Il March 17, 2023 is celebrated on “World Sleep Day”, World Sleep Dayan annual event that aims to raise public awareness of theimportance of sleep for our health. The day is supported, in every part of the world, by the World Sleep Society and, in Italy, fromItalian Association of Sleep Medicine.
WHAT THE S. ANNA DOES. At the Neurology Unit of the University Hospital of Ferrara (Acting Director, Dr. Daniela Gragnianiello) there is a Clinic dedicated to the Diagnosis and Treatment of Sleep Disorders (Contacts, Dr. Edward Cesnik and Dr. Elisa Fallica), active for over 20 years. It is a second-level specialist service, accessible for booking on specialist neurological, pneumological, ENT or internal medicine indications, where the various sleep disorders can be correctly diagnosed and treated.
At the Sant’Anna Pneumology Unit (directed by Prof. Alberto Papi) is active onSleep Respiratory Disorders and Respiratory Insufficiency Outpatient Clinic. This service is aimed at both patients with obstructive sleep apnea (OSAS), and to those with other pathologies (respiratory and neuromuscular which are complicated by respiratory insufficiency) which must be treated with oxygen and/or home ventilation. Various activities are carried out at the clinic, including cardiorespiratory monitoring (also called polysomnography), the choice of ventilation mode to correct apneas and the interface – i.e. the type of mask (nasal or oronasal) most suitable for each patient – and the follow-up. During the follow-up visits, various aspects are evaluated together with the patient: possible difficulties in using the ventilator, side effects due to the mask, presence of residual sleepiness, variations in the clinical picture, family or work problems that can influence adherence to the therapy. The clinic also interfaces with the prosthetic office of the Local Health Authority of Ferrara for the administrative procedures relating to the supply of aids. Also, it was recently established a Intercompany Diagnostic Therapeutic Path to coordinate the activities of the healthcare operators involved (including Pulmonologist, Otolaryngologist, Neurologist, Dietician), favor a more rapid identification of patients and a correct therapeutic approach.
OBSTRUCTIVE SLEEP APNEA. The obstructive sleep apnea syndrome (also referred to by the acronym OSAS – Obstructive Sleep Apnea Syndrome) is a very common pathology, characterized by a recurrent obstruction (apnea) or sub-obstruction (hypopnea) of the upper airways during sleep. Apneashypopneas cause an intermittent reduction in blood oxygenation when the airways are obstructed. The common consequences on the organism are: heart rhythm alterations (bradi or tachycardia), hypertensive peaks, sleep fragmentation, activation of the sympathetic nervous system. In the long term, this leads to an increased risk of cardiac arrhythmias, cardiovascular and cerebrovascular diseases, hypertension (particularly drug-resistant hypertension), metabolic disorders, cognitive impairment and depression. Added to this are the risks associated with falling asleep during the day, in particular a higher risk of road accidents.
It is estimated that around 1 billion people worldwide suffer from OSAS and that the moderate or severe forms (more than 15 apnea-hypopnea episodes per hour of sleep) are about 425 million. In Italy it is estimated that the prevalence of OSA (more than 5 apneashypopneas per hour of sleep) is around 20.5%, with 15.5% of moderate-severe forms. The prevalence of OSA in the population of Emilia Romagna regionover the age of 35, is around 35% in men and 17% in women. The cases they involve daytime sleepiness interest until11% of men and 5% of women. Currently, in territory of FerraraI am about 1,300 people are followed up with night ventilation devices, which represents the type of intervention to contrast the onset and consequences of airway obstruction, characteristics of OSAS. It has been estimated that for every General Practitioner (about 1500 patients) there would be about 100 subjects with OSAS of varying severity.
SLEEP DAY. This year the day focuses on the concept that sleep disorder therapy helps to decrease the risk of other diseasesbeing aware that sleeping well has a fundamental role in maintaining our health brain and in preventing cardio-metabolic diseases. Sleep is not a passive phenomenon but a real behavioral state, characterized by the temporary suspension of the state of alert consciousness. It’s a basic biological function, such as feeding and breathing and, precisely for this reason, sleep exists in all living beings in a more or less evolved form. Sleep deprivation comes with a biological and cognitive toll. This is why it is important to rest well.
In recent years, it has assumed increasing importance non-pharmacological therapy of sleep disorders, which has as its point of reference the concept of “sleep hygiene”. The decalogue of the “good sleeper” provides, in fact, a series of environmental, dietary and behavioral rules that can have a positive impact on our sleep. For example they go reduced all awakening physical stimuli and the removal of objects symbolizing waking activity; the consumption of alcohol, tobacco and coffee in the evening hours is not recommended, as well as meals rich in proteins which tend to limit the absorption of tryptophan, the amino acid precursor of serotonin. Conversely, the intake of sugars facilitates the absorption of the latter, favoring the maintenance of sleep. Behavioral norms are essential for proper sleep hygiene, so much so that they are the basis of “Cognitive-behavioral therapy” (CBT) in the treatment of insomnia. CBT aims to improve the perceived quality of sleep and restore the sense of controllability of the same.
CIRCADIAN RHYTHMS. Circadian rhythms, regulated by the alternation of light and dark, organize the life of every living being. “Among these – highlights the prof. Roberto Manfredini, Director of the Medical Clinic, University Hospital of Ferrara and expert in Chronobiology – sleep is of strategic importance, if we think that we spend a third of our life sleeping. In one night we alternate several sleep cycles, of about 90 minutes each, organized into phases: I-II (falling asleep), III-IV (deep sleep) and REM (dream). At night, while the body rests, the brain is instead extremely busy in multiple activities, including organizing the hundreds of thousands of new information that accumulates every day, building new synapses to increase storage and memory capacity, eliminating toxic waste. These activities are performed during deep sleep, so the quality of sleep is more important than the quantity. Some factors can disturb the internal clocks that scan the circadian rhythms: change of time zone, shift work, excess of night lighting and time changes. About a century ago – recalls Prof. Manfredini – due to the war and the need to save energy, the so-called was adopted daylight savings time. We now know that changing the time twice a year desynchronises circadian rhythms and exposes us to a number of health consequences. We are about to approach the spring time change, the least tolerated by the body: the night of Sunday March 26 we will move the hands of the clock forward an hour and sleep an hour less. About one in three people may experience sleep disturbances in the following daysincluding nocturnal insomnia, daytime sleepiness, decreased concentration, anxiety, mood swings. Here are a few simple tips for those who know they suffer from time changes: starting 5-6 days before, go to sleep 30-60 minutes earlier, keep the room dark, do not use electronic devices in the evening ( smartphones, computers, tablets) which have a blocking effect on melatonin and, from Sunday morning, get at least a good half hour of natural light”.
To consult the regional press release on the subject of sleep medicine, click WHO