Floppy Eye Lid Syndrome. What?!
What is Floppy Eye Lid Syndrome?
Floppy eyelid syndrome (FES) is considered a common and under-diagnosed eyelid syndrome. FES is characterized by a loose or “floppy” eyelid that easily contorts or everts without spontaneously returning to its normal shape. Typical presenting symptoms include tearing, irritation, photosensitivity, and foreign body sensation in the eye.
Who develops Floppy Eye Lid Synrome?
Studies suggest that 98% of patients with FES are male and 57% of patients with FES suffer from Obstructive Sleep Apnea.
What is Sleep Apnea?
This is when you stop breathing while asleep or have almost no airflow. It combines the Greek roots “a,” which means “not” and “pnea,” which refers to breathing. Combined, it means “breathless.” Sleep apnea is a potentially serious sleep disorder. If you snore loudly and feel tired even after a full night’s sleep, you might have sleep apnea.
The main types of sleep apnea are:
- Obstructive sleep apnea (OSA), which is the more common form that occurs when throat muscles relax and block the flow of air into the lungs
- Central sleep apnea (CSA), which occurs when the brain doesn’t send proper signals to the muscles that control breathing
- Treatment-emergent central sleep apnea, also known as complex sleep apnea, which happens when someone has OSA — diagnosed with a sleep study — that converts to CSA when receiving therapy for OSA
Obstructive sleep apnea
Obstructive sleep apnea occurs when the muscles that support the soft tissues in your throat, such as your tongue and soft palate, temporarily relax. When these muscles relax, your airway is narrowed or closed, and breathing is momentarily cut off.
This causes excessive snoring and forces them to frequently awaken and turn to sleep on their stomach or side. As a result, their face is pressed onto the pillow, mechanically stretching and pulling open the eyelid, leading to chronic eye irritation and drooping of the eyelid(s).
How is Floppy Eye Lid Syndrome treated?
Regarding the eyes, patients can use metal shields to cover their eye(s) while sleeping to reduce the mechanical trauma. Medications can be tried to lessen the eye irritation, and there are surgeries which can be performed to tighten the eyelid and/or raise it to correct the drooping. However, unless the underlying obstructive sleep apnea is addressed, the condition will continue.
How does one get checked for Sleep Apnea?
You get booked for a sleep study, in a sleep lab or by a monitor at home. These studies determine if and how often your breathing pauses for a significant period of time while sleeping. Remarkably, people with obstructive sleep apnea may have hundreds of episodes each night in which they stop breathing for 15 seconds or longer.
Why is it important to diagnose and treat OSA?
Obstructive sleep apnea reduces oxygen flow to all parts of the body. This can lead to high blood pressure, heart failure, arrhythmias, and many other potentially fatal systemic diseases. In addition, the poor quality of sleep has effects on daytime performance at work and other activities. Management of the condition always starts with diet, exercise, and weight loss. Once diagnosed, it can be treated with continuous positive airway (CPAP) masks and/or mouth and nose pieces to prevent collapse of the airway while sleeping. Treated patients sleep more soundly, feel better, and are healthier. Often, once the sleep apnea is treated, the changes seen on the eyelids will slowly revert to normal without the need for surgery.
For further information Fourie and Associates can be contacted. Fourie & Associates Clinical Technology Group is a team of experienced technologists with advanced sleep facilities in Cape Town, Johannesburg and Pretoria. They help patients understand, diagnose and treat sleep disorders such as sleep apnea using latest technology and expert advice to combat fatigue and daytime sleepiness.
Article by HZ Eye Care.
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The Various Types Of Sleep Disorders
Obstructive Sleep Apnea
Obstructive sleep apnea (OSA) (or apnoea) is far more common than generally understood and is caused by obstruction of the upper airway.
It is characterized by brief interruptions in breathing during sleep, despite the effort to breathe. It is also associated with a drop in blood oxygen saturation. These interruptions in breathing are called “apneas” (which literally means “without breath”) and have to occur for over ten seconds per episode to be classified as an apnea.
The individual with OSA is not always aware of having interruptions in breathing, even when waking up. It is usually recognized as a problem by the individual’s bed-partner or other family members. Others witness heavy snoring or that the individual struggles to breathe while sleeping. OSA is very often accompanied with snoring. Symptoms may be present for years without being identified. Symptoms include daytime sleepiness and fatigue due to significant levels of sleep disturbance. Without a regular bed-partner to notice and make them aware of their symptoms, individuals who generally sleep alone are often not aware of the condition.
Certain mechanical and structural problems in the airway cause the interruptions in breathing during sleep. The throat muscles and tongue relaxes and sags causing a partial or full obstruction in the airway.OSA very often occurs among obese people because of excessive fatty tisssue narrowing the airway. This results in heavy snoring, periods of not breathing and frequent arousals (causing abrupt changes from deep sleep to light sleep).
Sleep Insomnia
Insomnia, or sleeplessness, is a sleep disorder where an individual struggles to fall asleep or to stay asleep as long as desired.
Insomnia is generally thought of as both a medical sign and a symptom that can accompany a number of sleep, medical, and psychiatric disorders often characterized by a continuous inability to fall asleep and/or stay asleep or having sleep of poor quality. Functionality usually becomes impaired whilst awake. Insomnia can occur at any age, but it is most common in the elderly. Insomnia can be short term (up to three weeks) or long term (above 3–4 weeks); it can eventually cause memory problems, depression, irritability and an increased risk of heart disease and motor vehicle related accidents (caused by excessive daytime sleepiness).
Individuals that suffer from insomnia could complain of prolonged sleep onset latency (difficulty in falling asleep), sleep maintenance being easily disturbed or experiencing non-refreshing sleep.
Often insomniacs turn to sleeping pills, which may help, but could also lead to dependency or addiction if constantly used over a long period of time. A very useful therapy for insomnia is cognitive behavioral therapy. One is then able to get to the root of the problem and be retrained into a regular sleep pattern.
Restless Leg Syndrome
Restless legs syndrome (RLS) also known as Willis-Ekbom disease (WED) or Wittmaack-Ekbom syndrome, is a neurological disorder whereby one feels an irresistible urge to move one’s body to stop uncomfortable or strange sensations.
It is most commonly felt in the legs, but can also affect the arms, torso and head. Moving the body part affected by the sensations, provides temporary relief.
RLS sensations range from pain or an aching in the muscles, to “an itch you can’t scratch,” an unpleasant “tickle that won’t stop,” or even a feeling that your skin is “crawling”. A lot of individuals with RLS suffer from periodic limb movement disorder (limbs jerking during sleep), which is usually a prominant indicator of the disorder. It can also be caused by low iron levels.
Periodic limb movement disorder
Periodic limb movement disorder (PLMD), which used to be known as nocturnal myoclonus, is a sleep disorder where the patient moves limbs involuntarily during sleep, and has symptoms or issues related to the movement.
PLMD should not be confused with restless leg syndrome (RLS), although PLMD occurs in most individuals suffering from RLS. RLS occurs while awake as well as when asleep, and when awake, there is a voluntary response to an uncomfortable feeling in the legs. PLMD on the other hand is involuntary, and the patient is usually not aware of these movements at all.
Narcolepsy
Narcolepsy, also known as hypnolepsy, is a chronic neurological disorder where the brain loses it’s ability to regulate sleep-wake cycles normally.
People with narcolepsy experience frequent excessive daytime sleepiness. Those with narcolepsy generally experience the REM stage of sleep within 5 minutes of sleep latency, while people who don’t have narcolepsy (unless they are severely sleep deprived) do not experience REM until after a period of slow-wave sleep, which lasts for more or less the first hour of a sleep cycle. Another common symptom of narcolepsy is cataplexy, a sudden and brief episode of muscle weakness while in a full state of consciousness, often triggered by emotions such as laughing, crying, terror, etc. Cataplexy occurs in about 70% of people who have narcolepsy.
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Good Sleep Hygiene
Sleep hygiene is a term used to describe good sleep habits, that is things you can do to give yourself the best chance of a good refreshing sleep. Most of these things are common sense but in the hustle and bustle of modern life are often neglected. Here are some “Dos” and “Don’ts” to help you get a good night’s sleep. If you’re having trouble sleeping, attention to some of these simple things may help.
DO:
Do – Go to bed at the same time each day.
The body has a natural clock which will make you sleepy when you’re ready for bed. Try not to ignore this. Going to bed too early may also result in disturbed sleep.
Do – Get up from bed at the same time each day.
Getting up at the same time helps to keep your body clock synchronised with what is going on outside. If you can stick to a fairly regular waking and sleeping time, your body will become accustomed to it. Avoid the temptation to try to make up for a poor night’s sleep by sleeping in. However, this doesn’t mean that you should be obsessive about it, an occasional night out or sleep in is not going to hurt.
Do – Get regular exercise each day.
There is good evidence that regular exercise improves restful sleep. Ideally this should be taken before dinner or in the morning.
Do – Try to spend some daytime outdoors or in natural light.
Light is important for the body to produce melatonin which is a sleep promoting substance. Sunlight early in the day is particularly helpful in synchronising your body clock.
Do – Make the bedroom as restful as possible.
This means keeping the temperature cool, keeping noises and outside light (darken curtains) to a minimum and leaving distracting things such as beeping watches or clocks outside.
Do – Use your bed only for sleep and sex.
Some people use the bed as a lounge room, by knitting, studying, watching television, telephoning etc. You need to try and avoid this and make sure that the bed is associated with sleeping. The brain makes connections between places (the bedroom) and events (sleeping) and you need to reinforce these. Make sure the bed is for sleeping and sleeping happens in the bed.
Do – Take medications as directed.
Prescription medications may cause you to be alert or sleepy and the instructions that come with them should be followed. Don’t vary the time of day that you take your medication.
Do – Be comfortable and relaxed.
If you are cold in bed, warm the room or wear warm pyjamas. Warm hands and feet are particularly important. If you have uncomfortable pillows, mattress or bedclothes, get them fixed. You will spend the next eight hours in bed and you don’t want to be uncomfortable. A warm bath about an hour before bedtime causes the body’s temperature to rise and then fall which may promote sleep.
Do – Understand your sleep need.
Most people need between seven and nine hours sleep each day but this includes naps and time spent dozing in front of television. Don’t build up unrealistic expectations of your sleep needs.
The Don’ts
Don’t – Exercise just before going to bed.
Exercise immediately before bed stimulates the body and may make it difficult to fall asleep. Take your exercise earlier in the day, preferably before dinner time.
Don’t – Engage in stimulating activity just before bed.
Playing a competitive game, watching an exciting program on television or a movie, or having an important family discussion stimulates your mind and thoughts will overflow to the bedroom. Worrying about or planning the next day’s activity may be a natural thing to do, but try to avoid it.
Don’t – Drink caffeine containing drinks in the evening.
Coffee and tea are the obvious caffeine containing drinks but things such as colas and many other soft drinks also contain caffeine. Read the labels. A glass of warm milk is an old fashioned recipe that may work well. If frequent trips to the toilet are a problem during the night, try not to drink too much before bedtime and make sure you go to bed with an empty bladder.
Don’t – Go to bed too hungry or too full.
If you are in the habit of taking a light supper, you should keep doing this but don’t each too much.
Don’t – Nap in the evening before you go to bed.
If you are in the habit of taking a daytime nap and it doesn’t seem to affect your night-time sleep, you might want to keep doing this but try not to sleep in the evening as that is going to reduce your body’s need to fall asleep.
Don’t – Stay in bed if you are awake.
You can’t force yourself to sleep. If you do not fall asleep in a reasonable time, perhaps 20-30 minutes, then get up and do something boring, but do this in another room. Try and keep the lighting fairly dim. When you are tired, go back to bed. This helps your mind associate the bed with sleeping.
Don’t – Share your bed with children or pets.
Research has shown that parents sleeping with young children sleep less and have more disturbed sleep.
Don’t – Look at the clock all the time.
Clocks with bright numbers are a distraction and obsessing over time, will just make it more difficult to sleep.
Don’t – use tech cellphones etc.an hour before bed.
They produce blue light which suppresses sleep hormone production.
Don’t – Smoke.
Quitting smoking not only brings many health benefits to any smoker, it eliminates the stimulant effects of nicotine that contribute to sleep loss.
Don’t – Use alcohol to help you sleep.
Alcohol may help you to get to sleep but it has a number of bad effects. It causes you to need more trips to the toilet, it causes you to wake up early, it causes fragmented sleep and it worsens snoring and sleep apnea.
Don’t – Rely on sleeping tablets to help you to sleep.
Sleeping tablets have a role where there is some event or other circumstance that may temporarily cause you to have trouble falling asleep but they are a temporary fix only. Some tablets may cause you to be a bit sleepy in the daytime and when you stop taking them you may get a “rebound” and find it harder to fall asleep.
Many sleeping problems are due to bad habits built up over a long period. You won’t fix sleeping problems in one night; persevere with good sleep habits and sleep should get better. Different things may work for you, find out what works and stick with it. Above all, don’t obsess about your sleep problems, one poor night’s sleep is not a problem. Just return to your good sleep habits the next night. However, if despite good sleep habits you still have difficulty, then see your doctor as something else may be disturbing your sleep.
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Ask Our Sleep Technologist
Question 1: What are the symptoms of sleep apnea?
Stopping breathing in your sleep, snoring, fatigue and feeling sleepy during the day and high blood pressure
Question 2: What is sleep apnea?
Sleep apnea is the reduction of airflow to the lungs during sleep. This may be due to obstructive sleep apnea (OSA), where the soft tissues in the throat collapse and block the air passage, or to central sleep apnea, where the brain fails to signal the body to breathe. OSA sufferers constantly battle to breathe and are restless throughout the night, seldom achieving refreshing sleep.
Question 3: Why should sleep apnea be treated?
Numerous severe health problems are caused by or associated with the condition. To avoid increasing your risk of high blood pressure, heart disease, stroke and motor vehicle accidents and work-related accidents, it is vital that the disorder be correctly diagnosed and effectively treated.
Treatment will reduce snoring, which is often troublesome to others, and lack of productivity due to poor concentration and sleepiness can be reversed.
Question 4: How is this diagnosis made?
A study and thorough observation of your pattern of sleep, breathing, snoring, oxygen levels, heart rate and body movements is made during an overnight test in a dedicated sleep laboratory.
Treatment will reduce snoring, which is often troublesome to others, and lack of productivity due to poor concentration and sleepiness can be reversed.
Question 5: What is involved and who performs the sleep study?
Before the study, sleep clinic staff will make an appointment with you to discuss all your symptoms in detail, explain how the test is done and assist you with arrangements with your medical aid.
Dedicated technologists perform the sleep study during the night of investigation.
The specialist sleep physician will interpret the results and explain them to you the following morning and suggest various methods of treatment with you.
Question 6: WHow is sleep apnea treated?
Therapy is done by means of Continuous Positive Airway Pressure (CPAP). A device delivers a small amount of air pressure to your airways while you sleep, thus maintaining an open airway passage.
If obstructive sleep apnea is diagnosed during the overnight sleep study, a repeat sleep study will be arranged, this time with the assistance of CPAP, to determine what the optimum air pressure for your level of seriousness would be.
Question 7: How do I make an appointment?
Contact your local doctors and discuss your problem or contact us directly.