Western Wisconsin

Women have more sleep problems

Ask a woman about sleeping, and she will probably say that she needs more.

Insomnia, trouble falling asleep or difficulty staying asleep all affect daytime sleepiness and can result in poor performance and accidents.

A woman’s sleep problems may start during her teen years as she adapts to hormonal changes and social expectations. During puberty, girls and boys both experience major changes in hormones and role expectations. But for some reason, girls are three times more likely than boys to develop insomnia during this period. As the years pass, the reasons for sleep problems may change, but the gender difference continues.

“In their 20s and 30s, women work long hours, often in stressful situations, trying to balance the demands of career and family,” said Stacey Gusman, MSN, APNP, FNP-C, a family nurse practitioner with Ministry Victory Medical Group’s Owen Clinic “In many cases, this means not enough hours in the day and too much stress during the little bit of sleep time that is available. Nearly one-third of women working outside the home report sleep problems.”

Pregnancy and Hormones can disrupt sleep

Add pregnancy and childbirth to a woman’s life, and sleep deprivation is virtually guaranteed. During the first trimester, the body needs more rest to accommodate the growing fetus and placenta. Later in the pregnancy, the mother’s sleep may be interrupted by frequent urination, heartburn, fetal movements, low back pain, leg cramps, nightmares, snoring or sleep apnea.

And sleep problems are particularly prevalent during menopause–often associated with hormonal changes and symptoms such as hot flashes and night sweats. Both during and after menopause, a woman is likely to notice that her sleep is lighter, more easily interrupted and less restful. At age 65, a woman’s risk of insomnia is 73 percent greater than a man’s.

Common causes of sleep disorders

The most common sleep disorder, at any stage of life, is insomnia–most commonly trouble falling asleep or difficulty staying asleep. The effect is daytime sleepiness which, in turn, results in poor performance and accidents.

Short-term insomnia can start with something as simple as an illness, a stressful event or drinking too much coffee. Jet lag and shift work can disrupt the body’s circadian rhythms.

Emotional problems such as anxiety and depression are a major reason for sleep problems. And poor sleep, for any reason, triggers irritability, anger and depression.

When a short-term problem is allowed to continue too long, bedtime can become associated with anxiety that makes the problem worse. If you dread bedtime and expect to have trouble falling asleep or staying asleep, chances are that you will.

Another major reason for poor sleep is sleep apnea, basically a breathing problem. When the muscles in the throat relax too much during sleep, breathing can be partially blocked resulting in snoring and, in many cases, obstructive sleep apnea, causing numerous brief sleep interruptions every night. These may go undetected but result in poor quality sleep, daytime sleepiness and an increased risk of hypertension, atrial fibrillation, accidents, falls and fractures. It’s estimated that one in four women age 65 and over have sleep apnea.

Restless leg syndrome (RLS) involves calf discomfort and restlessness in the legs that may occur just before sleep starts and is relieved by movement. Periodic leg movement disorder is a similar problem that occurs during sleep and often awakens the person.

About 20 percent of pregnant women get RLS, often because of reduced levels of folate. Restless leg syndrome is also common in older persons; it can be triggered by nerve disorders, kidney disease, vitamin or iron deficiencies or certain medications such as antidepressants.

The effects of sleep deprivation

Gusman says, “There is a great deal of overlap between sleep disorders, their causes and their effects. While stress or bad sleep habits might be the initial trigger, poor sleep eventually can cause health problems that, in turn, make good sleep increasingly difficult to obtain.”

Women suffering from sleep deprivation are more likely to gain weight, and they have a higher risk of hypertension, the metabolic syndrome, diabetes, heart disease and virtually every other health problem. One recent study found a 65 percent increased risk of cardiovascular disease in persons who sleep poorly.

Self-help measures can help you sleep

Gusman recommends self-help measures to patients who have trouble sleeping. Having regular bedtime and waking schedules; exercising regularly; avoiding heavy or spicy meals, alcohol, caffeine and nicotine in the evening; and developing relaxing bedtime rituals, may help you fall asleep and stay asleep.

“In nearly every case, sleeping pills are not the answer,” said Gusman. “Most sleep medications offer only a short-term solution, have side effects and are notorious for leading to dependency and abuse. Medications may be needed, however, to treat underlying conditions that may be causing the sleep problem. That’s why it’s important to see your health care provider if sleeping problems persist.”

Sleep Apnea

Sleep apnea was first identified as a sleep disorder as recently as 1965. The combination of symptoms–daytime sleepiness, snoring, excess weight – were recognized much earlier, however.

“Most people with sleep apnea are unaware of it,” according to Betsy Wacker, PA-C, a physician assistant with Ministry Victory Medical Group’s Stanley Clinic. “We usually discover the problem because the person’s bed partner is disturbed by the major sleep apnea symptom – snoring – usually loud and punctuated by sudden snorting or choking sounds.”

The breathing interruptions actually occur during the snorting, choking phase, and they cause the person to awaken for a brief period, during which time normal breathing resumes.

Wacker warns, “In addition to the daytime sleepiness, the consequences of poor sleep quality and frequent drops in blood-oxygen level can be substantial – an increased level of stress hormones which can result in a higher heart rate, hypertension and irregular heartbeats. People with untreated sleep apnea are at risk of heart attacks, heart failure and atrial fibrillation.”

More than half of apnea patients are overweight or obese, but even thin people can develop sleep apnea, usually because of the shape or size of their throat passage.

Central sleep apnea occurs when the brain fails to send the proper signals to the muscles that control breathing,” Betsy explains. “This often is an effect of heart disease or a stroke or heart attack. Obstructive sleep apnea, the most common type, occurs when throat muscles relax too much to keep the airway open. A third type, complex sleep apnea, combines features of both central and obstructive.”

The obstruction is typically caused by fat deposits around the upper airway, a neck circumference greater than 17 inches (usually associated with excess weight), enlarged tonsils or adenoids or a genetically narrow throat.

The other major factor is relaxation of throat muscles. Smoking and use of alcohol, sedatives or tranquilizers can cause these muscles to weaken and relax too much during sleep. So can age; sleep apnea becomes increasingly common after age 45.

“Because of chronically poor sleep, individuals with sleep apnea are prone to nodding off at inappropriate moments–even in the middle of an important business meeting.” Wacker says. “They also represent a hazard when they are behind the wheel or operating heavy equipment. Sleep apnea patients are frequently unproductive at work, have difficulty concentrating and are prone to memory problems, headaches, mood swings, feelings of depression, frequent urination during the night and erectile dysfunction. Over the long term, they are vulnerable to hypertension, heart attack, stroke and heart failure.”

Sleep apnea is most commonly detected either because of the snoring or the effects of sleep deprivation, including accidents on the road or on the job.

Not all snorers have sleep apnea, nor are all people with sleep apnea are snorers, but the connection is strong. Your healthcare provider can often make a diagnosis on the basis of signs and symptoms, but sleep studies may be needed. An evaluation usually includes an overnight stay (either in a specially equipped hospital hotel room). Electrodes are attached to the patient’s body and head to monitor heart, lung and brain activity; breathing patterns; arm and leg movements, and blood oxygen levels during sleep.

Wacker says, “The preferred method for treating moderate to severe sleep apnea is continuous positive airway pressure or CPAP. During sleep, the patient wears a mask that delivers enough air pressure to keep the airway passages open, preventing snoring and apnea.

“Less effective but preferred by many patients are oral appliances designed to keep the throat open. These are usually obtained from a dentist or orthodontist. The newest treatment is a small, disposable nasal device that re-directs air flow.”

When all else fails, surgery can be used to remove excess tissue from the nose and throat. In some cases, removal of tonsils, adenoids or nasal polyps or straightening of a crooked nasal partition (deviated septum) may be what’s needed.

Wacker advises, “For mild cases, overweight patients should lose some weight. Smokers should quit, and drinkers should reduce their alcohol consumption, particularly in the late evening. Also, most snorers breathe better when they sleep on their side rather than their back.”

Read Kerry’s story about getting a good night’s sleep.

Pediatric hospitalists provide continuity of care

When a child is admitted to the hospital, it can cause stress for parents and children alike. During those times, consistency of care is important.

Now, children seen at Ministry Saint Joseph’s Children’s Hospital in Marshfield can count on a full-time dedicated staff of hospitalists who specialize in the needs of hospitalized children and adolescents.

Ministry Saint Joseph’s Children’s is one of three recognized children’s hospitals in Wisconsin with a full-time pediatric hospitalist program. “It is an advantage that the family can see the same familiar faces throughout their stay and that the parents know who is taking care of their child,” said Adrienne Cruz, MD. “The physicians are on the same day, night or weekend shifts for a period of 4 weeks.”

Pediatric hospitalists are available 24-hours a day, which means they are able to spend more time with patients and their families, monitoring treatment, consulting with specialists and answering questions.

Dr. Cruz attended UW-Madison’s School of Medicine and Public Health and came to Ministry Saint Joseph’s Hospital as a medical student. Dr. Cruz is a board certified pediatrician and a full-time pediatric hospitalist managing the pediatric hospitalist program at Ministry Saint Joseph’s Children’s Hospital.

Visit hospitalist program for more information.

Women often have different heart attack symptoms

Many heart attack deaths in women are due in part to lack of immediate action.

“Half of heart attack deaths occur in the first hour after symptoms begin, before the patient ever gets to a hospital,” said Pundeep Kahlon, MD, a family physician with Ministry Victory Medical Group in Thorp. “It’s important to take action.”

Just about all of us are aware of one of the classic and most dramatic signs of a heart attack: crushing chest pain, “like an elephant standing on my chest” as many survivors have described it.

But oftentimes, women do not experience the typical crushing chest pain.

“Severe chest pain is just one of a number of possible symptoms that a heart attack is in progress,” said Dr. Kahlon. “However, symptoms of heart attack in women are often more subtle and, as a result, more likely to be dismissed, especially in the early stages when medical intervention can be most effective.”

A heart attack (myocardial infarction) occurs when the blood supply to the heart is compromised, usually because a clot in a coronary artery blocks blood flow to an area of the heart. Restoring blood flow as quickly as possible is essential to saving the patient’s life and preserving heart function.

Common symptoms of a heart attack are:

  • chest pain or discomfort
  • pain in the jaw, neck, arm or back
  • pain or discomfort in the arm or shoulder
  • shortness of breath
  • feeling lightheaded, dizzy or faint

In studies of heart attack survivors, half of women and up to one third of men reported no chest pain at all. When women did report chest pain, it was often mild. Dizziness, heartburn and nausea were also seen more often in women. Women were more likely to report overwhelming fatigue, breathlessness and sleep disturbances, often for up to a month before the heart attack.

What outward signs of heart attack can you see?

A person suffering a heart attack may touch or rub areas that hurt, sweat, turn pale and show other indication depending on the symptoms he or she is experiencing.

Chest discomfort such as the feelings of pressure, squeezing, fullness, or intense pain that lasts a few minutes and goes away. In response to chest pain, a person may place his or her hand on or rub the chest.

Pain or discomfort in either or both arms, the back, the neck, the jaw or the stomach. If you see someone touching or rubbing those areas of his or her body, he or she might be experiencing discomfort as the pain ebbs and flows.

Shortness of breath It may be hard for the person to carry on a conversation. If shortness of breath is severe feelings of anxiety might also be reflected in a person’s facial expression, signaling that he or she is not okay.

Sweating. Even though the temperature has not changed, the person experiencing a heart attack may start sweating and mopping his or her brow.

Nausea or Dizziness. People experiencing nausea or dizziness, may react by holding their heads in their hands, leaning on their arms, or putting their heads down.

Numbness of the arms. A person whose arms are numb or tingling may rub his or her arms to relieve the numbness.

Unexplained weakness or fatigue. Someone experiencing fatigue or weakness may become noticeably lethargic, move slowly, lean, try to lie down, or try to sleep.

Unexplained weakness or fatigue and sleep disturbance and are the most common heart attack symptoms for women.

Unexplained anxiety. A person suffering heart attack may become anxious which will be noticeable through facial expressions and movements. Anxiety is another common sign in a woman suffering a heart attack.

Color. When heart attack strikes, the person’s face may become pale.

Indigestion. Complaints of an upset stomach, repositioning in a chair, or rubbing the stomach may be the cues that a woman is experiencing a heart attack. Watch carefully and look for other symptoms since indigestion is a common problem for many people.

If you notice any of these signs, ask how the person is feeling. If you believe he or she is having a heart attack, call 911 immediately. Emergency medical staff will arrive with the equipment necessary to assist the person if heart attack is occurring.

Not all cardio tests are gender neutral

“The reality that heart disease tends to occur later in life for women can lead to a false sense of security,” said Dr. Kahlon. “This can be compounded by the fact that standard tests to diagnose heart disease that are effective for men don’t seem to work as well in identifying high-risk women.”

The WISE study, designed to evaluate heart risk in women, found that only one of three women known to have significant narrowing of the arteries which put them at risk for heart attack, had abnormal results on an exercise stress test.

Angiography, considered a highly reliable test for detecting blockages in the coronary arteries, was also shown by the WISE study to be far less effective in detecting heart disease in women. The study found that women with chest pain who showed no evidence of obstruction on an angiogram frequently suffered from microvascular dysfunction, blockages in smaller vessels that are not detected by angiography.

Other tests such as stress echocardiography or SPECT (single photon emission computed tomography) may be more reliable in assessing heart symptoms in women.

Control the your risk factors

Although a heart attack is a sudden event, heart disease is not. It is the result of a long process often signposted by factors beyond our control such as age and heredity, and by choices we make related to diet, smoking, exercise, health care, weight control and blood pressure.

Dr. Kahlon says, “Making lifestyle changes such as quitting smoking, getting at least a half hour most days of moderate exercise, keeping weight and blood pressure under control and eating a healthy diet can dramatically lower a woman’s risk of heart disease.”

For women older than 65, the American Heart Association now recommends low-dose aspirin therapy of 81 mg daily or 100 mg every other day. Women with other related health issues such as diabetes, need to be especially vigilant in maintaining control of weight and blood sugar levels and minimizing heart risks.

One meta-analysis found that women with type-2 diabetes had a 50 percent higher risk of fatal heart disease than men. The Danish Nurses Health Study also found a much higher risk of death from heart disease in women with type-2 diabetes, a risk that was compounded for women who were also using hormone replacement therapy.

Dr. Kahlon concludes, “Women ignore the threat of heart disease at their own risk. The threat is real, but it can be lowered by making good lifestyle choices.”

For more information on heart health visit www.oneheartcareteam.org

Hyperbaric oxygen therapy available at Ministry Saint Joseph’s Hospital in Marshfield

Hyperbaric oxygen therapy is usually used in combination with antibiotics and surgery to speed the healing of patients with traumatic soft tissue damage, impaired blood flow, chronic bone infections, graft failure and problematic chronic wounds.

During therapy, patients lie comfortably in a pressurized chamber. This chamber delivers two to three times more oxygen than patients would receive if they were breathing 100 percent oxygen through an oxygen mask in their hospital bed.

The increased oxygen is delivered to all the tissues of the patient’s body through the blood stream to heal injured tissues, promote blood vessel growth, improve infection control, eliminate toxins and help avoid amputation. The number of treatments needed depends on the patient’s condition.

Hyperbaric oxygen therapy is usually painless. There may be some discomfort in the ears due to the changes in pressure, similar to that experienced when flying in an airplane.

“Hyperbaric oxygen therapy is an additional treatment option that will enhance the already well-established, comprehensive wound healing program available in Marshfield,” said Michael Caldwell, MD, a Marshfield Clinic surgeon on staff at Ministry Saint Joseph’s Hospital, and director of hyperbaric medicine.

For more information about hyperbaric oxygen therapy for wound care, visit ministryhealth.org/hyperbaric.

Join us for an evening filled with fun and laughter!

Wildwood Station, Marshfield

Thursday, April 19

5:30 p.m. Hors d’oeuvres, cocktails and silent auction
6:30 p.m. Program featuring a special miracle family followed by a vocal auction
7:45 p.m. Entertainment by Maxine Jeffris, comedian
9:00 p.m. Announcement of silent auction and raffle winners

Special Early Bird Tickets available – $25 per person

Tickets purchased after March 16, 2012 – $30 per person

For more information or to purchase tickets, call 715.389.3955 or email cmn@ministryhealth.org.

Miracle Fest 2012 benefits the Child Life Program at Ministry Saint Joseph’s Children’s Hospital and Marshfield Clinic Children’s through the Children’s Miracle Network.

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