There are several types of sleep apnea but, today we’re going to discuss the most common type, which is obstructive sleep apnea (OSA). It affects approximately 3-7% of the male population and 2-5% of the female population. This equates, in the US, to about 22 million Americans with approx. 80% of these people not being diagnosed yet. So, what’s going on?
Our society is not only on a 24-hour clock, where we are working odd shifts or overnight (which can affect our internal clock), but we are becoming a heavier society by our poor eating habits and our sedentary lifestyles. All of these things can lead to problems with sleep and/or obstructive sleep apnea. Obstructive sleep apnea is actually a mechanical problem in the airway.
Our airways are lined with “smooth muscle”. These muscles relax in the airway and cause it to narrow or collapse down on itself during sleep. This can be caused by extra tissue crowding the space, it could be that the airway is slightly crooked or the airway can be very narrow already. Some individuals have enlarged tonsils, an enlarged uvula, or a very large tongue, which can block the airway and lead to obstructive sleep apnea symptoms. But, usually, it’s from an increase in the individual’s physical weight. When we gain weight, we also gain it in the neck, belly, and chest area. This can put added stress on those areas and lead to collapse during sleep.
First, the person drifts off to sleep, as they do so, the muscles in their airway start to get relaxed and begin to collapse and the airway begins to narrow. You may hear some light snoring or noises coming from the individual. As the OSA patient drifts deeper into sleep, the airway narrows further or fully collapses. The light snoring may become loud and constant and it may be disrupted by gasps, choking and snorts, and ultimately a pause in breathing. If you were to be able to observe the person with no shirt on, you’d see the chest heaving, struggling to open the now blocked airway, but no airflow will be coming out of the mouth or nose.... this is the full collapse of the airway and called obstructive apnea. Sometimes, the person will wake themselves up with the snoring, but usually, they are awakened by low blood oxygen levels. The awakenings can go on hundreds of times during the night and the person will not even be aware that they have woken up that much. Prior to the “arousal” (when the brain is actually affected and changes to a different sleep stage or to wakefulness), the person was not breathing. This can be sustained for minutes and at that time is when the oxygen level in the blood starts to drop. It will drop to a certain level and then trigger a receptor in the brain to wake the person up to breathe! The apneas and arousals go on all night, often not allowing the individual to actually get any sustained sleep.
They wake up tired, and unrefreshed, they may wake up with headaches or high glucose levels, they may feel “foggy-brained” and have an irresistible urge to nap all day long, some fall asleep on their jobs or while doing repetitive tasks or while driving. Secondary to their sleep apnea, and due to being so tired, most individuals do not exercise and do not eat properly, so the weight keeps going up and the OSA keeps getting worse. We know that an increase in BMI can cause the symptoms of OSA to become exacerbated. Unfortunately, studies now show that untreated OSA can lead to many health issues such as obesity, diabetes, dementia, high blood pressure, strokes, heart arrhythmias, A-fib, heart attack, trouble with concentration, depression, decrease in sex drive, motor vehicle accidents...and this is just part of the list...Lack of sleep is a health hazard that we do not take seriously.
First, contact your PCP or local sleep lab and discuss your symptoms. If your practitioner thinks that you may have a sleep disorder, he/she will send you for a sleep study. Most insurances cover at least part of or all of the cost of the study, but you can always check before going to see if it is a covered test. Sleep studies are done in several ways. It depends on your signs and symptoms and the sleep lab itself, if you will need to be tested in the laboratory or if you can do a “home sleep test”. If you are having the sleep test done in the lab, you can expect to be sleeping there overnight. They will instruct you on what to bring with you the night of the test and what you should not do or consume before testing. You will be wired up by a technician and they will be recording your brain activity, oxygen levels, sleep positions, as well as many other parameters while you sleep. There will be a camera in the bedroom of the sleep lab for the technician to observe you for movements and safety. Some sleep labs will have you keep a “sleep diary” for a week or two before you go for testing. This will give the doctor who interprets your test results a better picture of how you are sleeping currently. If your doctor opts for you to have a home sleep test, you will go to his office or the sleep lab to pick up the device and they will instruct you on how to do it properly at bedtime. The home sleep testing device will record all of the parameters needed to make a diagnosis. In the morning, the data from the overnight test is then uploaded to the cloud and the tech at the lab can download it, score it, and have the doctor interpret the results. If you are positive for OSA, the doctor will discuss options to treat it. There are several viable options for patients with OSA, but the “gold standard” is CPAP therapy.
CPAP is an acronym for “continuous positive airway pressure”. Basically, it is a pneumatic splint for the airway. It forces air into the airway, via pressure (which is prescribed by the MD), to keep the airway “splinted” open as you sleep. On CPAP, most, if not all of the apneas and arousals are eliminated. Once your apnea is treated, you will start to feel more refreshed after sleeping. Your blood pressure may go down. Many people report feeling less depressed and more energetic. Some report that it has changed their life, and some are even invited to sleep back in the bed with their partner after having been banished to the couch or another room! While on CPAP you should not hear any more snoring or gasping or pauses in breathing, if you are still having those symptoms while on CPAP therapy, you will need to report that to your doctor.
There should be no fear or hesitance in CPAP therapy. It is your therapy and it’s to benefit your health, both physical and mental. You will use it in the privacy of your bedroom and beside your bed partner, no one needs to know you even have a machine. It may be rather inconvenient but the alternative to not treating your OSA is not a good path to be on. There are a variety of CPAP units to suit your sleep needs and the masks that are used with the CPAP machine are being designed and manufactured with better materials and to be less obtrusive. There are also portable CPAP units so you never need to miss a night of therapy even if you are away from home. Treat your sleep apnea as soon as you can so that you can benefit from a good night’s sleep and hopefully avoid the health consequences that can come as a result of untreated OSA. Sleep is very important for your physical and mental health. If you are struggling to get adequate or refreshing sleep, contact your doctor, practitioner or call your local sleep laboratory and discuss your concerns. They will guide you to the next step on your journey to a good night’s sleep!
Author Profile: Laura Castricone, Respiratory Therapist
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