Dr. Christopher Manfredi – December 12, 2013

 

Dr. Christopher Manfredi, Medical Director of the Sleep Disorders Clinic at Norwalk Hospital spoke on sleep disorders and treatments offered by the clinic to restore restful sleep.

Dr. Manfredi spoke primarily on sleep apnea because of the demographic of the audience.  He noted that sleep disorders are a relatively new branch of medicine with much of the critical science in the area developed in the last forty years. If you seek treatment, he advised, be sure to deal with a board certified doctor like him.

Sleep apnea is a sleeping disorder characterized by pauses in breathing (for ten seconds to several minutes and 5-30+ times an hour) or instances of shallow or infrequent breathing during sleep. Most cases involve physical blockage of airflow by soft tissue. Dr. Manfredi noted that 7-10% of the population suffers from sleep apnea, with incidents increasing with age and leveling off at 65. Snoring and daytime drowsiness are common indicators and dry mouth and unexplained waking at night may also occur.  The resulting inadequate sleep can lead to cognitive impairment, workplace problems, more accidents, hypertension, abnormal heart rhythm and obesity.

Dr. Manfredi said that professionals at the Clinic meet with patients to discuss their symptoms and perform an overnight evaluation in one of the comfortable rooms available at the center, monitoring brainwaves, heart rhythm, oxygen levels and sleep patterns.  There is also an evaluation procedure that can be done at home.

A common treatment is use of a mask while asleep that applies air pressure to keep airways open during sleep. Dr. Manfredi also mentioned an oral mouthpiece that shifts the lower jaw forward and opens the back of the throat, a device placed over the nose that allows air in but not out so that outgoing air goes through the mouth and opens the airway, and surgery to cut back the soft palate at the back of the throat.

He commented on two common erroneous beliefs about sleep: (1) “I don’t need much sleep” – in fact, most people need 7 ½ to 8 hours of sleep; and (2) “All I need is deep sleep” – we need the full cycle of light, dream and deep sleep.

Dr. Manfredi touched briefly on insomnia, the inability to fall asleep or stay asleep as long as desired. It is common, he said, affecting 30% of us and there are procedures you can try to overcome it such as not drinking alcohol near bedtime, not watching TV or reading in bed, and not trying to compensate by going to bed early.

In the Q and A, Dr. Manfredi made the following comments:

It is not clear why people with sleep apnea gain weight. A traditional explanation is the effect of less activity. More recently, some argue that sleep apnea disturbs the hormonal control that tells the body when it has eaten enough.

Sleep apnea is the most common reason people wake at night and cannot get back to sleep. Another cause may be the body’s circadian rhythm moving to an awake phase after one has slept off the brain’s need for sleep. Whisky does not help in this situation. Melatonin cannot help you sleep but can affect the circadian rhythm if taken before sleep.

People who sleep on their backs tend to have more problems sleeping. Positional therapy, by, for example, positioning tennis balls down one’s back, works for some people, but most need additional therapy beyond positional.

Snoring is difficult to correct.

As for common traditional remedies such as hot milk, hot chocolate, honey or bananas and natural products such as valerian, give them a try, but one needs to determine why one is waking up.

Insomnia such as early morning waking may be associated with anxiety.

If you get your 8 hours by sleeping in spurts of 3, 3 and 2 hours, that may suffice, but may not. A nap in the afternoon at about 2 PM is natural because of a normal circadian rhythm low at that time.

Waking several times at night for up to ten minutes and then going back to sleep may not be problematic if you feel fine during the day.

Studies have shown that there may be an increase in cancer among users of Ambien, but the results of these tests are ambiguous. It may be that the users of Ambien may be higher risk people.

There are strategies that may be effective for insomnia, such as trying to stay awake as long as possible before going to bed or, if you are sleeping only five hours, schedule five hour sleeps so you really get tired.