Carrie Fisher’s death linked to Sleep Apnoea and other causes

2016 was the year of celebrity deaths; a year that became infamous for the many the celebrity deaths that occurred in it. In essence, it became one of the most dreadful years for music fans, movie fans, and pop culture fans. But for people that take science fiction and nerd culture seriously, then the biggest loss of the year has probably got to be the acclaimed Star Wars actress Carrie Fisher, a.k.a. Princess Leia because of Sleep Apnea.

Fisher was one of those rare celebrities who was famous from birth, as she was already hounded by tabloids and paparazzi from an early age as the daughter of singer Debbie Reynolds (who passed away the day after her daughter). She became a geek icon forever in 1977, after starring as the galactic badass Princess Leia, but the actress had many other strings to her bow.

That gave her fame beyond the wildest dreams of many people, and she became a pop culture icon.

Carrie Fisher - Sleep Apnoea

Sadly, she passed away at the age of 60 on December 27, 2016. After finishing the European leg of her book tour, Fisher was flying on a flight from London to Los Angeles, where she suffered a medical emergency around fifteen minutes before the plane landed. She was rushed to Ronald Reagan UCLA Medical Centre but died after four days in intensive care. The exact circumstances around her untimely death were not known, however, the news of her death was surrounded by many questions that have now been revealed.

Her death certificate said in January that the 60-year-old, best known for her role as Princess Leia, had suffered a cardiac arrest. But in a statement, the LA coroner said the exact cause was unknown. Sleep apnea is a common condition in which a person stops breathing during sleep, either for a few seconds or minutes. As well as listing sleep apnea as a cause of death, the coroner’s statement cited other factors, including heart disease and drug use.

According to Nancy Foldvary-Schaefer, the Director of Cleveland Clinic’s Sleep Disorders Center, sleep apnea affects at least 9% of women and 24% of men. Many people are unaware they have it because it only occurs during sleep, so a family member or partner may be the first person to notice the signs. Left untreated, sleep apnea can increase the risk of high blood pressure, heart attack, stroke, obesity, and diabetes. It can also raise the risk of or worsen heart failure, increase an individual’s chances of work-related or driving accidents, and make arrhythmias (irregular heartbeats) more likely.

Fisher experienced a cardiac arrest on an airplane flight. As opposed to a heart attack, in which a blocked artery causes the heart to stop, a cardiac arrest involves a malfunction in the heart’s functioning. She fell ill and lived for four days, but it could be that her sleep apnea, combined with possible drug use including alcohol, worsened the event and made it harder for her to fully recover.

Now, you must be wondering “Why is my dentist talking about Carrie Fisher and Sleep Apnoea?”. Sleep apnoea has a big relation to bruxism, or as it’s more commonly known, teeth grinding. Obstructive Sleep Apnoea (OSA) is defined as the cessation of airflow during sleep preventing air from entering the lungs caused by an obstruction. These periods of ‘stopping breathing’ only become clinically significant if the cessation lasts for more than 10 seconds each time and occur more than 5 times every hour. This is something you must consider very important as it not only relates to your oral health but your general health state and could possibly save your life.

OSA only happens during sleep, as it is a lack of muscle tone in your upper airway that causes the airway to collapse. During the day we have sufficient muscle tone to keep the airway open allowing for normal breathing. When you experience an episode of apnoea during sleep your brain will automatically wake you up, usually with a very loud snore or snort, in order to breathe again.

People with OSA will experience these awakening episodes many times during the night and consequently feel very sleepy during the day: they have an airway that is more likely to collapse than normal.

What is Sleep Apnoea? (Sleep Apnea)

Obstructive Sleep Apnoea (OSA) is defined as the cessation of airflow during sleep preventing air from entering the lungs caused by an obstruction. These periods of ‘stopping breathing’ only become clinically significant if the cessation lasts for more than 10 seconds each time and occur more than 5 times every hour. OSA only happens during sleep, as it is a lack of muscle tone in your upper airway that causes the airway to collapse. During the day we have sufficient muscle tone to keep the airway open allowing for normal breathing. When you experience an episode of apnoea during sleep your brain will automatically wake you up, usually with a very loud snore or snort, in order to breathe again. People with OSA will experience these awakening episodes many times during the night and consequently feel very sleepy during the day: they have an airway that is more likely to collapse than normal.

Sleep Apnea

What are the Symptoms of Sleep Apnea?

People with sleep apnoea may complain of excessive daytime sleepiness often with irritability or restlessness. But it is normally the bed partner, family or friends who notice the symptoms first. Sufferers may experience some of the following:

  • Extremely loud heavy snoring, often interrupted by pauses and gasps
  • Excessive daytime sleepiness, e.g., falling asleep at work, whilst driving, during conversation or when watching TV. (This should not be confused with excessive tiredness with which we all suffer from time to time)
  • Irritability, short temper
  • Morning headaches
  • Forgetfulness
  • Changes in mood or behavior
  • Anxiety or depression
  • Decreased interest in sex

Remember, not everyone who has these symptoms will necessarily have sleep apnoea. We possibly all suffer from these symptoms from time to time but people with sleep apnoea demonstrate some or all of these symptoms all the time.

Diagnosing Sleep Apnea

OSA can range from very mild to very severe. The severity is often established using the apnoea/hypopnoea index (AHI), which is the number of apneas plus the number of hypopneas per hour of sleep – (hypopnoea being a reduction in airflow). An AHI of less than 10 is not likely to be associated with clinical problems. To determine whether you are suffering from sleep apnoea you must first undergo a specialist ‘sleep study’. This will usually involve a night in hospital where equipment will be used to monitor the quality of your sleep. The results will enable a specialist to decide on your best course of treatment. The ultimate investigation is polysomnography, which will include:

  • Electroencephalography (EEG) – brain wave monitoring
  • Electromyography (EMG) – muscle tone monitoring
  • Recording thoracic-abdominal movements – chest and abdomen movements
  • Recording oro-nasal airflow – mouth and nose airflow
  • Pulse oximetry – heart rate and blood oxygen level monitoring
  • Electrocardiography (ECG) – heart monitoring
  • Sound and video recording

This is a very expensive investigation, with few centers able to offer it routinely for all suspected sleep apnoea patients. A ‘mini’ sleep study is more usual, consisting of pulse oximetry and nursing observation. A home sleep study is becoming more popular.

Sleep Apnea Treatment

There are several forms of treatment for sleep apnoea. In mild and moderate cases weight loss and the use of mandibular advancement devices can be wholly successful. In moderate and severe cases mandibular advancement device or nasal continuous positive airway pressure (CPAP) are normally prescribed. CPAP is the gold standard treatment for OSA.

Central & Mixed Sleep Apnoea

OSA is the commonest form of sleep apnoea, (about 4% of men and 2% of women) but there is also a condition called Central Sleep Apnoea (CSA). This is a condition when the brain does not send the right signals to tell you to breathe when you are asleep. In other words, the brain ‘forgets’ to make you breathe. It can also be associated with weakness of the breathing muscles. The assessment for CSA is often more complicated than for OSA and the treatment has to be carefully matched to the patient’s requirements. There is also a condition called Mixed Sleep Apnoea that is a combination of both obstructive and central sleep apnoea.

What’s the relation between bruxism and OSA?

If you go to the dentist because of suspected bruxism, chances are they’re going to recommend a night guard. While you definitely need to have a night guard to protect your teeth from grinding, it’s just the first step of treating bruxism.

To treat bruxism you must go beyond the night guard and address what is actually causing your bruxism. There are many possible causes for bruxism that should be considered when seeking treatment, of those is sleep apnea – one of the leading causes for bruxism.

How do you treat bruxism?

In many cases, treatment isn’t necessary. Many kids outgrow bruxism without treatment, and many adults don’t grind or clench their teeth badly enough to require therapy. However, if the problem is severe, options include certain dental approaches, therapies, and medications to prevent more tooth damage and relieve jaw pain or discomfort. Talk with to our specialists find out which option may work best for you.

Sleep Apnoea - Bruxism

However, if you or your child has bruxism, your doctor may suggest ways preserve or improve your teeth. Although these methods may prevent or correct the wear to your teeth, they may not stop the bruxism:

Splints and mouth guards. These are designed to keep teeth separated to avoid the damage caused by clenching and grinding. They can be constructed of hard acrylic or soft materials and fit over your upper or lower teeth.

Dental correction. In severe cases — when tooth wear has led to sensitivity or the inability to chew properly — your dentist may need to reshape the chewing surfaces of your teeth or use crowns to repair the damage.

Other approaches

One or more of these approaches may help relieve bruxism:

Stress or anxiety management. If you grind your teeth because of stress, you may be able to prevent the problem by learning strategies that promote relaxation, such as meditation. If the bruxism is related to anxiety, advice from a licensed therapist or counselor may help.

Behavior change. Once you discover that you have bruxism, you may be able to change the behavior by practicing proper mouth and jaw position. Ask your dentist to show you the best position for your mouth and jaw.

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