Sleep Answers from Sleep Expert Dr Susheel Patil

Sleep expert discusses major sleeping disorders

Sleep Answers from Sleep Expert Dr Susheel Patil | Johns Hopkins Medicine

In light of Sleep Awareness Week coming up this week, the Center for Health Education & Wellness (CHEW) and Nu Rho Psi co-hosted an event in Hodson 110 called “Sleep 101” on March 6.

This event sought to provide tips to students on how to make the most the sleep they get each night.

Susheel Patil, clinical director of the Johns Hopkins Sleep Medicine Program, was invited to speak about issues centering around sleep.

Patil’s research interest lies in understanding the development of obstructive sleep apnea. He is the author of more than 30 publications and has been invited to give lectures across the U.S.

Patil’s most recent publication described how diet and exercise can help prevent obstructive sleep apnea (OSA). The study, published in the European Respiratory Review, found that calorie restricted diets can help to improve obstructive sleep apnea. 

The symptoms of obstructive sleep apnea include upper airway obstruction during sleep and insomnia, but a variety of other symptoms can also be present. According to the study, Ninety percent of cases in men and 98 percent of cases in women may go undiagnosed every year.

Furthermore, the study cited exercise as another potential treatment. The study found that adults who exercised a moderate amount (three times a week) had a reduction of obstructive sleep apnea symptoms. In addition, these improvements were observed separately from weight loss, meaning that exercise may be directly related to OSA improvement.

“One hypothesis is that moderate exercise reduces fluid accumulation in the legs and nocturnal rostral fluid shift,” Patil and his co-authors wrote in the study.

At the end of his presentation last Monday, Patil mentioned his research and brought up the idea that sleep disorders are treatable and told his audience to talk to their physicians if they ever run into any concerning sleep problems.

Insun Yoon, a sophomore who attended the “Sleep 101” event, shared that she came to the event because she wanted to learn more about how to perform better under conditions of fewer hours of sleep.

“I wondered if there was a way to be more rested without necessarily getting more hours of sleep,” she said. “As a student, I feel that there a lot of pressure to perform well under sleepless conditions, and so I attended because the thought of productive sleep allured me.”

Yoon said that the most interesting thing she took away from this event was that insomnia is not actually considered a disorder.

“Insomnia is not a disorder in itself, but can be seen as a symptom! It is kind of scary to think that insomnia is so common because that means any underlying diseases that insomnia is merely a symptom of are also common,” Yoon said.

In addition to speaking about sleep disorders in his talk, Patil gave a brief introduction to sleep biology as a gateway to understanding the current treatments for various sleep disorders, in addition to tips that can improve sleep quality.

“What I wanted to do with today’s talk is to do a little bit of sleep biology 101, because I think if you understand a little bit about sleep and the science behind it, you will have a better understanding of the treatments and things I will talk about in terms of trying to improve sleep,” Patil said.

However, Patil admitted that scientists to this date still do not understand the purpose behind sleep. Although there are a variety of different theories, none of them have gained substantial acceptance.

In his presentation, Patil listed four main theories on the purpose of sleep that exist today: inactivity for survival, energy consumption, restoration and brain plasticity. Patil also emphasized that the area of brain plasticity research in sleep is currently a very popular topic in the field. 

“Brain plasticity is probably the newest theory that many scientists are looking into in terms of research,” he said. “There is this constant sort of creation and pruning [of synapses]. As a result of that, this may be important to memory development and functional development in life.”

Patil further went along to address the approximate hours of sleep humans need throughout their life.

“In terms of how much sleep we need, this changes over the course of a lifespan. Very early on, infants need somewhere in between 12 to 16 hours of sleep a day,” Patil said.

He showed in his figure that high schoolers between the ages of 13 to 18 need approximately eight to 10 hours of sleep per day. 

Adults that are 18 or above need at least seven hours of sleep per day. However, Patil stresses that it is important to note that these numbers can vary from person to person.

“These are normative data,” Patil said. “How much sleep any individual needs is going to vary. I see certain people that get six hours of sleep and can actually do very well.”

Patil also presented an interesting figure that compared sleep loss with drunkenness. Past research has shown that staying awake 20 to 24 hours leads to performance similar to when the blood alcohol concentration (BAC) is 0.1 percent. 

Patil also added that sleep loss can lead to higher rates of obesity and heart diseases.

The most important tip Patil suggested for people who seek to improve their sleep is to learn to make sleep a priority.

“The bottom line is that there is no shortcut. If you are having insomnia issues or having timing issues with your sleep, it really does require that you make sleep a priority for yourself,” Patil said.

Patil also strongly suggested his audience to stop all electronics 30 to 60 minutes before bed. He encouraged people to not make the brain accustomed to the notion that bed is a place of activity. Besides that, Patil also emphasized the importance of having consistent sleep and rise times.


Your Teens and Tweens Need More Sleep!

Sleep Answers from Sleep Expert Dr Susheel Patil | Johns Hopkins Medicine

We all know that sleep is important.  Not only do we need enough sleep to feel rested and have energy for our day, but there are also a variety of specific reasons why our bodies need sleep. These include heart health and brain health.

Our brains need sleep to process the information learned during the day, making connections between what we learned during the day and what we already know. and let go of negative emotions.  Lack of sleep leads to poor concentration and poor decision making, and can even contribute to mental health issues such as anxiety and depression.

How do you know if your teens and tweens are sleeping enough?  Sleep expert  Susheel Patil, M.D., clinical director of John Hopkins Sleep Medicine, says “you should be able to get into bed and fall asleep within about 15 minutes, and wake up without an alarm clock, feeling rested. On average, the amount of sleep you get this way is probably the amount you need.”

Nourishing Tweens is a participant in several affiliate programs, advertising programs that provides a means for sites to earn advertising fees by advertising and linking to and other websites. I only recommend things that I truly and would use myself. If you click through my links and make a purchase, there is no additional charge to you.

Sleep deprivation is very common among teenagers.  According to Dr.

Michael Crocetti , the Chief of Pediatrics at John Hopkins University, tweens and teens need 9-9 ½ hours of sleep per night because they are going through a second stage of cognitive development and maturation in the brain. Teens and tweens need the extra sleep to support this brain growth as well as physical growth spurts.  

Teens need more sleep
Photo by Gemma Chua-Tran on Unsplash

Many people are surprised to hear that teens and tweens need 9-9 ½ hours of sleep per night.  We know little kids need lots of sleep, but big kids? YES. Not only do their brains need sleep to allow for growth, but the sleep also protects them from negative consequences such as depression, anxiety, drug use, drowsy driving, and even suicide.  

Unfortunately, it can be really hard for teenagers to get enough sleep for a variety of reasons.  Busy schedules, lots of homework, and distracting tech phones, social media, and video games all contribute to the issue.

  But did you know that the teenage years also bring a change in the circadian rhythm? Many teenagers don’t feel ready to go to sleep until past 10 pm or even 11 pm.  Too many schools start at a very early hour, such as 7:30 am.

These two facts work together to make getting enough sleep seem impossible.

So what can parents do to help teens and tweens get more sleep?

Take a look at both the daytime and evening activities of your family:

Strategies you can do during the day to help with sleep

  • Get plenty of exercise and activity during waking hours so your body is ready for sleep at night.
  • Have a time during the day to tackle problems.  Many teens and tweens use bedtime as the time to “open up” to their parents, or they may just lay in bed fretting about things.  To combat this, make sure there is a chance earlier in the day to work through issues. Perhaps dinner time would be the right moment to discuss problems they’re facing at school or with friends.  It might also be good to teach them how to do a “brain dump” so that they can stop the circle of worry.
  • Think about whether your family’s schedule is interfering with sleep.  Are there too many activities planned? Can anything be let go? Could dinner time be changed?  Do you need to shut off the TV earlier?
  • With the circadian rhythm changes in mind, think about whether an earlier bedtime will work for your teens or not.  Perhaps a later wake-up could be a better answer. Look at the morning to-do list and think about what could be moved to the evenings so that tweens and teens could get up later.  For example, showers could be taken at night instead of in the morning. Clothes could be chosen and lunches could be made in the evening. Breakfast could be eaten on the way to school.  If you need an easy, portable breakfast for teens try my Super-Healthy Chocolate Protein Smoothie or my Grain-Free Chocolate Chip Banana Muffins.

Nighttime routines to help your teens and tweens get more sleep

When we have babies and toddlers in the house, most of us parents establish a nice bedtime routine to help with sleep patterns.  However, as the kids get older those routines get disrupted by things activity schedules and homework.

By the time we have teens, bedtime routines might be fairly nonexistent.  But everyone needs a bedtime routine. Routine signals to your brain that it’s time to sleep, and it can make falling asleep easier.

Take some time to think about how your family’s evenings play out, and what changes could be helpful so your teens can get more sleep.

  • Everyone needs to brush their teeth and do some other self-care tasks at bedtime.  Do you have time set for this? Or a certain order?
  • Even though teens are older, parents need to have clear limits and expectations, which needs to include a timeframe.  Teens are too young and their brain development is such that they cannot always make the best decisions for themselves.
  • No screens at bedtime.  There are several reasons for this.  First, the light of the screens interferes with melatonin production and disrupts the sleep cycle.  Second, the temptations of social media, texting friends, and playing games are too hard to resist when the opportunity is right there.  NO PHONES IN THE BEDROOM OVERNIGHT. Choose an end time for screens. In our house, my son is expected to be done with his computer games before dinner, by 7 pm (I am thinking of changing this to 6:30).  My kids are expected to have their phones in the kitchen by 9 pm. Do not disturb is set on their phones from 9 pm-6:45 am. This is a work in progress. You need to find the right time frame for your family and be strict about it.
  • When your kids were little, you probably read them a story and sang them a song every night as part of the bedtime routine.  If your kids are too old for these things, that’s fine…but what has it been replaced by? Finding the right bedtime activity can really help with sleep.  Maybe your teens enjoy reading at bedtime. Or maybe they would prefer journaling or drawing. Help them find a screen-free activity to help wind down the day.  Read Calming Activities for Tweens and Teens if you need ideas.
  • Make sure your tween or teen’s bedroom is the right cozy atmosphere for good sleep.  Is it dark and quiet? Room darkening curtains can help. Some people really benefit from a white noise machine for the relaxing sounds it gives.  Another popular choice is an essential oil diffuser that can be filled with sleep-supporting aromas lavender.  If you’d to learn more about how essential oils can help, read my article about why your family needs essential oils.

This is the white noise machine we use. It works just fine and is reasonably priced:

This is a white noise machine that’s also an essential oil diffuser and nightlight:

What to do if your tweens and teens struggle to fall asleep

I’ve already mentioned essential oils. They are good for everyone, but they can be especially helpful for those with sleep issues insomnia. They can be used in a diffuser for aromatherapy and can also be used topically.

I have a roll-on product from Young Living called Tranquil. I roll it on the back of my neck and onto my wrists as I go to bed, as does my daughter and my husband. We have found it really helps support falling asleep and staying asleep.

If you’re interested, please read my article about essential oils.

Another helpful product that we have in our house is a weighted blanket. Weighted blankets can help soothe the nervous system so that you can relax. This one comes in different colors and sizes and has a removable cover for washing:

Some people benefit from taking melatonin at bedtime to help them go to sleep. Our pediatrician recommended it for my daughter. Ask your doctor if this would be a good choice for your tween or teen.

Proper nutrition is also very important for quality sleep. Make sure caffeine is limited and not consumed more than 6 hours before bedtime. Consider reducing sugar intake and increasing healthy fats in your family’s diet. If you haven’t already, please read my article about why your family needs plenty of healthy fat.

If your family is eating well but still struggling to sleep well, there are supplements that can help. Perfect Supplements is an excellent company with well-sourced and tested supplements. They have several supplements that can support sleep, such as magnesium and Rhodiola Rosea.

If you head over to Perfect Supplements, use my code TWEENS10 to get 10% off! AND even better news…from Jan. 21-28 this code will get you 15% off! Buy three items and you get 25% off!

I hope you’ve found my suggestions helpful! Please pin and share!

Photo by Nur Taufik Zamari on Unsplash

Photo by Gemma Chua-Tran on Unsplash

I did a lot of research for this sleep article and I’d to share my sources in case you want to learn more:

Among Teens Sleep Deprivation is an Epidemic. – Stanford Medicine. This article is very thorough and describes several sleep research studies.

Teenagers and Sleep: How Much Sleep is Enough? – Hopkins Medicine

Why Teens Need Way More Sleep  -LP Tutoring

Tips on Getting to Sleep Faster – Parenting in Real Life


Alzheimer Biomarkers Linked to Sleep-Disordered Breathing

Sleep Answers from Sleep Expert Dr Susheel Patil | Johns Hopkins Medicine

PHILADELPHIA, Pennsylvania — Sleep-disordered breathing in healthy elderly subjects is associated with several biomarkers for Alzheimer's disease, leading researchers to think that sleep-disordered breathing might be a risk factor for the development of dementia.

But the reverse is also possible. It might be that “preclinical Alzheimer's increases or starts sleep-disordered breathing, but then sleep-disordered breathing makes things worse and produces brain injury and accumulation of amyloid beta,” said Ricardo Osorio, MD, from the New York University Langone School of Medicine, in New York City.

Dr. Osorio and his colleagues conducted a cross-sectional study of 68 healthy elderly subjects. The results were presented here at the American Thoracic Society 2013 International Conference.

All subjects underwent clinical examinations, neuropsychologic testing, home monitoring for sleep-disordered breathing, and testing for biomarkers of Alzheimer's disease, including cerebrospinal fluid amyloid beta-42, p-tau, t-tau, positron emission tomographic imaging with fluorodeoxyglucose for brain hypometabolism and with Pittsburgh compound B, and structural magnetic resonance imaging.

To diagnose sleep-disordered breathing, researchers used the apnea–hypopnea index (AHI4%), which measures the number hourly episodes of sleep-disordered breathing with at least 4% oxygen desaturation.

Of the 68 healthy elderly participants, 26.5% had normal breathing during sleep, but 48.5% had mild sleep-disordered breathing (AHI4%, 5 – 15) and 25.0% had moderate to severe sleep-disordered breathing (AHI4%, >15).

Body mass index was higher in those with moderate to severe sleep-disordered breathing than in those with mild sleep-disordered breathing (P < .05), but otherwise, there was no difference in terms of neuropsychologic tests or clinical parameters.

Only a few biomarkers of Alzheimer's disease were found in the obese subjects. However, in subjects with a body mass index below 25 kg/m², the pattern of biomarkers was “very similar to what we see in people who are facing Alzheimer's disease,” Dr. Osorio reported.

Lean subjects showed hippocampal atrophy, hypometabolism in the medial temporal lobe and the posterior cingulate cortex — regions that are usually very sensitive to risk for Alzheimer's disease — and an increase in p-tau and t-tau in the cerebrospinal fluid. In contrast, in obese subjects, glucose hypometabolism was significant only in the medial temporal lobe (P < .01).

Table. Biomarkers for Alzheimer's Disease in Lean Subjects

Biomarker P value
Increased cerebrospinal fluid p-tau .02
Glucose hypometabolism
   Alzheimer's disease-vulnerable regions .05
   Medial temporal lobe


Sleep disordered breathing in Marfan syndrome: Value of standard screening questionnaires

Sleep Answers from Sleep Expert Dr Susheel Patil | Johns Hopkins Medicine

A high prevalence of sleep disordered breathing (SDB) has been reported in persons with Marfan syndrome (MFS), a single gene disorder of connective tissue resulting in premature death from aortic rupture.

The burden of SDB and accompanying hemodynamic stress could warrant broad screening in this population. Our goal was to assess the utility of traditional SDB screening tools in our sample of persons with MFS.

Participants were recruited during an annual Marfan Foundation meeting and Marfan status confirmed using the Ghent criteria. Screening questionnaires were administered and SDB assessed by home sleep testing. We assessed accuracy of screening tools using receiver‐operating characteristic curve analyses.

The prevalence of moderate‐severe SDB was 32% in our sample of 31 MFS participants.

The Stop‐Bang questionnaire had the highest positive predictive value (PPV) of 60% and the highest negative predictive value (NPV) of 100% using the high‐ and moderate‐risk cut‐offs, respectively, and the Berlin questionnaire had a PPV of 50% and an NPV of 92.3% at the high‐risk cut‐off.

When those with mild SDB were included, the Stop‐Bang and the Sleep Apnea Clinical Score (SACS) questionnaires demonstrated useful screening accuracies with PPVs of 94.7% and 92.9%, and NPVs of 63.6% and 47.1%, respectively, at the moderate‐risk cut‐offs.

A survey of SDB in a sample of persons with MFS reveals not only a high burden of SDB but also that conventional screening instruments have utility if adapted appropriately. Future studies should validate the utility of these screening tools given concerns that SDB may contribute to progression of aortic pathology in MFS.

Keywords: connective tissue disorder, screening accuracy, SDB, surveys

Marfan syndrome (MFS) is a systemic disorder of connective tissue caused by mutations in the N1 gene. Aortic root aneurysms complicated by subsequent dissection and rupture are major causes of morbidity and mortality (Judge & Dietz, 2005).

Prolonged and cyclic hemodynamic stress on a weakened aortic wall is thought to facilitate aortic deterioration. The standard approaches to minimize this stress and prevent dissection include the use of anti‐hypertensives such as beta‐blockers and angiotensin receptor blockers (Teixido‐Tura et al.

, 2018) and, when necessary, surgical intervention to reinforce the structural integrity of the proximal aortic wall (Robicsek & Thubrikar, 1994).

Sleep disordered breathing (SDB), a known source of cardiovascular stress, is prevalent in MFS Kohler et al., 2013; Kohler et al., 2009). It is characterized by repetitive upper airway obstruction that presents both a mechanical and hypoxic load on the heart and aorta (Schneider et al., 1997; Serizawa et al., 2008).

The first study evaluating SDB in a group of MFS persons was conducted by Cistulli et al in 1993. They showed a 64% prevalence of SDB in a small cohort of persons with MFS compared to matched controls (Cistulli & Sullivan, 1993). Later, other studies (Kohler et al., 2009; Rybczynski et al.

, 2010) reported prevalence rates of 32% and 31%, with one demonstrating increased odds of aortic adverse events in the presence of SDB. A case report raises the possibility that SDB treatment with CPAP may attenuate aortic dilatation (Cistulli, Wilcox, Jeremy, & Sullivan, 1997).

Given the high prevalence of SDB and accompanying hemodynamic stress, the development of valid screening methods for SDB in the MFS population is needed.

Current screening tools for adults include the Berlin questionnaire, STOP‐Bang, and the Sleep Apnea Clinical Score (SACS) (Nagappa et al., 2015; Netzer, Stoohs, Netzer, Clark, & Strohl, 1999; Prasad et al., 2017; Verbraecken, Hedner, & Penzel, 2017).

The performance of these tools differ depending on the prevalence of SDB and characteristics of the studied population as demonstrated in prior studies (Mulherin & Miller, 2002).

We reasoned that the screening performance of these instruments in the MFS population might be different due to the unique anatomical and genetic features of the MFS population.

The primary purpose of this study was to examine the performance of traditional screening surveys in a convenience sample of persons with MFS.

Participants were recruited as part of a cross‐sectional study conducted at the annual Marfan Foundation meeting conducted in Baltimore, Maryland.

The hosting faculty, human subjects intuitional review board and the Marfan Foundation allowed for the participants of the meeting to be informed of the study through scheduled on‐site provider contact and attendance at the convention. The research team set up a booth at the conference to inform interested persons.

Eligible participants were adults over the age of 18 with self‐reported MFS which was later confirmed using the revised Ghent nosology (Loeys et al., 2010; Radonic et al., 2011). Demographic and anthropometric information were collected and several SDB screening questionnaires were completed.

A home sleep apnea test (HST) kit (AccuSom™; Novasom, Inc) was given to subjects to self‐apply overnight while sleeping in their hotel rooms after training by research staff. The study was approved by Committee 5 of the Johns Hopkins Institutional Review Board (IRB Number: NA_00073250) on human research and all participants provided written informed consent.

2.2.1. Anthropometry

Participants had the following measurements taken using standard techniques: height; weight; and waist, hip and neck circumferences (Barrios, Martin‐Biggers, Quick, & Byrd‐Bredbenner, 2016).

2.2.2. Home sleep test

All participants underwent a home sleep test (HST) using the AccuSom™ device (Claman, Murr, & Trotter, 2001). Participants were provided formal instruction on applying the device before use.

The device measures nasal and oral airflow (using sound), heart rate, oxygen saturation, respiratory effort, and snoring sound intensity (Hunsaker & Riffenburgh, 2006). The system also uses a voice alert to prompt the patient to readjust a dislodged sensor.

Participants used the device for one night and returned it for data download, scoring, and study interpretation.

The device does not differentiate sleep and wake, so the respiratory event index (REI) measurement was total night recording time (Reichert, Bloch, Cundiff, & Votteri, 2003). To maintain privacy, a pseudonym a study identification was assigned to each participant.

Scoring of the HST was performed the system's automated scoring algorithm that identifies hypopneas as a reduction in airflow ≥30% with an oxygen desaturation of 3% or more and an apnea as a complete absence of airflow with or without desaturation, both respiratory events lasting ≥10 s.

The automated scoring was reviewed by two investigators (MS, SP) using the American Academy of Sleep Medicine (AASM) manual updated in 2016 (AASM Manual for the Scoring of Sleep & Associated Events, 2016), to improve overall accuracy.

SDB was defined as an apnea‐hypopnea‐index (AHI) of ≥15 events per hr (moderate‐severe SDB).

2.2.3. Questionnaires

Three traditional screening questionnaires; the Berlin questionnaire, the STOP‐Bang, and the SACS were administered. Survey scoring criteria were used to stratify participants into groups with moderate‐risk and high‐risk for SDB (see Supporting Information). Snoring was determined by yes or no responses on the Berlin questionnaire.

The Mann‐Whitney's test was used to compare anthropometric, demographic, sleep study, and survey characteristics for those below and above an AHI of 15 events/hr. Data are presented as means ± SD or frequencies where appropriate.

Screening accuracy was examined by calculating the area under the curve (AUC) for the receiver‐operating characteristic (ROC).

The sensitivities, specificities, positive predictive values (PPV), and negative predictive values (NPV) were also calculated.

In post hoc analyses, we repeated the screening assessment with an SDB threshold of AHI ≥5 events/hr (mild‐severe SDB). All statistical analyses were performed using XLSTAT (XLSTAT, Addinsoft, 2017). Two‐tailed p values of less than .05 were considered to indicate statistical significance.

A total of 50 participants who completed the sleep surveys underwent the home sleep studies.

At the time of data analyses, participants were contacted to validate MFS status using the revised Ghent criteria (Loeys et al., 2010; Penpattharakul & Pithukpakorn, 2016; Radonic et al.

, 2011) and 31 participants met the criteria. The prevalence of moderate‐severe SDB among the 31 participants was 32%.

Anthropometric, demographic, and sleep study characteristics are shown in Table ​1 for those with and without moderate‐severe SDB. No significant differences were noted in anthropometry and demographics except for greater neck size in those with moderate‐severe SDB.

As expected, AHI was significantly greater in persons with moderate‐severe SDB but the prevalence of snoring and sleepiness did not differ between groups. The proportion of persons classified with the Stop‐Bang as having a moderate‐risk for SDB was greater in those with moderate‐severe SDB.

Similarly, the group with moderate‐severe SDB had a greater proportion of persons classified with the Berlin questionnaire as having a high‐risk for SDB.

Participant demographic, anthropometric, and SDB characteristics by presence of moderate‐severe SDB (AHI ≥15 events/hr)



Sleep Apnea – My Chat with Dr. Susheel Patil at John Hopkins University School of Medicine by Robin Gorman Newman

Sleep Answers from Sleep Expert Dr Susheel Patil | Johns Hopkins Medicine

In an effort to continue to educate myself about sleep apnea, to further my desire to treat my case and to share with others who may benefit, I’ve been speaking with medical practitioners who are not treating me at present but are experts in the arena.

I had the pleasure to chat with Dr. Susheel Patil, and below is our Q&A.

When someone has been sleep deprived for a while, and if you endeavor to treat your sleep apnea, does it take time to feel good again?  Absolutely.

  Given all the fragmented sleep someone has when they have sleep apnea, and even if someone doesn’t have it but doesn’t sleep well, you can develop a sleep debt that accumulates over time.

  Once someone is doing successful treatment for their apnea, it can take almost a month or more of getting enough sleep and treating the underlying sleep disorder, before one really begins to feel rested.  Sometimes it can be even longer than a month.

Do you see any benefits of caffeine?  Not for the treatment of sleep apnea directly.  In terms of addressing some of the issues of the sleepiness that many people have with sleep apnea, it is something people do, and in that sense, it can be helpful in moderate doses but not after late afternoon.

  Caffeine is a tricky thing because everyone metabolizes it differently.  One or two cups of coffee can stay in the bloodstream for 24 hours, and it can contribute to having unrefreshed sleep or difficulty sleeping.  So, you want to be judicious with it, and sometimes you have to experiment re: the right dosing.  If someone has a higher blood pressure, we advise against it.

  It is a stimulant and can affect your heart rate and blood pressure.

How essential is it to stick to the same daily sleep schedule?  We are creatures of habit, and because we have an internal clock, it tells us when it’s time to go to bed and wake up.

  The more we abuse it by going to bed one or two hours later or waking up at different times, it has a harder time adapting.

  The more you can stick to a consistent schedule, the better your sleep is going to be over the longer term.

Do you consider sleep apnea epidemic, and if so, why?  It is a common disorder.  Much of it has to do with the obesity epidemic.  Men are more at risk than women.  Women will start to have increased risk after the menopausal transition.  And, age can be a risk factor.

  Worldwide obesity rates are going up, and sleep apnea is traveling along with it.  The other reason is that people know more about what sleep apnea is.

  We used to think of it as a disease of obese or morbidly obese people, we are recognizing that you can see sleep apnea in those you wouldn’t normally think about.

What is the most effective treatment, and what are some new treatments?  CPAP is considered universally effective, considering you can use it on a nightly basis. There much more uncertainty with other treatments.

  Oral/dental devices are available as well, and while they are generally indicated for mild or moderate sleep apnea, there’s not always a guarantee that you’re going to complete resolve the sleep apnea.

  You have to test the therapy with a sleep study to see if it’s resolved.

If someone is wearing a CPAP mask, do they still need to sleep on their side?  They can typically sleep in any position they want after they are appropriately set.  If someone has an auto CPAP device, then the pressure will be automatically adjusted as they move from their back to their side.

What is someone is prone to sinus conditions and allergies, is a nasal CPAP still viable?  That’s always one of the biggest challenges we have.

  We do a lot of intensive work with out patients in terms of trying to address their nasal issues.

  Longer term, they are usually more comfortable long term with a nasal CPAP because it is so much less bulkier versus a full face mask.

What if someone is a mouth breather? A nasal pillow will be less effective if they truly are a pure mouth breather.

  In my practice, many say they are one, but they are actually a mouth breather because of the sleep apnea.  They breathe through their mouth if they are being asphixiated through their nose.

  Once you open the airway by delivering air through the nose via the CPAP, many times, the mouth can close.

There are some who still have mouth breathing despite that, depending on the degree of the mouth breathing, a nasal CPAP is going to be difficult in terms of being successful therapy.

Do you see any benefit in doing tongue or throat exercises?  There is limited data available with respect to that.

  In someone with mild sleep apnea, and if they really are adverse to traditional treatment, it may be a viable alternative.   The issue is doing the exercises correctly and if it can be translated into regular, everyday practice.

  It’s a great area  that deserves more research, but it’s not something I recommend on a regular basis because of the lack of research.

Should someone with sleep apnea drive on a long trip?  If they are being successfully treated and getting adequate sleep, there is no reason they shouldn’t drive. They need to know their body.

  If they aren’t treating it, it needs to be discussion between family members and their physician.  Particularly for severe sleep apnea, I will advise against them driving.

  There are different laws in different states, and drivers with sleep apnea are considered at higher risk for automobile accidents.  We can’t predict which with the apnea will be the ones to have the accident.

How can you inspire and support someone to pursue treatment if they remain resistant to wearing a CPAP mask?  As hard as it is, it’s having a discussion about how the sleep apnea is potentially the spouse or family.

  If they don’t take care of themselves, they are directly affecting their family’s happiness, and ability to function.  It helps for the patient to understand that.  A physician can be helpful in terms of talking about the risks such as heart disease, stroke.

  If you have moderate or severe sleep apnea, and it’s untreated, your lifespan is potentially gonna be shorter than those who don’t have it.   Many times patients with sleep apnea don’t recognize that they are impaired, and we we tend to tackle things that directly impair us.

  So, sometimes taking a different tact and talking about how it can impact long term health will have an effect.

If someone has sleep apnea, does that qualify them as having a disability?  I see insurance struggling with it.  Not all thing of it as a disability.  It is a health issue.  The issue relates to how it potentially impairs what you can and can’t do and your occupation.

Other than the CPAP and dental device, are there other treatments can be effective?  There are a number of different options including positional therapies in the right patients.

  If a sleep study demonstrates that you have positional sleep apnea, those patients can benefit from sleeping on their side on a nightly basis.

  Weight loss can improve sleep apnea, particularly if they have mild or moderate sleep apnea and can lose at last 20 pounds.  Beyond that, there aren’t a lot of approved therapies.  There is hypoglassal nerve stimulation — the new kid on the block.

  For certain times of patients, it may be very effective.  There is strict criteria in terms of who is eligible for that kind of treatment.  If you are eligible, the studies have shown that it can work well.

If someone has a CPAP, and they feel they need a break every now ‘n then or they have a vacation coming up, are they at risk during those down times if they elect not to use the CPAP?  It depends.

  By and large my general recommendation is that they should take their treatment with them, particularly if they feel rested when they use the CPAP.

  If you have more milder forms, it may be okay, but you should discuss with your physician.

If someone had a sleep test at home, do they need to have one in a lab as well?  Home sleep studies focus on diagnosing and evaluating for sleep apnea only.  They are not gonna give you any other information about other sleep disorders.

  Despite the name, a home sleep study doesn’t evaluate sleep.  They assess breathing but not sleep itself.  If a home study shows you have obvious sleep apnea, they are generally pretty good, and there is really no reason to come into a lab.

  An in-lab sleep study may give you a better sense of the cause of the sleep apnea because you are observed and seeing what is happening to brainwave activity in relation to your sleep.

  Sometimes poor sleep can influence how bad the sleep apnea is and have nothing to do with having a narrow airway.

What advice would you offer someone struggling with wearing a CPAP mask?  CPAP is not the most natural therapy for anyone to use.  if it were, we probably would have been born with masks on our noses.  It’s important to recognize that some may do very well from the starting gate, but a lot of people, it takes time to get used to it.

  And, it can take several months or even longer.  That said, if you’re struggling, don’t struggle with it alone. Talk to your physician or a sleep physician.  Use resources available to you.

  If you have a good medical equipment provider, many times the CPAP specialists or respiratory therapists they have can provide useful tips about how to use their CPAP.

One thing physicians don’t do well as a group is to start to think about alternatives sooner if it’s clear someone is struggling with CPAP.  I’d rather have a patient who is partially treated than not treated at all. For example, even if you might think an oral device might not be effective, it could be.  Eventually they would need a sleep test to see.

It’s perseverance and making sure you have someone you can go to who has the resources and expertise in terms of dealing with individuals who are having difficulties using CPAP.  Not every physician group or center may be equipped to do that.

Anything you’d to add?  The important thing is that if you’re tired or sleepy, recognize that you may not have to be tired or sleepy.  There may be a good explanation for why that may be address.

  So, you want to talk about these issues with your doctor to see if you would benefit from further evaluation.  Just because you snore, doesn’t mean you have sleep apnea, but still have the discussion with your physician to see whether it’s something of concern.

  Often people have had sleep apnea longer than they know.

Susheel P. Patil, MD, PhD is an Assistant Professor and Clinical Director of the Johns Hopkins Sleep Medicine Program. Dr. Patil received his undergraduate degree from Pennsylvania State University.

Subsequently, he graduated with his medical degree from Jefferson Medical College prior to pursuing training in Internal Medicine at Case Western Reserve University (University Hospitals of Cleveland). Following a year as Chief Resident at Case Western, Dr.

Patil came to Johns Hopkins for fellowship training in Pulmonary and Critical Care Medicine, during which he also completed training in Sleep Medicine. Dr. Patil also received a PhD in Clinical Investigation at the Johns Hopkins Bloomberg School of Public Health.

He is board certified in Sleep Medicine, as well as Pulmonary and Critical Care Medicine.

Dr. Patil has been active in numerous committees and leadership roles in the Sleep and Respiratory Neurobiology Assembly of the American Thoracic Society and the American Academy of Sleep Medicine, and the American College of Chest Physicians. He has organized or spoke in numerous scientific symposia at the international meetings related to sleep medicine.

He is the author of more than 30 publications, and has given invited lectures throughout the US. He is the Associate Director of the ACGME Sleep Fellowship at Johns Hopkins. Dr.

Patil is also active in sleep medicine related public policy at the state level with roles in the Maryland Sleep Society and Chair of the Polysomnography Practice Committee of the Maryland Board of Physicians.

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