Undiagnosed OSA in Women

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We know what sleep apnea looks like, right?

Middle-aged man, kind of stocky, looks tired and snores like a freight train? The truth is, that’s a common profile for Obstructive Sleep Apnea (OSA), but it’s far from the only one. OSA results from physical conditions that can affect people of any age, size or gender.

It often goes undiagnosed in women

Symptoms that point to OSA can be less pronounced in women than men, but studies suggest the consequences are just as damaging for women, if not worse. And it may be more common in women than we think; by some estimates, men are twice as likely to have sleep apnea, but are diagnosed with it 8 times more often. It’s been suggested that happens because women’s symptoms present differently from the typical male profile and therefore get missed.

Tired woman driving car

How does OSA work differently in women?

There are a number of factors that contribute to Obstructive Sleep Apnea in both men and women, but at the basic level what happens is the soft tissues at the back of the throat relax during sleep, sinking down and blocking the upper airway. This causes an interruption in breathing, which makes the brain alert the body to wake up slightly and re-open the airway. These micro-interruptions in sleep are rarely even noticed by the OSA sufferer, but they can happen many times an hour – meaning people not only lose sleep, but they’re often prevented from entering into deeper sleep phases, which makes for a groggy morning.

While a lot of men with OSA are loud snorers, and frequently report daytime sleepiness to the point of losing focus, women are less likely to report such symptoms. For whatever reason, women are less likely to report the feeling of “tiredness” unless the problem reaches extremes, at which point they are more likely to use words like “fatigued” or “exhausted.” In a woman who doesn’t fit the typical profile for OSA (overweight, male, loud snoring, etc.) a symptom like fatigue will often lead doctors to investigate thyroid issues or depression, and miss the possibility of sleep apnea.

Woman sleeping with mouth open

How does OSA in women get missed so often?

Doctors, like the rest of us, can fall victim to preconceived notions about what the condition looks like.

While a sleep study will often be ordered for a man who fits the profile and complains of related symptoms, those same symptoms may be overlooked or thought of as part of a different issue for a woman.

Male doctor with stethoscope

Some examples include

  • Snoring – women will often report lighter snoring, or none at all (because who wants to admit that?). On top of that, male partners are typically less likely to notice snoring. An almost comically frequent refrain from men who turn up for sleep studies is, “I’m here because my wife says I snore too much” – the same is more rarely true in the reverse.
  • Symptom overlap – symptoms that women do mention to their doctors are also associated with other conditions. Things like headache, fatigue, lack of energy or moodiness are often chalked up to menopause, depression, insomnia or other issues.
  • Low but present apnea events – women tend to have a lower apnea-hypopnea index (AHI) than men. That’s a measure of the number of breathing interruptions per hour, which means they (or their partners) are less likely to notice them.

snoring woman sleeping on her back

Getting missed doesn’t mean it doesn’t matter

Evidence shows that while OSA symptoms are typically less pronounced in women, the negative health effects are just as bad if not worse.

A 2013 UCLA study showed that normal autonomic responses to control things like blood pressure, heart rate and sweating are reduced in people with OSA, but the reduction is even more pronounced in women. They conducted a number of tests on men and women with OSA and their findings were concerning.

“The heart-rate results for these tests show that the impact of sleep apnea, while bad in men, is more severe in women,” said lead researcher Paul Macey. “This may mean that women are more likely to develop symptoms of heart disease, as well as other consequences of poor adaptation to daily physical tasks. Early detection and treatment may be needed to protect against damage to the brain and other organs.”

heart health woman

What to watch out for

Because it so often gets missed, it’s important to pay attention to symptoms that could mean you have OSA, in order to prevent further health complications down the road. Things you may notice that could point to sleep apnea include:

  • Your breathing stops and restarts while you sleep (noticed by a partner, perhaps)
  • You wake up a lot during the night (to use the washroom for example – under normal conditions you shouldn’t need to get up much at night)
  • You get a full night’s sleep but you feel tired anyway
  • You snore (even a little – no judgement!)
  • You have low energy or daytime fatigue
  • You’ve been told you have high blood pressure, or you have fibromyalgia
  • You get frequent morning headaches

OSA can be debilitating, and also comes with risks of more dangerous complications for overall health, but it can be effectively treated with CPAP. If you suspect you may have OSA, don’t hesitate to consult with us for more information.

tired woman rubbing temples

Risk factors for women

Even if you don’t have OSA or suffer from OSA symptoms now, there are certain factors that could put you more at risk of developing sleep apnea; if you have any of these, it’s a good idea to pay extra attention and act immediately if you notice symptoms appearing. There are also factors that can aggravate the negative health consequences of OSA.

Things to keep an eye on include:

  • Reaching a certain age – women aged 55-70 are 14% more likely to have OSA
  • Becoming pregnant – pregnancy can increase your chances of developing OSA, and if left untreated it can cause complications
  • Carrying extra weight – obese women in the 50-70 age range are 31% more likely to have OSA
  • Menopause can bring on sleep apnea
  • The chances of developing OSA for women with polycystic ovarian syndrome are up to 70%
  • A family history of sleep apnea increases the likelihood you’ll have it too
  • Chronic congestion, for any reason, can be linked to OSA
  • High blood pressure, diabetes and asthma all have strong associations with OSA

If you have concerns about any signs of Obstructive Sleep Apnea, book an appointment and get assessed:

tired woman eating pizza on couch

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4 Tips for using your CPAP machine with spring allergies

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Spring has sprung and so has allergy season in Montreal, making it a challenge for CPAP users like me who also struggle with a stuffy nose and sneezing fits.

Getting a good night’s sleep during this period needn’t be impossible. Below are my suggestions as a veteran CPAP user and allergy sufferer.

The time to take a break from your CPAP is NOT when you’re congested

When allergies are getting the better of me, I frequently wake up to find my mask flung unceremoniously on the floor. At some point during the night, I found it hard to breathe and unknowingly removed the offending mask.

I know from personal experience that this is precisely the time when it is even more important to keep using it. If used properly, the CPAP machine can relieve the discomfort of symptoms caused by nasal congestion and allow you to get a proper night’s sleep so that you can wake up feeling refreshed and ready to take on the day and the pollens drifting through the air.

So how can you optimize CPAP use when breathing through your nose feels downright impossible?

woman next to flowers, blowing her nose

CPAP Humidification is key.

Your nose is constantly doing two things:

Warming incoming air so it reaches your lungs at body temperature; and
Secreting fluid to help clear out allergens

Adding CPAP air without humidification means your nose has to work extra hard to warm all this extra air and produce even more fluid to maintain its moisture on top of clearing out allergens.

Humidifying your CPAP air takes the burden of warming that air off your nose so it can stay moist without extra effort and produce just enough fluid to combat allergens. This helps lower congestion and inflammation caused by allergens, since your nose is now more efficient at clearing them out.

If you have a humidifier and you’re not using it, it’s time to dust it off and fill it with distilled water. If you’re having trouble with your humidifier, we would be happy to help you.

sleepstyle humidification

Hypoallergenic filters

Change your CPAP machine’s filter at least once a month and use hypoallergenic filters. This is imperative for us seasonal allergy sufferers. Airborne particles, such as pollen, dust and spores can get into your CPAP machine. The filters are designed to clear these elements from the air that is directed into the machine and ultimately to your lungs.

hypoallergenic filters for Airsense 10

Reducing allergens in the home

Very simply, close your windows at night to reduce exposure to allergens and use AC if necessary. Seasonal allergies are usually brought on by tiny airborne particles from trees, pollen, grass, ragweed or outdoor mold, which are inhaled through the nose and trigger a chemical reaction in the body that leads to nasal congestion, sneezing, watery eyes, and runny nose. Why invite the offending allergens in?

pollen

Full Face CPAP mask

When all else fails, invest in a backup full face mask (FFM). If you’re using a nasal mask and you’re congested, swap out your nasal mask for one that covers your nose and mouth. A full face mask will allow you to breathe through your mouth and continue your CPAP treatment.

Full-face masks: Airfit F20, Vitera and Mirage Quattro

Think of your CPAP as your friend during allergy season

As an allergy sufferer, I am grateful to be using my CPAP. It gets me through the worst of the hay fever season. The warm, humid air clears my upper airways so that I can get some relief from a stuffy nose and a dry mouth. Patients frequently tell us that they don’t use their machine when they’re congested. Congestion is precisely the time when you want to be using your CPAP!

CPAP machine in a field

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A breath of fresh air for Mother Earth

Earth week is upon us and it reminds us to take stock of what we’re doing and think of ways we could improve

All in the name of restoring our planet from some of the devastating impacts we humans have had on it.

Options for sustainability

Even as COVID-induced reductions in travel and commuting have given the planet a bit of a breather (sleep apnea pun intended), other issues, like a spike in consumption of single-use plastics and the disposal of mountains of throw-away masks, have reared up to show us there are always areas to improve.

At Apnea Health, we know that change starts with action. We’ve worked hard over the years to make sure we keep our own footprint as light as possible, and we’re always looking for more ways to help our patients, and our planet, breathe easier.

forest

Electrifying the fleet

Our enthusiasm for the environment is electric – and so is our fleet of cars! With our easy access to clean hydro-electric power here in Quebec, there’s no reason not to jump on the growing wave of e-vehicles.

Our staff travel all over Greater Montreal to visit our 8 clinics (with a 9th opening soon in Chambly) and to visit patients. As our fleet of cars ages, we’re committed to replacing them with electric ones – we’re now up to four e-vehicles and we love them!

souad car

Taking the operation paperless

Back in 2019, when we reached 11 years of stockpiling paper patient files, we decided it was time to update to electronic medical records (EMR). Patient files may not sound like a lot, but if you’d visited some of the rooms in our clinics, you’d have seen what over a decade of paper files looked like! All those filing cabinets were cramping our style – so it was time to do something and we haven’t looked back.

That isn’t to say it wasn’t a challenge; digitizing all those files was a monumental job, and we also had to learn to change our habit of relying on notes jotted down on paper. But all of our patient files are now digital, and our clinics are feeling a whole lot airier for it! It means patient information is faster and easier to get to, all while saving trees.

Apnée Santé Employee sorting through a filing cabinet

Exploring ways to do more for the environment

We know there’s always more we can do to reduce waste in our clinics, and we’ll keep working hard to make even more changes to protect our planet. A new and encouraging trend, for example, is the use of the Lumin ultra-violet CPAP accessory cleaning system to clean and reuse Covid masks rather than throwing them all away.

We always keep an eye on reducing single-use items, and we never stop looking for new and better ways to make our clinics environmentally friendlier than ever!

Lumin and N95 mask

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Daylight Saving Time and how your internal clock reacts

This Sunday marks the beginning of Daylight Saving time, when the clocks “spring forward” by one hour.

In the Spring, some dread “losing” that all-important hour of sleep, but for others, the change in routine is disruptive and at times, detrimental.

For those suffering from sleep apnea the bi-annual changing of the clock represents a period where the general public gets to experience some of the same debilitating effects of sleep routine disruption, while simultaneously providing apnea sufferers with yet another hurdle in the battle for a good night’s sleep.

What happens when your sleep routine is affected?

According to Stuart Fogel, an assistant professor of psychology at the University of Ottawa, where he works in the Sleep Research lab, “…even a small amount of sleep loss can have some severe consequences”.

While you gain an hour on one end, you lose an hour on the other end. The result? Our biological clocks are off and everything about us is out of sync.

man lying awake in bed

Changes in your sleep schedule, even for only an hour, can have an effect on your brain.

According to Fogel, “That will have an impact on your vigilance, probably your attention, and probably your ability to concentrate, your ability to react to things in your environment.”

He adds that “There’s some literature showing that there are increases in accidents, workplace, motor-vehicle accidents and the severity of them is greater following the time change.” Coincidentally, the Société de l’assurance automobile du Québec (SAAQ) is currently running a campaign about fatigue behind the wheel, warning drivers to be vigilant and rest up, make sure to use their CPAPs if they are sufferers of sleep apnea, to keep our roads safe.

Sufferers of sleep apnea can totally relate to these side-effects of sleep inconsistencies. However, most non-sufferers of sleep apnea have their internal clocks adapt to the new schedule in the same way you might adjust to jet lag.

Tired man rubbing his eyes in his car

The practical fallout is real.

In 1999, researchers at Johns Hopkins and Stanford universities wanted to find out what happens on the road when millions of drivers have their sleep disrupted. Analyzing 21 years of fatal car crash data from the US National Highway Transportation Safety Administration, they found an increase in road deaths on the Monday after the clock shift in the spring: the number of deadly accidents jumped to an average of 83.5 on the “spring forward” Monday compared with an average of 78.2 on a typical Monday.

And it’s not just car accidents. Evidence has also mounted of an increase in incidences of workplace injuries and heart attacks in the days after we spring forward.

Tired woman driving car

How to regain your rhythm

Essentially, the same advice we give to sleep apnea sufferers applies here too – at the heart of it all is keeping a consistent schedule.

Here are a few tips that can help you find your groove:

  • Exercise regularly, but not too close to bedtime.
  • Eat well (avoid too much fat, salt and sugar; eat plenty of fruits and vegetables).
  • Limit your consumption of caffeine, energy drinks, alcohol and medication.
  • Take time to relax, and adopt good sleeping habits: Develop a bedtime routine to prepare for sleep (read a few pages, take a bath, etc.).
  • Go to bed and get up at regular hours (avoid large differences between weekdays and weekends).
  • Make the bedroom off-limits to phones, televisions, computers, etc.

Remember – getting a good night’s sleep isn’t a luxury. It’s a must for health!

couple jogging

A great way to remember to check your CPAP

Firemen use Daylight Saving time as a reminder for people to check the batteries in their fire alarms twice a year. Why not apply the same principal to your CPAP? Daylight saving time change is a great way to remember that you should get your CPAP checked.

Give us a call to book your CPAP check and our inhalation therapists will be happy to do a download, check your machine and make sure you are on track to get the best quality sleep – all year round!

Employee administering CPAP Therapy to a patient

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Love your pet day

At Apnea Health, we love our pets!

Working during the pandemic hasn’t been easy, but our cats, dogs, birds, fish and even a lizard have helped reduce our stress levels. Playing fetch with our dogs, cuddling with our cats and caring for all the others brings us such joy and peace.

Did you know that February 20 is love your pet day? Along with us, show your pets how much you appreciate all the love and support they provide.

Here’s how:

Spend Extra Time with Your Pets

Spend some additional quality time with your furry friend. Take your pup out for an extra long walk or cuddle up with your cat on the couch.

Sharing your time is one of the best ways to show your pets you care.

Man playing with a dog on a beach

Spoil Your Pets with a Treat or Toy

Everyone enjoys a surprise gift now and again, and your pet is no different. For Love Your Pet Day, pick out a special bone, treat or toy for them to enjoy.

If you don’t have a pet at home anymore, consider dropping off some toys at your local animal shelter instead.

Kitten playing with toy

Fun fact: over one-half of Canadians currently have a pet in their household

Perhaps unsurprisingly, cats and dogs are by far the most commonly-owned pets and are essentially tied in popularity (22% of Canadians own cats, 20% have dogs and 11% of pet households have both)

Interestingly, residents living in Quebec and Nova Scotia are less likely to own a dog and more likely to own a cat. Those in BC and the Prairies are more likely to own a dog compared to any other region.

Among Canadian pet owners, 18% report they obtained a new pet since the start of the pandemic.

pet stats en

Dogs and cats need more sleep

Your pets may seem like they spend a lot of time sleeping. Dogs and cats love their daily naps, not to mention adjusting to their parent’s nighttime sleeping patterns. Just how much sleep do dogs and cats really need?

Most dogs and cats get somewhere between 12 to 16 hours of sleep a day, although some (particularly kittens and puppies) can sleep up to 20 hours a day!

kitten and puppy sleeping together

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Sleep better, live better in the new year!

It’s a new year and a time to resolve to make positive change in our life. And while most New Year’s resolutions focus on losing weight, quitting smoking or other lifestyle changes, few include better sleeping habits.

Getting a good night’s sleep can have a myriad of health benefits

Studies have found a link between insufficient sleep and serious health problems including heart disease, heart attacks, diabetes, and obesity. So resolutions for positive change to diet and life habits should go hand in hand with attention to sleep needs in order to optimize your health.

Better health and sex life

An international sleep poll by the National Sleep Foundationfound that as many as 56 percent of American respondents’ sex lives suffer because they’re too tired.

people affectionate e1607981386462

Reduce Risk of Depression and Stress

Sleep impacts many of the chemicals in your body, including serotonin. People with serotonin deficiencies are more likely to suffer from depression. You can help to prevent depression by making sure you are getting the right amount of sleep: between 7 and 9 hours each night.

When your body is sleep deficient, it goes into a state of stress. The body’s functions are put on high alert, which causes high blood pressure and the production of stress hormones. High blood pressure increases your risk for heart attack and stroke, and the stress hormones make it harder to fall asleep.

stressed out man, rubbing temples

Less pain and risk of injury

Many studies have shown a link between sleep loss and lower pain threshold. The more sleep a person gets, the higher his or her pain threshold.

Sleep deprivation results in increased risk of workplace accidents and injury. The Association of Workers’ Compensation Boards of Canada (AWCBC) reported 852 workplace deaths in 2015 alone, in addition to the hundreds of thousands of claims processed every year for work-related injuries.

man experiencing back pain

Better memory and clearer thinking

Sleep helps the brain process and consolidate our memories from the day. Those who are sleep-deprived run the risk of those memories not getting stored correctly and instead getting lost.

Studies have found that people who are sleep-deprived are substantially worse at solving logic or math problems than when they’re well-rested.

memory

Better mood

Those who get enough sleep are less likely to be grumpy and are better able to control their emotions. This can have a positive impact in the workplace and in personal relationships.

Woman waking up, well rested

Weight control

When we sleep, the body produces more of the hormone leptin, which plays a key role in making you feel full. When we don’t sleep, our leptin levels drop, which can lead to late-night snacking and even overeating.

weight loss

Stronger immunity to illness

One study looking at the link between sleep and immunity discovered people who got less than seven hours of sleep and were exposed to a cold virus were three times more likely to get sick than those who got at least eight hours of sleep.

If your New Year’s resolution involves losing weight or otherwise improving your health and well-being, getting enough sleep could help you achieve your goal—and a whole lot more.

When we sleep better, we feel better. Start the year off on a good foot and make a promise to yourself and your loved ones to live a healthier, longer life.

two people with shields battling bacteria

Related articles:

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Get the lowdown on Daylight Saving Time

This weekend will bring a treat to those who love to sleep.

Daylight Saving Time kicks in early Sunday, Nov. 5th, meaning you’ll need to set your clocks back an hour on Saturday night. Of course, talking about DST brings up the inevitable debate about the usefulness of the practice.

The biggest consequence: The change shifts daylight back into the morning hours. For 9-to-5 office workers, it means saying goodbye to leaving work while it’s still light out. And for weekend workers, it means an additional glorious hour of sleep on Sunday. Hurrah!

Yet there’s still a lot of confusion about daylight saving time. The first thing to know: Yes, it ends in the fall, just as the decrease in daylight hours is becoming noticeable. But, why do we deprive ourselves of sunlight in the winter when we need it most!  Get the lowdown on Daylight Saving Time here.

What you will discover in this article

Why do we need to “save” daylight hours in the summer?

Daylight saving time in Canada started as an energy conservation trick in 1908, and expanded through World War I to become a (mostly) national standard in the 1960s to keep in step with the US.

The idea is that in the summer months, we shift the number of daylight hours we get into the evening. So if the sun sets at 8 pm instead of 7 pm, we’d presumably spend less time with the lights on in our homes at night, saving electricity.

Isn’t it “daylight savings time” not “daylight saving time”?

No, it’s definitely called “daylight saving time.” Not plural. Be sure to point out this common mistake to friends and acquaintances. You’ll be really popular.

Does it actually lead to energy savings?

As Joseph Stromberg outlined in an excellent 2015 Vox article, the actual electricity conservation from the time change is unclear or nonexistent: “Despite the fact that daylight saving time was introduced to save fuel, there isn’t strong evidence that the current system actually reduces energy use — or that making it year-round would do so, either. Studies that evaluate the energy impact of DST are mixed. It seems to reduce lighting use (and thus electricity consumption) slightly but may increase heating and AC use, as well as gas consumption. It’s probably fair to say that energy-wise, it’s a wash.”1

What does Saskatchewan know that we don’t?

Although all of Saskatchewan is geographically within the Mountain Time Zone, the province is officially part of the Central Time Zone. Most of Saskatchewan never changes their clocks, in fact they technically observe DST year round.2 The odd result is that their clocks match Winnipeg during the winter, and Calgary and Edmonton in summer. Though that seems funny, with the energy benefits being questionable, and all of the very real headaches that come from the semi-annual shift, no wonder our friends in Saskatchewan can get a little smug about opting out of the madness.

Is daylight saving time dangerous?

When we shift clocks forward an hour in the spring, many of us will lose that hour of sleep. In the days after daylight saving time starts, our biological clocks are a bit off. It’s like North America has been given an hour of jet lag.

One hour of lost sleep sounds like a small change, but if you suffer from Obstructive Sleep Apnea, you know what sleep disruptions can do to your alertness and your overall health.

According to Stuart Fogel, an assistant professor of psychology at the University of Ottawa, it’s in the second half of the night that you switch to rapid eye movement (REM) sleep, which is associated with dreaming. During this time you have spikes in brain activity that are important for learning and memory, as well as for mood regulation and cognitive function.3 Chopping an hour from that stage of sleep will obviously have consequences for those processes, so it’s no wonder we all feel groggy after the clocks “spring forward” every March.

The practical fallout is real.

In 1999, researchers at Johns Hopkins and Stanford universities wanted to find out what happens on the road when millions of drivers have their sleep disrupted. Analyzing 21 years of fatal car crash data from the US National Highway Transportation Safety Administration, they found an increase in road deaths on the Monday after the clock shift in the spring: the number of deadly accidents jumped to an average of 83.5 on the “spring forward” Monday compared with an average of 78.2 on a typical Monday.

And it’s not just car accidents. Evidence has also mounted of an increase in incidences of workplace injuries and heart attacks in the days after we spring forward.

Can’t we just get rid of Daylight Saving Time?

If only it were that easy! British Columbia is tabling new legislation this fall proposing to keep B.C.’s clocks fixed all year, a move supported by 93% of the province.4 The trouble is that economically it makes much more sense for them to stay in step with states like Washington and California, who have also considered the move, but who can do nothing without congressional approval from D.C. It means that wherever you are in Canada, it doesn’t seem likely that change will come unless we decide to live with time zones that differ from our friends south of the border.

So what should I do about it?

Well, for the fall, you should take your extra hour of sleep and enjoy it! Then come next spring, when you have to pay it back, make sure to get in lots of activity the day before, and consider using an over the counter herbal sleep aid to help you get to bed earlier on the day of the change. And as always, remember to consult the sleep experts at Apnée Santé for more tips and help with getting a great night’s sleep.

References:

  1. https://www.vox.com/2015/11/1/9640018/daylight-saving-time-year-round
  2. https://en.wikipedia.org/wiki/Daylight_saving_time_in_Canada
  3. https://globalnews.ca/news/4073944/daylight-savings-time-2018-sleep/
  4. https://globalnews.ca/news/5970879/new-legislation-coming-to-keep-b-c-s-clocks-fixed-but-seasonal-time-changes-not-yet-over/
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The Importance of REM Sleep

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Have you ever wondered what happens to your mind and body while you’re fast asleep?

Among sleep phases, REM stands out. It’s a sleep phase that is marked by closed-eyelid rapid eye movements and vivid dreams and has a major impact on your memory, mental focus, and mood.

Join us as we explore the secrets behind one of the most intriguing parts of your night.

What is REM sleep?

Rapid eye movement (REM) sleep is a stage of sleep associated with dreaming and memory consolidation. It was first discovered in the 1950s, when scientists studying sleeping infants noticed that there were distinct times during the night when their eyes moved rapidly from side to side.

Here’s a breakdown of what happens to your body during REM:

  • Eyes swiftly move back and forth behind closed eyelids.
  • Heart rate and blood pressure rise nearly as high as when you’re awake.
  • Breathing becomes faster and irregular.
  • Your brain consumes more oxygen and its activity increases significantly
  • Facial and limb twitching might occur, while other muscles experience temporary paralysis, preventing you from acting out your dreams.

REM is also often referred to as “Paradoxical Sleep” because it involves seemingly conflicting conditions of an active mind and a sleeping body.

Where in the brain does it occur?

During REM sleep, several parts of the brain are active and engaged in various functions 1. Some of the key parts of the brain that are active during this time include:

  • Brainstem and Pons: The brainstem, specifically the pons, is a crucial area for regulating REM sleep. The pons helps regulate aspects of REM sleep, such as suppressing voluntary muscle movement (also known as muscle atonia) which stops you from moving while you’re dreaming.
  • Amygdala: The amygdala, an almond-shaped structure involved in processing emotions, memories, and responses to fear, remains active during REM sleep.
  • Hippocampus: The hippocampus is involved in memory consolidation, and its activity during REM sleep suggests a role in processing and storing memories, especially those with an emotional or spatial component.
  • Thalamus: The thalamus is responsible for relaying sensory information to various parts of the brain, and it remains active during REM sleep. This could be related to the generation of dream imagery based on various sensory inputs.
  • Visual and Motor Cortex: Despite the muscle atonia that prevents physical movement, the motor cortex still shows some activity during REM sleep (such as the rapid eye movements and minor twitching in the limbs).
  • Prefrontal Cortex: The prefrontal cortex, responsible for executive functions like decision-making, planning, and self-control, shows reduced activity during REM sleep. This reduction in activity might explain the sometimes illogical or disjointed nature of dreams during this stage. The prefrontal cortex also regulates the amygdala and if you are sleep deprived, it ceases to ‘communicate’ with amygdala which can result in an unstable emotional state when you are awake.

Why is it important?

REM sleep plays a crucial role in your overall well-being as it’s associated with improved learning, memories, creativity, and emotional resilience.

The majority of your dreams take place during REM sleep. While REM is not the only stage in which dreams occur, the ones you experience in this stage are usually more vivid than their non-REM counterparts and studies show that these intense dreams are important for the processing of emotional memories (such as fear) 2.

During REM sleep, your brain processes new information and motor skills from the day, committing some to memory, maintaining others, and deciding which ones to delete.

Researchers hypothesize REM sleep promotes brain development, since newborns spend most of their sleep time in REM. Adding to the evidence is that animals born with less developed brains, such as humans and puppies, spend even more time in REM sleep during infancy than those that are born with more developed brains, like horses and birds 3.

Through its activation of our central nervous system, REM sleep might help us get ready to wake back up. This may explain why we spend increasing amounts of time in REM sleep as the night progresses and why we are easier to wake up during this stage.

Is REM sleep the same as deep sleep?

Even though people often use these two terms interchangeably, REM and deep sleep are actually two separate sleep phases.

While REM is associated with vivid dreaming and increased brain activity, deep sleep (also known as slow-wave-sleep) is the stage where the body focuses on physically repairing itself, boosting the immune system and restoring bones, muscles, and tissue.

Due to the subdued brain activity of deep sleep, it is also the phase that is most difficult to wake up from 4, and those who are woken up while in this state tend to experience a short period of fogginess and impaired cognitive performance.

How much REM do you need?

Babies and young children need the most REM sleep. During infancy, it can account for up to 50% of their total sleep time 5.

The significant amount of REM sleep observed in young children is thought to have a vital impact on their brain development, learning abilities, overall growth, as well as the maturation of their central nervous system and the establishment of neural connections.

As individuals reach adulthood, the portion of REM sleep you experience decreases to about 20-25% of your total sleep time6. This means you’ll typically get around 90-120 minutes of REM sleep each night. While this is much less than what you had as a baby, this sleep stage is still very important for brain functions as well as for emotional regulation.

It’s worth noting that sleep needs can vary from person to person, so some may feel well-rested with slightly more or less REM sleep than the average. If you have concerns about your sleep quality or are experiencing sleep-related issues, it’s a good idea to consult a healthcare professional or a sleep specialist for personalized advice.

What happens if you don’t get enough?

Not getting enough REM sleep can negatively impact your brain’s ability to learn and create new memories. For example, research shows that when people are deprived of REM sleep they have trouble recollecting things they are taught before falling asleep.

Additionally, because the majority of your REM sleep tends to come towards the end of your night in bed, a lack of REM is often a sign of sleep deprivation 7. Chronic sleep deprivation has been linked to greater risk of obesity, Type 2 Diabetes, dementia, depression, cardiovascular disease and cancer 8.

Sleep disorders are one of the main culprits in preventing you from getting enough REM sleep, some of which include:

  • REM sleep behavior disorder (RBD): People who have this condition may not experience muscle paralysis during REM sleep, which can lead to acting out dreams, resulting in disrupted sleep and injury.
  • Nightmare disorder: People with this condition experience intense, terrifying nightmares. This leads to disrupted sleep and considerable distress 9.
  • Narcolepsy: This condition involves having episodes where a person suddenly goes from wakefulness to REM sleep.
  • Sleep apnea: People with this condition experience brief lapses in breathing that lead to repeated waking. While this does not specifically affect REM sleep, it does contribute to worse sleep quality and duration.

homme fatigué

How to get more REM sleep

The best way to get more REM sleep is to concentrate on getting enough good quality sleep.

Here are some strategies to help you get better sleep:

  • Keep a consistent sleep schedule: Try to go to bed and wake up at the same time every day, even on weekends. Consistency helps regulate your body’s internal clock, improving the quality and quantity of sleep.
  • Create a Relaxing Bedtime Routine: Engage in calming activities before bed, such as reading, gentle stretching, or practicing relaxation techniques like deep breathing or meditation. This can help prepare your mind and body for restful sleep.
  • Create a Comfortable Sleep Environment: Ensure your bedroom is conducive to sleep. This includes having a comfortable mattress and pillows, controlling the room temperature. If you live in a bright, noisy city, consider trying to minimize noise and light disruptions with a sleep eye mask and/or earplugs.
  • Limit Screen Time Before Bed: The blue light emitted by electronic devices such as phones, tablets, and computers can interfere with your body’s production of melatonin, a hormone that regulates sleep. Try to avoid screens at least an hour before bedtime.
  • Limit Caffeine, Alcohol and other Stimulants: Avoid consuming these items close to bedtime. These substances can interfere with the quality of your sleep, especially REM sleep.
  • Watch Your Diet and Hydration: Avoid heavy meals, caffeine, and large amounts of fluids close to bedtime. These can disrupt your sleep or lead to nighttime awakenings due to bathroom trips.
  • Regular Physical Activity: Engaging in regular exercise during the day can help improve sleep quality. However, avoid vigorous exercise close to bedtime, as it may have a stimulating effect.
  • Manage Stress and Anxiety: High stress levels and anxiety can interfere with sleep. Practice stress-reduction techniques like mindfulness, yoga, or journaling to help calm your mind before bed.

If you still have trouble sleeping after following the tips above, it’s also a good idea to consult a doctor. They can help identify any underlying issues that might be affecting your sleep, such as sleep disorders or medical conditions.

Remember that individual sleep needs can vary, and it’s important to find what works best for you. Making gradual adjustments to your habits and maintaining a healthy lifestyle can lead to improved REM sleep and overall sleep quality.

Sweet dreams!

References

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2982729/

2. https://www.jneurosci.org/content/43/3/433

3. https://pubmed.ncbi.nlm.nih.gov/7546299/

4. https://www.ncbi.nlm.nih.gov/books/NBK526132/

5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5656471/

6. https://www.ncbi.nlm.nih.gov/books/NBK19956/

7. https://pubmed.ncbi.nlm.nih.gov/19896872/

8. https://www.ninds.nih.gov/health-information/public-education/brain-basics/brain-basics-understanding-sleep

9. https://pubmed.ncbi.nlm.nih.gov/30697860/

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Can sleep apnea cause car accidents?

Obstructive sleep apnea (OSA) has been linked to many health issues, among them reduced sex drive, dementia and weight gain.

However, sleep apnea could also make you a killer at the wheel.

That’s because if you have sleep apnea, you’re never fully rested. And fatigue can lead to inattentiveness and even sleepiness when you’re driving… which can cause car accidents.

Sleep apnea and dangerous driving

When we think of dangerous driving, we often think of driving while under the influence of alcohol or drugs. But being tired can impair driving, too, and it may affect your overall performance in other ways.

A medical review estimated that if you have sleep apnea, your risk of being in a car accident doubles!¹ And in Québec, more than one in five fatal car accidents are caused by driver fatigue.²

broken down car

Here are some of the effects of fatigue:³

  • Memory lapses
  • Difficulty concentrating
  • Slower reaction times
  • Decreased ability to make decisions
  • Reduced ability to do complex planning
  • Impaired communication skills
  • Lowered productivity and performance
  • Reduced attention
  • Diminished ability to handle stress
  • Slower reaction time
  • Decreased ability to recall details

It’s no wonder the risk of being in an accident doubles if you have sleep apnea!

tired man sitting on his bed with a concerned partner behind him

Sleep apnea: Driving home the numbers

  • Canadians at risk of sleep apnea: One in three⁴
  • Reported car accidents (Québec, 2018): 28,109⁵
  • Deaths: 359⁵
  • Injuries:  35,151⁵
  • Risk of car crash: double for people with sleep apnea⁵

What is OSA?

If you feel tired and/or sleepy all the time, and have the signs described above, obstructive sleep apnea may be the cause. OSA can wreak havoc on your nights and your days, make you fatigued when you need to be alert, and impact your long-term health.

Here’s what happens:

  • In obstructive sleep apnea the airway becomes blocked (obstructed) during sleep, which causes a pause in breathing.
  • When we stop breathing our oxygen levels drop, which triggers the brain to tell us to wake up and breathe.
  • However, we don’t wake up completely (these sleep interruptions are called “micro-arousals”).
  • It’s these micro-arousals that disrupt our sleep architecture and cause us to wake up in the morning feeling as if we haven’t slept a wink.

Diagram of the effects of sleep apnea

The most common signs of sleep apnea

The most common sign of sleep apnea is loud snoring, which is often reported by a partner. Sometimes, people with OSA have been told that they stop breathing or are choking or gasping in their sleep. Both of these may indicate sleep apnea.

What are the other signs and symptoms of sleep apnea?

Of course, a restless night can cause fatigue the next day. Other signs associated with OSA include insomnia, obesity, diabetes, reduced sex drive, dementia, and heart problems. If you and your doctor suspect you might have sleep apnea, it’s time to get tested!

Woman sleeping with mouth open

How does OSA cause snoring?

Snoring is the sound that is made when you try to breathe in while your airway is obstructed. Some people with sleep apnea may make a choking or gasping sound, while others experience silent breathing pauses as they try to inhale. The common factor is that oxygen isn’t getting through to the brain.

man sleeping with his mouth open

How continuous positive airway pressure (CPAP) can help

CPAP is the most effective treatment for OSA. Thousands of Canadians use it every time they sleep. CPAP consists of a gentle stream of air that is directed through the airway during sleep, allowing the airway to remain open and thereby preventing apnea. This results in a more restful sleep.

So are you a good candidate for CPAP?

The way to find out is to get tested for sleep apnea. If you have OSA symptoms and feel that your sleep is not restful, it’s important to talk to your doctor about it.  Apnea Health offers simple, fast and effective home sleep testing. You can also contact us for a free evaluation to see if a sleep test is right for you.

man sleeping in bed with CPAP mask

What your doctor wants to know

If you’re a good candidate for a sleep test, the first step is to make an appointment to see your doctor. Make sure to let them know if you feel tired when you wake up in the morning, or if others have told you that you snore. Treating your OSA will help you feel more rested, reduce your health risks, and make it safer for everyone on the road.

Male doctor with stethoscope

Here’s a checklist of signs and symptoms of sleep apnea to review with your doctor.

Do you have any of these signs or symptoms?

  • Loud snoring
  • Occasionally waking up during the night feeling that you’re choking or gasping
  • Restless sleep
  • Having a sore or dry throat in the morning
  • Having a headache in the morning
  • Sleepiness, low energy or fatigue during the day
  • Feeling sleepy behind the wheel
  • Weight gain
  • Erectile dysfunction
  • Forgetfulness, mood changes, and a decreased interest in sex

a checklist

If I have OSA, are there other benefits of CPAP treatment?

According to Dr. Timothy Morgenthaler, President of the American Academy of Sleep Medicine (2017),⁶ “Obstructive sleep apnea is a destructive disease that can ruin your health and increase your risk of death,” creating health hazards that include high blood pressure, heart attack, stroke, obesity and type 2 diabetes.

Through treatment with CPAP, all of these risks can be reduced – and treating sleep apnea offers other benefits, as well. After just a few weeks of therapy, most patients notice higher energy levels, a boost in mood, and more stamina. All of that, and a good night’s sleep, too. Now, that’s good news!

Woman waking up, well rested

Other tips to prevent driver fatigue

If it turns out you don’t have sleep apnea, there are still things you can do to prevent yourself from “driving drowsy”. Here are a few measures that can help you get a good night’s rest:⁷

  • Exercise regularly, but not too close to bedtime.
  • Eat well (avoid too much fat, salt and sugar; eat plenty of fruits and vegetables).
  • Limit your consumption of caffeine, energy drinks, alcohol and medication.
  • Take time to relax, and adopt good sleeping habits: Develop a bedtime routine to prepare for sleep (read a few pages, take a bath, etc.).
  • Go to bed and get up at regular hours (avoid large differences between weekdays and weekends).
  • Make the bedroom off-limits to phones, televisions, computers, etc.

Remember – getting a good night’s sleep isn’t a luxury. It’s a must for health!

Woman stretching to get ready to exercise

Sources:

  1. Tregear S, Reston J, Schoelles K et al. J Clin Sleep Med 2009;5(6):573-581. Accessed May 26, 2019 at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2792976/
  2. Société de l’assurance automobile du Québec, Canada, 2010.
  3. https://safetyalliancebc.ca
  4. Statistics Canada. Sleep Apnea in Canada,2016 and 2017. Release date: October 24, 2018 (Statistics Canada. Sleep Apnea in Canada,2016 and 2017. Release date: October 24, 2018 (https://www150.statcan.gc.ca/n1/pub/82-625-x/2018001/article/54979-eng.htm).
  5. https://saaq.gouv.qc.ca/en/saaq/documents/road-safety-record/
  6. Accessed at https://aasm.org/brain-damage-caused-by-severe-sleep-apnea-is-reversible/ on Aug. 7, 2019.
  7. Accessed at: saaq.gouv.qc.ca/fatigue on Aug. 26, 2019.
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Hot tips for summertime sleeping

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These top tips can help you get a good night’s sleep every night this summer so that you can have the energy to enjoy the season to the fullest.

Ah, summer nights – we wait all year to enjoy warm evenings outdoors, relaxed school and work schedules, big BBQ get-togethers, and time spent in and on the water. But the summer heat and increased activity makes it harder to sleep peacefully, and can worsen symptoms for sleep apnea sufferers. Get a good night’s sleep every night this summer with these top tips that will have you waking up rested and brimming with energy to make the most of everything the season has to offer.

sun tired

Why is it so hard to get a good night’s sleep in the summertime?

  • Elevated temperatures and humidity

    Summer nights can be hot and steamy – and during heat waves in particular, it can be very difficult to find to get comfortable to sleep. According to the National Sleep Foundation, the ideal temperature range for sleep is between 12°C and 24°C, and if temperatures vary outside that range, sleep can be disturbed. Add in a few extra degrees for the humidity, and it’s common for evening temperatures in the summer to be well above this range.

  • Longer days and more sunlight

    The farther away we live from the equator, the more the summer season lengthens our days. In much of Canada, the sun doesn’t set until well into the evening, and is up long before we want to be. Early light can wake us up and make it difficult to fall back asleep, robbing us of precious hours of rest.

  • More time spent outdoors

    While fresh air can actually help improve sleep, increased time spent outside can also heighten our exposure to allergens, which can lead to nasal congestion that makes it harder to breathe when sleeping and can worsen symptoms for sleep apnea sufferers. Click here to read more about seasonal allergies and sleep apnea.

  • Vacation travel

    Travel across time zones can cause jet lag, which upsets our regular circadian rhythms and can leave us wide awake in the middle of the night and sleepy during the day. In addition, sleep apnea sufferers who require equipment to help them sleep can forget to bring what they need on vacation, or find themselves in a situation where it is difficult to use the equipment, such as on a camping trip. Not using this equipment, even for one night, can have drastic effects on the quality of sleep.

Woman lying in bed, rubbing her blocked sinuses caused by allergies

Six tips for getting a good night’s sleep every night this summer:

  1. Stick to a routine as much as possible.

    Go to bed around the same time every night and wake up at the same time every morning, including on weekends. Because digestion can cause discomfort in the heat, avoid eating and drinking for one to two hours before bedtime, and if drinking alcohol, have your last drink at least three hours before going to bed. Caffeine is also known to disrupt sleep, so avoid it after midday.

  2. Embrace the darkness.

    Make sure your room is dark at nighttime by drawing the curtains or blinds and limiting ambient light from lamps and screens. If sunlight streams into your window before you are ready to rise, look into blackout curtains or sleep with an eye mask.

  3. Turn down the noise.

    While it’s tempting to sleep with the windows open on summer nights, there’s nothing like the noisy chirping of birds at dawn or the roar of a lawn mower to wake us up earlier than we’d like to rise. If that is the case for you, close the windows or wear earplugs. If noise is an issue when you are falling asleep, you may want to look into a white noise machine or use a fan (see #4 below).

  4. Create a comfortable environment for sleep.

    Make sure the room temperature is comfortable, and switch out your regular duvet for something lighter. If you sleep with a partner, you may both be more comfortable with your own light quilt or coverlet. If your pillow gets overheated, consider one made of buckwheat, which does not trap heat. To keep temperatures cool, use air conditioning if possible, or perhaps a fan, which has the added benefit of providing a soothing ambient noise. Are you experiencing condensation in your CPAP mask? Learn how to adjust the humidity on your CPAP machine.

  5. Have a heat-wave game plan.

    When the temperature and humidity spike, a cool shower or swim before bed can help cool the body before slipping between the sheets. If it’s really hot, consider slipping ice packs between your sheets a few hours before bed, and take them out when you turn in. Remember that most body heat escapes via the head, hands, and feet, so make sure those body parts are left exposed. And drink plenty of water throughout the day to stay hydrated, but ease up one to two hours before bed, so that you won’t wake up during the night to use the bathroom.

  6. When traveling, plan ahead for good sleep.

    Make a checklist to be sure to pack any equipment you may need for sleep apnea, and carry supplies that can help improve sleep on the plane with you, including earplugs, a sleep mask, and a travel pillow. Upon arrival, do what you can to make your sleeping environment as comfortable, dark, and cool as possible. To mitigate the effects of jet lag, adopt the schedule of your new time zone immediately, and make every effort to be outside in the morning sun at the time you would now like to wake up. This will help reset your body’s natural circadian rhythm.

routine

At Apnea Health, we can help

If you still find that despite this tips you are unable to get a good night’s sleep, there may be more than the summer heat, humidity and long hours of sunlight to blame. If you are not sleeping well and waking up exhausted, contact one of our sleep specialists today to set up a sleep test. Summer is too short not to be enjoyed to the fullest, and we can help you get your sleep back on track so that you will have the energy you need to get outside, have fun, and make the most of the beautiful weather.

guy sleeping

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