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Sleep Care: Sleep Apnea

Sleep apnea is the cessation of breathing during sleep. During an apnea there is no airflow into or out of the lungs. Apneas can last from 10 seconds to more than 30 seconds and can occur hundreds of times throughout the night. 

This interruption of airflow prevents much needed oxygen from entering the bloodstream via the lungs and prevents the release of carbon dioxide, the body's waste product. When oxygen levels in the blood decline and carbon dioxide levels rise, the brain is stimulated.

The brain then signals the heart and the muscles in charge of respiration to work harder. As a result, there is an increased stress placed upon the body during each apnea. Sleep quality is also affected by the repetitive brain stimulations. These stimulations disrupt the sleep cycle by interrupting the deeper stages of sleep or by causing a complete awakening.

Apnea is a serious condition that can contribute to numerous other health problems such as hypertension, stroke, heart attack, impotency, and excessive daytime sleepiness.

There are three different types of sleep apnea, central, obstructive, and mixed. A central apnea (GSA) occurs when the brain fails to send a signal or stimulate the respiratory muscles. As a result of this brain malfunction, the respiratory muscles do not initiate inspiration and airflow to the lungs ceases. An obstructive apnea (OSA) is the most common sleep breathing disorder that is treated in the sleep lab. Once a person falls to sleep, the muscles throughout the body relax, including airway muscles. An OSA occurs when the airway has been obstructed and airflow has been partially to completely restricted. This obstruction can be caused by excessive tissue, enlarged tonsils, adenoids, or uvula or by the collapse of the airway due to muscle relaxation. Finally, a mixed apnea (MSA) contains both of these apneas together. There is a central apnea that usually occurs first and then the obstructive component that follows.

Who gets sleep apnea?

Sleep apnea can affect men and women of all ages. Although uncommon, children can also be afflicted by sleep apnea. The incidence of GSA increases with age. OSA is primarily seen in 35–50 year old men. However, the incidence of OSA increases once women reach menopause.

Approximately, every 1 in 100 people in America suffer from obstructive sleep apnea. Other predisposing factors include people who are overweight, those with anatomical malformations, and certain medications. Overweight individuals increase their risk for developing OSA because of the excessive adipose or fatty tissue that surrounds the airway.

This excessive tissue places extra weight on the airways, thus causing airway collapse once asleep. Anatomical malformations such as enlarged tonsils, adenoids, uvula, etc. may restrict airflow. Medications such as sleeping pills or other sedatives also increase the risk for sleep apnea by decreasing airway muscle tone.

What are the symptoms?

Those suffering from sleep apnea may experience different symptoms unique to their type of apnea. Symptoms that are common to all types include:

  • Excessive daytime sleepiness
  • Morning headaches
  • Depression
  • Lack of energy
  • Poor job/task performance
  • Restless sleep

Other symptoms unique to GSA include:

  • Snoring
  • Gasping for air
  • Morning dry mouth
  • Breathing pauses
  • Excessive night sweating

Individuals with GSA usually complain about difficulty sleeping throughout the night.

How do I find out if I have sleep apnea?

Diagnosis of sleep apnea requires an evaluation by your Physician and a visit to the sleep laboratory. The sleep study used to diagnose sleep apnea is the Polysomnogram. This test involves spending one to two nights in the sleep lab while having several different aspects of your sleep recorded and analyzed. Generally, the first night is used to establish and document the severity of your sleep apnea. The second night is needed to initiate and evaluate treatment.

 What are the treatment options for sleep apnea?

There are some general guidelines to follow for individuals with sleep apnea:

  • Practice good sleep hygiene habits.
  • Diet & exercise: Overweight individuals can benefit from the effects of weight loss and exercise. Weight loss may lessen the severity of GSA.
  • Avoid alcohol and smoking.
  • Avoid sedatives: Seek your Physician’s advice.
  • Sleep on your side or attempt to elevate the head of your bed.
  • Treatment options include:
  • Continuous Positive Airway Pressure (CPAP): positive pressure is generated by a small, quiet machine and transmitted to your airways via a small mask that fits over your nose. This positive pressure acts as a splint to keep your airway from collapsing and prevents obstructions. This device is usually small enough to fit on a nightstand and as quiet as a fan on low. The mask is specially fit to your face for optimal comfort. This is the most common treatment and is very effective.
  • Oral devices: these devices help to prevent obstruction in the mouth and upper airway. However, oral devices tend to be uncomfortable and ineffective in some patients.
  • Surgery: There are several types of surgeries that may help apnea, such as tonsillectomy, adenoidectomy, or corrective surgery to repair malformations. Uvulopalatopharyngoplasty (UPPP) is a surgery that involves the removal of excess tissue in the throat. Not all people benefit from this surgery.
  • Supplemental oxygen: Oxygen may be added for those with excessive low oxygen levels during sleep. Although this helps maintain healthy oxygen levels, it does not treat the underlying apnea.
  • Treatment options should be discussed with your Physician so that the best plan of care for you. For more information about sleep apnea and other sleep disorders please contact the Wayne HealthCare Sleep Lab at 937.547.5665.

 Other sources for more information about sleep apnea?

American Sleep Disorders Association
6301 Bandel Road #101
Rochester, MN 55901

National Sleep Foundation
729 Fifteenth Street NW
Fourth Floor
Washington, DC 20005

www.sleepfoundation.org