Sleep Apnea

Introduction

Sleep apnea is a common and under-diagnosed sleep disorder. It causes repeated episodes of stopped breathing (apneic episodes) and startling or gasping for air during sleep. People with sleep apnea frequently do not realize that they have it. The consequences of untreated sleep apnea can be severe or life threatening therefore early diagnosis and treatment is essential. Sleep apnea may be treated or managed with lifestyle changes, use of a breathing assist device at night, or surgery.

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Anatomy

Sleep is vital for life, just like eating and breathing. Sleep allows your body to rest. It is believed that during sleep your brain performs important functions, such as storing memory and processing brain chemicals.

In a way, your body goes on “auto-pilot” while you sleep. Your brain regulates automatic functions for you, such as breathing, heart rate, and blood pressure. Although sleep is a complex process that is not fully understood, it is known that a good night’s sleep is important for optimal health and functioning.

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Causes

Sleep apnea occurs when breathing stops in repeated episodes during sleep. Apnea means lack of breathing. The majority of sleep apnea cases are caused by obstructions in the nose or throat that block a person’s breathing airway. During sleep, the airway muscles relax and the airway closes or is blocked.

Central sleep apnea is less common. It is caused by a low blood carbon dioxide level. Carbon dioxide is a powerful breathing signal and if it is too low, the brain fails to signal the lungs to breathe.

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Symptoms

People may have sleep apnea and not be aware of it. People with sleep apnea may stop breathing numerous times during the night and not fully awaken to realize it. In many cases, a household member is the first to notice that a person snores loudly, stops breathing for periods of time, and gasps or snorts during sleep. Daytime drowsiness, headache upon awakening, weight gain, depression, irritability, leg swelling, sexual dysfunction, and difficulty thinking or remembering may be signs of sleep apnea. Sleep apnea can contribute to high blood pressure, and researchers suspect that up to half of all people with sleep apnea have high blood pressure. Sleep apnea can contribute to stroke, heart attack, or death.

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Diagnosis

You should contact your doctor if you suspect that you have sleep apnea. Your doctor will examine your nose and throat for structural abnormalities. Your doctor may recommend a sleep study to help diagnose sleep apnea and determine its severity.

A sleep study may be performed at a sleep disorders clinic or in some cases, in-home equipment may be used. Polysomnography testing is used to record a variety of body functions while you sleep. During this test measurements of your brain activity, blood oxygen levels, airflow, heart rate, breathing, eye movements, and muscle movements will occur. A multiple sleep latency test may be used to determine how quickly you fall asleep. A multiple sleep latency test is helpful for identifying the extent of daytime sleepiness.

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Treatment

Treatment for sleep apnea depends on the cause and extent of the condition. Treatment may include lifestyle changes, use of an air device, dental appliance, and surgery. Some people may use more than one type of treatment.

Lifestyle changes may treat mild cases of sleep apnea and help reduce the number of apneic episodes for others. Achieving and maintaining a healthy weight can help. Even small weight loss amounts can reduce the amount of apneic episodes. You should avoid using alcohol, tobacco, sedatives, or sleeping pills. Additionally, it may be helpful to sleep on your side instead of your back.

Continuous positive airway pressure (CPAP) is the most common treatment for sleep apnea. CPAP entails wearing a device over the nose during sleep. The nasal device is connected to a small machine that creates airflow and gentle air pressure to keep the airway open. CPAP is an effective way to treat sleep apnea.

Dental devices are another method of treatment. Dental appliances are used to position the lower jaw and tongue during sleep. Such devices may be appropriate for people with mild to moderate sleep apnea.

In some cases, surgery may be used to increase the size of the airway. Common surgeries include removal of the tonsils, adenoids, and excess throat or palate tissue. Nasal surgery may be used to remove obstructions, such as polyps. Children appear to benefit more from surgery for sleep apnea than adults do.

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Prevention

You may be able to prevent sleep apnea by reducing the risk factors that you can control, such as maintaining a healthy weight and avoiding smoking, alcohol, and sedatives. Early diagnosis and treatment may help reduce the serious consequences that may result from sleep apnea.

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Am I at Risk

Sleep apnea most frequently occurs in people over the age of 40, although individuals of all ages, including children, may experience it. In adults younger than 65, sleep apnea is more common in African Americans than Caucasians. Sleep apnea is more common in the elderly and obese populations.

Risk factors for sleep apnea include:

• Being overweight, especially with a large collar (neck) size is a risk factor for sleep apnea. However, many people that are not overweight have sleep apnea.
• Consuming alcohol increases the risk of sleep apnea.
• People with blocked nasal passages, a large tongue, narrow throat, or other structural problems have an increased risk of sleep apnea.
• High blood pressure and other medical conditions are associated with sleep apnea.
• Sleep apnea appears to run in families, and researchers are studying a possible genetic pattern of inheritance.
• People that snore loudly are more likely to have sleep apnea than people that do not snore.

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Complications

It is very important to treat sleep apnea. Sleep apnea has recently been identified as a contributor to high blood pressure and other medical conditions. Sleep deprivation from sleep apnea can cause personality changes, hallucinations, and confusion. Sleep apnea can contribute to serious and life threatening medical complications, including stroke, irregular heartbeat, heart attack, and sudden death.

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Advancements

Recent research on sleep apnea is focused on the effects of signaling chemicals, called cytokines, that may be responsible for regulating immune responses to inflammation. Cytokines may be the reason we become more sleepy when we are sick. Sleep apnea increases the amount of cytokines circulating in the body. These cytokines, along with the poor quality sleep, may cause the daytime sleepiness seen in patients with sleep apnea.

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