Sleep Disorders

Key Sleep Disorders
Sleep-related difficulties affect many people. The following is a description of some of the major sleep disorders. If you, or someone you know, is experiencing any of the following, it may be important to receive an evaluation by a healthcare provider or, if necessary, a provider specializing in sleep medicine.

Insomnia
Insomnia is characterized by an inability to initiate or maintain sleep. It may also take the form of early morning awakening in which the individual awakens several hours early and is unable to resume sleeping. Difficulty initiating or maintaining sleep may often manifest itself as excessive daytime sleepiness, which characteristically results in functional impairment throughout the day. Before arriving at a diagnosis of primary insomnia, the healthcare provider will rule out other potential causes, such as other sleep disorders, side effects of medications, substance abuse, depression, or other previously undetected illness. Chronic psychophysiological insomnia (or “learned” or “conditioned” insomnia) may result from a stressor combined with fear of being unable to sleep. Individuals with this condition may sleep better when not in their own beds. Health care providers may treat chronic insomnia with a combination of use of sedative-hypnotic or sedating antidepressant medications, along with behavioral techniques to promote regular sleep.

Narcolepsy
Excessive daytime sleepiness (including episodes of irresistible sleepiness) combined with sudden muscle weakness are the hallmark signs of narcolepsy. The sudden muscle weakness seen in narcolepsy may be elicited by strong emotion or surprise. Episodes of narcolepsy have been described as “sleep attacks” and may occur in unusual circumstances, such as walking and other forms of physical activity. The healthcare provider may treat narcolepsy with stimulant medications combined with behavioral interventions, such as regularly scheduled naps, to minimize the potential disruptiveness of narcolepsy on the individual’s life.

Restless Legs Syndrome (RLS)
RLS is characterized by an unpleasant “creeping” sensation, often feeling like it is originating in the lower legs, but often associated with aches and pains throughout the legs. This often causes difficulty initiating sleep and is relieved by movement of the leg, such as walking or kicking. Abnormalities in the neurotransmitter dopamine have often been associated with RLS. Healthcare providers often combine a medication to help correct the underlying dopamine abnormality along with a medicine to promote sleep continuity in the treatment of RLS.

Sleep Apnea
Snoring may be more than just an annoying habit – it may be a sign of sleep apnea. Persons with sleep apnea characteristically make periodic gasping or “snorting” noises, during which their sleep is momentarily interrupted. Those with sleep apnea may also experience excessive daytime sleepiness, as their sleep is commonly interrupted and may not feel restorative. Treatment of sleep apnea is dependent on its cause. If other medical problems are present, such as congestive heart failure or nasal obstruction, sleep apnea may resolve with treatment of these conditions. Gentle air pressure administered during sleep (typically in the form of a nasal continuous positive airway pressure device) may also be effective in the treatment of sleep apnea. As interruption of regular breathing or obstruction of the airway of the individual during sleep can pose serious complications for the health of the individual, symptoms of sleep apnea should be taken seriously.

cdc

What is Asthma?

What Is Asthma?

Asthma (AZ-ma) is a chronic (long-term) lung disease that inflames and narrows the airways. Asthma causes recurring periods of wheezing (a whistling sound when you breathe), chest tightness, shortness of breath, and coughing. The coughing often occurs at night or early in the morning.

Asthma affects people of all ages, but it most often starts in childhood. In the United States, more than 22 million people are known to have asthma. Nearly 6 million of these people are children.

Overview

The airways are tubes that carry air into and out of your lungs. People who have asthma have inflamed airways. This makes the airways swollen and very sensitive. They tend to react strongly to certain substances that are breathed in.

When the airways react, the muscles around them tighten. This causes the airways to narrow, and less air flows to your lungs. The swelling also can worsen, making the airways even narrower. Cells in the airways may make more mucus than normal. Mucus is a sticky, thick liquid that can further narrow your airways.

This chain reaction can result in asthma symptoms. Symptoms can happen each time the airways are irritated.

Asthma

Figure A shows the location of the lungs and airways in the body. Figure B shows a cross-section of a normal airway. Figure C shows a cross-section of an airway during asthma symptoms.

Sometimes symptoms are mild and go away on their own or after minimal treatment with an asthma medicine. At other times, symptoms continue to get worse. When symptoms get more intense and/or additional symptoms appear, this is an asthma attack. Asthma attacks also are called flareups or exacerbations.

It's important to treat symptoms when you first notice them. This will help prevent the symptoms from worsening and causing a severe asthma attack. Severe asthma attacks may require emergency care, and they can cause death.

Outlook

Asthma can't be cured. Even when you feel fine, you still have the disease and it can flare up at any time.

But with today's knowledge and treatments, most people who have asthma are able to manage the disease. They have few, if any, symptoms. They can live normal, active lives and sleep through the night without interruption from asthma.

For successful, comprehensive, and ongoing treatment, take an active role in managing your disease. Build strong partnerships with your doctor and other clinicians on your health care team.

NIH

Mold

After natural disasters such as hurricanes, tornadoes, and floods, excess moisture and standing water contribute to the growth of mold in homes and other buildings. When returning to a home that has been flooded, be aware that mold may be present and may be a health risk for your family.

People at Greatest Risk from Mold

People with asthma, allergies, or other breathing conditions may be more sensitive to mold. People with immune suppression (such as people with HIV infection, cancer patients taking chemotherapy, and people who have received an organ transplant) are more susceptible to mold infections.

Possible Health Effects of Mold Exposure

People who are sensitive to mold may experience stuffy nose, irritated eyes, wheezing, or skin irritation. People allergic to mold may have difficulty in breathing and shortness of breath. People with weakened immune systems and with chronic lung diseases, such as obstructive lung disease, may develop mold infections in their lungs. If you or your family members have health problems after exposure to mold, contact your doctor or other health care provider.

Recognizing Mold

You may recognize mold by:

• Sight (Are the walls and ceiling discolored, or do they show signs of mold growth or water damage?)

Smell (Do you smell a bad odor, such as a musty, earthy smell or a foul stench?)

Safely Preventing Mold Growth

Clean up and dry out the building quickly (within 24 to 48 hours). Open doors and windows. Use fans to dry out the building. (See the fact sheet for drying out your house, Reentering Your Flooded Home).

When in doubt, take it out! Remove all porous items that have been wet for more than 48 hours and that cannot be thoroughly cleaned and dried. These items can remain a source of mold growth and should be removed from the home. Porous, noncleanable items include carpeting and carpet padding, upholstery, wallpaper, drywall, floor and ceiling tiles, insulation material, some clothing, leather, paper, wood, and food. Removal and cleaning are important because even dead mold may cause allergic reactions in some people.

To prevent mold growth, clean wet items and surfaces with detergent and water.

Homeowners may want to temporarily store items outside of the home until insurance claims can be filed.

If you wish to disinfect, refer to the U.S. Environmental Protection Agency (EPA) document, A Brief Guide to Mold and Moisture in Your Home.

If there is mold growth in your home, you should clean up the mold and fix any water problem, such as leaks in roofs, walls, or plumbing. Controlling moisture in your home is the most critical factor for preventing mold growth.

To remove mold growth from hard surfaces use commercial products, soap and water, or a bleach solution of no more than 1 cup of bleach in 1 gallon of water. Use a stiff brush on rough surface materials such as concrete.

If you choose to use bleach to remove mold:

Never mix bleach with ammonia or other household cleaners. Mixing bleach with ammonia or other cleaning products will produce dangerous, toxic fumes

Open windows and doors to provide fresh air.

Wear non-porous gloves and protective eye wear.

If the area to be cleaned is more than 10 square feet, consult the U.S. Environmental Protection Agency (EPA) guide titled Mold Remediation in Schools and Commercial Buildings . Although focused on schools and commercial buildings, this document also applies to other building types. You can get it free by calling the EPA Indoor Air Quality Information Clearinghouse at (800) 438-4318.

Always follow the manufacturer's instructions when using bleach or any other cleaning product.

If you plan to be inside the building for a while or you plan to clean up mold, you should buy an N95 mask at your local home supply store and wear it while in the building. Make certain that you follow instructions on the package for fitting the mask tightly to your face. If you go back into the building for a short time and are not cleaning up mold, you do not need to wear an N95 mask.

CDC

Resistant TB

Extensively Drug-Resistant TB
Extensively drug-resistant tuberculosis (XDR TB) is a relatively rare type of multidrug-resistant tuberculosis (MDR TB). It is resistant to almost all drugs used to treat TB, including the two best first-line drugs: isoniazid and rifampin. XDR TB is also resistant to the best second-line medications: fluoroquinolones and at least one of three injectable drugs (i.e., amikacin, kanamycin, or capreomycin).

Because XDR TB is resistant to the most powerful first-line and second-line drugs, patients are left with treatment options that are much less effective and often have worse treatment outcomes.

XDR TB is of special concern for persons with HIV infection or other conditions that can weaken the immune system. These persons are more likely to develop TB disease once they are infected, and also have a higher risk of death once they develop TB disease.

The risk of acquiring XDR TB in the United States appears to be relatively low. However, it is important to acknowledge the ease at which TB can spread. As long as XDR TB exists, the United States is at risk and must address the threat.

•Extensively Drug-Resistant TB (Fact sheet)

Laboratory Guidance
The emergence of Mycobacterium tuberculosis strains that cause XDR TB has prompted the issuance of interim guidelines for clinical and research laboratories handling XDR TB specimens.

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What other names do people use for cystic fibrosis?

What other names do people use for cystic fibrosis?

CF

Cystic fibrosis of pancreas

Fibrocystic Disease of Pancreas

Mucoviscidosis

cdc

What is cystic fibrosis?

What is cystic fibrosis?

Cystic fibrosis is an inherited disease of the mucus glands that affects many body systems. The disorder's most common signs and symptoms include progressive damage to the respiratory system and chronic digestive system problems.

Mucus is a slippery substance that lubricates and protects the linings of the airways, digestive system, reproductive system, and other organs and tissues. In people with cystic fibrosis, the body produces mucus that is abnormally thick and sticky. This abnormal mucus can obstruct the airways, leading to severe problems with breathing and bacterial infections in the lungs. These infections cause chronic coughing, wheezing, and inflammation. Over time, mucus buildup and infections result in permanent lung damage, including the formation of scar tissue (fibrosis) and cysts in the lungs.

Most people with cystic fibrosis also have digestive problems because thick, sticky mucus interferes with the function of the pancreas. The pancreas is an organ that produces insulin (a hormone that helps control blood sugar levels). It also makes enzymes that help digest food. In people with cystic fibrosis, mucus blocks the ducts of the pancreas, preventing these enzymes from reaching the intestines to aid digestion. Problems with digestion can lead to diarrhea, malnutrition, poor growth, and weight loss. Some babies with cystic fibrosis have meconium ileus, a blockage of the intestine that occurs shortly after birth.

Cystic fibrosis used to be considered a fatal disease of childhood. With improved treatments and better ways to manage the disease, many people with cystic fibrosis now live well into adulthood. Adults with cystic fibrosis experience medical problems affecting the respiratory, digestive, and reproductive systems. For example, most men with cystic fibrosis are unable to father children (infertile) because the tubes that carry sperm (the vas deferens) are blocked by mucus and do not develop properly. This condition is known as congenital bilateral absence of the vas deferens (CBAVD). Infertility is also possible, though less common, in women with cystic fibrosis.

How common is cystic fibrosis?

Cystic fibrosis is a common genetic disease within the Caucasian (white) population in the United States. The disease occurs in 1 in 2,500 to 3,500 Caucasian newborns. Cystic fibrosis is less common in other ethnic groups, affecting about 1 in 17,000 African Americans and 1 in 31,000 Asian Americans.

What genes are related to cystic fibrosis?

Mutations in the CFTR gene cause cystic fibrosis.

The CFTR gene provides instructions for making a channel that transports negatively charged particles called chloride ions into and out of cells. The flow of chloride ions helps control the movement of water in tissues, which is necessary for the production of thin, freely flowing mucus.

Mutations in the CFTR gene disrupt the function of the chloride channels, preventing them from regulating the flow of chloride ions and water across cell membranes. As a result, cells that line the passageways of the lungs, pancreas, and other organs produce mucus that is unusually thick and sticky. This mucus clogs the airways and glands, causing the characteristic signs and symptoms of cystic fibrosis.

Other genetic and environmental factors likely influence the severity of the condition. For example, mutations in genes other than CFTR might help explain why some people with cystic fibrosis are more severely affected than others. Most of these genetic changes have not been identified, however.

How do people inherit cystic fibrosis?

This condition is inherited in an autosomal recessive pattern, which means both copies of the gene in each cell have mutations. The parents of an individual with an autosomal recessive condition each carry one copy of the mutated gene, but they typically do not show signs and symptoms of the condition.

Where can I find information about treatment for cystic fibrosis?

These resources address the management of cystic fibrosis and may include treatment providers.

NIH

Sleep Apnea

Also called: Sleep-disordered breathing
Sleep apnea is a common disorder that can be serious. In sleep apnea, your breathing stops or gets very shallow. Each pause in breathing typically lasts 10 to 20 seconds or more. These pauses can occur 20 to 30 times or more an hour.

The most common type is obstructive sleep apnea. That means you are unable to get enough air through your mouth and nose into your lungs. When that happens, the amount of oxygen in your blood may drop. Normal breaths resume with a snort or choking sound. People with sleep apnea often snore loudly. However, not everyone who snores has sleep apnea.

When your sleep is interrupted throughout the night, you can be drowsy during the day. People with sleep apnea are at higher risk for car crashes, work-related accidents and other medical problems. If you have it, it is important to get treatment.

National Heart, Lung, and Blood Institute

What is Alveolar Echinococcosis (AE)?

AE disease results from being infected with the larval stage of Echinococcus multilocularis, a microscopic tapeworm (1-4 millimeters) found in foxes, coyotes, dogs, and cats. Although human cases are rare, infection in humans causes parasitic tumors to form in the liver, and, less commonly, the lungs, brain, and other organs. If left untreated, infection with AE can be fatal.

AE is found worldwide, mostly in northern latitudes. Cases have been reported in central Europe, Russia, China, Central Asia, Japan, and North America. In North America E. multilocularis is found primarily in the north central region from eastern Montana to central Ohio, as well as Alaska and Canada. Human cases have been reported in Alaska, the province of Manitoba, and Minnesota. Prevalence among wild foxes and coyotes is high, and may reach over 50% in some areas; however, even in these areas, transmission to humans has been low.

Wild foxes, coyotes, and cats get infected when they eat Echinococcus multilocularis larvae in infected rodents, field mice, or voles. Cats are less susceptible than dogs, but because they catch and eat rodents often, may also become infected. Once the animal becomes infected, the tapeworm matures in its intestine, produces eggs, and the infected animal passes eggs in the stool. These tapeworm eggs, which are directly infectious to other animals, are too tiny to see, and will stick to anything with which they come in contact. Coyotes, foxes, dogs, and cats are not harmed by the tapeworm and do not have symptoms of AE.

Routine fecal examinations are not sufficient to diagnose E. multilocularis infection. Infection with the E. multilocularis tapeworm and other tapeworms may occur at the same time. Eggs of Taenia species tapeworms and Echinococcus tapeworms are similar in shape and size and are very difficult to tell apart. If you live in an area where this parasite occurs or you are concerned about your dog or cat being infected with E. multilocularis or other tapeworms, see your veterinarian who can answer your questions and assess the risk of possible infection.

By accidentally swallowing the eggs of the E. multilocularis tapeworm. Humans can be exposed to these eggs in two main ways, both of which involve "hand-to-mouth" transfer or contamination:

• By directly ingesting food items contaminated with stool from foxes or coyotes. This might include grass, herbs, greens, or berries gathered from fields.
• By petting or handling household cats and dogs infected with the E. multilocularis tapeworm. These pets may shed the tapeworm eggs in their stool, and their fur may be contaminated. Some dogs "scent roll" in foreign material (such as wild animal feces) and may become contaminated this way.

For 50 years, E. multilocularis was thought to be confined to the Alaskan coast and Canada. Now, because wild coyotes, foxes, and wolves are being trapped and transported to states where E. multilocularis has not previously been found, there is increased risk of spreading the disease to animals and humans. Wild animals carrying the tapeworm could set up the transmission cycle and expose animals not already infected. Many states prohibit this movement of wild animals, but trapping and movement of infected wild canines still occurs. If the transportation and relocation of these animals continues, the risk of human transmission will increase. Although the chances of contracting AE are low, certain groups may be at greater risk.

You may be at greater risk if you live in an area where E. multilocularis is found (see above). People at high risk include trappers, hunters, veterinarians, or others who contact wild foxes, coyotes, or their stool, or household cats and dogs who have the opportunity to eat wild rodents infected with AE.

AE is caused by tumor-like or cyst-like tapeworm larvae growing in the body. AE usually involves the liver, but can spread to other organs of the body. Because the cysts are slow-growing, infection with AE may not produce any symptoms for many years. Pain or discomfort in the upper abdominal region, weakness, and weight loss may occur as a result of the growing cysts. Symptoms may mimic those of liver cancer and cirrhosis of the liver.

See your health care provider if you think you may have been exposed to AE by one of the ways listed above. He or she can order a blood test for the presence of the parasite or antibodies to E. multilocularis.

Surgery is the most common form of treatment for AE, although removal of the entire parasite mass is not always possible. After surgery, medication may be necessary to keep the cyst from growing back.

If you live in an area where E. multilocularis is found in rodents and wild canines, take the following precautions to avoid infection:

• Don't touch a fox, coyote, or other wild canine, dead or alive, unless you are wearing gloves. Hunters and trappers should use plastic gloves to avoid exposure.
• Don't keep wild animals, especially wild canines, as pets or encourage them to come close to your home.
• Don't allow your cats and dogs to wander freely or to capture and eat rodents.
• If you think that your pet may have eaten rodents, consult your veterinarian about the possible need for preventive treatments.
• After handling pets, always wash your hands with soap and warm water.
• Fence in gardens to keep out wild animals.
• Do not collect or eat wild fruits or vegetables picked directly from the ground. All wild-picked foods should be washed carefully or cooked before eating.

*This information was prepared in association with the American Association of Veterinary Parasitologists (AAVP).

This fact sheet is for information only and is not meant to be used for self-diagnosis or as a substitute for consultation with a health care provider. If you have any questions about the disease described above or think that you may have a parasitic infection, consult a health care provider.

CDC

Health Effects of Smokeless Tobacco

Smokeless Tobacco and Cancer

• Smokeless tobacco contains 28 cancer-causing agents (carcinogens).
• Smokeless tobacco is a known cause of human cancer; it increases the risk of developing cancer of the oral cavity and pancreas.

Smokeless Tobacco and Oral Health

• Smokeless tobacco is also strongly associated with leukoplakia—a precancerous lesion of the soft tissue in the mouth that consists of a white patch or plaque that cannot be scraped off.
• Smokeless tobacco is associated with recession of the gums, gum disease, and tooth decay.

Smokeless Tobacco and Reproductive Health

• Smokeless tobacco use during pregnancy increases the risks for preeclampsia (i.e., a condition that may include high blood pressure, fluid retention, and swelling), premature birth, and low birth weight.
• Smokeless tobacco use by men causes reduced sperm count and abnormal sperm cells.

Smokeless Tobacco and Nicotine Addiction

• Smokeless tobacco use can lead to nicotine addiction and dependence.
• Adolescents who use smokeless tobacco are more likely to become cigarette smokers.

CDC

Facts on Tobacco Use

Morbidity and Mortality (Related to Tobacco Use)

Tobacco and Disease

• Tobacco use causes—
  • Cancer
  • Heart disease
  • Lung diseases (including emphysema, bronchitis, and chronic airway obstruction)
• Cigarette smoking increases the length of time that people live with a disability by about 2 years.
• For every person who dies from a smoking-related disease, 20 more people suffer with at least one serious illness from smoking.

Tobacco and Death

Worldwide

• Tobacco use causes more than 5 million deaths per year.
• Current trends show that tobacco use will cause more than 8 million deaths annually by 2030.
• On average, smokers die 13 to 14 years earlier than nonsmokers.

In the United States

• Cigarette smoking is the leading preventable cause of death.
• Cigarette smoking is responsible for about one in five deaths annually, or about 443,000 deaths per year.
• An estimated 49,000 of tobacco-related deaths are the result of secondhand smoke exposure.

Tobacco-Related Costs and Expenditure in the United States

Costs of Smoking

• Annually, in the United States, cigarette smoking costs more than $193 billion:

$193 billion =$97 billion in lost productivity+$96 billion in health care expenditures

• Annually, in the United States, secondhand smoke costs more than $10 billion in health care expenditures.

State Spending on Tobacco Control

States have billions of dollars available to them—from tobacco excise taxes and tobacco industry legal settlements—for preventing and controlling tobacco use. States currently use a very small percentage of these funds for tobacco control programs:

• $24.9 billion was available to states in 2007 from tobacco taxes and legal settlements
• States spent less than 3% of the $24.9 billion in 2007 on tobacco control programs
• Investing only 15% (i.e., $3.7 billion) of the $24.9 billion would have funded every state tobacco control program at CDC-recommended levels

Cigarette Industry Spending

The cigarette industry spends billions each year on advertising and promotions:

• $13 billion total spent in 2005 (latest available data)
• $36 million spent a day in 2005 (latest available data)

Tobacco Use in the United States

Numbers of Smokers

Millions of people in the United States smoke cigarettes.

Current* Smokers

• 19.8% of U.S. adults (43.4 million people 18 years of age and older)
• 20.0% of high school students
• 36.4% of American Indian/Alaska Native adults
• 21.4% of white adults
• 19.8% of African American adults
• 13.3% of Hispanic adults
• 9.6%   of Asian American adults (excluding Native Hawaiians and other Pacific Islanders)

*Current smokers are defined as persons who reported smoking at least 100 cigarettes during their lifetime and who, at the time of interview, reported smoking every day or some days.

Starting to Smoke

Thousands of young people and adults begin smoking every day:

• Each day, about 1,000 persons younger than 18 years of age become regular smokers (i.e., begin smoking on a daily basis).
• Each day approximately 1,800 adults 18 years of age and older become daily smokers (i.e., begin smoking on a daily basis).

Quitting

Many adult smokers want or try to quit smoking:

• Approximately 70% of smokers want to quit completely.
• Approximately 40% of smokers try to quit each year.

Cessation treatments found to be effective include the following:

• Brief clinical interventions
• Counseling
• Over-the-counter and prescription nicotine replacement products (e.g., nicotine gum, inhaler, nasal spray, lozenge, or patch)
• Prescription nonnicotine medications, such as bupropion SR (Zyban^®) and varenicline tartrate (Chantix^®)

CDC

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