Firefighters may Have an Elevated Risk of Sleep Disorders

Two of the leading causes of death for firefighters in the United States are heart attacks and motor vehicle crashes, both of which share independent risk factors in sleep disorders.
In a recent national sample of almost 7,000 firefighters, researchers at Brigham and Women’s Hospital examined the prevalence of common sleep disorders and their association with adverse health and safety outcomes. The study found that sleep disorders are highly prevalent, and associated with substantially increased risk of motor vehicle crashes and cardio-metabolic diseases among firefighters.

Based on specific criteria, 66 US fire departments were selected to participate in a workplace based sleep disorders screening and educational program. Approximately 7,000 participants were assessed for common sleep disorders and surveyed about health and safety. Documentation was also collected for reported motor vehicle crashes. Participants reported current health status, previous diagnoses of sleep and other medical disorders, the likelihood of falling asleep while driving, motor vehicle crashes, near crashes, and injuries.

Researchers found that a total of 37.2 percent of firefighters screened positive for sleep disorders including obstructive sleep apnea, insomnia, shift work disorder and restless leg syndrome.  Firefighters with a sleep disorder were more likely to report a motor vehicle crash and were more likely to report falling asleep while driving than those who did not screen positive.  Additionally, firefighters with sleep disorders were more likely to report having cardiovascular disease, diabetes, depression and anxiety, and to report poorer health status, compared with those who did not screen positive.
More than 80 percent of firefighters who screened positive for a common sleep disorder were undiagnosed and untreated. 

Findings of the study, published in the Journal of Clinical Sleep Medicine, demonstrate the impact of common sleep disorders on firefighter health and safety, and their connection to the two leading causes of death among firefighters.

Excessive daytime sleepiness (EDS) is a common problem in today's society; it is so common that in some circles people almost consider it a normal aspect of a productive society. The fact is that daytime sleepiness and fatigue are leading causes of accidents, both on the job and on the road, and the cost to society is estimated in billions of dollars per year.
There are several common causes for increased daytime sleepiness, including OSA, PLMS and RLS: these problems are all treatable, but unfortunately many physicians are still not familiar with  the diagnosis of these conditions.
If you have a problem with daytime sleepiness and have tried to increase your sleep length without improving your daytime sleepiness, then you should be evaluated by a Sleep Disorders Specialist. With proper care most people can obtain the treatment they need to improve this problem.

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Further Reading:
Sleep Disorders That Raise Heart Disease And Depression Risk More Prevalent In Firefighters

SLEEP APNEA SUPPORT GROUP IN HOUSTON!

THE SLEEP EDUCATION CONSORTIUM (S.E.C.) is Excited to Announce the Start of the A.W.A.K.E. GREATER HOUSTON Monthly Patient Advocacy Group for Individuals Suffering from Obstructive Sleep Apnea and Other Sleep Disorders.

A.W.A.K.E. is a national patient advocacy group sponsored by the American Sleep Apnea Association. Its mission is to increase awareness and education about Obstructive Sleep Apnea.
The A.W.A.K.E. GREATER HOUSTON chapter will meet monthly on a rotating cycle of three locations: the Houston Medical Center, The Woodlands, and Sugar Land. Meetings will start with patient discussion, followed by a brief interactive lecture about varying sleep disorders. These lectures will be given by local sleep specialists and will encourage patient Sleep Disorders. and education about Obstructive Sleep Apnea. involvement in the topics discussed.

The first meeting will be on Tuesday, August 26, 2014
At Comprehensive Sleep Medicine Associates
15423 Creek Bend Drive, Sugar Land, TX 77478

Patient Discussion Begins – 6:30 P.M.
Physician presentations:
Overview of Obstructive Sleep Apnea – 7:00 P.M.
Dental Appliances as an alternative treatment to CPAP – 7:20 P.M.
Discussion will follow the conclusion of the lectures.

RSVP by calling 281-269-7881 or by sending an email to AWAKEGreaterHouston@gmail.com

Sleep deprivation isn't always obvious.

"Sleep debt" (or sleep deficit) is the difference between the amount of sleep you should be getting and the amount you actually get. This difference represents a deficit which increases every time we skim some extra minutes off our nightly sleep.
"People accumulate sleep debt surreptitiously," says psychiatrist William C. Dement, founder of the Stanford University Sleep Clinic. In fact, studies have shown that such short-term sleep deprivation leads to a "foggy brain", worsened vision, impaired driving and problems in short-term memory. Long-term effects include obesity, insulin resistance, and heart disease.
And most Americans suffer from chronic deprivation. A 2005 survey by the National Sleep Foundation reports that, on average, Americans sleep 6.9 hours per night -6.8 hours during the week and 7.4 hours on the weekends: experts recommend eight hours of sleep per night.
The problem is that after a long period of sleep deprivation, you stop realizing how tired you actually are.

In a study by the University of Pennsylvania School of Medicine, researchers followed three groups of subjects for 14 days; one group slept for eight hours a night, the second group slept for six hours a night, and the third group slept just four hours a night. Cognitive tests after the two-week period showed that the people with only six hours of sleep a night showed similar reaction times as people with a blood alcohol content of 0.1 percent; a level which is considered legally impaired.

Other studies have indicated that a consistent lack of sleep may cause permanent damage to your brain. 
One in particular, also conducted by the University of Pennsylvania School of Medicine and published in The Journal of Neuroscience looked at lab mice that were kept awake to replicate the kind of sleep loss common in modern life, through night shifts or long hours in the office.
The team studied certain brain cells which are involved in keeping the brain alert. After several days of sleep patterns similar to those followed by night workers - three days of night shifts with only four to five hours sleep in 24 hours - the mice lost 25% of the brain cells in vital parts of the brain stem.

After only a night or two of sleep deficit, a few nights of adequate sleep are usually enough to reverse the effects and "recharge" your system. But chronic sleep deprivation may be harder to recover from.
For information on how to increase your sleep drive and improve your waking hours, take a look at our  sleep hygiene recommendations. If you have a problem with daytime sleepiness and you have increased your sleep length without improving your daytime sleepiness, then you should be evaluated by a Sleep Disorders Specialist. With proper care most people can obtain the treatment they need to improve this problem.

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References:
Sleep-Deprived People Can’t Tell They’re Sleep-Deprived; Melissa Dahl, NYMag.com
Lost sleep leads to loss of brain cells, study suggests; Helen Briggs, BBC News

Commercial Drivers Still at High Risk From "Drowsy Driving"

The issue of sleep-deprived or "drowsy" driving has made the news again following the tragic June 7 accident involving the comedian Tracy Morgan. Prosecutors say that the Walmart truck driver whose tractor-trailer slammed into a van, critically injuring Mr. Morgan and killing another passenger, had not slept in over 24 hours.
Drowsy driving is a leading cause of crashes and highway fatalities, according to federal officials: more than 30,000 people die on highways annually in the United States and crashes involving large trucks are responsible for one in seven of those deaths.
Federal rules introduced last year reduced the maximum workweek for truckers from 82 to 70 hours, after which drivers have a mandatory 34-hour resting period. This “restart” must include two periods between 1 a.m. and 5 a.m. to allow drivers to rest at least two nights a week: they cannot drive for more than 11 hours a day and must have a 30-minute break in their schedule.

But the trucking industry has been battling to get the new nighttime-break regulations repealed. On June 6, Senator Susan Collins, Republican of Maine, pushed an amendment through the Senate Appropriations Committee that would freeze the rules, pending further studies. Ms. Collins said the administration had failed to take into account that the new rules would put more trucks on the roads during peak traffic hours. Trucking officials and executives also said that drivers needed to be afforded maximum flexibility in their work and should not be told when to rest.

Safety investigators said that sleepy or drowsy driving is a far more common problem than most people realize, but how extensive the problem is remains a matter of debate, partly because it is difficult to obtain evidence that drivers fell asleep. In 1990, a National Transportation Safety Board study of 182 heavy-truck accidents in which the truck driver died concluded that fatigue played a role in 31 percent of the cases, more than alcohol or drugs.
But the American Trucking Associations said that a federal database of fatal crashes cited fatigue in less than 2 percent of police reports about accidents involving trucks; a more accurate estimate, they claim, is that driver fatigue plays a role in about 7 percent of truck crashes. “Until we have a blood test for determining fatigue, all estimates are likely going to under-report fatigue, because the dead don’t speak and the living often plead the Fifth, especially if they are facing criminal charges,” said Deborah A. P. Hersman, former chairwoman of the N.T.S.B. and now the president and chief executive of the National Safety Council.

The Transportation Department has proposed that all interstate commercial truck and bus companies be required to use electronic logging devices to increase compliance with driving-hour rules. Paper logs are easier to manipulate and more difficult for law enforcement officials to verify. The comment period for the rule is scheduled to end this month. Some commercial truck fleets already such devices. For instance, Walmart’s trucks have GPS and electronic logging systems, which track where the vehicles are and what they are doing. A Walmart spokeswoman said the truck involved in the accident that injured Mr. Morgan, who remains in a New Jersey hospital, was also outfitted with anti-collision technology, which is supposed to alert drivers if there is a car in a neighboring lane when they activate their turn signal, for example. It is also supposed to slow the truck down automatically if it is approaching slow-moving or stopped traffic. Citing the incomplete investigation, Walmart declined to provide specifics on the accident or the driver’s schedule in the days leading up to the crash.

Excessive daytime sleepiness is a common problem in today's society. It is so common that in some circles people almost consider it a normal aspect of a productive society. The fact is that daytime sleepiness and fatigue are leading causes of accidents, both on the job and on the road. The cost to society is estimated in billions of dollars per year. There are several common causes for increased daytime sleepiness. The simplest cause of daytime sleepiness that can be corrected results from insufficient sleep. The average person requires 7 to 8 hours of sleep per night. If a person routinely gets less than this, it will most likely cause excessive daytime sleepiness. Another common problem can be sleeping in a noisy environment. This can cause many short awakenings, so brief that a person doesn't remember them the next morning. This results in non-restful sleep with resulting excessive daytime sleepiness. If a person gets 8 hours of sleep a night and still feels sleepy during the day, one should consider that they may have a medical problem which hinders their ability to obtain restful sleep.
For more information on the causes of "drowsy driving" and how you can get treatment for the sleep-related issues involved, visit Dr.Simmon's website at houstonsleep.net.

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References:
Truckers Resist Rules on Sleep, Despite Risks of Drowsy Driving (NYT, June 16, 2014

F.D.A. Recommends Lower Dose of Lunesta Sleeping Pill

As part of the agency’s continuing effort to reduce sleep aids’ risky side effects such as drowsiness while driving, the Food and Drug Administration has announced that people prescribed the sleeping pill Lunesta should be starting with half the current recommended dose of two milligrams.

The dosage change is based, in part, on findings from a study of 91 healthy adults ages 25 to 40. The study shows, compared to an inactive pill (placebo), Lunesta 3 mg was associated with severe next-morning psychomotor and memory impairment in both men and women 7.5 hours after taking the drug. The study found that recommended doses can cause impairment to driving skills, memory, and coordination as long as 11 hours after the drug is taken. Despite these long-lasting effects, patients were often unaware they were impaired.

Taken at bedtime, the recommended starting dose of Lunesta (eszopiclone) has been decreased from 2 milligrams to 1 mg for both men and women. The 1 mg dose can be increased to 2 mg or 3 mg if needed, but the higher doses are more likely to result in next-day impairment of driving and other activities that require full alertness. Using lower doses means less drug will remain in the body in the morning hours.
Patients currently taking the 2 mg and 3 mg doses of Lunesta should contact their health care professional to ask for instructions on how to continue to take their medicine safely at a dose that is best for them.

According to IMS Health, a health care services company, about 55 million prescriptions for sleep aids were dispensed in the United States in 2013. Lunesta represents a relatively small part of that market, with about three million pills prescribed.

It was not the first time the agency has reduced the recommended dose of sleeping pills. In January 2013, the FDA said that doses of Ambien and other sleeping pills that contain zolpidem should be halved for women. The agency also told manufacturers that labels should recommend that health care providers “consider” prescribing lower doses for men.

Drowsiness is listed as a common side effect for all insomnia drugs, along with warnings that people may still feel drowsy the next day after taking one of these products. The FDA is continuing to evaluate the risk of impaired mental alertness with the entire class of sleep drugs, including over-the-counter drugs, and will update the public as new information becomes available.

Studies show that sleepiness can impair driving performance as much or more so than alcohol; the American Automobile Association (AAA) estimates that one out of every six (16.5%) deadly traffic accidents, and one out of eight (12.5%) crashes requiring hospitalization of car drivers or passengers is due to drowsy driving.  To learn more about the dangers of poor sleep habits and how you can get a better night's sleep, visit us at the HoustonSleepNet.

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Source:
FDA News Release: May 15, 2014

Engineer in fatal Bronx train derailment had sleep apnea

The commuter train engineer at the center of last year's deadly derailment in the Bronx was found to have obstructive sleep apnea that went undiagnosed before the Dec. 1 derailment, a sleep medicine doctor said in the National Transportation Safety Board's investigation docket. Rockefeller told investigators that he felt fine that day, but experienced something like highway hypnosis as he stared straight ahead at the tracks. "I came up with that hypnotized feeling, dazed, that's what I was in," he said. "The only thing that shook me out of it was the feeling of the train. Something wasn't right with it.
" He activated the emergency brake, but it was too late. The train derailed as it headed around a sharp curve at 82 miles per hour, nearly three times the speed limit.

A report on Rockefeller's medical history revealed he had never been tested for a sleeping disorder by any of his doctors prior to the accident. He had a history of snoring but "not of choking or gasping" awake. His sleep was disrupted as much as 65 times per hour, the report stated.
Sleep apnea occurs when a person involuntarily stops breathing while asleep. Rockefeller's lawyer said that
"...He had absolutely no idea of this condition prior to the diagnosis. It was exacerbated by the change in shifts two weeks earlier."

 Excessive daytime drowsiness is a tendency to sleep at inappropriate times regardless of activity or circumstance. It can manifest itself in mild or severe forms.
Excessive daytime sleepiness is a common problem in today's society. It is so common that in some circles people almost consider it a normal aspect of a productive society. The fact is that daytime sleepiness and fatigue are leading causes of accidents, both on the job and on the road. The cost to society is estimated in billions of dollars per year. There are several common causes for increased daytime sleepiness. The simplest cause of daytime sleepiness that can be corrected results from insufficient sleep.

A common medical problem that can cause increased daytime sleepiness results from having a breathing problem during sleep. Snoring for example, is a form of obstructed breathing. Obstructive breathing can make it difficult to breathe properly during sleep and can even cause a complete blockage in the airway during which breathing stops. Breathing is re-established with a brief disruption of sleep and possibly a brief gasp or choking sound.

Another common medical problem causing frequent disruptions of sleep is called Periodic Limb Movements of Sleep. This occurs when a person has multiple brief leg movements every 20 to 60 seconds for long periods during the night. These leg movements can fragment sleep, resulting in increased daytime sleepiness. Frequently people with this problem also have what is called Restless Legs Syndrome (RLS). RLS occurs when a person is sitting still or lying in bed, which makes it difficult to keep their legs still. This frequently can keep people awake, causing insomnia. People with this problem feel that moving their legs relieves this restless sensation.

These problems are all treatable. Unfortunately, many physicians are not yet familiar with treating these conditions. Ask your doctor about treatment and feel free to have your doctor contact us for questions on diagnosis and treatment for these conditions.
If you have a problem with daytime sleepiness and you have increased your sleep length without improving your daytime sleepiness, then you should be evaluated by a Sleep Disorders Specialist. With proper care most people can obtain the treatment they need to improve this problem. Contact us today at 281-407-6222 or visit www.houstonsleep.net  for more information.