Hormone links sleep apnea, diabetes
Dear Dr. Rosenberg: I have what is called borderline diabetes. My husband told my doctor that I snore. My doctor wants me to have a sleep study. I feel fine and I am not sleepy, but the doctor said it could be contributing to my diabetes. I am having trouble understanding the connection between sleep and diabetes.
A: Until recently, we thought there was a relationship, but could not prove that it was more than coincidental. The latest information is that recent studies have discovered a hormone called Adiponectin, which is released from fat cells. This hormone is low in people with sleep apnea. One of its main effects is to increase sensitivity to insulin. We think that the low levels of this hormone in sleep apnea may be the link to diabetes. I can tell you from personal experience, that I often see a marked improvement in blood sugar control when patients with sleep apnea receive treatment.
Dear Dr. Rosenberg: I was recently diagnosed with sleep apnea. I have a copy of the study and it says I had "seven events per hour". Friends who have had the same test tell me this is very mild case of sleep apnea. Yet my doctor thinks I should get on the CPAP mask treatment. What do you think?
A: I tend to agree with your physician, especially in light of a recent study in The Journal of Respiratory and Critical Care, in which people with mild sleep apnea such as you were studied. This group was found to have stiffer and narrower arteries than those who had no apneas. Their blood pressures tended to be higher as well. It was the conclusion of the authors that even mild sleep apnea, if left untreated, poses significant cardiovascular risks.
Dear Dr. Rosenberg: I have been diagnosed with fibromyalgia. When I go on the Internet for fibromyalgia-based support groups, they talk about sleep. The information, however, is not very specific, and I'm wondering what you think?
A: The whole topic of fibromyalgia is rather controversial. There are debates in the medical community ranging from its very existence to its cause. There are many who feel sleep is intimately involved in the disease. Studies done several years ago involved short awakenings from deep or Delta sleep in healthy volunteers. This was done in a sleep lab over a week's period. Interestingly, by week's end, the subjects complained of symptoms suggestive of fibromyalgia. Even more striking was the appearance of brain waves called Alpha Delta. These are characteristic of fibromyalgia. This has led many of us to feel that sleep disruption may not just be a symptom of fibromyalgia, but may be a contributing cause. Basically, it's the old chicken or the egg debate of which came first. People with fibromyalgia who have sleep problems should not ignore them as a symptom of the disease. Underlying sleep disorders such as restless leg syndrome, sleep apnea and periodic limb movements resulting in arousals are common in fibromyalgia and should be evaluated by a sleep specialist.
Dear Dr. Rosenberg: I have sleep apnea, but my real problem is suffering from GAD (Generalized Anxiety Disorder). Therefore, I am extraordinarily anxious about returning to the sleep lab and having a mask placed over my face. My psychiatrist tells me that my GAD might actually improve if I have the sleep apnea treated. Do you have any suggestions for patients such as me?
A: Yes, I do. It is well known that patients with psychiatric problems such as GAD, depression and bipolar disorder have more trouble adjusting to and adhering to CPAP. There are various techniques available to help these patients. At our sleep center we are using a new technique called the PAP-NAP (Positive Airway Pressure Nap session). Patients come in during the day and basically nap on and off for two hours. During this time period we work with them on the difficulties, such as mask fitting, claustrophobia and adapting to sensations of pressure in their airways. We have found it especially useful in anxiety-prone patients. Basically, it allows patients to work out their problems ahead of returning to the sleep lab. This makes the actual study much easier and less intimidating.
Dr. Rosenberg will answer individual reader questions by incorporating them in future columns. Contact him at firstname.lastname@example.org or via mail at the Sleep Disorders Center of Prescott Valley, 3259 N. Windsong Dr., Prescott Valley, AZ 86314.