Sleep Apnea

 

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Good quality sleep is important to maintaining good health. Specific types of mental and physical restoration occur only during sleep periods, and research is associating specific physiological maintenance activities with specific sleep stages. Disruption of sleep, therefore, has been recognized as detrimental to such natural repair and restoration. There are more than 80 sleeping disorders that have been medically identified, according to the American Academy of Sleep Medicine. Several of these fall into the category of Sleep Disordered Breathing. Sleep apnea is one of the most prevalent of the breathing disorders of sleep.

Sleep apnea is a sleep disorder in which the sleeper stops breathing for periods of up to two minutes, caused by obstructions to the movement of air in the upper respiratory passages. These obstructions occur when the muscles in the throat relax and collapse in on themselves as the sleeper reaches deeper levels of sleep. The person then stops breathing, wakes up to a lighter level of sleep and begins breathing again. The cycle keeps the person from ever reaching the deeper levels of sleep. Generally, the patient does not remember these breathing interruptions and feels tired and not refreshed after waking up, even though he may have slept through the entire night.

Sleep apnea is a potentially life-threatening condition that can cause or contribute to heart attack, stroke, impotence, high blood pressure (hypertension) and heart disease. More than half of all people with sleep apnea are first diagnosed at age 40 or older, and men are more likely to develop the disorder. Extremely overweight people have a greater risk of developing apnea also.

There are three primary types of sleep apnea.

• Obstructive Sleep Apnea Syndrome (OSAS) is when the airway is obstructed or “collapses” to some extent during sleep, usually caused by muscle tone loss of the throat tissues and soft palate, often worsened by weight gain.

• Central Sleep Apnea Syndrome (CSAS) occurs when respiratory effort ceases intermittently during sleep. CSAS is failure of the nerve pathways that actuate respiratory effort and causes airflow to decrease or stop.

• Mixed Sleep Apnea Syndrome (MSAS) occurs when the combination of a collapsed airway and cessation of chest and abdominal effort happen during disordered breathing events. MSAS apnea is where Polysomnogram identifies both CSAS and OSAS as causes of airflow decreasing or stopping.

Apneas are disorders that often are hidden, and the patient may not be aware of unhealthy effects for some years. Even then, the gradual progression may lead the patient to dismiss changes as normal aging. A common initial patient complaint is Excessive Daytime Sleepiness (EDS).

Failing to recognize excessive sleepiness can have serious consequences. It is dangerous to operate machinery if you are excessively sleepy. Sleep apnea sufferers are two to five times more likely to have car accidents than those without the disorder, for example. Work-related accidents also are significantly more common among these sleep-deprived people than in the general population.

Other warning signs include persistent loud snoring, snoring interrupted by pauses and gasps or choking sounds and cessation of breathing usually followed by a loud snort after which air refills the lungs. Bed partners observing these last few events often are frightened by the “want of breath,” which is the translation of the word apnea (Greek). Other warning signs include decline of powers of concentration, forgetfulness, irritability, anxiety and even clinical depression.

Sleep apnea is best identified by medical evaluation. A Polysomnogram (PSG) may be indicated, which records the body’s activity during sleep.

Common Sleep Apnea Symptoms

Apnea can cause oxygen levels in the bloodstream to fall. Years of apnea often result in cardiopulmonary complications, according to the National Institutes of Health. Years of nightly oxygen decreases can cause temporary changes in blood pressure and heart rhythms as the body attempts to stabilize itself during sleep. After a period of time, these changes can be more persistent, resulting in progressive heart disease and high blood pressure, among other problems. The following symptoms may be present.

• Excessive, unexplained tiredness during the day
• Loud snoring
• Morning headache
• Episodes of obstructed breathing during sleep (often noticed by a bed partner)

Sleep Apnea Treatment Options

There are several treatments available for sleep apnea.

• Behavioral changes, including sleeping on the side, losing weight and avoiding alcoholic beverages.

• Dental appliances that bring the jaw forward, elevate the soft palate or keep the tongue from falling back and blocking breathing passages.

• Use of a continuous positive airway pressure (C-PAP)—a machine that blows air through a mask into your nose, helping keep airways open and unobstructed.

• For more serious sleep apnea problems, surgery may be recommended.

The UT Sleep Disorders Center at UT Medical Center offers sleep evaluations performed by diplomats of the American Board of Sleep Medicine. The Sleep Laboratory has a staff of technologists registered by the Board of Registration of Polysomnographic Technologists.

For more information, call the Knoxville UT Sleep DIsorders Center at 865.305.8761.