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Are You Getting Enough Sleep? Video Transcript

I will be talking mainly about two things.  In the beginning I'll be giving you some basic information about sleep -- very simple stuff and then we'll talk about sleep apnea and how it becomes a sleep disorder. As you all know most of our sleep comes within one long stretch during the night.  This is the way our clock is, internal clock, is set and it's very common in some cultures to have a supplemental nap in the afternoon.  This is very normal in most of the cultures, unfortunately it's not considered as a normal thing here.  Although our clock, as you would see is really designed to allow us some quiet time, some down time if you like, in the early afternoon.

We could sleep by putting some electrodes on the brain.  Now we can cause a variety of brain waves and with that we're able to divide sleep into two major types.  You have probably heard some of those terms -- especially REM sleep -- stands for Rapid Eye Movement sleep.  And non-REM sleep which is when the eyes really aren't moving in rapid fashion.  As we drift from wakefulness into sleep we transition into very early shallow sleep then gradually into the deeper stages of sleep which is the non-rapid eye movement sleep, then in about an hour or an hour and a half we get into stage of rapid eye movement sleep then that cycle repeats itself all over again and we get about maybe four cycles of the rapid during the night.

For most adults, sleep requirements are anywhere between 7 to 9 hours.  This seems to be the magic number.  Actually there are some variety of studies that show both long sleepers, those who sleep more than nine hours and short sleepers particularly very short sleepers -- less than five hours of sleep -- for some reason they have higher incidence of mortality. We have not really figured that out exactly why.  Some of that mortality is related to cardiac disorders.

Multiple medications can have significant adverse impact on sleep and sleep quality.  And there are variety of sleep disorders that can also affect that.  Sleep apnea happens to be one of the most common sleep disorders that we have found.

To define some terms that you probably hear often so you have a clear idea of what they are.  We talk about obstructive sleep apnea.  Obstructive sleep apnea means the complete stopping of the breathing or the briefing comes very shallow because the upper airway, the airway in the neck becomes narrowed or collapsed.  I’m talking about that segment here, in the airway (points to slide) behind the tongue basically.  That airway should be made open when you sleep -- this way air can move in and out of the lungs -- it should flow easily.  When that segment fails to maintain open, it collapses, then air does not flow into the lungs.  So you see the person trying to breathe, but they cannot move the air in, so if the breathing stops completely we call that apnea.  If the breathing becomes very shallow we call that hypopnea.

Another term that's called central sleep apnea.  This is probably we see nine patients with obstructive sleep apnea before we see one patient with central sleep apnea.  There are a variety of mechanisms or reasons for that, but the basic principle behind that is that the brain center in the study does not fire appropriate signals for the breathing system.  So now the airway is open, there's no problem there, but the brain center is not sending adequate signals to the breathing muscles, so they have no reason to breathe.  That goes on for 10, 20 seconds, maybe sometimes longer, then the breathing center wakes up and fires the signals again.  We  call that central sleep apnea.

We talk about something called obstructive sleep apnea syndrome.  This consists of a variety of things that have to be met before we say that someone has the sleep apnea syndrome.  They have breathing stoppage, apneas, or shallow respiration which is the hypopnea, and arousals that happens at the end of each of these events.  As the airway closes up, there's no air flowing in, the person can't breathe so the sleep cycle has to be interrupted.  They have to wake up, briefly, open up that airway passage, let the airflow in and go back to sleep.  But as soon as they fall asleep, that cycle repeats itself again.  There are a lot of sleep disturbances associated with that and as a consequence, a variety of daytime symptoms including very tired, very fatigued, falling asleep a lot, loss of concentration, mood disturbance, attention deficits and a variety of problems.

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