of the most interesting of Sleep Disorders in the International Classification of Sleep Disorders (ICSD-3). It is characterised by the classic tetrad was Excessive Daytime Sleepiness, Cataplexy, Sleep Paralysis and Hypnagogic Hallucinations. The addition of Sleep disruption makes the Narcolepsy pentad. The most often used test for this diagnosis is the in-hospital Multiple Sleep Latency Test (MSLT).

Whilst the symptom of sleepiness is helpful, sleepiness is a symptom of many sleep disorders. Some Narcoleptics are not aware of how sleepy they really are. Objective testing is crucial.

A Multiple Sleep Latency Test (MSLT) involves an overnight sleep study, followed by timed nap opportunities the following day. A urinalysis is also part of the testing process. Depending on the overnight and subsequent-daytime testing, and in the absence of another sleep disorder, a diagnosis of Narcolepsy (or Idiopathic Hypersomnia) can be confidently made.

A home sleep study (also known as an ambulatory sleep study) will never be able to diagnose Narcolepsy.

Measuring CSF Hypocretin levels are useful when an MSLT is not possible.

Here at Adelaide Sleep, we look after all aspects of Narcolepsy including the counselling, diagnosis, and treatment of all Narcolepsy symptoms. If you’d like to know whether you have Narcolepsy or one of the Narcolepsy-like conditions, call us now and see one of our doctors.

© APSS 2018

The History of Narcolepsy – Excessive sleepiness in evolution

Central Disorders of Hypersomnolence encompass conditions including Narcolepsy and Idiopathic Hypersomnia - at here at the best Adelaide Sleep clinic in Adelaide, we manage all these conditions. Narcolepsy was first described the 1870’s were it was associated with Cataplexy and Postencephalitic Narcolepsy. With these reports from over a century ago, it was the first known primary sleep disorder to be described, identified and the symptomatology reported. It was from here that the classic tetrad was Excessive Daytime Sleepiness, Cataplexy, Sleep Paralysis and Hypnagogic Hallucinations was coined. Fragmented sleep is also a common symptom that is often overlooked. Our understanding of Narcolepsy progressed with the development of treatments such as Methylphenidate in the 1950’s - known to ameliorate some Narcolepsy symptoms. In the following decade of the 1960’s came tricyclic antidepressants (TCAs) and their use in cataplexy, at around the time we discovered sleep-onset REM periods (SOREMPs). The first consensus for the definition fo Narcolepsy was ratified in the 1970’s under the International Classification of Sleep Disorders (ICSD). The following decade saw the first documented association of Human Leukocyte Antigen (HLA)-DR2 and Narcolepsy (Honda et al, Sleep 1986). With the 1990’s came the discovery of Hypocretin 1 and the Hypocretin Receptor 2 Gene. Today we can diagnose Narcolepsy with the Multiple Sleep Latency Test (MSLT) and CSF Hypocretin levels. At Adelaide Sleep, we have experts who are trained in specifically counselling, diagnosing, and treating Narcolepsy and all Sleep Disorders. We treat the whole spectrum fo sleep disorders, and pride ourselves on being able to differentiate and treat each of these separately. If you believe you may have Narcolepsy or one of the Narcolepsy-like conditions, we can help. Call us now for an appointment. © APSS 2018

2017 Nobel prize winners : the first to be awarded in the field of Sleep Medicine!

Congratulations to the 2017 Nobel Prize Winners in Physiology or Medicine : Jeffrey C. Hall, Michael Rosbash and Michael W. Young. Their work was in discovering molecular mechanisms crucial to control of the circadian rhythm (body clock). Hall, Rosbash and Young used fruit flies as specimens, isolating a gene that controlled the fly's daily biological rhythm. From their work, this has led to a much better understanding of biological rhythms in other species... including humans. Circadian Rhythm Disturbances (CRD) comprise a large proportion of Sleep Medicine, and accounts for a notable number of sleep disorders - particularly in childhood an adolescents. At Adelaide Sleep, we loudly congratulate Hall Rosbash and Young for their ever-enduring work, and amazing accomplishments! Thankyou! © APSS 2017

Diaphragm pacing for Central Sleep Apnoea

Treatments for Central Sleep Apnoea (CSA) are limited - that's why we're excited about the potential for new treatments such as Transvenous Neurostimulation... essentially, pacing the diaphragm to help you breathe. Obstructive Sleep Apnoea (OSA) is the upper-airway closure resulting in a drop in oxygenation (oxygen saturations). Central Sleep Apnoea (CSA) is when there is a lack of air flow (breathing) but because of no effort. IE, the muscles moving your chest wall and diaphragm do not proceed as one would expect. CSA can occur in many circumstances, including :

  • Heart failure ** (the most common cause)
  • Strokes
  • Opioid use (methadone, morphine)
  • Myotonic dystrophy
  • Renal failure
  • High altitude.
Whilst OSA is almost always treated with CPAP, the success in treating CSA with CPAP is limited. With the departure of ASV as an option in heart failure patients (Serve-HF trial results), diaphragmatic pacing comes at an opportune time. Costanzo et al (1) looked at those with almost all kinds of CSA (but mainly heart failure), offering them diaphragmatic pacing vs. no-pacing. At 6 months, more than half (51%) of those with pacing managed to reduce their CSA events by 50%, compared to 11% in those without pacing. There was also an improvement in the Quality of Life Scores, their sleepiness (ESS), and oxygenation. These very promising results will hopefully one day allow us to provide an alternative treatment for those with CSA. If you have a Sleep Disorder and would like to see one of our Medical Specialists, give us a call for an appointment now. 1. Costanzo et al. Lancet 2016; 388: 974–82 © APSS 2017

Showcasing the Burnside Sleep Centre

Your sleep study produces over 1,000 pages of data - and that's why we prefer a local Adelaide centre with staff who are well trained with higher degrees. We prefer not to rely on computer-automation, someone who won't outsource your important medical data to interstate- or overseas-groups. That's why our Sleep Studies are performed at the Burnside War Memorial Hospital. Burnside Sleep Centre (BSC) is an independent purpose-built six-bed facility within Burnside Hospital, catering to the sleep needs of our community. It's location is perfect for sleep studies : free parking overnight surrounding the hospital, in a quiet inner-city suburb. Designed with the comforts of home in mind, each private sleep study room comes with Wifi, a king-single bed, sound proofing, its own ensuite and TV. BSC staff continue to participate in regular National Quality Control programs (both in-house, and national Q-Sleep), and hold regular meetings with their medical Sleep Committee. BSC is also one of the very few Sleep Laboratories to offer the full range of Sleep Tests, including :

•  Diagnostic sleep studies •  CPAP titration studies •  BiLevel PAP studies •  Adaptive- or Auto- Servo Ventilation (ASV) titration studies •  Supplementary Oxygen titration, Carbon Dioxide (TcCO2) monitoring •  Multiple Sleep Latency Testing (MSLT) •  Maintenance of Wakefulness Testing (MWT). •  Specialising in sleep studies for adolescents, adults, and the elderly.

At Adelaide Sleep, in conjunction with BSC, the doctor who sees you is also the doctor who analyses and interprets your complex sleep study. Both Adelaide Sleep doctors and BSC do not have any affiliation with CPAP outlets, CPAP sales, or vested interest in particular treatments. This is why we believe the Burnside Sleep Centre is the premiere Sleep Centre for diagnostic testing, and we're excited to refer our sleep studies to Burnside Hospital. Contact us now for an appointment. © APSS 2017

Rapid Access to Sleep Services

We’re delighted to announce that our Adelaide Sleep clinic and sleep study services have been extended!

We now have more sessions available and can consult you within days.

Similarly, our sleep study (polysomnography) sessions have increased to almost every night of the week. We can accommodate your schedule much easier and sooner.

With our Rapid Access Sleep Services, we’ll be able to see you, study your sleep, and start treatment immediately.
And for our country patients travelling into Adelaide, we can even see you the following morning with your sleep study results, and start treatment that same day.

For local Adelaideans, your Sleep Study reports are often released to yourself and / or your referrer within 24-48hours of your sleep study.

At Adelaide Sleep, we don't think it's fair to make you wait days, weeks, months to have your sleep study. You shouldn't have to wait for your results either. See us now.

© APSS 2016

Does REM-dependent OSA matter? In Hypertension, it does!

Whilst we know that Severe OSA is associated with cardiovascular risk, a significant ‘grey area’ exists. This grey area is where the evidence for cardiovascular risk is less obvious…

OSA is usually worse in REM : it’s a well known phenomenon. REM sleep is associated with more hypotonia (less muscle tone) and your tongue base will be more prone to collapsing… and that will lead to worsening oxygen desaturations (drop in oxygen levels).

When OSA occurs entirely in REM, does it lead to worse health outcomes?

Mokhlesi et al (1) looked at the association between OSA during REM Sleep and Hypertension (high blood pressure). Sleep Data from the Wisconsin Sleep Cohort was analysed, in conjunction with ambulatory blood pressure monitoring.

Those with higher REM-AHI (worse OSA in REM) were more likely to develop hypertension.

OSA outside of REM was not a significant predictor of hypertension.

• Take-home message : REM-dependent OSA is associated with Higher blood pressure issues down the track.

If you have high blood pressure, we’d recommend an in-hospital sleep study. Ring us for an appointment now.

1. Mokhlesi et al. Am J Respir Crit Care Med. 2014.

© APSS 2016

CPAP for OSA can lower the risk of Car Accidents

There is a wealth of data that acknowledges poor sleep (namely poor sleep due to Obstructive Sleep Apnoea (OSA)) being associated with Motor Vehicle Accidents, and now there is evidence that fixing OSA with CPAP will lessen your risk of car accidents.

In a Swedish Study performed by Karimi et al (1), MVA rates were monitored in the those with OSA, and then those with OSA on CPAP. This was compared to the risk of MVAs from the general population as provided y the Swedish Traffic Accident Registry.

They came to some predictable (and not so predictable) conclusions :

•  Untreated OSA increases your risk of car accidents
•  Using CPAP for OSA reduces that risk considerably

Surprisingly, the ‘severity’ of OSA did not entirely correlate with MVA risk... Suggesting it’s more than just about how Severe someone’s OSA is.

Treating OSA won’t make you a formula-One driver, but will at least lower your risk of a Car Accident in everyday driving. If you’d like to see one of our Medical Sleep Specialists, contact us for an appointment.

1. Karimi et al. Sleep. 2015.

© APSS 2016

Cancer and OSA – an unlikely link?

Does having Severe OSA increase your risk of Cancer? Looking back on the years of Obstructive Sleep Apnoea (OSA) research, we've been eagerly watching this unexpected link.

This association has not been studied widely. We’ve known for a long time that repeated intermittent hypoxaemia (low blood oxygen levels) can result in demonstrable problems to the human body – increasing your heart attack risk, stroke risk, Atrial Fibrillation risk, and even cognitive decline.

Martinez-Garcia et al has published both in the Am J Respir Crit Care Med (2013) and Sleep med (2014) with data suggesting those with OSA have an unusually high link to Cancer.

They found that Severe OSA measured by a drop in Oxygen Saturations below 90% (TSat90) and now the Apnoea Hypopnoea Index (AHI) is independently associated with increased cancer mortality. This was even after correcting for confounding variables, particularly true in those below the age of 65, and men.

This is however not a firm causal-link… but not beyond the realm of possibility. More research needs to be done in this field, and we'll be watching that space closely. Drop us a line and we’ll be able to discuss your sleep in more detail.

Campos-Rodriguez, Martinez-Garcia et al. Am J Respir Crit Care Med. 2013.
Martinez-Garcia et al. Sleep Med. 2014.

© APSS 2016

45% of those with heart disease have OSA

OSA has long been known to increase your Cardiovascular (heart attack) and Cerebrovascular (stroke) risk. The constant drops in your oxygen levels known as desaturations, cortical arousals, and cardiovascular responses can have significant detrimental effects on your cardiac state, and predispose to heart disease.

We've known about this link for a long time, and we've advocated screening for OSA in all people with heart disease.

A recent multicentre observational study by Furlan et al (1) has confirmed the extremely high prevalence of OSA in those with known Coronary Artery Disease.

The study looked at over 1300 adults over the age of 18 from another multicentre study (Sleep and Stent Study), across multiple countries. These adults underwent percutaneous coronary intervention (PCI) for known coronary artery disease - ie. atherosclerosis, blockages inside their coronary arteries, angina, and heart attacks.

OSA was found in 45% of individuals with Coronary Artery Disease!

Given this extremely high prevalance of OSA, we highly recommend you have an in-hospital Sleep Study if you have Coronary Artery Disease, including:

•  Atherosclerosis
•  A history of angina or heart attacks
•  Coronary blockages needing ballon / stent insertion
•  Coronary bypass surgery

 Your heart health is important to us. Contact us now for an appointment.

 

1. Furlan et al. Am J Respir Crit Care Med. 2015.

© APSS 2015

OSA and Congenital long QT syndrome

We've long known OSA has been associated with a higher prevalence of AF, and worsening AF control. We now know it's also associated with many Cardiac Arrhythmias, including deadly Congenital long QT syndrome (LQTS).

LQTS is characterised by prolonged ventricular repolarization and increased risk of torsades de pointes. Those with LQTS usually present with seizures, syncope, even sudden cardiac death (SCD).

Shamsuzzaman (1) looked at patients with LQTS and performed sleep studies in them, and (not un-expectedly) they concluded that OSA in these patients were asscoiated with a worsening of their LQTS.

•  OSA worsens QTc
•  Worsening QTc is a biomarker for sudden cardiac death
•  This worsening in their QTc was during wake, as well as sleep!

OSA has a profound impact on your Cardiac burden.

Adelaide's resident Specialist Cardiologists at the Centre for Heart Rhythm Disorders (2) agree that it's time we all acknowledged OSA's impact on Cardiac Arrhythmias.

If you have a cardiac problem, whether it be a rhythm problem or otherwise, see us now.

1. Shamsuzzaman et al. Sleep 2015.
2. Dr Rajeev Pathak, Dr Rajiv Mahajan, Dr Dennis Lau, Prof Prashanthan Sanders. Sleep 2015

© APSS 2015

Don’t forget Depression and OSA!

A poor night's sleep can affect anyone's mental state, and can lead to depression and anxiety. Being excessively sleepy during the day can also lead to depression. We've realised this for a long time, and this is why we're keen on fixing your sleep for your physical and mental wellbeing.

A recent Australian trial has found that one of the most common sleep disorders (Obstructive Sleep Apnoea, OSA) and Excessive Daytime Sleepiness (EDS) is independently associated with Depression.

Lang et al (1) looked at almost 2000 community-dwelling Australian men over a period of 5-years.

Of these, 857  random participants without previously diagnosed OSA underwent a sleep study and performed the Epworth Sleepiness Scale questionnaire. Lang found that if you had previously undiagnosed OSA you were almost 2x as likely to have depression (adjusted OR 1.9), even after adjusting for confounders.

Being sleepy during the day (EDS) made you almost 2.5x more likely to have depression (adjusted OR 2.4).

Having both OSA and EDS meant a 4.2 times higher risk of developing depression.

So in summary :

•  Having OSA, EDS, or a combination of OSA+EDS increases your risk of depression
•  Those with depression have a high chance of having undiagnosed OSA

We should all be mindful of checking for both comorbid diseases (depression and OSA) as they can both negatively impact each other. Call us now for an appointment.

(1) Lang et al. Am J Respir Crit Care Med. 2015.

© APSS 2015

Urgent recall : Resmed ASV machines could increase mortality risk in heart failure

Central Sleep Apnoea (CSA) in the setting of Heart Failure usually presents as Cheyne Stokes Respiration (CSR) on a sleep study. One of the ways to attempt to correct CSR is with a particular kind of PAP machine called "ASV"... Auto Servo Ventilation.

ASV machines map your breathing, and apply particular pressures on a breath-to-breath basis.

Today, Resmed released an Urgent Recall of their ASV machines because of an apparent safety concern.

Preliminary analysis of their data suggests an exceedingly high risk of cardiovascular death (33.5% higher) in those with Heart Failure using ASV, compared to those not on ASV.

At Adelaide Sleep, we keep abreast of all new Sleep Developments. All of our patients are consulted before and after their sleep studies, and before and after their treatment commencement, as per the current recommendations by the Australasian Sleep Association (ASA). We do not believe in direct-CPAP-outlet sales, nor do we believe in direct-to-consumer-sleep-study services. By seeing a Medical Specialist, you would've had a face-to-face medical consultation regarding your ASV machine.

If you believe that you are on an ASV machine, and would like to speak to a Medical Specialist regarding this, contact us now.

Addit : Philips Respironics have also released a statement echoing that of Resmed - caution in prescribing and using their BiPAP autoSV / BiPAP autoSV Advanced therapy machines and algorithm, in the at-risk group.

© APSS 2015

CPAP prevents Atrial Fibrillation (AF) in OSA

Previously we described how those with Obstructive Sleep Apnoea (OSA) have a 4-fold increased risk of Atrial Fibrillation (AF)... and how it also significantly increases the risk of recurrence to AF even after procedures such as cardioversion and cardiac ablation.

There is now evidence that treating OSA with CPAP can significantly decrease AF recurrence.

Shukla et al performed a meta-analysis across seven large cardiac studies, totalling over 1000 patients with OSA+AF. If you have OSA+AF, and use CPAP, then your relative risk (RR) is reduced by a tremendous 42%. This was completely independent of whether or not you underwent cardiac ablation!

This confirms our understanding of why OSA is such an important and underestimated condition. CPAP prevents atrial fibrillation recurrence in those with OSA.

We recommend that everyone with AF should consider an in-hospital sleep study.

Contact us now if you'd like to discuss this further.

1.Shukla et al. JACC Electrophysiol. 2015.

© APSS 2015

Blue light and Body Clock Problems

Does your body clock feel as though it isn't running at 24hours? Are you sleeping too early, too late, or all over the place? Then perhaps you have a Circadian Rhythm Disturbance (CRD) and blue light therapy may be able to help you.

Your body clock (Circadian Rhythm) runs at slightly longer than 24hours, but most of us can realign our body clock if needed, with the help of external cues called zeitgebers. When your central body clock generator malfunctions, or those external cues do not help as well as they should, then you could develop a Circadian Rhythm Disturbance (CRD).

The commonest CRD is Delayed Sleep Phase and is commonly seen in the young. Free Running Rhythm (now known as Non-24-Hour Sleep Wake Rhythm) and Advanced Sleep Phase can also disrupt your sleep.

If you can't control your sleep-time, or wake-time, you'll arise unrefreshed and subsequently become tired, sleepy, and performing at school or work will be difficult.

The typical adolescent with a CRD will be difficult to rouse in the morning, sleeps in often, falls asleep at school, under-performs during testing, and won't go to sleep at an appropriate time.

Realigning your body clock is easy, and includes the use of sleep timing methods, blue light therapy, and Melatonin. This re-entrainment program should only be performed after exclusion of other sleep disorders, and under the direction of a Specialist in this field. A home sleep study or use of a CPAP machine won't be able to address Circadian Rhythm problems.

If you think that your Circadian Rhythm isn't what it should be, call us for a consultation.

© APSS 2015

OSA, poor sleep linked to memory loss, poor concentration

We have long known that a poor night's sleep will impair your next-day functioning, but in recent times we've had ever-increasing evidence that many Sleep Disorders are truly to blame. Sleep deprivation, poor sleep, and constantly-disrupted sleep will impair your skills the next day.

A recent article (Varga et al, J Neurosci. 2014) looked at one of the most common sleep disorders and it's effects on how your brain functions.

Those with Obstructive Sleep Apnoea (OSA) were found to have poorer memory and spatial navigation... compared to when they had treatment for their OSA. Their cognition was slower, memory recall slower.

Consulting with our Adelaide sleep doctors, we've learnt that this is not surprising, given that :

•  OSA is usually much worse in REM sleep
•  OSA can inherently reduce your REM sleep
•  OSA can dramatically reduce your sleep efficiency
•  Recurrent OSA can starve your brain of oxygen throughout the night
•  Constant pauses in breathing will keep waking you up in the night
•  Disrupted sleep will cause memory loss, poor concentration

When you translate this to the real world, this means mistakes and reduced productivity during the day, lapses in concentration during time-critical events, and recurrent micro-sleeps as you try and catch up on lost sleep.

"My concentration and 'snappiness' isn't what it used to be"
"I keep forgetting my keys and people's names"
"I need to write everything down now"

Don't let poor sleep deprive you of the important things in life, call us now.

© APSS 2015

RLS Treatment associated with gambling, Impulse Control Disorders

One of the most common sleep disorders is The Restless legs Syndrome (RLS), and one of the common treatments is associated with Gambling and Impulse Control Disorders (ICDs).

RLS is a common sensorimotor disorder, typically amenable to treatment with dopamine agonist therapy. Dopamine agonists are mainly used for Parkinson Disease, but they have an important role in treating RLS.

These medications include pramipexole (Sifrol), ropinirole (Repreve), cabergoline (Cabaser, Bergoline), pergolide (Permax), and levodopa (Kinson, Madopar).

One of the unfortunate unpredictable side effects is that of Impulse Control Disorders (ICDs). These include :

•  Compulsive gambling (casino, pokies, tele-lotteries)
•  Compulsive shopping
•  Hypersexuality
•  Intermittent Explosive Disorder
•  Punding
•  Kleptomania (stealing)

More recently, there have been legal proceedings regarding some medications and ICDs.

We’ve known about this for some time, and we published the first Australian cohort of RLS patients with ICDs. We've looked after one of the largest groups of RLS patients in Australia, we routinely manage these problems effectively, and can adjust medications / medication-types as required.

RLS is easy to treat, and also easy to monitor even in the setting of potential side effects. And if Dopaminergic agents are not suitable, we have many more alternative medications at hand.

Call us now if you’d like to discuss this further.

© APSS 2015

Fixing Sleep in teenagers and adolescents

Sleep problems exist at every age group, and that’s why we’re delighted to remind everyone that we not only consult adults, but also adolescents above the age of 14years. The sleep needs of your Teenager should be as tailored to them as it would to any Adult. Sleep in Teenagers is unique.

Adolescents aren’t just ‘little adults’. Their problems are specific in their age group, and are well and truly above and beyond a simple ‘sleep apnoea’ test. They shouldn't be treated just like any other adult.

In the younger age group, there is a higher propensity for Central Hypersomnias (including Narcolepsy and Idiopathic Hypersomnolence). They’re more likely to experience NREM parasomnias, sleep walking and sleep talking, night terrors and arousal disorders. Their Circadian Rhythm is more likely to be reflective of Delayed Sleep Phase Syndrome, or Free Running Rhythm (now known as Non-24-Hour Sleep-Wake Rhythm).

Increasingly we’re seeing more and more of those with Periodic Limb Movements or The Restless Legs Syndrome too.

Home sleep studies are restricted to those above 18yo, and often have no consultation with any specialist of any kind. That’s why we prefer in-hospital studies, and our specialists will always personally see you with the results.

We're accredited to see more than just adults, and we routinely perform Sleep Studies on those under the age of 18.

If you want your Sleep needs taken seriously, no matter what age you are, give us a call and we’ll put you in contact with our Adelaide Sleep Specialist.

© APSS 2014

High blood pressure and Sleep Apnoea : an often overlooked link

There are many reasons why someone's blood pressure may be high, including genetic reasons, dietary reasons, and cardiac reasons. But did you know that one of the most important (and often missed) contributors is Obstructive Sleep Apnea?

The common link between Obstructive Sleep Apnoea (OSA) and Hypertension (high blood pressure) has been known for a long time, and yet we all still overlook this. There is significant literature regarding the link between the two.

More recently, an analysis of the heartBEAT study by Walia et al(1) showed an association between severe untreated Obstructive Sleep Apnea and resistant Hypertension. This was even whilst on blood pressure medications!

They found those with Severe OSA had a 400% higher risk of resistant hypertension. Medications often did not help, unless the OSA was treated.

The messages from this study are simple : Always think about OSA in those with hypertension, always exclude OSA first...

 

Key points :

•  OSA is a recognized major contributor to Hypertension
•  On more than 2 antihypertensives... think OSA!
•  Not responding to blood pressure medications... think OSA!
•  OSA increases risk of treatment-resistant hypertension by 4x

 

Our Adelaide sleep doctors can consult you, perform and report your sleep study, and your Adelaide sleep specialist will commence you on treatment. Give our Adelaide sleep clinic a call now.

1. Walia et al. J Clin Sleep Med. 2014;10:835-843

© APSS 2014

Sleepwalking, Sleeptalking, Parasomnias

Do you sleepwalk, sleeptalk, perhaps sleep-eat, or even hurt yourself or others in the night? This is usually indicative of a Parasomnia.

Undesirable and non-deliberate behaviours in the night whilst asleep (or at the transition in/out of sleep) are known as Parasomnias. These are exceedingly common in the younger age group, and can often be an indicator of other co-morbid sleep disorders in the older age group. More recently, they've attracted a lot of attention in the form of sleep-sex (sexsomnia!), sleep-related violence, and sleep-driving.

More commonly Parasomnias present as sleepwalking, sleeptalking, perhaps hitting out and hurting themselves or others.

In the past, these phenomena were attributed to behavioural or psychiatric disorders, but we now know that :

•  Parasomnias are a manifestation of many sleep disorders
•  Parasomnias are readily explainable
•  We can diagnose them easily
•  Parasomnias (both NREM and RBD) are treatable.

NREM Parasomnias are more common in the young, REM Parasomnias (REM Behaviour Disorder) more common in the older group and in those taking particular medications. Parasomnias also overlap with other conditions such as Narcolepsy. Treating Parasomnias without knowing their true triggers can make matters worse.

In our local Adelaide sleep clinic, we can consult you.

In our state-of-the-art Adelaide Sleep Laboratory, we can study these, assess the true triggers, and video-record any activity (something home sleep studies cannot do). We can also assess to see if these overlap with other conditions including Narcolepsy - this also can't be done in the home.

If you suffer from a Parasomnia, contact us for an appointment.

© APSS 2014

Untreated OSA : Costing Australians health, time, and lost productivity

Untreated OSA is associated with a higher risk of heart attacks, strokes, worsening diabetes, and car accidents. Did you know that it could be costing you a lot more than you think? Consider the sick days, lost productivity, and higher long-term health costs.

In a recent economic review by Tarasiuka et al (Curr Opin Pulm Med. 2013), leaving OSA untreated doubled your overall medical expenses - mainly because of heart disease.

Hillman et al (Sleep 2006) similarly found disturbing costs associated with Sleep Disorders in Australia, costs that are unseen and affect every citizen. These included costs from work-related accidents, car accidents, reduced productivity, and lost work days. Hillman estimated a loss of $7,494,000,000 USD (yes, that many zeros!) to the Australian economy in 2004 as a result of Sleep Disorders.

How are you performing?

•  Lost productivity from poor memory?
•  Walking in a fog?
•  Waking up unrefreshed?
•  Sleeping away your days?
•  Finding it difficult to stay awake, even when off-work?

 

Don’t lose any more productivity.

Enjoy your time at home more. Make each day count. Come see one of our Adelaide Sleep Specialists now.

© APSS 2014

Ocular manifestations of OSA

Did you know that OSA can manifest in your eyes?

Obstructive Sleep Apnoea (OSA) can contribute to many changes in your body. It can manifest with snoring, apneas, excessive daytime sleepiness, poor memory and concentration.

Did you know that OSA can manifest in eye disease? And we’re talking about more than just baggy eyes! These eye conditions include :

•  Glaucoma
•  Floppy Eyelid Syndrome
•  Papilloedema
•  Anterior Ischemic Optic Neuropathy
•  Retinal Vein Occlusion

Several studies have linked all the above eye conditions with untreated OSA. If picked up early by your optometrist / ophthalmologist / GP, your OSA could be diagnosed earlier and get treatment earlier.

OSA can cause fluctuations in oxygenation levels, blood pressure, and subsequently ocular perfusion pressures.

If you have one of these eye disorders, make sure that OSA is not contributing to it. Call our Sleep Clinic to organise a sleep study.

© APSS 2014

Atrial Fibrillation (AF) and OSA

Obstructive Sleep Apnoea is associated with diabetes, hypertension, erectile dysfunction, glaucoma, and of course heart disease. One of the more exciting and new links is between Atrial Fibrillation (AF) and OSA.

Both conditions are very common. AF is the most common cardiac arrhythmia in Australia, and OSA affects upto 24% of men and 9% of women. OSA combined with sleepiness (OSA Syndrome) occurs in 4% of men and 2% of women (1).

Patients with AF and those with OSA share similar demographic features - they are more likely to be male, hypertensive, of an older age, and have a higher body mass index. However, this link is much more than statistical chance.

Many studies have established that patients with severe OSA are significantly more likely to develop AF, increasing their risk by four times (2).

OSA decreases the likelihood of successful cardioversion (from medications or electrically) and increases the risk of AF returning. The recurrence rate of AF after cardioversion can be as high as 82% (3).

AF also recurs more often in those with OSA after radiofrequency catheter ablation (4).

According to Sleep Disorders Physician Dr Dien Dang, this is unsurprising considering the severe degree of haemodynamic compromise that occurs with OSA.

“OSA causes severe desaturations, cyclical hypoxaemia, and can structurally change your heart over time,” said Dr Dang, "Everyone who has ever had AF should consider a Sleep Study at Burnside Hospital."

•  The OSA and AF population overlap considerably.
•  OSA can affect AF profoundly
•  Untreated OSA increases AF risk by 4x
•  Untreated OSA increases cardioversion failure by 4x

 

If you have Atrial Fibrillation, call us now for an in-Hospital Sleep Study.

1.  Young et al. NEJM 1993
2.  The Sleep Heart Health Study. AJRCCM 2006
3.  Kanagala et al. Circulation 2003
4.  Naruse Y et al. Heart Rhythm. 2012

© APSS 2014