New Study: Sleep Disorders, Health, and Safety in Police Officers

In the current issue of JAMA “Journal of the American Medical Association” A large study of Police Officers in the U.S and Canada found 40% of police officers had symptoms of a sleep disorder, including sleep apnea and insomnia.

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Officers who screened positive for those disorders were also more likely to be burned out, depressed or have an anxiety disorder. Over the next two years, they committed more administrative errors and safety violations and were more prone to falling asleep at the wheel than sound sleepers.

“In general we have this cultural attitude of, sleep is for the weak,” said Dr. Michael Grandner, from the Center for Sleep and Circadian Neurobiology at the University of Pennsylvania in Philadelphia.

“When you’re in an environment where signs of weakness are particularly discouraged, there may be a social pressure to not address sleep problems or to shrug them off,” added Grandner, author of a commentary published with the new study in the Journal of the American Medical Association.

When police officers in particular suffer from sleep problems, he said, it becomes a public health and safety problem. “It’s not just the people with sleep disorders that are affected,” Grandner told Reuters Health. “If they’re impaired, you’re at risk.”

Researchers say police departments could do more to make sure that officers with sleep disorders receive appropriate treatment, which may include sleep machines, therapy or changes in work schedules.

For the new study, close to 5,000 police officers were surveyed on sleep problems and other health topics. That included Philadelphia officers and Massachusetts state police as well as a broader range of other U.S. and Canadian cops.

The officers were on average 38 to 39 years old and most had been in the police force for more than decade.

Dr. Charles Czeisler from Brigham and Women’s Hospital in Boston and his colleagues found that 40% of the officers screened positive for at least one sleep disorder.

The most common was sleep apnea, which affected a third of cops, followed by moderate or severe insomnia and shift work disorder, which consists of sleepiness and insomnia associated with working at night.

DEPRESSION, BURNOUT, ANXIETY

Officers with a sleep disorder were more than twice as likely as healthy sleepers to report depression, emotional exhaustion or burnout and anxiety disorders on their original surveys.

On follow-up questionnaires sent out over the next two years, they were also 40 to 60% more likely to report making serious administrative errors, falling asleep while driving or committing a fatigue-related error or safety violation during work.

Poor sleepers reported more citizen complaints and more often showed uncontrolled anger toward a suspect or citizen.

“You have people who are sleep deprived, which means that their ability to make good decisions, to respond effectively, to drive emergency vehicles well … all of those things are impaired,” said Bryan Vila, a criminal justice professor who studies sleep and performance in cops at Washington State University in Spokane but wasn’t involved in the study.

The researchers noted that being heavy increases the risk of sleep apnea, and that almost 80% of the officers they surveyed were overweight or obese.

Czeisler said the lowest rates of both sleep apnea and overweight and obese conditions were in Massachusetts state cops, and that that’s no coincidence.

Those officers get one hour paid exercise time for every work shift, he told Reuters Health, and undergo regular fitness tests that simulate chasing a suspect or dragging a victim, with a bonus in pay if they pass.

“It’s an impressive program and perhaps a model for the nation,” Czeisler said.

HEALTH AND SAFETY ISSUES

Putting in measures to catch sleep disorders early could help prevent future health and safety consequences, researchers say. Those could include on-the-job screening in police departments, according to Czeisler, and making sure cops with sleep problems get help.

“We have great treatments for sleep disorders, we have great screening tools, the technology is there,” Grandner told Reuters Health. Sleep apnea can be treated with a breathing machine and mask used at night, and behavioral therapy is often the first line of treatment for people with insomnia, he said.

Czeisler said next up is a study funded by the Federal Emergency Management Agency to look at sleepdisorders in firefighters.

Source: JAMA

Pregnancy and Periodontal Disease

The physical and economic costs of pre-term infants are great. Pre-term infants are at an increased risk for a number of serious health complications, including chronic lung disease, severe brain injury, motor and sensory impairment, learning difficulties and behavioral problems. First-year mortality rates are significantly higher for pre-term infants. Plus, these children often require significantly greater family practitioner services, education services and social services than infants born at term or normal birth weight. The economic impact associated with the perinatal period, as well as throughout life, can be substantial. The annual societal financial burden is more than $26 billion. Individually, on average, a pre-term infant costs %51,600 more than the average cost for full-term infants in the first year of life. Additional long-term costs often continue over the individual's lifetime.

Several studies have examined the associated between periodontal disease and deliveries of pre-term, low-birth weight infants. The majority of these studies shown an association. Various studies indicate that pregnant women who have periodontal disease range from 3-5 to 7 times more likely to deliver pre-term, low birth weight children.

Recent studies also indicate the treatment for periodontal disease may reduce the incidence of pre-term low birth weight infants. An American study showed a 28 percent reduction for low-income African America and Hispanic women when periodontal disease was treated, while a Chilean study of low-income found an 82 percent reduction.

Although further studies are continuing to explore the link between periodontal disease and pre-term, low birth weight babies as well as the outcome of periodontal treatment during pregnancy, the potential health ramifications, quality of life and economic impact of the condition warrant taking precautions to reduce its incidence.

There are two major dental concerns for pregnant women -- avoiding dental emergencies and/or treatment in the last trimester and preventing periodontal (gum) disease.

If you are trying to become pregnant or have recently learned that you are, you should try to schedule a dental check-up and a prophylaxis (cleaning) within the first trimester. It is better to have dental work completed within the fourth to sixth month of pregnancy than to do deal with potential complications from anesthesia, medication, or extensive procedures during the last trimester; consult your obstetrician and call your dentist. Definitely postpone all elective procedures until after you give birth.

It is common for pregnant women to develop "pregnancy gingivitis." Gingivitis is an inflammation of the gums and surrounding tissues. It is characterized by redness, swelling, tenderness and bleeding. The primary cause is an increased level of hormones -- especially estrogen and progesterone, which correlates with an increase in dental plaque (a sticky mixture of bacteria, food and debris). This condition starts to become evident in the second trimester. If you had gingivitis prior to your pregnancy, it will probably worsen. Left untreated, it could lead to bone loss around the teeth.

Pregnant women also risk developing "pregnancy tumors" which are benign growths that arise our of swollen gums. Normally, the treatment is to leave them alone until they break on their own. However, if they interfere with eating or oral hygiene, they may have to be surgically removed.

To prevent of minimize "pregnancy gingivitis," take extra care and time with good brushing and flossing techniques to remove plaque. It is advisable to visit your dentists in the first or early second trimester. Eat a good balanced diet, getting plenty of vitamins C and B12. Smokers should refrain from smoking throughout the entire pregnancy term.

- Delta Dental

Sleep Apnea: Prevalence and Ramifications

Obstructive Sleep Apnea Syndrome (OSA) is a life threatening disorder affecting over 18 million Americans. 40% of Americans snore and 40% of snorers have OSA with no signs or symptoms of the disease.

Serious repercussions /consequences of untreated OSA include: 

• Increased risk of stroke.
• Increased high blood pressure.
• Increased incidence of atrial fibrillation.
• Increased risk of diabetes.
• Poor memory and other cognitive impairments.
• Male impotence and decreased sex drive.
• Headaches.
• Increased risk of motor vehicle accidents.
• Increase in Gastrointestinal Reflux Disease (GERD).
• Increase in ADHD in children.
• Death.

Signs of Obstructive Sleep Apnea and Sleep Disordered Breathing

• Snoring.
• Waking up due to gasping or choking.
• Excessive daytime sleepiness.
• Irritability.
• Memory loss.
• Nighttime grinding of teeth.
• Restless or unrefreshed sleep.
• Frequent waking during sleep.

How common is OSA?

• 40% of adults over 40 snore
  (approx. 87 million Americans)
• 9% of men and 4% of women suffer from some form of OSA.
  (approx. 30 million Americans)
• Less than 10% of OSA sufferers have been diagnosed
  (Approx 3 million Americans)
• Of those diagnosed with OSA, less than 25% have been successfully treated."

Incidence of Obstructive Sleep Apnea

Obstructive Sleep Apnea Syndrome (OSA) is a life threatening disorder affecting over 18 million Americans. Research estimates that up to 9% of adult males and 4% of females suffer from sleep disordered breathing, yet fewer than 10% have been diagnosed. In fact, the most recent studies have shown that 1 in 4 adults in the United States (31% of all men and 21% of all women over 18) are at "high risk" for OSA (based on analysis of the National Sleep Foundation's 2005 Sleep in America survey).

Regular Visits to the Dentist Can Save Your Life

INFORMATION PROVIDED AS A SERVICE TO THE FRIENDS OF DR. GLENN A. MACFARLANE

Regular Visits to the Dentist Can Save Your Life   Did you know that your dentist can spot serious health risks like... oral cancer, heart disease, diabetes, and premature birth? Most people would never think a trip to their dentist would actually save their lives. Dental appointments are typically made to either relieve pain or help maintain a beautiful smile. But, we should really think of our dentist as a health care provider and part of the team of physicians that helps us to maintain our overall health. Dentists, after all, are physicians of the mouth. Although this may seem like a new concept to some people, dentists are trained to diagnose diseases of the mouth in both the hard tissue (teeth) and soft tissue (tongue, roof of the mouth, lips, and gums). During every visit, the dentist inspects these tissues for any changes that could be the warning signs of disease. A regular visit to your dentist will not only help you and your family maintain your overall health...but it could also save your life. Oral Cancer Over 30,000 Americans will be diagnosed with oral cancer this year. Oral cancer has a higher death rate than cancers of the ovaries, cervix, liver, brain, testes, kidney, and skin, as well as Hodgkin's disease. If diagnosed early, there is a better chance for survival. Your dentist is trained to observe changes in the soft tissue of the mouth and recognize precancerous lesions. These changes may include ulcers on the lips, white patches on the cheeks, or ulcers under the tongue. Heart Disease Studies have shown a connection between gum disease, heart disease, and stroke. Gum disease makes gum tissue weaker, allowing oral bacteria to enter the blood stream. Dental bacteria can cause blood clots or a clumping together of blood cells. Blood clots can travel through the blood stream, causing a stroke or heart attack. Regular visits to your dentist, along with recommended treatments, will assist in removing this risk factor. Diabetes Many people with diabetes were initially diagnosed with the disease as a result of a routine dental visit. Your dentist is not the health care provider who can diagnose whether or not you have diabetes; however, dentists often suspect diabetes during their treatment of gum disease. Periodontal disease is considered one of the complications of diabetes. In some people, the presence of periodontal disease decreases their ability to control blood sugar. When a person treated for gum disease shows no improvement following treatment and good oral hygiene, a referral to his or her physician is in order. Pregnancy Recent studies have investigated the connection between premature births and gum disease. Some investigators speculate that as many as 18 percent of all cases of premature births may be associated with gum disease. Pregnant women produce substances known as regulators, which determine when the process of birth is to occur. Once these regulators reach a certain level, they signal the birth process to begin. Gum disease produces regulators, known as prostaglandins. In a pregnant woman, prostaglandins may send out a false signal to the body, thereby initiating the birth process prematurely. Regularly scheduled maintenance visits to your dentist are critical to maintaining healthy gums, especially prior to and during pregnancy. Horizon Blue Cross Blue Shield of New Jersey hopes that you make an appointment with your dentist when you are in pain or need a cleaning. At the same time, please consider how important it is to see your dentist regularly to detect the early warning signs of problems that could affect your overall health. These visits could actually save your life.  Glenn A. MacFarlane, D.M.D. 252 Broad Street Red Bank, N.J. 07701 732-530-4020 www.DocSmile.com www.DocSmileTV.com Email: docsmile@aol.com

Prevention is the Best Medicine: What Every Woman Needs to Know About Sleep Apnea and Oral Systemic Disease!

Docsmile.com, Red Bank is the New Jersey dental pioneer for preventative measures to correct sleep apnea issues as well as oral systemic disease. "Sleep apnea has been linked to anxiety and depression, and cardiovascular disease. Oral systemic disease leads to near every medical disorder in the body," informs Dr. Glenn A. MacFarlane, DMD, dentist, owner, and Executive Director of Docsmile.com.

"A state-wide initiative is underway to integrate my dental practice with physicians at large to work with them to alleviate mass disease through preventative dental measure. Education, information, and cooperation are all key for the success of this far reaching effort, and my office provides all of this," explains Dr. MacFarlane.

"Unfortunately sleep apnea is a growing concern in families," states Dr. MacFarlane. "Three types of sleep apnea dominate, of which, obtrusive (OSA) is the most common. People with untreated sleep apnea stop breathing repeatedly during their sleep, sometimes hundreds of times during the night, and often for a minute or longer.

Obtrusive sleep apnea is caused by a blockage of the airway, usually when the soft tissue in the rear of the throat collapses and closes during sleep. With each apnea event, the brain briefly arouses people with sleep apnea in order for them to resume breathing, but consequently sleep is extremely fragmented and of poor quality.

Sleep apnea is very common, as common as adult diabetes, and affects more than twelve million Americans, according to the National Institutes of Health. Risk factors include being over the age of forty, but sleep apnea can strink anyone at any age, even children. Yet still because of the lack of awareness by the public and healthcare professionals, the vast majority remain undiagnosed and therefore untreated, despite the fact that this serious disorder can have significant consequences.

Untreated, sleep apnea can cause high blood pressure and other caridovascular disease, memory problems, weight gain, impotency, and headaches. Moreover, untreated sleep apnea may be responsible for job impairment and motor vehichle crashes. Fortunately, sleep apnea can be diagnosed and treated.
Threr are mainly 3 type of treatment for sleep apnea; breathing devices, oral appliances ad surgery. The goal of these treatments is to restore regular breathing during sleep and to relieve symptoms of sleep apnea, such as loud snoring and daytime sleepiness.

Oral appliances can be used for mild to moderate sleep apnea and loud snoring. These appliances are the most comfortable of the 3 treatment types. They are fitted to your upper and lower teeth, pulling the lower jaw forward, and keeing your tongue from blocking your airway while you sleep. The other 2 types of treatment have stumbling blocks. Breathing devices usually employ large, cumbersome facemasks, while surgery is invasive, sometimes radical, and has limited success. "Oral appliances and other remedies are available through my practice," shares Dr. MacFarlane.

"Docsmile.com, Red Bank is in the process of expanding its dental offices to also create a dental education and diagnostic center in-house. From there, it will be a full service practice and education canter with the intention of creating overall patient wellness through preventative dental measures. Longtime and new patients, as well as physicians and other medical professions, stand to benefit greatly from our initiative," concludes Dr. MacFarlane.

For more information about sleep apnea, contact:
DocSmile
Glenn A. MacFarlane, D.M.D.
252 Broad Street
Red Bank, NJ 07701
(732)-530-4020