Our Life Asleep
Sleep is Nothing to Yawn At
Written by John Ferrari
You may think of sleep as rest – it’s when we relax and lay aside our cares for the day. But inside our bodies, sleep is dynamic. Sleep is when the body heals. During sleep, our brains release hormones that encourage tissue growth to repair blood vessels, healing wounds and sore muscles. Our bodies produce white blood cells and strengthen our immune systems. Our hearts get a break, too. Our blood pressure drops, our breathing slows and our muscles relax, reducing inflammation which promotes further healing. But sleep is dynamic in other ways, too. Sleep changes as we age, and interruptions to our nightly slumber can result in serious health consequences.
“We know what happens if we don’t sleep,” says Khalid Eltawil, MD, a Torrance Memorial Physician Network board-certified specialist in internal medicine, pulmonary disease, critical care and sleep medicine. “Our memory and cognitive functions are affected, even losing a single night’s sleep.” Over time, inadequate sleep leads to poor immune response and increases the risks of health conditions including diabetes, hypertension, heart attacks and strokes.
As we age, our need for sleep changes.While newborns need 15 to 17 hours of sleep a day, and teenagers perhaps 9 or 10 hours a day, mature adults may need 7 or 8 hours. It’s a myth, though, that our sleep needs decrease much more than that as we age.
Our sleep patterns also change. Sleeping involves four basic stages: light sleep or dozing, fully asleep, deep sleep and REM sleep when we dream. In older adults, the amount of deep sleep we experience decreases. Dr. Eltawil notes as we age we are subject to more conditions that interfere with sleep – from aches and pains to stress and emotional distress and physical maladies such as sleep apnea. That explains why Dr. Eltawil, a pulmonologist, is also a sleep specialist.
“Many specialties deal with sleep, but the most common cause of sleep deprivation is sleep apnea which is a pulmonary issue,” he says. “Men are especially vulnerable. About 50% of men over 50 have some degree of sleep apnea.”
Sleep is complex, Dr. Eltawil notes, and it’s not always easy to pinpoint the cause of sleep problems. Insomnia, for example, may be caused by a circadian rhythm issue, which may itself be caused by emotional (such as persistent stress), physical (aches and pains that make bed more comfortable than staying up) or environmental (say, bright light) factors. Other sleep-related conditions may be common but still mysterious in their origins. Parasomnias – that is, acting out during sleep, such as sleepwalking, may be associated with neurological issues. Restless leg/ limb syndrome may be related to a neurotransmitter disturbance but is still not fully understood.
“We see a lot of other things in older adults that interfere with sleep – lung conditions such as chronic obstructive pulmonary disease and asthma, orthopedic conditions, poor habits such as excessive caffeine intake in the evening hours, and alcohol consumption – but obstructive sleep apnea is the most common single condition. A new technology like Inspire has the potential to really help people.”
Khalid Eltawil, MD, practices at Torrance Memorial Physician Network Pulmonary & Sleep in Torrance and is located at 2841 Lomita Blvd, Ste 235. He can be reached at 310-517-8950.
Inspire Sleep Technology
"Sleep,” notes Nathan Eivaz, MD, “is a hot topic in medicine. We’re constantly learning more and more about it.
“What we’ve found,” adds Dr. Eivaz, an ear, nose and throat specialist with Beach Cities ENTS, “is the paradigm we used in the treatment of sleep apnea cannot be uniformly applied. Every individual’s sleep apnea is highly specified to that patient.”
Sleep apnea takes different forms. One of the most disruptive, and potentially harmful, is obstructive sleep apnea (OSA). “We are hearing about OSA more for a couple of reasons,” says Torrance Memorial Physician Network otolaryngology specialist Alexander Gertel, MD. “We’re recognizing the serious health problems sleep apnea can cause further down the line, and testing for OSA has become a lot easier. It no longer requires overnight evaluation at a sleep lab. Now it can be done at home using equipment delivered to your house.”
In one sense, OSA is a case of our bodies resting too well during sleep. “In sleep, muscles relax,” Dr. Gertel explains. “When we sleep, some of the soft tissues in the back of our throat can collapse and cause an obstruction. As we age, our muscle tone decreases, we tend to gain weight and we know weight gain adds weight in our neck and throat.”
“It’s a dynamic collapse of the upper airway,” Dr. Eivaz adds. “This is where new treatments such as Inspire come into play. They treat aspects of sleep apnea that couldn’t be treated before. Inspire works by stimulating the muscles in the palate, throat and tongue, which tend to be the areas we see in patients with dynamic collapse. Inspire senses when the patient is attempting to breathe and cannot, and it sends a signal to the nerve to tense those muscles and open the airway. It’s a strong enough impulse to alleviate the obstruction, but not strong enough to wake the patient.”
The Inspire sensor is implanted in the patient’s chest in an outpatient procedure. A slender lead connects the sensor to the patient’s hypoglossal nerve, which controls movement of the tongue and other key airway muscles. It’s only on when the patient is asleep and at risk of the airway collapse that causes OSA.
“Inspire was FDA approved in 2014,” note Dr. Gertel. “It’s already been around for a number of years with more than 40,000 surgeries in the U.S. since that approval.
“CPAP is a great treatment,” Dr. Gertel continues. “It’s still the gold standard for sleep apnea, but a very high percentage -- up to 50% -- of patients do not tolerate CPAP. They might feel claustrophobic, the mask may fall off or they may be uncomfortable and unable to sleep with air blowing constantly. In the past, there weren’t really any other options. Inspire is for those patients with moderate to severe OSA. Our Inspire program at Torrance Memorial is the only one in the South Bay, and we should be ready to go in the first half of 2023.”
Alexander Gertel, MD, practices at Torrance Memorial Physician Network ENT in Torrance and is located at 23550 Hawthorne Blvd, Ste 125. He can be reached at 310-891-6733.
