What is sleep apnea?
Sleep apnea is a sleep disorder in which a person’s breathing is interrupted during sleep. Approximately 18 million Americans have this condition, though many are not diagnosed with the sleep disorder. Oftentimes the person who suffers from it is not even aware their breathing is stopped or slowed during sleep; rather, they are told about their condition by others who witness it. They may also suffer from symptoms of this condition without knowing that is what they derive from. People with this condition often exhibit “excessive daytime sleepiness,” moodiness, depression, and a decrease in alterness. A polysomnogram (or sleep study) allows a sleep doctor or technician to diagnose the condition.
Sleep apnea can be classified in three different forms: obstructive, central, and complex or mixed. Of the three, obstructive is the most common form. Obstructive sleep apnea occurs when the windpipe collapses during sleep, blocking airflow. Once the brain recognizes that the blood oxygen level is falling, the person wakes up enough to tighten up the muscles and open the airway. Those with soft tissue and low muscle tone around the windpipe (often due to obesity) are at a high risk for obstructive sleep apnea. Daytime sleepiness, interrupted sleep and snoring are all symptoms of this form.
Central sleep apnea occurs when there is an imbalance in the brain’s respiratory control centers during sleep, causing an uneven respiratory rate which in turn causes the sleeper to cycle between apnea and hyperpnea. They start and stop breathing with no sign that they are struggling to breathe. When they regain their breath, their breathing may be faster in an effort to absorb more oxygen and rid the body of excess waste gases. This is sometimes referred to as Cheyne-Stokes respiration.
When people exhibit both of these forms, it is referred to as “complex or mixed.” Central apnea can sometimes develop if a case of obstructive sleep apnea is severe or chronic.
SLEEP APNEA SYMPTOMS
- Loud, disruptive snoring
- Gasping, choking during sleep
- Restless sleep
- Difficulty concentrating
- Excessive daytime sleepiness
- Morning dry mouth, headaches
- Depression or irritability
- High blood pressure
HOW IS Obstructive sleep apnea DIAGNOSED?
Although anyone can have obstructive sleep apnea (OSA), it is more common in obese men over 40 years old. The three factors which are most suggestive of OSA are: loud snoring disruptive to others, labored and obstructive breathing witnessed by others, and excessive daytime sleepiness.
While a patient's physical features and sleeping pattern raise the possibility of OSA, a formal sleep study in a lab or hospital is required to confirm the presence and severity of OSA.
Treatment depends on the type and severity. Mild cases may be treated with behavioral therapy, such as changing sleeping position or avoiding alcohol, cigarettes or sleeping pills. There are also dental appliances that can be used. CPAP machines are by far the most common form of treatment. Surgical treatment may also be a possibility.
WHY DOES OSA REQUIRE TREATMENT?
One common problem associated with OSA is heroic snoring which is extremely disruptive to bed partners and others. Admittedly, this snoring is more of a social problem than a medical problem.
Because OSA disrupts the quality of your sleep, another potential problem is excessive daytime sleepiness. For example, you may feel tired every morning, experience frequent fatigue, have difficulty concentrating or even doze off at inappropriate times.
The third reason OSA warrants treatment is its potential contribution to high blood pressure and other cardiovascular problems. While studies have well established that OSA is one of many risk factors for high blood pressure, we still cannot quantify how much risk it is for any one person.
WHAT THINGS CAN I DO ON MY OWN TO HELP TREAT MY OSA?
The most important one is weight loss. While you do not have to be overweight to have OSA, obesity is a major determining factor in the development of OSA in most cases. Although long term weight loss is difficult to achieve, doing so is extremely likely to improve your OSA. In fact, studies suggest that a 10% weight loss is associated a 25% decrease in OSA severity.
Other conservative measures include
- avoidance of alcohol and other sedatives at night
- sleeping on your side by placing a large, wedge-shaped pillow behind you or even wearing a stuffed backpack to bed
- using a cervical pillow which keeps your neck in a neutral position, instead of a regular pillow which flexes your neck and possibly contributes to airway obstruction.
WHAT IS THE BEST TREATMENT OPTION FOR OSA?
Good question, but no good answer. There is no single best treatment for OSA. Instead, the treatment should be decided on a case-by-case basis taking into account the severity of your OSA, your own physical features and your personal preferences. Fortunately, lifestyle changes (ex. weight loss), CPAP (continuous positive airway pressure), oral devices and surgery offer multiple treatment options from which you can choose.