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About Sleep Apnea

Tens of millions of people in the United States suffer from sleep apnea. This disorder affects between 5-10% of the entire adult population and 3-4% of the pediatric population. Unfortunately, 80% of those with sleep apnea remain undiagnosed and suffer needlessly.

Sleep apnea is a breathing disorder that occurs during sleep where a person stops breathing anywhere from a few seconds to a few minutes. This can happen up to 30 times in a single hour.

The person unknowingly wakes up to start breathing normally again and quickly falls back asleep. As a result, the person suffers from sleep deprivation because they are waking up repeatedly throughout the night.In addition, chemical changes to the blood from repeated suffocation puts strain on the heart and vascular system. This can cause and worsen many cardiovascular disorders.

  • Types of Sleep Apnea

    There are several types of "under breathing" in sleep or sleep-related breathing disorders. Often more than one type is present but usually one type predominates an individual's condition.

    Obstructive Sleep Apnea (OSA)

    This is the most common type of Sleep Apnea and is caused by some type of constriction or narrowing of the upper airway passage. This is associated with snoring and snoring-type sounds.

    Central Sleep Apnea (CSA)

    This occurs when the brain’s signal to breathe is not sufficient. There is no snoring and little evidence of attempting to breath except that, upon waking from an episode, the patient may briefly hyperventilate by taking a few deep breaths. CSA is often exhibited in patients with a hypoactive thyroid.

    Sleep Related Hypoventilation

    For some period during sleep, the breathing becomes shallow and slow. This can be seen in certain inherent or acquired brain conditions such as stroke, Parkinson's, increased brain pressure, taking certain medications affecting brain function, or various types of congenital hypoventilation.

    Periodic Breathing In Sleep

    Periodic breathing, also known as cyclical hypo-hyperventilation, often seems very similar to central sleep apnea or sleep related hypoventilation. It is frequently seen in patients with heart failure or stroke, and usually results in a worsening of the underlying condition. Patients with kidney problems also often exhibit periodic breathing (along with other forms of sleep apnea) contributing to their sense of fatigue.

    Impairment of Breathing in Sleep Secondary to Medical Conditions

    • Asthma - Certain asthmatics exhibit deterioration of the of their asthma during sleep causing waking with shortened breath or cough.
    • Gastric Reflux – While awake, gravity helps keep excess stomach acid where it belongs. Upon lying down, the acid is more likely to leak back into the esophagus causing pain which can then disrupt sleep.
    • Heart Failure - The condition can often worsen during sleep causing labored breathing, obstructive or central apnea, and periodic breathing. This results in poor sleep quality and a feeling of fatigue and deterioration of heart function.
  • Consequences of Sleep Apnea

    • Feeling of tiredness, sleepiness, lack of energy.
    • Negative impact on brain and cognitive function and performance including memory problems, difficulty learning, irritability, mood problems, depression, and a high risk of driving-related accidents.
    • Increase in stress and stress-related hormones (cortisol and norepinephrine), which leads to metabolic changes including difficulty losing weight and poor control of diabetes.
    • High incidence and increased risk of high blood pressure, difficult to manage blood pressure, or hypertension, at a young age.
    • Increased mechanical impact of apnea imposes a high work burden on the heart causing thickening of the heart muscle and contributing to the development of systolic or diastolic heart failures.
    • Increased vascular wall inflammation, deposition of cholesterol, as well as increased blood coagulation, all causing a much higher risk of atherosclerosis and vascular disease, heart attack, stroke, and narrowing of the arteries.
    • Danger of cardiac arrhythmia (irregular heart rate) such as atrial fibrillation, dangerous ventricular arrhythmia, and slowing of the heart because of the high stress imposed on the heart.
    • Higher risk of pulmonary hypertension (elevation of the pressure in the pulmonary arteries).
    • Increased risk of blood clots.

    Associated Conditions

    If you have any one of the following conditions, there is a substantial likelihood that you have sleep apnea:

    • Sinusitis, nasal allergies, and congestion
    • Asthma
    • GERD, gastric reflux, and heart burn
    • Diabetes and diabetic neuropathy (nerve damage)
    • Obesity
    • Cardiovascular disease, hypertension, stroke, heart attack, heart failure, and irregular heart rate
    • Underworking thyroid
    • Vascular diseases of the eye
    • Droopy eyelids
    • Depression, memory loss
    • Attention Deficit Disorder and Hyperactivity specially in children
  • Signs And Symptoms Of Sleep Apnea

    • Family history of snoring, tiredness, and poor sleep
    • Snoring or irregular breathing during sleep
    • Restless sleep, difficulty going to sleep, or staying asleep
    • Excessive dreams or nightmares
    • Sleep walking or sleep talking specially in children
    • Bed wetting, especially in children
    • Waking up at night with palpitations, panic, shortness of breath, or sweating
    • Waking in the morning with confusion, disorientation, grogginess, headache, and dry mouth
    • Feeling tired or drowsy during the day
    • Excessive caffeine intake
    • Poor performance at work or school, including poor memory and concentration
    • Irritability, depression
    • Difficulty losing weight
  • Diagnosis of Sleep Apnea

    The cornerstone of the diagnosis of sleep apnea is a comprehensive medical history and examination. If sleep apnea is likely, the patient will need to undergo a sleep study with polysomnography (PSG) to confirm the diagnosis.

  • Treatment Options For Sleep Apnea

    Once a diagnosis of sleep apnea is made and confirmed by the appropriate testing, a clinical decision needs to be made regarding the treatment. In planning the treatment, the following factors should be considered:

    • Age, anatomy of the airways, presence or absence of nasal and sinus diseases, dental health (conditions such as overbite and underbite), mandibular joint disease.
    • Weight, presence or absence of conditions such as heart disease, pulmonary disease, diabetes, or hypertension.
    • Detailed characteristic of the sleep-related breathing disorders such as obstructive or central sleep apnea, sleep related hypoventilation, periodic breathing.
    • Presence and extent of daytime tiredness and/or sleepiness.
    • PPsychological factors such as anxiety or claustrophobia

    Before or along with initiating the treatment, it may be necessary to treat other conditions such as nasal and sinus disorders and anxiety.

    CPAP or BiPAP

    Positive airway pressure (PAP)is based on providing air pressure via a mask or tube to the upper airways or lungs to improve airflow and ventilation. This may be done through constant positive airway pressure (CPAP), bilevel positive airway pressure (BiPAP), adjustable positive airway pressure (APAP), and cervo ventilation. Your doctor will decide what treatment is best for you.

    Sleep Position Treatments

    Adjusting the patient's physical position during sleep through developing new habits or utilizing specialized pillows can open the airways and sometimes alleviate sleep apnea.

    Surgical Treatments

    The most commonly effective treatments consist of tonsillectomy and adenoidectomy in children. Surgical options may also be explored in adults. Surgical treatments may include nasal and septum surgery, surgeries involving tongue, or facial bones (mandible and maxilla). Surgery may also include operations on uvula, pharynx, and palate that form the soft airway passage (the tube) between the nose and mouth to the larynx.

    Dental Options

    Dental mandibular and tongue retaining devices can be helpful by keeping the tongue forward, thereby maintaining the upper airwayand preventing obstruction of the mandible. The successful and safe application of these devices, in addition to a careful assessment of the medical issue and sleep evaluation, also depend on an expert examination by a dentist trained in the field of dental sleep medicine.

    Weight Reduction

    While weight loss does not always eliminate sleep apnea, it often reduces the severity. If other forms of treatment are needed, weight loss often makes them easier to apply.

    Lifestyle Changes

    Sometimes, certain measures such as changing the body position during sleep, avoiding alcohol and sedatives, or appropriate treatment of coexisting medical conditions will significantly improve a patient's sleep apnea.