Obstructive Sleep Apnea (OSA)

By Vicki Holmes MD, NCMP

Snoring seems to be a common problem as people age. It can be rather annoying but can also be dangerous. Snoring may be a sign of significant obstruction of the upper respiratory tract.

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Food and Mood

 

By Sarah Nixon-Jackle RN, BScN, NCMP

What Is Marijuana?

Recently I had the opportunity to seek and review information about how the foods we eat contribute to our mental well-being.  We know how valuable healthy, unprocessed foods are to our physical health. The focus of research and mental health advice is now focussing on the foods we eat and our gut biome (the healthy bacteria in our gut that create health) and inflammation.

 

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Alcohol – Healthy, Harmful or Both?  

 

Look for Non-Alcoholic Sparkling Cranberry Tea Recipe

By Donnelly Sellars, RD

In the heat of summer, a slushy cocktail, an ice cold beer or a cold glass of sangria can be the ultimate refreshment. When fall comes around, nothing beats the chill like a glass of wine by the fire, or coffee with a hint of liqueur. Alcohol is one of those things that has divided research; on one side, there are apparent heart health benefits to having 1-2 drinks per day. There are also health risks associated with overconsumption, but some are linked to a moderate amount.


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Resources to Check Out!

 

Resources

 

We have a wealth of resources on our website and keep adding to them. So check back often. Here are a few great ones to check out!


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Continued....Obstructive Sleep Apnea (OSA)

17% of men are affected with OSA, while 9% of women 50-70 years of age have OSA, that rises sharply after menopause. It is one of the most common sleep disorders that affect women during perimenopause.

We screen for OSA during the initial interview with women we see at our clinic. We have referred over a hundred women to the Sleep Program and 49% had a positive diagnosis of OSA.

OSA is recurrent episodes of partial or complete collapse of the upper airway during sleep. Partial collapse leads to lower oxygen in your blood and total or complete collapse leads to apnea or cessation of breathing.

These episodes lead to a drop in oxygen levels, short periods of wakefulness, sleep fragmentation, daytime sleepiness and impairment in quality of life.

There are many adverse effects of this drop in oxygen. It is associated with a surge in blood pressure that can lead to elevation even in the wakeful times.

Usually our blood pressure drops about 10% during the night. If it does not, it becomes an independent risk factor for worse cardiac outcomes and more organ damage from high blood pressure.


Patients with TIA’s, commonly called “mini-stroke” or “mild stroke” have a high prevalence of OSA at60-80%.

  • A recent study SLEEP TIGHT reported that treatment of OSA with CPAP (Continuous Positive Airway Pressure) in people who have recently had a TIA or minor stroke resulted in improved cardiovascular and metabolic risk factors, better neurological function and reduced recurrent vascular event rate. CPAP is a device that applies continuous positive air pressure that is administered into your nose/mouth to prevent the structures from collapsing.

A recent study from Japan showed that after angioplasty or MI, those with OSA were more than twice as likely to have heart failure, heart attack or stroke in the next five years. It’s SO IMPORTANT to recognize and treat this!


OSA is associated with

  • Daytime sleepiness and moody behavior
  • High blood pressure
  • Increased rate of irregular heartbeat, heart attack or sudden death
  • Type 2 diabetes and metabolic syndrome
  • Higher post surgical complications due to a greater risk of breathing problems when lying on their backs or sedated
  • More likely to have abnormal liver function
  • MVAs (Motor Vehicle Accidents) from falling asleep at the wheel
  • Sleep deprived partners
  • Three times greater risk of osteoporosis because increased cortisol levels suppress bone formation.

DO YOU HAVE OSA?


 A simple screening tool that can be used to detect sleep apnea is the STOP-BANG questionnaire:

  • Snore: Have you been told that you snore loudly?
  • Tired: Are you often tired during the day?
  • Observed apnea: Do you know if you stop breathing, or has anyone witnessed you stop breathing while sleeping?
  • Pressure: Do you have or are you being treated for high blood pressure?
  • Body mass index: Is your body mass index greater than 35 kg/m2?
  • Age: Are you older than 50?
  • Neck circumference: Is it greater than 40 cm?
  • Gender: Are you male?

A score of 3 or more indicates a high risk of obstructive sleep apnea, and further investigation is appropriate.

 

WHAT CAN YOU DO IF YOU HAVE OSA?


1.Lose weight

  • Exercise
  • Quit  tobacco
  • Treat respiratory allergies
  • Avoid alcohol and sedating drugs
  • Sleep on your side
  • After appropriate testing, use CPAP

This is a common serious condition, increasing as we age. OSA is under-diagnosed because people assume that snoring is normal.  When there is a prolonged phase of not breathing, you should see your doctor as soon as possible for appropriate tests.

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Continued....Food and Mood

Sadly, many of us have started to rely on highly processed convenience foods, thinking they will save us time in our oh-so-busy life.  Well, it may save time in the short term, but the long term mental and physical health deficits are going to cost us dearly in time, expense and most importantly, our compromised health.  This quote from the Journal of Anthropology gives us a hint:

“The transition away from whole-foods diet based on nutrient rich vegetables, fruits and whole grains – to a steady fare of nutrient-poor, high-calorie and highly processed foods is associated with increases in depression and other mental disorders.”


Mood disorders are common with one in five adults diagnosed with depression, anxiety or bipolar disorder. In 2014, researchers from the University of Newcastle in Australia concluded that a high intake of fruits, vegetables, fish and whole grains protected against depression.

  • Rates of depression, low mood, emotional problems and anxiety can be lowered with higher intake of nutrient-dense foods, vegetables, salads, fruits, and fish.
  • Higher intake of saturated fat, sugar, refined starches and processed foods are linked to poorer mental health.
  • Anti-inflammatory properties of nutrients in vegetables, fruits, nuts, whole grains and oily fish may influence concentrations of chemicals in the brain that regulate emotions and cognition. Omega 3 fatty acids found in fatty fish are essential for the integrity of brain cell membranes and how brain cells communicate with each other. Nutrients in whole foods increase a protein that improves mood, attention and learning, promotes brain cell growth and lowers brain inflammation. 
  • “Good” gut bacteria (prebiotics) and gut microbes are important for most of the body’s serotonin.

Here is more information and tips about food and mood to get you on the right path:

  • Adjust your lifestyle: exercise, reduce use of tobacco and alcohol, change negative thinking to more positive thought processes, supportive relationships.
  • Keep blood sugar in balance; imbalances in blood sugar affect mood, energy and sleep.  Reduce refined sugars.
  • Eat whole foods low in natural sugar and high in fibre.
  • Stay away from artificial sweeteners;  they contribute to weight gain, stimulate appetite, and instigate processes that favor Type 2 diabetes!
  • Follow an anti-inflammatory diet. Dr. Andrew Weil’s Anti-inflammatoryDiet is a great place to start.
  • Include probiotic foods to get your gut biome back in shape. Many of us have an altered gut biome that is contributing to all that ails us.

Some of you are already on the journey of reorganizing your diet to improve your mood and over all wellbeing.  If this is new to you, enjoy the journey of learning.  It’s all about  changing how we eat.

Some additional resources that may help you are:

  • The Good Gut , Taking Control of your weight, your mood, and your long term health by Justin Sonnenberg and Erica Sonnenberg , 2014 Penguin Press
  • The Healthy Mind Cookbook, Big Flavour Recipes to Enhance Brain Function, Mood, Memory and Mental Clarity  by Rebecca Katz and Mat Edelson. Ten Speed Press, Berkley
  • Brain Maker, The Power of Gut Microbes to Heal and Protect your Brain-for Life by David Perlmutter, MD 2015
  • The Longevity Kitchen, Satisfying BIG-FLAVOUR RECIPES Featuring the top 16 AGE-BUSTING POWER FOODS by  Rebecca Katz and Mat Edelson
  • Spontaneous Happiness: A New Path to Emotional Well Being  by Dr. Andrew Weil
  • Dr. Mark Hyman, author of many books and you can follow his blog
  • Mindful Cookbook by Carol Greenwood PhD, Daphna Rabinovich, Joanna Gryfe,  Baycrest Geriatric Centre, Toronto www.baycrest.org
  • The Anti-inflammatory Diet by  Andrew Weil MD, www.drweil.com

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Continued....Alcohol – Healthy, Harmful or Both?

So let’s break it down. First we need to define what “moderate” and “a drink” means. Moderate drinking is defined as no more than one drink per day for women, and one to two drinks per day for men. The drinking pattern is more important than the amount.  Having one drink per day versus saving all of your drinks until Saturday and having seven margaritas, is more significant than a woman occasionally having two or three beer with dinner. 

When it comes to the definition of “a drink”, the guidelines are fairly consistent. One drink is 355 mL (one can or bottle) of 5% alcohol beer, 145 mL (2/3 cup) of 12% alcohol wine, or 45 mL  (1.5 oz) of 40% alcohol. Serving sizes of liqueurs and higher alcohol content beer and wine amounts will vary.

What are the potential benefits to moderate drinking?

  • Decreased risk of heart disease
    • Moderate consumption of alcohol has been shown to increase HDL (good) cholesterol, as well as being linked to improved insulin sensitivity and affecting the enzymes, proteins and other factors involved in developing blood clots. Red wine has a high level of polyphenols, an antioxidant that has heart protecting benefits. This same antioxidant is also abundant in other foods  such as grapes, berries, cocoa, flax and ginger.
  • Social and psychological factors
    • Having a drink after a stressful day can have a relaxation effect that is most likely due to the act of drinking,  not necessarily due to the alcohol. Having a drink with friends can also have a calming or mood boosting effect, not necessarily caused by the alcohol.
  • Improved appetite and digestion
    • Alcohol is often consumed as an aperitif (before the meal) or a digestif (after the meal) to stimulate appetite and improve digestion.

The risks are dependent on how much and how often you drink. Looking beyond the most well-known risks such as potential for addiction, dehydration, lowered inhibitions and hangovers, here are a few others:

  • Increased cancer risk
    • Studies have found that having two or more drinks per day for women may increase their chance of developing breast cancer. Ensuring adequate folate intake can mitigate this risk, but alcohol also inhibits the absorption of the vitamin as well. Heavy drinking has been linked to other forms of cancer in men and women such as esophageal, liver, colon and colorectal cancer.
  • Weight gain
    • While alcohol itself isn’t high in calories, the vehicle in which it is delivered does. One shot of hard alcohol contains approximately 95 calories.  When soda pop is added as a mix, the calories increase to 285. Slushy and fruity cocktails have an average of 250 calories. Winehas about 100 calories per serving, but sangria can bring it up to 150-200 calories. Regular beer has about 150 calories, but if you prefer coolers, you are looking at 250-300 calories per bottle or can. You can see how easily the calories can add up!
  • Sleep cycle disruption
    • Alcohol may help you fall asleep faster, but it also reduces the amount of restorative REM sleep that you need. The more you drink, the stronger the disruption.
  • Interaction with medications
    • Alcohol can intensify or suppress the actions of both prescription and non-prescription medications. It can even react negatively with some herbal supplements and vitamins. Knowing how alcohol interacts with any medications you are taking is extremely important to having safe drinking habits.

The choice to drink in moderation is up to you. The important thing is being informed on the risks and rewards! For more information check out this website: https://www.hsph.harvard.edu/nutritionsource/alcohol-full-story/

 

Non-Alcoholic Sparkling Cranberry Tea


If you need something refreshing on a hot day – try this non-alcoholic iced tea!

Servings: 6
2 cups unsweetened, cold tea
2 cups cranberry juice (can use low calorie juice to decrease the amount of sugar)
2 cups sparkling water or club soda
Lemon/lime slices for garnish

  1. In a pitcher, combine the tea and juice and mix well.
  2. Add sparkling water or club soda and gently stir.
  3. Serve over ice and garnish with a citrus slice.

NOTE: To avoid the tea going flat over time, you can pour 2/3 cup of juice/tea blend over ice and top up with the sparkling water or club soda in the glass.


Nutrition Information (per 1 cup):

Calories 40 calories
Protein 0 g
Fat 0 g
Carbohydrates 9 g
Fibre 0 g

 

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Continued...Resources to Check Out!

The North American Menopause Society website hosts excellent resources for midlife women at www.menopause.org

Dr. Marla Shapiro hosts a series of interviews with experts in their field of menopause practice. You will know Dr. Shapiro from her role as medical consultant for CTV.
Topics currently posted are (and more to come):

  • Vaginal Health with Dr. Jan Shifren
  • Non-hormonal Therapy Options for Hot Flashes with Pauline Maki, PhD
  • Fragility Fractures and Treatment Options with Risa Kagan, MD
  • Menopausal Hormone Therapy with Peter Schnatz, DO
  • Sex After Menopause with Sheryl Kingsberg, PhD
  • Menopause and Breast Cancer with Andrew Kaunitz, MD

Sexual Health and Menopause Online is a separate resource full of information and troubleshooting about changes many women experience with regard to sex.  Check it out, it's excellent!

These are just a sampling of resources on this website.

 

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News and Events

 

Mid-Life Matters

Watch for Dr. Vicki Holmes on CTV News at Noon with Jeff Rogstad. A series of short segments on women’s health topics will be presented on some Mondays during the noon show. Jeff is planning to set up a bulletin board on the CTV site to host archived editions. Each topic will have a handout which will be on our website www.menopausecentre.org.

 

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