If you snore, sleep an inordinate amount of time during the day, or experience any number of seemingly unrelated physical and emotional signs, you may need more than a warm glass of milk at bedtime and an earplugs-wearing bedmate. You may have a sleep disorder such as sleep apnea, in which you stop breathing throughout sleep.

“Sleep apnea is implicated in cardiovascular diseases, vascular diseases, endocrinological diseases like diabetes ,” says Dr. Won Lee, medical director of the Sleep and Breathing Disorder Center at UT Southwestern Medical Center at Dallas.

“The best way to think of it is this: When patients have sleep apnea, there’s a narrowing of airways, which causes no airflow and therefore no oxygen is delivered to the lungs. We see a significant drop in oxygen levels. Sometimes the levels may be in the 95 percent range and during an obstructive event, drop to 75. It causes the patients to wake up to open their airways. I have some who stop breathing 100 times per hour. I’m flabbergasted, blown away.”

Apnea and other sleep disorders can be diagnosed in a sleep lab, where patients spend one to two nights being observed. Treatment is often nightly use of a machine called the CPAP (continuous positive airway pressure).

“The beauty of my job and profession is when you put patients on CPAP, it markedly improves their oxygen level,” he says. “It’s literally night and day between before and after … they feel more refreshed, and clearly this has benefits, time after time. Treating improves their neurocognitive function. It helps support the importance of the quality of sleep overall, plus I’m sure they’re more pleasant to be around.”

The machine can be tricky to get used to wearing. Lee encourages patients to keep trying, citing a study of 1,000 Spanish men published in 2005.

“Those with severe apnea had double the risk of death, of major cardiovascular events,” he says. “Most encouraging were those who wore the CPAP consistently for four hours, 70 percent of the time and were monitored twice a year. They ended up having their cardiovascular events back to what’s normal for the general population.”

He recommends making certain the sleep center you choose is accredited by the American Academy of Sleep Medicine (aasmnet.org).

“This ensures the provider is board-certified and has proper training in sleep medicine, and that the facility meets all stringent requirements, including testing procedures, diagnostic procedures, and that it maintains the quality of sleep physicians and technologists working with patients at night.”

Leslie Barker Garcia

However, a new study is shedding some light on a particular class of movement disorders called synucleinopathies, a subcategory of movement disorders that include Parkinson’s disease and Lewy Bodies, by establishing a link between REM sleep behavior and the onset of such neurodegenerative diseases at least a decade later.

REM sleep behavior is characterized as a disorder wherein dreams are accompanied by excessive body movement.

The research was conducted by the Minnesota Regional Sleep Disorders Center in Minneapolis, and focused on 27 patients who had REM sleep behavior at least 15 years prior to the onset of Parkinson’s and/or Lewy Bodies.  Diagnosis of these disorders in the study group came from the Mayo Clinic in Rochester, MN.

Two-thirds of the patients had been diagnosed with either Parkinson’s disease dementia or dementia with Lewy Bodies, while the remaining third were diagnosed with multiple system atrophy, according to Medscape.

The dreams typically associated with REM sleep behavior involve either running away from someone or defending oneself from a predator.  Movements associated with these dreams include punching, getting out of bed, and/or shouting.   The average age of onset of REM sleep behavior among participants was 49, while the median age for developing one of the neurodegenerative disorders was 72.
The median time between the development of REM sleep behavior and the neurodegenerative disorders was 25 years.  In one case, 50 years elapsed between the two diagnoses; typically, the span between the two was about a decade.

What is the significance of the study?  According to the researchers, there have been other studies that have shown a link between REM sleep behavior and neurodegenerative disorders.   However, these studies did not take long latencies into consideration.  The team does concede, however, that more research will need to be conducted to determine whether or not all patients who develop REM sleep behavior will eventually develop a neurodegenerative disorder.

Details of the study are being published in the journal Neurology.