Abstract

Background

Good sleep hygiene includes the establishment of a regular bedtime and wake-up time, adequate time in bed for sustained and sufficient sleep, restriction of alcohol and caffeinated beverages before bedtime, and proper use of exercise, nutrition, and environmental factors that promote restful sleep.

Case presentation

A 57-year-old man with a BMI of 29.2 and a history of obstructive sleep apnea was diagnosed with severe obstructive sleep apnea (AHI: >30) and has been on oral appliance therapy for two years.

 

Despite good compliance with therapy, the patient continued to experience unsatisfactory restfulness after sleep and reported regular fatigue during the day.  The patient’s dentist suggested sleep testing with Wesper.

 

Analysis with Wesper across six nights of sleep showed a poor overall sleep quality, with very low total sleep time and inconsistent timing of sleep

 

Following testing, a Wesper sleep expert educated the patient about the correlation between sleep hygiene and overall sleep quality. Poor sleep hygiene habits were addressed, and the patient was provided a plan to increase <sleep duration/total sleep time> and improve the consistency of their sleep schedule.

 

Adherence to the plan and periodic repeat testing with Wesper steadily increased the patient’s total sleep time until the patient consistently got at least 7 hours of sleep per night.

Conclusions

This case study highlights the importance of addressing patient sleep hygiene concurrently with sleep apnea therapy.

 

Clinical research supports addressing sleep hygiene concurrently with sleep apnea therapy to improve patient satisfaction and long-term health outcomes.

Background

Sleep hygiene is not a single practice but rather a collection of many behavioral modifications to improve sleep quality.

The term “sleep hygiene” was first introduced to modern sleep research by psychophysiologist Nathaniel Kleitman, who defined it as “the practices associated with day-and-night living that affect the ability to sleep.”

 

The term comes from the analogous concept of sanitation, which is concerned with ideas and behaviors that promote or maintain physical, mental, and social well-being, especially concerning personal and community health.

 

Research has found that, after controlling for associated risk factors, people with good sleep hygiene tend to have a lower severity of OSA, as measured by AHI, than those with poor sleep hygiene.

Case presentation

A 57-year-old man with a BMI of 29.2 and a history of obstructive sleep apnea was diagnosed with severe obstructive sleep apnea (AHI: >30) and has been on oral appliance therapy for two years.

 

The patient returned to his dentist for a new oral appliance because he was still experiencing severe daytime sleepiness and cognitive impairment, which he presumed to be related to his obstructive sleep apnea.

 

The patient’s dentist then gave him a Wesper kit to monitor his sleep and therapy compliance during the titration of the new oral appliance. The patient took six Wesper tests while using his oral appliance to determine the appliance’s effectiveness.

 

Despite the patient’s assumption that his oral appliance was no longer effectively treating his severe sleep apnea, his six Wesper tests while using the oral device showed that his breathing events score ranged from 4 to 8 (average breathing events per hour).

 

The average number of breathing events per hour across all six tests (6.1) was consistent with the lower end of mild OSA.

 

A substantial improvement from the patient’s initial severe OSA diagnosis was evident and did not explain the patient’s ongoing symptoms. Further analysis demonstrated that the patient was still experiencing mild snoring (<60 minutes of total snoring) on two of the six tests.

 

Further investigation was warranted to understand the root cause of the patient’s persistent daytime sleepiness and poor cognitive function. 

 

Analysis with Wesper across six nights of sleep showed a poor overall sleep quality, with very low total sleep time and inconsistent timing of sleep.

 

The patient’s total sleep time across six tests ranged from 4 hours and 12 minutes to 7 hours and 23 minutes. 5 out of 6 tests had sleep times of less than 5 hours and 10 minutes, with an average sleep time across six tests of 5 hours and 10 minutes, well short of the recommended minimum of 7 hours.

 

Adults require at least 7 hours of sleep to maintain health, so the patient chronically undercut his total sleep time. 

 

The patient’s sleep efficiency ranged from 82% to 95%, with an average sleep efficiency of 90%, indicating that the patient did not have difficulty maintaining sleep during the night and that his oral appliance was preventing any sleep apnea-related arousals from sleep.

 

It is typical for an individual with severe OSA to have frequent arousal and awakenings throughout the night. This patient’s high sleep efficiency demonstrates that his oral appliance prevents sleep apnea-related awakenings.

 

Finally, the timing of the patient’s sleep was assessed. The patient’s bedtime and wake time were highly inconsistent and deviated by up to 3 hours.

 

Sleep timing consistency is vital for maintaining a healthy circadian rhythm and sleep quality. 

 

In consultation with the Wesper Sleep Expert, the patient understood that his oral appliance appeared to be effectively correcting his severe obstructive sleep apnea.

 

The sleep expert discussed the essentials of good sleep hygiene and sufficient sleep duration, explaining that sleep timing consistency is vital for maintaining a healthy circadian rhythm and sleep quality. 

 

The patient reported numerous poor sleep habits, including the use of electronic devices before bed, an inconsistent sleep schedule, and intake of caffeinated beverages late in the day.

 

The sleep expert educated the patient about improving overall sleep quality by addressing poor sleep hygiene habits and provided the patient with a plan to get on a consistent sleep schedule and increase total sleep time.

 

Adherence to the plan and periodic testing with Wesper steadily increased the patient’s total sleep time until the patient consistently got at least 7 hours of sleep per night.

Conclusion

Maintaining sleep hygiene involves practicing behaviors that facilitate good sleep and avoiding behaviors that interfere with sleep.

 

Good sleep hygiene includes the establishment of a regular bedtime and wake-up time, adequate time in bed for sustained and sufficient sleep, restriction of alcohol and caffeinated beverages before bedtime, and proper use of exercise, nutrition, and environmental factors that promote restful sleep.

 

This case study highlights the importance of addressing patient sleep hygiene concurrently with sleep apnea therapy.

 

One of the most significant failings in sleep medicine when treating an individual for sleep apnea is neglecting assessed lifestyle and behaviors that may conflict with their therapy.

 

Clinical research supports addressing sleep hygiene concurrently with sleep apnea therapy to improve patient satisfaction and long-term health outcomes.

 

All Wesper users can book a consultation with a Wesper Sleep Expert to understand their test results better and receive personalized guidance on how to best move forward.

Explanation of Metrics

Breathing events—Prolonged periods (>10s)  of reduced airflow.

Snoring time – The total amount of recorded snoring in minutes.

Total sleep time – Total accumulation of sleep in minutes.

Sleep efficiency – The percentage of time asleep during the testing period.

Awakenings – The total number of awakenings during the testing period.

References

 

1. Su Young Jung, Hyung-sik Kim, Jin-Young Min, Kyoung Jin Hwang, Sung Wan Kim. Sleep hygiene-related conditions in patients with mild to moderate obstructive sleep apnea. (2018). Retrieved from (https://www.sciencedirect.com/science/article/abs/pii/S0385814618301068)
2. Nazia Naz S. Khan, MD, MS, David Todem, PhD, Shireesha Bottu, MBBS, M. Safwan Badr, MD, MBA, Adesuwa Olomu, MD, MS. Impact of patient and family engagement in improving continuous positive airway pressure adherence in patients with obstructive sleep apnea: a randomized controlled trial (2022). Retrieved from (https://jcsm.aasm.org/doi/10.5664/jcsm.9534)
3. Eric Suni, Dr. Abhinav Singh. How Much Sleep Do We Really Need? (2022). Retrieved from (https://www.sleepfoundation.org/how-sleep-works/how-much-sleep-do-we-really-need)

Shepard JW Jr, Buysse DJ, Chesson AL Jr, Dement WC, Goldberg R, Guilleminault C, Harris CD, Iber C, Mignot E, Mitler MM, Moore KE, Phillips BA, Quan SF, Rosenberg RS, Roth T, Schmidt HS, Silber MH, Walsh JK, White DP. History of the development of sleep medicine in the United States. (2005). Retrieved from (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2413168/)