A 'family curse': First insomnia, then death

The latest from The National Sleep Foundation @ www.sleep.org.

September is Suicide Prevention Month. According to the most recent report published by the United States Department of Veterans Affairs, which analyzed 55 million veterans' records from 1979 to 2016, the current analysis indicates that an average of 20 veterans a day die from suicide. Service members and Veterans who have defended our freedom have earned our enduring gratitude. They should have the opportunity to live meaningful, productive lives, in the same freedom and peace that their service and sacrifices made possible for so many other Americans.

Sleep problems among active-duty military and veterans are all too common. We’ve seen a growing body of research exploring the problems associated with soldiers’ sleep—and much of the news is not good. Both are at significantly greater risk for sleep disorders than the public.

Do you constantly struggle in some way with sleep? Do you have trouble getting or staying asleep? Do you wake in the middle of the night unable to return to sleep, or wake in the morning feeling as if you never really slept at all? Or maybe you've even been told that you exhibit strange behaviors during sleep. Do you feel tired and worn down nearly everyday? If so, you might just have a sleep disorder.

Approximately 80 million Americans suffer from a sleep disorder. And while there are over 70 recognized sleep disorders, some are much more prevalent than others. Here we describe the four most common sleep disorders that could be robbing you of quality sleep.

Your circadian rhythm is an ingrained biological clock that regulates the timing periods of tiredness and wakefulness throughout the day. Your body clock is calibrated by the appearance and disappearance of natural light in a 24-hour period. The term circadian is derived from the Latin "circa diem" meaning "approximately a day."

The functions of your circadian rhythm are based in the part of the brain known as the hypothalamus. Within the hypothalamus are a group of cells known as the suprachiasmatic nucleus (SCN), which is connected to our optic nerves that sense changes in light. The SCN is also responsible for regulating many body functions that revolve around the 24-hour cycle including: body temperature, heart rate, blood pressure, and the release of hormones such as melatonin which helps us with sleep.

Bedwetting (also known as sleep enuresis and urinary incontinence) is a fairly common condition in young children and is seen as a sign of an immature, developing bladder. It is estimated that 15% of children over three, and 10% over five wet the bed occasionally. In fact, most doctors don't consider bedwetting in children to be a sign of a problem unless the child is older than seven years old, or the child has begun wetting the bed again after six months of maintaining overnight bladder control.

However, when adults wet the bed it is often an indication of an underlying illness, disease, or a symptom of other untreated medical conditions.

Nearly everybody has experienced those days where you didn't get hardly any sleep the night before (or maybe even a few nights in a row). You're groggy all day, have trouble focusing, your mind drifts as you try to perform mundane tasks, and you may even feel a little more irritable than normal. However, with just one night of good rest, you're back to your normal, focused, alert self in no time.

Now try and imagine what it must be like to live in a state of perpetual drowsiness, chronically plagued with sleepiness. To make matters worse, imagine that you actually sleep just as much, if not more, than the necessary amount, and take frequent naps on top of that. Imagine living a life where you sleep as much as you can, but never get that rested, recharged feeling that sleep is supposed to give you. This is what it's like for those suffering from the rare disorder known as idiopathic hypersomnia.

You may be wondering why you received a Veterans Choice Card in the mail.

On November 5, 2014 the Department of Military and Veterans affairs began implementation of the Veteran's Access, Choice, and Accountability Act (VACAA) of 2014. The program's goals are to help alleviate difficulties veterans have been having in finding adequate and expedient health care.

Problems veterans were experiencing included long wait times to receive care at VA owned medical facilities and difficulty traveling to these health facilities that were far from their home.

Do you ever find yourself awake in the middle of the night staring at the ceiling for hours, willing sleep to come? Do you sometimes lay in bed dwelling on troubles of the past, worries of the present, or concerns for the future, all the while struggling to fall asleep? Or maybe you have difficulty staying asleep and constantly find yourself waking multiple times in the middle of the night and have trouble getting back to sleep, or you simply wake up earlier than you'd like, but find it impossible to go back to sleep.

If any of these examples sound like something you've experienced, chances are that you've had some form of insomnia, and depending on how often this happens to you, your restless nights could be sign of a serious sleep disorder.

Unlike sleep disorders that are easier to diagnose and understand, central sleep apnea (CSA) can be baffling. CSA patients might not snore, may be at their ideal weight, and may have not had a history of sleep disorders yet still find themselves with the condition characterized by pauses in breathing many times during the night. Central sleep apnea is a neurological condition—in other words, the brain is not sending the correct signals to the respiratory system to keep breathing while the patient sleeps. Sometimes another medical condition causes CSA; sometimes, pain medication can lead to it; and sometimes, the apnea occurs for no known reason. Whatever the cause, treatments are available for central sleep apnea. Here five of the most effective ways to help the CSA patient:

Central Sleep Apnea Treatments

1. Treating the medical condition that is also causing central sleep apnea. Congestive heart failure or the aftermath of a stroke can interfere with night-time breathing and lead to CSA. The solution here is simple: Treat the heart failure or the stroke and the apnea will likely subside.
2. Cutting back or eliminating the use of opiods. Studies have proved that more powerful pain medications such as morphine, codeine and oxycodone can cause central sleep apnea. Reducing the dosage or not taking them altogether can help, but discussing this option with your doctor and with a sleep specialist is important. Pain medications do just that—help with pain, and trying to fix the apnea might not be worth additional suffering when you are awake.
3. Continuous positive airway pressure (CPAP). More commonly associated with obstructive sleep apnea (OSA), a CPAP device can also help CSA sufferers, particularly those who are recovering from heart failure. With this treatment, the patient wears a mask that continuously delivers a constant pressure of air to the lungs, thus countering any inclination the body might have to pause breathing.
4. Bilevel positive airway pressure (BPAP). This is another treatment used for OSA sufferers that can be effective for central sleep apnea patients. Similar to a CPAP mask, a BPAP device adjusts the amount of air delivered to the lungs depending on whether the patient is inhaling or exhaling.
5. Adaptive servo-ventilation (ASV). Yet another device that uses a mask, ASV goes one step further by continuously detecting and adjusting to the patient’s breathing needs and delivering the correct amount of oxygen. If the user is breathing fine, the device reduces the air it provides. It the patient’s breathing begins to pause, ASV increases the oxygen.
6. Phrenic Nerve Stimulation.  Phrenic Nerve Stimulation is a new FDA-approved therapy for moderate to severe central sleep apnea in adult patients.  Phrenic nerve stimulation is delivered by a pacemaker-like implantable device that stimulates a nerve in the chest (phrenic nerve) to send signals to the diaphragm to control breathing.  It monitors respiratory signals while you sleep and helps restore normal breathing patterns. Because the device is implantable and turns on automatically during sleep, it does not require wearing a mask.

   
   

   Phrenic nerve stimulation allows normal breathing to resume by stabilizing carbon dioxide, preventing apneic events and the subsequent period of rapid breathing.

   
   

    

   
   

   Of course, the most effective treatment will vary from patient to patient, so discussing these options with a sleep specialist is crucial in determining how best to alleviate central sleep apnea.