Do you wake up tired after a full night’s sleep? Does your roommate or partner complain that you snore loudly every time your head hits the pillow? You might be in danger of doing more than just irritating those around you – you could have the deadly disease sleep apnea.

During sleep, your tongue, uvula, throat and jaw can align in such a way that your airway becomes blocked. If this happens, breathing can be interrupted, causing snoring and preventing valuable oxygen from reaching the brain! Not only does this interrupt your sleep and cause you to be fatigued and drowsy even after a full night’s sleep but also the loss of oxygen can result in serious conditions like heart disease! An event when breathing stops is called a sleep apnea and, if common enough, can cause real physical damage to the body. Sleep apnea affects more than twenty million Americans across the country. Like most sleep disorders, education about sleep apnea is not a priority and the disease can be left untreated for years. It is estimated that some 80% of sleep apnea patients are currently undiagnosed.

Read on to learn about the symptoms, causes, and treatment of the disease! Remember to always seek professional medical advice if you are concerned about the health of yourself or others. And remember – DROWSINESS IS RED ALERT!

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Symptoms of Sleep Apnea

The most important, and most easily diagnosed, symptom of sleep apnea is the characteristic snoring sound made by people with the condition. There are two key aspects of the snoring. First, the snoring should be loud and breathing should sound difficult and labored. Whenever breathing during sleep isn’t easy and natural, you may have a problem. More importantly, though, the snoring should stop after a period of time along with the sleeper’s breathing. During this time, no air is going into the lungs of the sleeper. After a few seconds, the sleeper will cough loudly and return to breathing and snoring. Dr. Dement has seen patients who have stopped breathing for several minutes!

Check out this video to see a sleeper with severely impaired breathing: https://www.youtube.com/watch?v=mjQdAf9cQBo. You can clearly observe that his breathing stops for upwards of a minute at a time. This is extremely unhealthy and can cause permanent bodily damage!

Frequently, sleepers won’t fully wake up after their coughing fit, but will continue to sleep after having held their breath for an extended period of time. Sometimes, however, the sleeper will wake up choking or gasping – this is a clear sign of sleep apnea. Because of the violent coughing at the end of each Sleep Apnea event, the sleeper may wake up in the morning with a sore throat, even if he or she never woke up during the night.

The amount of sleep apnea events you have per night defines the severity of your case of sleep apnea. The measurement used is the Apnea Hypopnea Index (AHI). This index counts the number of apnea (breathing too little) or hypopnea (breathing too much) events in one hour. The standard resting breathing rate is different for each person, but is around sixteen breaths per minute. An AHI score between 5 and 15 can be mild sleep apnea while 15-30 is significant sleep apnea – that is coughing nearly every two minutes.

Because people with significant or even mild sleep apnea disturb their sleep so frequently with bouts of coughing, many are unable to get truly restful and gratifying nights of sleep. Because of this, many victims of sleep apnea report feeling fatigued in the morning, even though they were in bed for a full night. They never got more than three minutes of sleep at a time! Not only does sleep apnea have the negative effects during the night when airflow is restricted to the brain, but it also manifests in the day through drowsiness. Plus, your drowsiness can have detrimental effects on your partner’s sleeping habits – both of you could be losing out on valuable sleep and the ensuing drowsiness could put you in danger the next morning, especially if you’re behind the wheel of a car. As always, keep in mind the mantra DROWSINESS IS RED ALERT!

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Causes of Sleep Apnea

There are three types of sleep apnea: Obstructive, Central, and Complex. All three of them manifest in similar symptoms (as listed above).

Obstructive sleep apnea is the most simple – the construction of the jaw, mouth, and airway makes the individual prone to blocking the airflow during the night. That can be due to large tonsils, tongue, or uvula or a small throat or jaw. Obesity is a risk factor here, as well. As the airway gets smaller, it takes more effort for the diaphragm to suck air in and out of the lungs. Obese people have larger stomachs and chests, which put additional strain on the lungs and limit the airflow. Having a weak throat can be problematic here, too. When the airway gets restricted, the diaphragm can actually suck the windpipe closed, rather than move air down into the lungs. This is just like a vacuum that is too powerful for its narrow tube (see below!).

Image Credit: http://www.end-your-sleep-deprivation.com/images/vacuum-illustrates-cause-of-sleep-apnea.jpg

Central sleep apnea is different in that neurological and psychological issues cause the effects of sleep apnea, rather than the airway being physically blocked. All appears to be normal in the patient, but during sleep their brain doesn’t tell the diaphragm to breathe like it normally should. Central sleep apnea is much less common than its obstructive counterpart, and it may occur as a result of other conditions, including cardiac conditions like heart attacks and strokes. It has also been demonstrated that sleeping at high altitudes can cause central sleep apnea. This version is harder to diagnose, as the snoring patterns that are so obvious in obstructive sleep apnea are much more difficult to spot in patients with central sleep apnea.

Finally, complex sleep apnea or can be understood as a combination of both central and obstructive sleep apnea. For this reason, it is also caused mixed sleep apnea. The Mayo Clinic found a group of patients who had sleep apnea and confirmed that not only was there a physical blockage in their airways but when that blockage was eliminated, they continued to have apnea events – meaning that their brains was not sending the correct signals to the muscles that control the lungs.

Overall, age, gender, alcohol use, and family history can all be contributing factors that cause Sleep Apnea. As you get older, the likelihood of sleep apnea emerging increases. In addition, men are diagnosed with sleep apnea at a rate four times that of women. Alcohol use, especially before bed, can also precipitate sleep apnea events. There are also studies that show family history and certain racial or ethnic groups playing a role in a patient having sleep apnea.

Diagnosis of Sleep Apnea

If you think that you could have Sleep Apnea, your first hints will probably be from your roommate or partner – they’ll probably complain about you snoring. Make sure to ask them if you exhibit the telltale sounds (consistent snoring punctuated by breathless seconds followed by strong coughing). You also could feel tired during the day because you aren’t getting enough sleep. If drowsiness affects your day-to-day life, it’s time to see a sleep doctor.

A sleep specialist has a few options with which to diagnose you. First, you can try an in-lab Polysomnography. That is an overnight sleep study where doctors will take recordings of your breathing, heart rate, oxygen saturation, and brain waves. By using these measurements and video and audio recordings of your sleep, the doctor can get a conclusive understanding of exactly how sleep apnea is affecting your nights.

Alternatively, the sleep specialist can send you home with a home sleep test. The home sleep test is similar to the lab test, but records fewer metrics and can be performed in your own bed in your own home. As medical devices become smaller and more portable, home sleep tests can become more and more available to patients across the country. There are websites online that strongly advertise their home sleep test kits for sleep apnea.

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The doctor can consider other diagnoses and it’s important to realize what the other conditions you may have are. Some are: chronic insufficient sleep, nocturnal panic attacks, or just simple snoring. Without consulting a medical professional, it will be impossible to know exactly how your sleep is touched by sleep disorders.

Treatment of Sleep Apnea

There are a handful of treatments for sleep apnea! Some are more involved than others, but it is good to know all of the options. First, a simple recommendation is to sleep on your side. With obstructive sleep apnea (the most common type), it is easier for your airways to stay open if you are on your side. When Dr. Dement was first researching Sleep Apnea, they would sew tennis balls into the backs of the pajamas of patients with the condition – that’s a quick way to train someone to sleep on their side! There are still devices like this that try to position you on your side for the full night.

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There are also simple devices to improve your airflow by manipulating the position of your nose or jaw. Depending on the root cause of your Obstructive Sleep Apnea, different mouth guards or nosepieces may help to keep your airway open at night. Some mouth guards will keep your mouth slightly open or your tongue out of the back of your throat where it could block your airway. These Mandibular Advancement Devices jut your jaw forward so as to open the airway more overnight.

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One treatment that is more intensive is surgical. Oral surgeons can change the structure of your nose, jaw, or throat to make sure your breathing can’t be impaired overnight. This is obviously a big step to take, but years of getting bad sleep can be extremely detrimental both physically and mentally. Sometimes, however, the effects of a surgery diminish overtime and lots of the soft-tissue removing surgeries may not be permanent fixes. However, this may be the recommended path from your medical physician.

Finally, a mechanical option is a device called the CPAP – Continuous Positive Airway Pressure. The CPAP machine is a ventilator that connects to a mask that fits snugly on the face. It constantly forces positive pressure into your airway so that your throat cannot close up over the night, causing an apnea event. This is the number one most recommended available for Sleep Apnea. However, committing to using the CPAP machine nightly requires a strong commitment from you and your partner. There are lots of people who quit using the machine and find the mouth devices much more user-friendly, but with a less-conclusive positive result.

Photo Credit: http://upload.wikimedia.org/wikipedia/commons/7/7f/CPAP.png

Conclusion

Millions of Americans across the country have been diagnosed with sleep apnea and millions more remain undiagnosed, some even unaware of the disease. If your partner or roommate complains of loud snoring and you feel tired every morning, you may have sleep apnea, too! Go see a sleep specialist, as she or he will be the only person who can conclusively diagnose you and treat you for this deadly disease.

Sources

http://www.mayoclinic.org/diseases-conditions/sleep-apnea/in-depth/cpap/art-20044164

http://www.sleepapnea.org/i-am-a-health-care-professional.html

http://emedicine.medscape.com/article/295807-differential

http://www.helpguide.org/articles/sleep/sleep-apnea.htm

Dement, William C. and Rafael Pelayo. Dement’s Sleep and Dreams. Published independently 2015.

http://www.sleepapnea.org/