Sleep Apnea – Do You Have It?

What It Is

Sleep apnea, spelled ‘apnoea’ by our friends across the pond, is one of the most common sleep disorders in the United States. People affected by the disorder experience involuntary interruptions in their breathing, lasting at least 10 seconds, as they sleep. The word ‘apnea’ is of Greek origins and literally means ‘without breath’. Some patients stop breathing hundreds of times in the night sometimes for longer than a minute. This can seriously diminish the oxygen levels in a person’s blood and create poor sleep as the interruptions cause the body to awaken enough to breathe. Sources differ in the estimation but it is thought that over 22 million Americans are afflicted with this sleeping disorder. Unfortunately, many experts believe that a large number of people with the sleep disorder remain undiagnosed.

There are three types of sleep apnea.

Obstructive sleep apnea (OSA). This type is the most common form of sleep apnea and is caused by a block in the airway that is physically stopping the ability to breathe. It is often due to soft tissues and muscles relaxing at the back of the throat as a person’s body relaxes. A person with this type of sleep apnea may sound like they’re choking or gasping for breath. For the purposes of this article, we will focus mainly on this type of sleep apnea.

Central sleep apnea (CSA). Patients with this type of sleep apnea do not have a blocked airway but the brain fails to send signals to the body to breathe. This insinuates an instability in a person’s respiratory control center.

Mixed sleep apnea. As the name suggests, this is a combination of both obstructive sleep apnea and central sleep apnea.

Why It’s Bad

Untreated sleep apnea can lead to a plethora of consequences for the sufferer. These include:

• Disturbed sleep
• Fatigue
• Daytime sleepiness
• High blood pressure
• Stroke
• Heart disease
• Heart problems: failure, arrhythmia (irregular heartbeats), heart attack
• Diabetes
• Memory problems
• Depression
• Headaches
• Worsening ADHD
• Weight gain
• Mood problems
• Impotence
• Drowsy driving and motor vehicle crashes
• Poor performance, impairment, and underachievement in activities such as work and school

Risk Factors

Anyone can have sleep apnea, even children, but certain risk factors increase your likelihood:

• Men are more likely than women
• African-Americans, Hispanics, and Pacific-Islanders are the more likely than others
• Overweight
• Over 40
• Large neck size (greater than 17” for men and 16” for women)
• GERD
• Having large tonsils or tongue, or having a small jaw
• Nasal obstructions: deviated septum, allergies, sinus issues
• A family history of sleep apnea
• Smoking
• Drinking alcohol

Do I Have Sleep Apnea?

Sleep Apnea can present in a variety of different ways but below are some of the most common.

Symptoms:

• Loud snoring
• Waking up with a dry or sore throat
• Choking or gasping while sleeping
• Daytime sleepiness and fatigue
• Difficulty concentrating
• Morning headaches
• Irritability and mood changes
• Depression
• Sexual dysfunction
• Learning and memory difficulties, forgetfulness

Epworth Sleepiness Test

This is a short self-evaluation of a person’s daytime sleepiness. This is not a diagnosis but an assessment. You can take one by clicking this link.

STOP-BANG

Another self-assessment questionnaire for sleep apnea. This is just an assessment and not a diagnosis.

If you think you might have sleep apnea speak to your doctor or a sleep specialist. The only way to definitively confirm sleep apnea and the severity of it is through a sleep test called a polysomnogram (PSG).

At Integrated Neurology Services, our patients start with a clinical consultation. It is a critical first step in evaluating the patient. Based on the consultation the doctor may recommend a sleep test. We offer several types of diagnostic testing depending on the type of study needed.

Treatment

There are several options for treatment of obstructive sleep apnea depending on the severity and a patient’s situation.

Lifestyle Changes – Patients may benefit from some simple lifestyle changes but results may vary depending on the severity of their OSA. This can include things such as:

• Lose weight
• Exercise & maintain a healthy diet
• Stop smoking
• Avoid alcohol and sedatives
• Changing sleep positions and not sleeping on your back

Continuous Positive Airway Pressure (CPAP) – This is the most form of treatment is considered the gold standard. The patient wears a mask that allows for a continuous airflow to keep the passageway from being blocked while sleeping. Machines have gotten quieter and a wide variety of masks are available including full face masks and ones that just cover the nostril openings. Another type of similar machine is called a bi-level, or BPAP, where the airflow changes with a person’s breathing. These machines are most effective when consistently used and Integrated Neurology Services has a comprehensive compliance program to ensure our patients’ comfort and application of their treatment.

Dental Device – Patients with mild to moderate sleep apnea may consider having a specially trained dentist fit them for an oral appliance. This pushes the lower jaw forward opening the airway while one sleeps at night.

Surgery – Several types of surgery are available to help with obstructive sleep apnea. Nasal surgery corrects the problem of a deviated septum which may contribute to OSA. Uvulopalatopharyngoplasty (UPPP) cuts out the extra soft tissue to help free space in the airway. Mandibular maxillomandibular advancement surgery fixes some facial and jaw problems or throat blockage. Surgery can, however, be expensive and may not always lead to a permanent solution.

Inspire – A new device on the market that creates a mild stimulation to nerves that keep the airway open. It is inserted near the upper chest with wires that lead to the lungs and neck and it learns your breathing patterns. A trained doctor is able to program it externally and the patient has a remote to turn it on before bed.

It’s important to get a full night’s rest every night. If you feel that you may be suffering from any sleep disorder it’s best to discuss your concerns with your doctor and seek treatment, if diagnosed.