Sleep Apnea
By Alexander Golbin, MD, PhD
Sleep apnea is a breathing disorder occurring during sleep where an individual has recurrent episodes of stopping breathing (apnea) for short periods of time (10 to 30 seconds or more). These apneic episodes may occur as often as 20 to 100 times per hour in individuals with severe sleep apnea. These typically occur as one’s muscles relax while asleep and their tongue falls to the back of the throat or one’s throat tissue collapses while breathing in (obstructive sleep apnea). Apneas may also occur as a result of a disturbance in the brain’s breathing center (central sleep apnea). Sleep apnea is believed to affect at least 1 to 2% of the adult population, particularly males 30 to 60 years of age, but realize it is also seen in children and women.
This sleep disorder is a serious problem. Even though a person may not know they stop breathing at night, repeated apneic events cause disruptions of normal sleep. As a result of these disruptions, individuals become sleep deprived which leads to daytime sleepiness, fatigue, irritability, memory loss, and lack of energy. Furthermore, life-threatening reductions in blood oxygen level as well as heart beat irregularities may occur during these apneic events. It is also well known that apnea causes high blood pressure, early heart attacks and strokes.
Three common characteristics found in individuals with obstructive sleep apnea include being overweight or having a pear shaped abdomen, being a loud snorer, and being sleepy or fatigued. Snoring alone is a common finding in the general population, occurring in about 10 to 30% of all people. Not everyone that snores has obstructive sleep apnea. Individuals that snore loudly, however, and complain of persistent sleepiness warrant evaluation by a sleep specialist. A sure sign of having sleep apnea is having a cyclical snoring pattern followed by quiet or silent periods (apneic periods), which are then followed by a snoring or grunting episode as well as kicking or movement in bed (an arousal event). Because individuals with sleep apnea are not awake, and therefore are not aware of their sleep behavior, it is often the bed partner leading the person to seek medical attention as they observe this pattern of abnormal breathing during sleep. The only symptom sleep apneics may realize is not feeling refreshed in the morning or always feeling sleepy. Another feature for individuals with sleep apnea is falling asleep easily during inactive tasks such as watching television, reading, sitting in church or listening to a boring lecture or even at inappropriate times such as while at work, driving an automobile, or even while carrying on conversation with another person. Individuals may also experience morning headaches, a dry or sore throat upon awakening, forgetfulness, difficulty with concentration, being depressed, anxious, or irritable.
Proper treatment of sleep apnea may prevent or reverse the potentially life threatening consequences. The diagnosis of sleep apnea requires an evaluation by a physician who recognizes the symptoms found in sleep apnea. An individual suspected to have apnea should then undergo an overnight sleep study to evaluate their breathing pattern, blood oxygen level, and heart beat during sleep. The number of times a person stops breathing per hour, the duration of the events, and the affect they have on one’s oxygen and heart beat determine the severity of the apnea. A physician specializing in sleep medicine can decide whether a sleep test can be performed.
Treatment of sleep apnea is individualized and depends on the disease severity. General measures include weight loss, avoidance of alcohol or sleeping pills before bedtime, and treatment of any sinus problems. A positional device worn around the waist may be used to help minimize sleeping on one’s back, a position where apnea is often worse.
In the more severe cases of sleep apnea, a continuous positive airway pressure (CPAP) device is typically recommended for use. The CPAP device includes a nasal mask which the person wears to bed. This device provides a gentle column of air to the upper throat that acts to keep the airway open during sleep, preventing tissue collapse and eliminating the snoring and the apnea. The amount of air pressure required to treat sleep apnea will vary for different individuals. The treatment is very effective, but an adjustment period may be needed to get used to wearing the CPAP machine. In selected individuals not treatable by the above measures, surgical approaches may be useful.
It is important to realize that sleep apnea is a common disorder, that if untreated, may lead to poor health, persistent sleepiness and fatigue, social and psychological problems, and an increased risk of injury related to falling asleep while driving or in dangerous situations. If you suffer from loud snoring, have restless sleep associated with grunting or choking sensations have daytime sleepiness or fatigue, or a bed partner has observed episodes in which you have stopped breathing, consider a complete evaluation by a health professional that is experienced in the diagnosis and treatment of sleep apnea.
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