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Sleep Disorders

Sleep disorders are a very common cause of cardiovascular disease as the sleep disorders create a proinflammatory state that is causing an inflammatory response 24/7 whereever blood vessels are found. There are 3 primary sleep disorders that include obstructive sleep apnea (OSA), restless leg syndrome (RLS), and narcolepsy. Each of these sleep disorders make it difficult for the patient to have any stage 3 and 4 sleep (AKA N3 sleep), the stages of sleep where brain chemicals are made. The purpose of sleep is for the synthesis of brain chemicals within the brain, as these brain chemicals are generally used up during the course of a day. A healthy sleeper goes to bed tired due to the lack of brain chemicals in their respective neurons and this healthy sleeper wakes up refreshed due to an abundance of chemicals present within the brain - enough chemicals to sustain all of the activity and stresses of the upcoming day. Patients with sleep disorders go to bed tired due to the lack of brain chemicals, but usually wake up tired due to a serious deficiency of brain chemicals still existing because the sleep disorder disturbed the brain's ability to make brain chemicals due to ineffective sleep. When a patient's brain is deficient of neurochemical, this patient will have to circulate very high levels of adrenaline (AKA epinephrine) that will help keep the neurons functional. For instance, if a serotonergic nerve lacks serotonin, and the patient sends up a signal with no neuron firing, then another signal is sent up the same neuron only to fail to excite the nerve again. The patient may send up 5, 10, and even 15 signals up the serotonergic nerve that lacks serotonin, only to finally have adrenaline show up at the postsynaptic membrane "jumpstarting" the nerve finally making the nerve function take place. This use of excess circulating adrenaline to keep the brain firing isn't efficient, but at least this alternative nerve fuel in the form of adrenaline allows the patient to continue functioning. Adrenaline levels, within the nondepressed patient that sleeps normally, are usually rather low within the circulation. Adrenaline is only supposed to be elevated in patients that have a "fright or flight" experience such as a moment of sudden fear or stress, and after about 4 minutes of elevation the adrenaline usually returns to normally low levels within the circulation. When adrenaline circulates at high levels 24/7 within sleep disorder patients, you have a proinflammatory problem that is going nonstop within these patients 24/7. In the year 2000, CMS reported that 90% of primary care physicians never diagnosed even 1 case of obstructive sleep apnea within a Medicare patient. If approximately 30% of a primary care physicians patients are Medicare patients (and this would not be an unusual percentage of Medicare patients for any PCP), it would be statistically unlikely that they would practice an entire week without seeing at least 5 Medicare patients per week that have obstructive sleep apnea. This would suggest that physicians need to be more suspicious of the likelihood of sleep disorders within their patients, as I am convinced that sleep disorders cause a rather large amount of the cardiovascular disease that we are seeing today. Just being knowledgeable about the physical exam findings of a patient with obstructive sleep apnea patient will increase the likelihood of a clinician making the OSA diagnosis, the most common sleep disorder seen today. An OSA patient's PE will reveal at least one of the following: 1) a drooping soft palate, 2) an enlarged and/or elongated tongue, or 3) bilateral intranasal airway obstruction. Restless Leg Syndrome patients often have vague leg pains during the day with difficulty controlling leg movement or they will hurt. Restless leg patients often wake up with their bed covers tossed and turned about the bed. Narcolepsy patients usually have fragmented, broken sleep at night but they stays tired throughout the day and like to take naps during the day when possible. Narcolepsy patients may have cataplexy (sudden, unexplained weakness of muscles throughout various places of the body), hypnogogic hallucinations (extremely vivid dreams that are often frightening and remembered for long durations - days and weeks), and sleep paralysis (waking up paralyzed and aware of your surroundings often after a vivid dream). It is impossible to be good at cardiovascular risk reduction if you aren't good at identifying and treating sleep disorders!

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  • English (UK)

Get In Touch

  • Straight To The Heart
  • Sam Fillingane, D.O.
  • 1021 North Flowood Dr.
    Flowood MS, 39323
  • (601)-664-2424
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