Sleep Apnea: More Serious Than it Sounds; More Prevalent Than You Think

The College of Physicians and Surgeons at Columbia University report that "twenty-four percent of adult men and nine percent of adult women, or more than 20 million Americans, are estimated to have some degree of obstructive sleep apnea. Of these, six million are estimated to have cases severe enough to warrant immediate therapeutic intervention."

What Is Sleep Apnea?

In sleep apnea, breathing pauses or stops during sleep for 10 seconds or more at least five time per hour of sleep. These pauses, called apneas, each last long enough so one or more breaths are missed, and occur repeatedly throughout sleep Each pause in breathing typically lasts 10 to 20 seconds or more and apneas can occur 20 to 30 times or more an hour.

Two types of sleep apneas have been defined: Obstructive Sleep Apnea (OSA) and Central Sleep Apnea. OSA is the most common and typically involves an obstruction or partial blockage in the airway. Central sleep apnea is rare, and is not a physical condition but rather one in which the brain fails to signal the muscles to breathe. Central sleep apnea usually occurs in people with either central nervous system dysfunction, after a stroke or similar event or in those with diseases like ALS and other neuromuscular diseases.

What Are The Risk Factors For Sleep Apnea?

If you are a 40 year old, overweight male, you are among those most likely to have obstructive sleep apnea. Keep in mind though, sleep apnea can affect anyone at any age, even children. Having a large neck size (17 inches or greater in men and 16 inches or greater in women) seems to increase a person's risk of having OSA, as does having large tonsils or an abundance of tissue in the back of the throat. In the case of enlarged tonsils or adenoids, removal may be the only treatment required to eliminate the condition. There also appears to be a genetic role involved in some people since it can run in families.

What Are The Symptoms of Sleep Apnea?

Some people with obstructive sleep apnea complain that they wake up with a very sore and/or dry throat. They may also occasionally wake up with a choking or gasping sensation and sometimes seem to wake themselves up with their own snoring. The most common symptom of sleep apnea is the loud snoring that sounds like a loud snort or choking sound. During sleep even though you try to breath automatically, enough air cannot flow into your lungs through your mouth and nose. Breathing stops, and the oxygen level in the blood drops. Upon waking, when normal breaths begin again, the loud snorting or snoring occurs.

Not everyone who snores has sleep apnea, and it's important to remember the some people with sleep apnea don't know they snore! In fact, a family member and/or bed partner may notice the signs of sleep apnea first. A less-talked about side-effect of apnea is the impact the snorting and loud snoring on the quality of sleep of those within earshot; not to mention the concern over whether or not the apnea sufferer will indeed take the next breath.

With sleep apnea your sleep is not restful because of the frequent occurrences of breathing pauses, many brief drops in the oxygen levels in your blood and moving in and out of deep sleep throughout the night. All of these cause poor sleep quality. Constantly waking because of upset sleep throughout the night causes sleepiness during the day and can impact work performance and routine day-to-day functioning due to diminished alertness and sleepiness.

Other symptoms, occurring separately or together may include awakening not rested in the morning, daytime sleepiness, including falling asleep at inappropriate times in extreme cases, morning headaches, limited attention and decreased interest in sex.

Unlike adults with sleep apnea, children with OSA are more difficult to recognize and diagnose. Though they have many similar symptoms such as daytime sleepiness, lethargy, poor attention and diminished judgment, the symptoms may also manifest themselves in failure to thrive (weight loss or poor weight gain), mouth breathing, enlarged tonsils and adenoids, daytime cognitive and behavior problems, including problems paying attention, aggressive behavior and hyperactivity, which can lead to problems at school.

Perhaps the most overlooked symptom of sleep apnea, and one of the least understood is that of clinical depression. Knowledge of the intellectual and emotional impact of sleep apnea by physicians, psychiatrists and psychologists may be important in making a correct diagnosis. Unfortunately not many of these health care practitioners consider the possibility of obstructive sleep apnea or another sleep disorder as possible cause of depression.

What If Sleep Apnea Goes Untreated?

Untreated sleep apnea can increase the chance of having high blood pressure, and in the some severe cases, leg swelling. Untreated sleep apnea can also increase the chance of heart attack, work-related accidents and driving accidents as well as academic underachievement in children and adolescents, as well as clinical depression in both children and adults.

How Is Sleep Apnea Diagnosed?

As with any medical condition, the health care practitioner takes a complete medical history, as the first step in diagnosing sleep apnea. Often, a survey that asks a series of questions about daytime sleepiness, sleep quality and bedtime habits is given. A thorough examination of the mouth, neck and throat is important to detect abnormalities that may predispose an individual to sleep apnea or other sleep disorder. Your doctor may order a sleep evaluation in a sleep disorder center and/or a referral may be made to an ENT (Ear Nose and Throat doctor) for further investigation.

A polysomnogram (PSG) is a multiple-component test used to diagnose sleep apnea that is conducted in a specially outfitted sleep laboratory, very much like a motel room. When you are dressed for bed, electrodes are glued to the scalp in order to record information about your sleeping experience. Information about specific physical activities while you sleep including physical activity and respiration rate is electronically transmitted and recorded. This information becomes data used by qualified professionals to determine if you do have sleep apnea. After the study is completed, the number of times breathing is impaired during sleep is tallied and the severity of sleep apnea is graded. Additional tests, often ordered at the same time as the sleep study may include echocardiogram to evaluate the function of the heart and thyroid function studies.

The diagnosis of obstructive sleep apnea in children is usually based on the characteristic symptoms and evidence of enlarged tonsils and adenoids and reported mouth breathing. Children suspected of having sleep apnea should be evaluated by a Pediatric ENT specialist for further evaluation and often a pediatric sleep study will be ordered.

How Is Sleep Apnea Treated?

Although many younger children with sleep apnea may not be overweight, if a child is overweight, weight loss is important for overweight children with obstructive sleep apnea. Other underlying medical conditions, especially allergies, should also be treated. The doctor may prescribe a nasal steroid to help improve nasal obstruction caused by allergies. In mild cases of sleep apnea, losing weight if you are overweight, and changing sleep positions to promote regular breathing may be all that is needed.

All overweight persons can benefit from losing weight. Those diagnosed with apnea should avoid the use of alcohol and sleeping pills, which make the airway more likely to collapse during sleep and prolong the apneic periods. If you smoke, quit. Cigarette smoke can increase the swelling of tissue in the upper airway which may worsen both snoring and apnea. In some cases where individuals have mild sleep apnea, the breathing pauses occur only when they sleep on their backs. In that case, merely switching to a side position may relieve the symptoms.

If these conservative measures are unsuccessful in stopping sleep apnea, or for those with more severe symptoms, continuous positive airway pressure (CPAP), a mechanical breathing system that involves the use of a specially-designed mask worn over the nose or nose and mouth at night, may be prescribed. CPAP prevents airway closure while in use, but when CPAP is stopped or used improperly, apnea episodes return. Other types of devices that vary in the way in which pressure is delivered are also available for people having difficulty tolerating CPAP.

Dental appliances, or oral mandibular advancement devices, can be made that help keep the airway open during sleep by preventing the tongue from occluding the throat and/or advance the lower jaw forward when one is lying down.

In the most extreme cases, or if relief is not found through the use of dental devices or CPAP, surgery may be performed. There are several types of surgery procedures, some of which can be done as an outpatient.

Because the symptoms of sleep apnea resemble other common disorders, many sufferers may go undiagnosed each year. Obstructive sleep apnea contributes a large number of serious health issues and can limit the quality of life for thousands of adults and children. It is important to discuss with your doctor all symptoms you are experiencing. Let the professionals determine the best course of action to diagnose OSA or any other medical condition.