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Q1 / 2021
Sleep has been scientifically proven to improve almost every area of our lives Lisa Artis Deputy CEO, The Sleep Charity
Sleep disordered breathing is a health burden Dr Aditi Desai President, British Society of Dental Sleep Medicine British Academy of Dental Sleep Medicine
It’s time to see sleep for what it is - a provider of mental health and wellbeing Professor Colin A Espie PhD, DSc, CPsychol, CSci, FBPsS, FRSM, FAASM
Full campaign on www.healthawareness.co.uk
Professor of Sleep Medicine & Senior Research Fellow, Somerville College, University of Oxford
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Sleep is a vital part of health. Jazz Pharmaceuticals supports the medical and patient community in deepening our understanding of sleep disorders and working towards a healthy future. March 2021 | UK-JPC-2100005
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IN THIS ISSUE
04 8 million people in the UK suffer from obstructive sleep apnoea (OSA). Kath Hope, Founder & CEO, Hope2Sleep Charity
How to protect your sleep
06
Self-care is important for a healthier, happier life. In difficult times, it’s easy to neglect our physical and mental health but we must make it a priority.
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hen we talk self-care, we talk about the actions you can take to develop, protect, maintain and improve health and wellbeing. Our daily lives can play a big impact on our overall wellbeing both positively and negatively.
Seeing a sleep specialist is the best way to understand your sleep. Dr Allie Hare, Consultant Sleep Physician and Secretary, British Sleep Society
WRITTEN BY
Lisa Artis Deputy CEO, The Sleep Charity
On line Having poor mental health can affect your sleep, and not sleeping well can negatively impact your mental health. Stephen Buckley, Head of Information, Mind
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The best self-care starts with sleep Self-care can include lots of different things from taking a walk and eating well to spending time with family and friends and even investing in some ‘me time’. But the best selfcare routine starts with getting good quality sleep, which is fundamental to our wellbeing. In difficult times, it’s extremely important to safeguard your sleep. It has been scientifically proven to improve almost every area of our lives – from how you feel, look, behave and perform. When routines are disrupted it can affect how well we sleep. How to safeguard your sleep Our sleep isn’t always the same and certainly isn’t always ‘perfect’, depending on what’s going on with our lives and how well we look after ourselves. It’s not uncommon to have an odd night of unrest but it’s important this doesn’t become a regular occurrence. Making changes to daily lifestyle Start by having a good morning routine. Try to wake up at a similar time and avoid lengthy lie-ins to strengthen the body clock and where possible, expose yourself to natural
In difficult times, it’s extremely important to safeguard your sleep. It has been scientifically proven to improve almost every areas of our lives. light in the morning to suppress melatonin and boost alertness. Consider what you do during the day that may impact on sleep. For instance, if you are sensitive to caffeine, avoid it eight hours before bed so it doesn’t interfere with getting off to sleep. Exercise is great for sleep and for mental health but try to do it earlier in the day. Assess your bedroom environment and make sure it’s fit for purpose. You will sleep a lot better if your bedroom is cool, quiet, dark, clutter free and has a super comfy bed to get into! Don’t work from the comfort of your bed though – it should only be used for sleeping and sex. When it comes to a pre-bedtime routine, you need to look at ways to relax and de-stress. Some people like to read or have a warm bath, others may prefer to practice mindfulness or meditation. Whatever you decide, switch off your phone and ideally keep it out of the bedroom so you’re not tempted to check it one last time. Read more at healthawareness.co.uk
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Sleep your way to better health
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Major health benefits can be lost without something we often take for granted: sleep, the best medicine.
T Mr Michael Oko FRCS(Ed) FRCS (ORL-HNS) Consultant ENT Surgeon and Sleep Apnoea Specialist, Lincolnshire
Written by: Ailsa Colquhoun
What is sleep apnoea OSA is usually when your airways become partially blocked while you sleep, which you may not be aware of. Other symptoms include snoring, self-waking, multiple trips to the loo at night and loss of libido. During the day, you may find concentrating difficult or feel tired, which can be associated with depression, cause mood swings and then escalate to further difficulties in sleeping.
This condition - often dismissed as ‘just’ snoring – is, in fact, potentially fatal if not treated.
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Seeking a diagnosis or treatment for sleep apnoea often comes from family members concerned about their relative’s interrupted breathing. Mr Oko advises taking the sleep apnoea ‘STOPBANG’ questionnaire and comments “A score of three or more is concerning as this condition - often dismissed as ‘just’ snoring – is, in fact, potentially fatal if not treated.”. Mr Oko explains: “In severe cases, its effect on the body is akin to strangulation, which prompts a stress response from the body. Too much of this puts a strain on the heart.” He says that one in three people with severe sleep apnoea will have a heart attack or stroke and around 15% will die if left untreated; crucially, with treatment, risk numbers revert to a normal level.
Leaders in home respiratory care, Dolby Vivisol manage services for sleep-related breathing disorders including remote sleep diagnostics, treatment and equipment, such as MADs (Mandibular Advancement Devices) and CPAP therapy, with monitoring and compliance management. Patients’ treatments are fully supported by Dolby Vivisol’s team, working with leading physicians. Sleep your way to better health. Contact Dolby Vivisol at info@dolbyvivisol.com
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INTERVIEW WITH
he best thing you can do in preparation for your COVID-19 vaccine is to get a good night’s sleep. Flu studies show that your immune system is twice as likely to respond well to the vaccine if you sleep well. Sleep is vital to keep your immune system at its best. As Lincolnshire ENT surgeon and sleep specialist Mr Michael Oko says: “Before you get that all-important jab, make sure you sleep well”. This is often easier said than done. COVID-19, work worries, money concerns, home/family-life are common issues that affect sleep. Mr Oko says: “When you have anxieties, it is not surprising that you can’t fall asleep easily.” However, you could be suffering from a form of obstructive sleep apnoea (OSA).
OSA is twice as common in men versus women. Women going through menopause are also more likely to develop OSA yet tend to attribute their tiredness, headaches and general feeling directly to menopausal symptoms. Signs of sleep apnoea in children Three per cent of children have sleep apnoea. The signs can include restless sleep, night-terrors, bed-wetting and difficulty concentrating during the day. It is often confused with ADHD causing unnecessary consequences from the misdiagnosis. Treatment Lifestyle changes can help towards a better night’s sleep. Taking a gentle evening walk, practising yoga, a hot bath, listening to an audiobook on a timer and not going to bed too late are all important elements in sleep hygiene. Eating well and lighter evening meals, giving up smoking and drinking less alcohol, as well as making sure that mobile phones or similar devices are not used for 90 minutes before sleeping may be enough to reset your body. Studies show that the ‘blue light’ from the mobile device screens enormously reduce the ability for quality sleep. Apps are also available that focus on cognitive techniques to help reset sleeping patterns naturally.
A gentle evening walk, practising yoga, a hot bath, listening to an audiobook on a timer and not going to bed too late are all important elements in sleep hygiene. If treatment is required, it will start by visiting your GP who will be able to refer you to a sleep specialist. Referrals continue during the pandemic; the consultation can take place via video call and the equipment to perform a sleep study can be sent to your home. For adults, treatment may involve a breathing device called a CPAP (Continuous Positive Airway Pressure). This machine gently provides air into a mask you wear over your nose and mouth throughout the night while you sleep. For children, surgery in the form of removing tonsils is sometimes recommended. Diagnosis and treatment make a massive difference to whole families, says Mr Oko. “People describe it as “transformative”: everyone enjoys a higher quality of life and better relationships. Once everybody sleeps well, everybody benefits.”
Read more at dolbyvivisol.com/sleep
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Making good sleep a priority
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There has never been a more important time to address our sleep than in the middle of a pandemic.
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here has been lots of research done on how sleep deprivation weakens the immunity, increasing susceptibility to infections. The NHS also states “lack of sleep is bad for your health.” Lack of healthy restorative sleep can lead to weight gain, anxiety/depression, diabetes, low testosterone levels and libido, increases the risk of heart attacks, strokes and many other medical conditions.
WRITTEN BY
Kath Hope Founder & CEO, Hope2Sleep Charity
Don’t ignore the snore Snoring not just disturbs the bed partner, but also prevents the snorer getting good restorative sleep. However, before spending vast amounts of money trying to fix the snoring, it’s important to check the snoring isn’t the audible red flag warning you’re actually suffering from obstructive sleep apnoea (OSA). Whilst there are no reliable statistics on how many snorers have OSA, we do have recent statistics from 2018, published by the European Respiratory Society, that claim 8 million people in the UK suffer from obstructive sleep apnoea (OSA).
8 million people in the UK suffer from obstructive sleep apnoea (OSA). Health risks of untreated sleep apnoea The concern too is that 80% of these people remain undiagnosed. Although they know they snore, people have no idea they’re actually stopping breathing, resulting in their heart rate increasing and oxygen levels desaturating. In fact, sleep is neither safe nor restful! Don’t be fooled by thinking that only overweight people suffer from OSA as it can affect all sizes, sexes and ages, including children. Untreated sleep apnoea, and indeed sleep deprivation, actually exacerbates weight gain! Untreated sleep apnoea is a huge health risk, linked to heart attacks and strokes along with many other conditions like diabetes, high blood pressure, hypothyroidism and mental health. The good news is that it’s one of the few serious medical conditions that doesn’t even require taking lifelong medication. For more information, please visit Hope2Sleep’s charity website: hope2sleep.co.uk/sleepapnoea-information.html
Tackling the burden of sleep disorders WRITTEN BY
Dr Aditi Desai President, British Society of Dental Sleep Medicine British Academy of Dental Sleep Medicine
During these unprecedented times, while healthcare systems are overwhelmed and struggling to cope, there are other areas of healthcare that require attention on an ongoing basis.
O
ne such health burden is sleep disordered breathing, of which obstructive sleep apnoea (OSA) is the most common. The consequences of this disease are vast with overwhelming evidence to suggest that OSA patients are more vulnerable to the COVID-19 virus. The Dalai Lama once said: “sleep is the best meditation.” We must do all we can to help combat this disease and give our hospitals the help they need to focus on critical care patients. The role of dentistry in sleep health One might ask why I, as a dentist, write this editorial for a medical condition. As we move towards understanding the pathophysiology of this disease to provide a personalised model of care, it’s accepted that dentistry is uniquely placed to provide an alternative to CPAP. One such alternative is mandibular advancement devices (MADs), which help stabilise the airway during sleep. One of the main causes of airway collapse is the fatiguability of the tongue and airway muscles, which do not respond to stimulation as quickly as needed. However, while mechanical splinting of the airway with CPAP therapy and mandibular advancement devices remains the conventional route to treat these patients, alternative treatments
continue to emerge. Looking for alternative new treatments A newly emergent neuromuscular electrical stimulation (NMES) device has been shown in clinical trials to help patients at the snoring and mild OSA end of the disease continuum, who are either unable or unwilling to access and comply with conventional treatment methods. Patients often shy away from using any device over their face. The consequence of low compliance is low treatment efficacy. These devices are another solution for patients who do not want the burden of wearing something when they sleep. Ensuring support for all patients More patients have mild OSA than moderate or severe and more needs to be done to help those who may not be suitable for secondary care. So, one wonders if more patients were offered a daytime therapy device or a mandibular advancement device earlier, would it reduce the burden on our healthcare system in more ways than one? Economies of scale would suggest starting the treatment journey early can only be beneficial to those several millions affected. Contact at info@bsdsm.org.uk
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Shifting the burden of care in obstructive sleep apnoea Addressing obstructive sleep apnoea early: how to address an unmet need for patients without a tenable treatment option, while reducing the burden on the NHS.
O WRITTEN BY
Professor Adrian Williams FRCP AASM
Paid for by Signifier Medical Technologies
bstructive sleep apnoea (OSA) is universally appreciated to be extremely common, to some degree affecting 25% of middle-aged men and 13% of middle-aged women globally. OSA is of course also invariably associated with troublesome snoring, which has a huge additional impact on both the family dynamic and work productivity. It impacts on almost all body organs and, as a result, has many and varied effects often first seen in primary care, both by the general medical practitioner and dental practitioner. Early intervention in OSA With the ongoing COVID-19 pandemic, the push to lighten the burden on tertiary care has been accelerated. Moving the initial management of OSA to secondary and primary care is therefore a logical next step for earlier intervention, improving quality of life, reducing the risk of complicating medical conditions such as high blood pressure and diabetes and, most crucially, ensuring that the NHS is able
to work more efficiently and costeffectively. The collapse of the breathing passage, related to insufficient action of the ‘dilator’ muscles that keep the airway open, is the recognised origin of OSA. Hence, the almost universal approach to treatment, after usual behavioural interventions such as weight loss, is through the splinting of the upper airway either by positive airway pressure from continuous positive airway pressure (CPAP) or a dental mandibular advancement device. But in mild-to-moderate OSA, this is not commonly tenable, leaving many patients without treatment. An alternative approach is therefore appealing, especially one addressing a primary underlying factor, specifically the insufficient tone of the dilator muscles, including the tongue, that can lead to the breathing passage fully collapsing during sleep. The low-touch approach The advancement in material science and technology has allowed many new and exciting innovations in the field of
Sleep problems are easily treated for many people Sleep problems are ubiquitous in society, doubling over the last year as a result of living under lockdown conditions, cognitive behavioural therapy could be able to help those living with insomnia.
S WRITTEN BY Dr David Lee BSc PhD CertEd CPsychol AFBPsS CSci Founder and Clinical Director, Sleep Unlimited Ltd
Paid for by Sleep Unlimited
truggling to find a worklife balance has become an increasing challenge for many, with the ability to ‘leave work at work’ being diminished. Many people have been forced to take their work into their home, with many even bringing work into their bedrooms. There has been an obvious increase in anxiety over the last year, with increases in worry about health, work, finances and home-schooling. There has also been a reported increase in alcohol consumption, with 25% of adults in the UK admitting to drinking more since March 2020. Collectively, these societal and individual changes have caused this doubling of sleep problems. Cost of insomnia on society Insomnia was reported to cost the UK £35.5billion-, amounting to 1.86%
of our GPD by the RAND Institute in 2016. Inevitably these costs are set to increase and potentially double based on the population experience reported above. The NHS recommend Cognitive Behavioural Therapy for insomnia (CBTi) as the treatment pathway of choice to manage sleep problems, as there is a wealth of scientific evidence for its effectiveness, going back over 40+ years. Several well-respected reviews in the late 1990s and early 2000s indicate a level of effectiveness of CBTi at 70%. This is a fantastic ‘hit rate’ with seven in 10 people with a sleep problem being ‘cured’ after a relatively short (typically six, one-hour, weekly sessions) intervention period of CBTi. So, we have a large population of people in need of help with their sleep and an effective intervention in the form of CBT for insomnia,
Improving quality of life, reducing the risk of complicating medical conditions such as high blood pressure and diabetes and, most crucially, ensuring that the NHS is able to work more efficiently and cost-effectively. sleep therapies. One such device that is both clinically proven and low-touch, is the new daytime therapy for mild OSA called eXciteOSA, which uses neuromuscular electrostimulation applied to the tongue. From my practice’s experience, devices that are easy to use and utilise virtually connected technology are a potentially important part of the solution for a large number of patients with no current acceptable solution. As such, devices such as this one have significant potential to meet not only the NHS’s current COVID-impaired care commitments but future health and financial goals.
Signifier Medical Technologies’ new eXciteOSA device offers an innovative daytime therapy for patients with mild OSA. Multiple international clinical studies showed convincing evidence of substantial improvement in mild OSA and snoring. For more information, visit uk.exciteosa.com
Insomnia was reported to cost the UK £35.5billion-, amounting to 1.86% of our GPD by the RAND Institute in 2016.
where then is the problem? The issue that we face at the present time is an extreme paucity of suitably qualified and experienced health professionals to deliver evidence-based behavioural sleep medicine in the form of NHS approved and recommended CBTi. Bridging the gap In order to overcome the significant issue of sleep problems to us as a society, both at a population and at an individual level, we need to bridge the gap between the needs of the many and the effective intervention of CBT for insomnia. We can do this by training more health professionals in Behavioural Sleep Medicine and raising awareness and access to CBTi for the people that need it.
Please contact our friendly team of experts at info@ sleepunlimited.co.uk for information about training in CBTi, our assessment and treatment services for individuals and for health care professionals to access. Plus information on Sleep Apnoea and our oximetry service. Sleep Unlimited – Teaching the world to sleep for nearly 20 years.
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What happens in a sleep study?
Nature’s primary provision for mental health is our sleep WRITTEN BY
Seeing a sleep specialist is the best way to understand your sleep and what may be preventing you sleeping well. A sleep specialist can help give you the tools to develop healthy sleep for life, enabling you to wake refreshed, energised and positive. WRITTEN BY
Dr Allie Hare Consultant Sleep Physician and Secretary, British Sleep Society
I
n the first appointment, the specialist will ask detailed questions about your sleep and how you feel on waking. The clinician will also ask about the impact of your sleep problem on your daytime functioning, work and relationships. There will also be questions designed to determine whether you might have sleep apnoea, leg movements disturbing sleep (restless legs syndrome, or limb movements in sleep), a parasomnia (unusual behaviours in sleep), hypersomnia (an increased need for sleep) or another form of sleep pathology. Sometimes you will be asked to complete a sleep diary. This involves recording your sleep patterns for a two-week period, so that the clinician can understand your sleep in more detail. You may also be asked to complete questionnaires about your sleep.
Sleep studies are painless, non-invasive and involve wearing monitoring equipment attached to various points on your body during your sleep. Conducting the sleep study Once these initial assessments have been completed, the clinician will decide whether any special tests are required. A sleep study may be necessary. Sleep studies are painless, non-invasive and involve wearing monitoring equipment attached to various points on your body during your sleep. These monitor things like your heart rate, oxygen levels and breathing during sleep. Sometimes, video monitoring of your sleep may be required. The equipment is designed to be as comfortable as possible and most people sleep fine during a sleep study, but even if you do not sleep quite as well as you would normally, this should not affect the results. If you are asked to stay in a sleep laboratory, you will usually come to the sleep centre during the early evening. You will have your own room, designed to enable you to have a good night’s sleep. You will be encouraged to bring in anything which usually helps you sleep and wear your own sleepwear. You will then be invited back to the clinic to discuss the findings with your specialist and an individualised treatment programme will be developed to help improve your sleep.
Professor Colin A Espie PhD, DSc, CPsychol, CSci, FBPsS, FRSM, FAASM
Sleep is nature’s medicine, especially for our mental health. Most of the time, emotional and mental repair is going on completely without our awareness.
W
hat would be on your short-list of things that are crucial to good mental health? I immediately think of close relationships, a sense of purpose and sufficient resources. We might all agree on those, amongst other things. What advice would you give to someone needing help with their mental health? I expect we would listen and support that person, perhaps share a wellbeing strategy that has worked for us and suggest they should speak to a professional with a view to treatment or therapy. All of these things are hugely important.
Sleep is when our brain does its best work. Nature’s role in mental health However, there is something even more fundamental. Nature has put something in place for our mental health, and that provision is our sleep. Your brain is a shift-worker - there is so much essential development, repair and maintenance going on during sleep that it’s a whole night of work. Even evolution hasn’t managed to get it down from six to eight hours! You may think sleep is down time, respite from the busyness of the day, so that you can rest and recover. Sleep does all that as well. However, sleep is when our brain does its best work. Don’t you look forward to getting the kids off to school or settled down at
Professor of Sleep Medicine & Senior Research Fellow, Somerville College, University of Oxford
Sleep provides us with the emotional intelligence and the power of reasoning to live our lives. night, so that you can finally get on with things? If our brain was the parent it would say “You get yourself off to sleep now, I’ve got a whole load of things I need to get through in the next few hours”. Regulating our emotions One of the crucial functions of sleep is what we call ‘emotion regulation’. It is during sleep that our thoughts, feelings and experiences are processed, learned and stored for future use. Sleep provides us with the emotional intelligence and the power of reasoning to live our lives. Although it is good news that sleep is there for us, we need to do much more to recognise the importance of addressing sleep concerns. For too long we have seen struggles with sleep, like insomnia, as a symptom of other problems like depression, anxiety or daytime attentional and behavioural problems. It’s time to see sleep for what it is - a provider of mental health and wellbeing. Let’s make sleep a health priority and provide help that is evidence-based when people need it. Colin advised the Mental Health Foundation on its report “Taking Sleep Seriously”, published in 2020.
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How snoring could be a sign of sleep apnoea Sleep is important for your health and wellbeing. Sleep apnoea is a serious medical condition, with 80% of sleep apnoea cases undiagnosed. There are a number of misconceptions that exist around the condition.
I WRITTEN BY
Tony Keating CEO, ResApp Health
Paid for by ResApp Health
t’s one of the oldest cliches of modern life: one person lies wide awake with their pillow folded over their ears, while their partner, deep in slumber, unwittingly sends out thunderous vibrations like they’re trying to start a lawnmower in their throat. However, snoring can be a sign of something medically serious. Sleep apnoea is a disorder in which breathing stops and starts during sleep. It can also have serious health consequences that go beyond sleep deprivation and fatigue, like high blood pressure, mood imbalances, an impaired immune system and headaches. If left untreated, sleep apnoea can lead to depression, stroke, and cardiovascular disease later in life, as well as being seven times more likely to be in a car accident. There are a number of common misconceptions that exist around the condition which can lead to delays in seeking help:
Myth one: Snoring is harmless Snoring could be a warning sign that you may have sleep apnoea. Sleep apnoea is where your throat is partly or completely blocked, causing you to stop breathing multiple times during the night. Often, the sufferer is unaware of it happening during sleep. Untreated sleep apnoea can lead to an increased rate of stroke, depression, dementia, heart disease and motor accidents. Myth two: Sleep apnoea only affects men Women tend to be underdiagnosed with sleep apnoea as they may experience symptoms differently to men. Whilst sleep apnoea has been commonly linked to men snoring heavily, a recent study has shown that sleep apnoea occurs in 50% of females aged 20–70 years. Myth three: Only overweight people have sleep apnoea People of all sizes and ages can experience sleep apnoea. Obesity
Sleep apnoea is where your throat is partly or completely blocked, causing you to stop breathing multiple times during the night. is often a high-risk factor for sleep apnoea, however other factors may include age, type 2 diabetes and hypertension. Check your risk of sleep apnoea Before you rule out the possibility of sleep apnoea for yourself or your partner, check your risk. This can be done using ResApp’s SleepCheck app which listens to your breathing whilst you sleep. If you think you have sleep apnoea please consult your health care professional for advice to seek diagnosis and treatment.
Find out if there’s more to your snore. Z
ZZ
If you snore, suffer from tiredness or sleeping problems, you might have sleep apnoea. If you do, there’s treatment available, so the sooner you get a diagnosis, the better. SleepCheck is a cost-effective in-home check that will tell you if you’re at risk.
* Available on Apple iPhone and Samsung Galaxy S9, S10 and S20 phones. SleepCheck by ResApp Health is a CE marked medical device. For use on adults aged 18 years and above. ALWAYS READ AND FOLLOW THE INSTRUCTIONS FOR USE. This test is not intended to provide a diagnosis or a be substitute for a full sleep study. Please always consult with a registered healthcare professional.
by ResApp Health
SleepCheck is a clinically validated health app that can help determine whether you are at risk of sleep apnoea from the comfort of your own home. While you sleep, it will record your breathing and snoring sounds to assess whether there’s a risk of sleep apnoea. Download the SleepCheck app (Available on iPhone & Samsung phones for £4.99)
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BETTER SLEEP FOR YOU AND THEM ZEUS is small, unobtrusive, reusable and attaches underneath the chin with disposable adhesive stimulation pads.
Sleep is essential for a happy, healthy lifestyle, and yet chronic snoring affects over a third of the world’s population. A recent UK study found that approximately 90% of partners sleeping with a snorer have trouble achieving successful REM sleep and regularly struggle with sleep deprivation. What causes snoring? Snoring is incredibly common and develops from vibrations in your throat, mouth and nasal cavities as you breathe in and out. Your airways narrow when you are asleep, causing vibrations to occur more frequently.
hope2sleep Charity
Zeus are proud to be working with Hope2Sleep, the sleep apnoea and sleep support charity, for our product trials.
Renowned sleep expert Professor Joerg Steier & Morgan Innovation & Technology have collaborated to develop a new device to tackle snoring and improve the lives of snorers and their partners alike. Zeus is a sleek, non-invasive solution to prevent snoring and provide the wearer with a relaxed night’s sleep. It is a flexible, silicone device which sits underneath the wearer’s chin with adhesive pads and circulates gentle electrical currents to stimulate the snorer’s tongue muscle. This allows the airways to remain open and stop the vibrations which typically causes snoring.
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