Sleep Facts Checker

There is a lot of online health information. In this information age that can be a great thing to provide individuals with health education. However, research has shown that online health information is often factually incorrect. Other times it is difficult to understand, incomplete, misleading or unclear. The great intentions of providing online health content can provide unintended consequences. We will attempt to analyze online content related to sleep apnea from commonly viewed websites. Our goal is to initiate a dialogue capable of increasing the overall quality of online content related to sleep apnea and other sleep disorders.  The fact-checker project was inspired when errors were noted on several Sleep Apnea Wikipedia pages. That is where we will begin.

Key to fact checking

Statements will be reviewed and broken down for analysis. Different elements or assertions will be graded in a scale from True to false and also provide for characterizing assertions that are unclear, misleading or incomplete.

True – Mostly True – Misleading – Incomplete – Mostly False – False.

Wikipedia Sleep Apnea Article

“Sleep apnea, also spelled sleep apnoea, is a sleep disorder characterized by pauses in breathing or instances of shallow or infrequent breathing during sleep. Each pause in breathing, called an apnea, can last for several seconds to several minutes, and may occur, by definition, at least 5 times in an hour. Similarly, each abnormally shallow breathing event is called a hypopnea. Sleep apnea is classified as a dyssomnia, meaning abnormal behavior or psychological events occur during sleep.” [version: 12/18/15]

1. Sleep apnea is also spelled sleep apnoea.

True or false: True but may be misleading and slightly incomplete, especially if you are located in the United States.

2.  Sleep apnea characterized by pauses in breathing or instances of shallow or infrequent breathing during sleep.

True or false: Mostly false.

Sleep apnea is a broad term that encompasses both central and obstructive sleep apnea. Obstructive sleep apnea may have complete or partial obstruction in breathing. So this is not exactly a pause to breathing nor is it infrequent breathing.  Central apnea, does include complete or partial pauses to breathing but only very rarely does it include infrequent breathing (in Biot respiration, usually secondary to opioid use). In more frequent types of Central Sleep Apnea, such as cheyne-stokes breathing patterns during sleep, breathing is frequent during sleep.

3. Pauses to breathing can last several seconds to several minutes.

True or false: Mostly false.

It depends on the definition of “several” which usually means greater than two. Pauses to breathing in apneas are defined by a duration of at least 10 seconds. But up to several minutes? I don’t know about that, maybe I should search wikipedia to see how long you can live without air? But seriously, rarely, if ever are apneas greater than 90 seconds. The average apnea in patients with obstructive sleep apnea is between 10 and 30 seconds. The average in central apnea depends on the type with the most common types including a length of less than 40 seconds or a length between 40 & 90 seconds.

4. Each pause in breathing, called an apnea, occurs by definition, at least 5 times in an hour.

True or false: Mostly true (Just false the way it is written)

If this statement sounds confusing to you, you aren’t alone. The definition of apnea does not include an occurrence of 5 times an hour. But what I think this person meant to say is that for a diagnosis of sleep apnea you need to have an average of 5 events per hour.

5. …each abnormally shallow breathing event is called a hypopnea.

True or false: Mostly True. Technically, false. Practically, misleading.

Each abnormally “shallow breathing” event may be a hypopnea. It could be an apnea as well. Alternatively, it may be neither.  Shallow is really just a bad term to use in this context because if it defines decreases to overall airflow (which is I believe how they want to use it) then apneas which are complete obstructions, technically may have a little bit of airflow and would then qualify as shallow. Similarly, hypoventilation which is not a form of sleep apnea, would also be a form of shallow breathing.

6. Sleep apnea is classified as a dyssomnia, meaning abnormal behavior or psychological events occur during sleep.

True or false: Mostly False

Is sleep apnea classified as a dyssomnia (Jeopardy music sounding)? Maybe. Sleep disorders are classified in different places. One of the major classifications come from the American Academy of Sleep Apnea who publish the International Classifications of Sleep Disorders (now in its third version). It isn’t classified as a dyssomnia over there. This already makes the statement misleading. The nomenclature of dyssomnia is found in the Diagnostic and Statistical Manual of Mental Disorders (now in its fifth version) published by the American Psychiatric Association. However, the definition advanced in this statement is not very relevant to sleep apnea. It cannot mean “abnormal behavior” or a “psychological event” in the context of sleep apnea. In medicine, the word psychological usually refers to, well, pychological disorders like depression. Behavioral problems refer to disorders like being obsessive compulsive or having a personality disorder. I don’t think it would be impossible to find a definition of “behavior” that includes breathing. But it just doesn’t make sense.

For a better description of sleep apnea please see the article on the American Sleep Apnea Society website.

Note 1: This review only includes the first paragraph of the article.

Update 1: After contacting wikipedia about these errors and attempting to make changes on their site, Wikipedia made the changes but failed to provide credit to the American Sleep Apnea Society. That’s OK. We aren’t in this business for recognition.

Wikipedia Microsleep Article

“A microsleep (MS) is a temporary episodea of sleep which may last for a fraction of a secondbor up to 30 secondsc where an individual fails to respond d to some arbitrary sensory input eand becomes unconsciousf.”

True or False: Mostly false

I have broken this topic sentence down into 6 assertions marked in superscripts “a” through “f.”

Mostly true, true, false, false, misleading, false or misleading.

a. Microsleep is temporary: Mostly True. It is transient, to be more precise.
b. Microsleep may last for a fraction of a second: True
c. Microsleep may last…up to 30 seconds: False. If it lasted for 30 consecutive seconds it would be sleep, not microsleep.
d. Microsleep is when an individual fails to respond: False. Failure to respond is not a requirement. It might happen as an outcome but if I wake you up and you respond you may still have been microsleeping.
e. Arbitrary sensory input: Unclear, therefore misleading. What is “arbitrary”? Arbitrary is defined as “based on random choice or personal whim, rather than any reason or system.” If it is measured in research then it has a reason and is part of a system. If it is in real time, while someone is driving and starts to head towards oncoming traffic, someone honking their horn is also not random. It has a reason.
f. Microsleep…and becomes unconscious. Mostly False or misleading. The word conscious may have different definitions, when used in conversation compared to in a scientific journal. Even variation might exist between different scientific publications. Even being asleep is not really being “unconscious.” In a broad sense, even in normal conversational usage, you might say someone who is very drunk and passed out is unconscious as when you try to wake them, they wont get up.

About the author: Dr. Michael Morgenstern is a board certified Neurologist, expert in Sleep Medicine and  founder of the American Sleep Apnea Society. He is Director of the Cedarhurst Sleep Center in Long Island, New York and also sees patients with neurologic conditions.