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Sleep Care

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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. Sleep apnea is a serious condition that can cause numerous other health problems, such as hypertension, stroke, heart attack, impotency and excessive daytime sleepiness. There are three different types of sleep apnea: central sleep apnea (CSA), obstructive sleep apnea (OSA) and mixed sleep apnea (MSA). CSA occurs when the brain fails to send a signal or stimulate the respiratory muscles. As a result of this brain

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malfunction, the respiratory muscles do not initiate inspiration and airflow to the lungs ceases. OSA is the most common sleep breathing disorder that is treated in the sleep lab. Once a person falls asleep, the muscles throughout the body relax, including airway muscles. OSA occurs when the airway has been obstructed and airflow has been partially or 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, MSA contains both of these apneas together. A central apnea usually occurs first, and then the obstructive apnea follows. Who gets sleep apnea? Sleep apnea can affect men and women of all ages. Although it is uncommon, children can also be afflicted by sleep apnea. The incidence of CSA increases with age. OSA is primarily seen in 35-50 year-old men. However, the incidence of OSA increases once women reach menopause. Approximately 1 in every 100 people in America suffers from obstructive sleep apnea. Other predisposing factors include obesity, 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 the person is 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 of 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 OSA include: Snoring; Gasping for air; Morning dry mouth; Breathing pauses; Excessive night sweating. 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 and exercise. Overweight individuals can benefit from the effects of weight loss and exercise. Weight loss may lessen the severity of OSA. Avoid alcohol and smoking. Avoid sedatives. Seek your physician’s advice. Sleep on your side or attempt to elevate the head of your bed. Continuous Positive Airway Pressure (CPAP): Positive air 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. Oral devices: These devices help 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 sleep 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 excessively 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 can be developed.

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