Are you feeling sleepy all the time? Do you snore? Is your doctor having a
difficult time treating your high blood pressure? If you answered “yes” to any of
these questions, then you might have Sleep Apnea (also called Obstructive Sleep
Apnea or OSA).
Sleep Apnea is a condition involving pauses or decreases in breathing during sleep.
It is usually due to airway collapse. This collapse occurs in the nose and/or the
throat – anywhere from where air enters the nostrils to the back of the tongue.
Imagine a straw collapsing when trying to suck on a thick milkshake. Frequently,
this airway collapsibility problem is inherited and starts in childhood. In the
daytime, it is not a problem because there is good muscle-tone in the airway and
the brain monitors breathing. But at night, the throat muscles become relaxed and
the brain is not as attentive to the airway. So on inhalation, the airway walls can
either completely collapse or significantly narrow. This is a problem because 1) the
body must struggle to breathe and 2) the brain has to “wake up” to reopen the
airway.
These frequent awakenings lead to fragmentation of nighttime sleep. You may not
remember them because they are so short. In fact, patients with sleep apnea can
wake-up more than 30 times an hour and think that they slept uninterrupted
through the night. Since sleep must be continuous and consolidated in order to be
restorative, a number of cognitive problems can occur with sleep fragmentation:
daytime sleepiness, memory problems, concentration difficulties, emotional
instability, irritability, slowed reaction time, and most importantly, an increased risk
of motor vehicle accidents.
There are also cardiovascular consequences of this constant “struggling to breathe.”
This puts a strain on the heart and blood vessels, leading to increased risk of high
blood pressure, heart disease and stroke.
Finally, there are social implications to Sleep Apnea. The snoring associated with
sleep apnea can disrupt the sleep of others. In fact, one study showed that when a
person treats his/her sleep apnea, the sleep partner gets the equivalent of one hour
more sleep per night.
Sleep apnea is a progressive disease and often gets worse with age. Weight gain,
alcohol, and other sedating/relaxing substances exacerbate it.
Who Gets Sleep Apnea?
A common misconception is that only overweight men that snore loudly have sleep
apnea, but the facts are:
1) Sleep apnea can occur without snoring
2) Thin people can have sleep apnea
3) Women can have sleep apnea
4) Children can have sleep apnea
In other words, anyone can have it. Even skinny women. Even children.
I Think I Might Have Sleep Apnea, How Do I Find Out If I Have It?
Make an appointment with your primary care physician, or if your insurance allows
it, go straight to a sleep specialist. If your physician thinks you might have sleep
apnea, then he/she can refer you for a sleep study or comprehensive sleep
evaluation.
How Is Sleep Apnea Treated?
There are four main categories of treatment for sleep apnea: Continuous Positive
Airway Pressure (CPAP), Surgery, Oral Appliances, and Behavioral Modification.
The most effective way to treat sleep apnea is with CPAP. CPAP is a mask worn over
the nose attached by a hose to an air compressor. The air compressor gently and
quietly blows room-air into the nose, which “stents” the airway open, preventing
airway collapse. This is the most effective way to treat sleep apnea, and all patients
diagnosed with sleep apnea should at least try it before considering other options.
Surgery can be an effective way to treat sleep apnea. A number of different
procedures can be performed. These range from nasal septum repair to jaw
reconstruction. Talk to your doctor about whether surgery is the right option for
you.
An oral appliance is a device made by a dentist or an orthodontist designed to pull
your lower jaw forward. By pulling your lower jaw forward, the tongue is pulled
away from the back of the throat. If your airway obstruction is occurring behind the
tongue, then this can be an effective way to treat your sleep apnea. The treatment
of sleep apnea with oral appliance should be a coordinated effort between the sleep
physician, the dentist/orthodontist, and the patient.
Behavioral modifications can help in the treatment of sleep apnea, but are usually
the least effective. These include such techniques as weight loss, sleeping on your
side, and avoiding alcohol before bedtime.
None of these treatment options is ideal, but they all can be useful in treating sleep
apnea and resulting in more restful sleep. With risks like heart attack and stroke,
you should do everything you can to get your sleep apnea under control. If you
think you have sleep apnea, contact your doctor or go to a sleep center. It could be
the best decision you ever made.
