Sleeping the night away


Special to The Miami Herald

Belkys Veloz fears she will die in her sleep.

The 41-year-old mother of three has sleep apnea, a condition that causes breathing interruptions during sleep due to a tracheal blockage.

Doctors, however, say Veloz will not die from a temporary halt of her breathing. Rather, they are more concerned about other health problems spawned by the sleeping disorder — high blood pressure, a heart condition and a mini stroke she had five years ago.

Studies have shown that sleep apnea is linked to diabetes, high blood pressure, heart conditions and strokes. Most recently, sleep apnea is correlated to a higher risk of cancer. A study of 5,600 patients at seven sleep clinics in Spain indicated that those with severe sleep apnea have about double the risk of cancer-caused deaths than those without it.

“We used to think, ‘Let’s get enough sleep so we feel refreshed and rejuvenated.’ But now we know if something is interrupting your sleep at night, you might be tired and cranky but you are also much more at risk for all of these health diseases,” said Dr. Timothy Grant, medical director of Baptist Sleep Center at Sunset, in Miami.

The breathing interruptions lead the brain to signal that it is not getting enough oxygen, prompting the heart to pump more blood. That elevates blood pressure, said Dr. Belen Esparis, medical director of the Sleep Disorder Center at Mount Sinai Medical Center in Miami Beach. While blood pressure usually is lowest at night and in the morning, it is highest in the morning for those with sleep apnea — and remains high throughout the day.

The high blood pressure, in turn, causes small blood vessels in the brain to rupture, causing a stroke. And each time a sleep-apnea patient is jerked out of deep slumber, the heart is strained, leading to cardiac complications.

“That up and down, up and down every night, puts a strain on your heart when it should be resting,” said Esparis, adding that such sleep interruptions may occur as often as 50 times an hour.

Esparis said sleep apnea is the second most common sleep disorder after insomnia. Overall, between 50 and 70 million U.S. adults were estimated to have a sleep or wakefulness disorder in 2009, according to a Centers for Disease Control and Prevention Morbidity and Mortality Report released in 2011.

Esparis groups sleep disorders into seven main divisions:

• Insomnias.

• Breathing disorders such as sleep apnea.

• Hypersomnia and narcolepsy, in which a person falls into frequent and uncontrollable periods of deep sleep.

• Circadian rhythm disorders, a disorder where the natural body clock of going to sleep and waking up at certain times is disrupted. Commonly, it is seen in older people and teenagers who struggle to wake up in the morning.

• Parasomnias, or sleep walking and night terrors. They’re generally associated with the rapid eye movement, or REM, portion of sleep.

• Sleep-related movement syndromes such as restless legs syndrome.

• Pediatric sleep disorders.

Circadian sleep disorders are not considered disorders unless they affect everyday life, Esparis said.

The good news? Circadian sleep disorders are easily treated with a simple tool: light.

When it is dark, the brain produces a hormone that prompts sleep: melatonin. When lights are kept on — including the glow from a phone, tablet, computer screen or video game — the brightness inhibits the production of melatonin, making sleep more difficult. Sleep experts often recommend staying away from computers at least an hour before going to sleep.

Some disorders, however, require medications.

Suvorexant, which the Food and Drug Administration has not yet approved, is a sleeping pill that researchers say will have fewer side effects than Ambien or Lunesta. Suvorexant works by blocking the chemical orexin produced in the brain’s hypothalamus, the part of the brain that regulates the nervous system, including sleep cycles. Orexins are the chemicals that keep people awake.

“Sleep is like the new frontier of medicine,” said Grant, the Baptist sleep physician and neurologist. “You can really improve not just people’s quality of life and sleep but you can also prevent all these other symptoms, like blood pressure.”

Indirectly, sleep disorders like sleep apnea may also lead to weight gain. Such was the case with Veloz, a patient at the University of Miami Miller School of Medicine UHealth Sleep Program.

Veloz had been diagnosed with a mild sleep apnea, as she had breathing halts 11 times per hour. But she left her condition untreated over the years, which led to more serious health problems.

“I had no energy. I was always sleepy or tired. I could not play with my children,” said Veloz, of Homestead.

Things were at their worst five years ago. She weighed about 252 pounds, got fired from her job at a Miami factory for falling asleep on her shift, and her systolic blood pressure was as high as 220.

Gaining more weight has been linked to worsening sleep apnea because of the extra fat deposits in the neck and cheeks that obstruct air passage.

“You wake up in the morning and you are tired,” said Dr. Alexandre Abreu, with the UHealth Sleep Program and Veloz’s physician. “You can’t have the regular activity with the family. You become depressed and some anti-depressants cause obesity. It’s a never-ending cycle.”

Recently Veloz began using a CPAP (continuous positive airway pressure) machine during sleep. The machine pushes air through her nostrils, opening up the airway to the trachea.

Abreu calls CPAP “the gold standard” of sleep apnea treatment.

Said Veloz: “Now, I’ll be able to go to the beach and exercise. I have regrets about not using it [CPAP)] before because now I have heart problems.”

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