“Snore, snore…….SNORE, snore, snore……. SNORE, snore…..” If you have ever heard this breathing pattern before, you may have been witness to sleep apnea. These pauses in breathing may last from a few to prolonged seconds, happening fifteen, thirty, even sixty or more times in an hour. Another presentation of sleep apnea may be present as very shallow breathing. Either problem will commonly disrupt sleep as it drives sleep patterns from deep to shallow sleep. The result of this poor quality sleep may cause daytime fatigue and tiredness. Signs of this include falling asleep during the day, at work, or while driving. Other signs and symptoms may include morning headaches, memory complaints, irritability or depression, frequent nighttime awakenings and dry mouth or sore throat upon awakening.
Mild sleep apnea affects about one out of five people, and moderate to severe impacts one out of fifteen. In the United States, that influences about 22 million Americans. As there are no physical findings or lab tests that diagnose the problem, sleep apnea is not a problem that can be found on a routine exam. Most often, the question is brought to the attention of the patient or physician by the spouse or bed partner.
Obstructive sleep apnea, the more common form of this sleep disorder, occurs when the muscles of the throat and tongue relax excessively and allow the tissues to collapse, blocking off the upper airway. When breathing stops and oxygen levels drop, the brain is triggered to disrupt sleep, tighten the muscles and stimulate a breath. But in addition to disruptive sleep, the stress hormones that are released can raise your heart rate and increase the risk for high blood pressure, heart attack, stroke and arrhythmias (irregular heartbeats). Although sleep apnea can occur in anyone, it is commonly associated with men more than women, and increases with age. People who are overweight may be prone to sleep apnea as well as those who drink alcohol, smoke, take sleep aids, or sleep on their back. Other considerations include those with smaller upper airways, allergies or other airway congestion, facial disfiguration, or in children, swollen tonsils.
Central sleep apnea is less common than obstructive, and occurs when the brain fails to send the correct message for the respiratory muscles to function properly. As a result, breathing simply ceases momentarily. Although snoring doesn’t typically occur with central apnea, there can be mixed apnea, that both forms are present in a patient.
When sleep apnea is suspected, testing includes an overnight study. Screening may be done at home, (commonly the preference of many insurances) measuring breathing patterns and air flow, heart rate, lung expansion and oxygen levels of the patient in his own bed. More extensive evaluation may be required in a sleep lab clinic that includes, among other measurements, heart and brainwave monitoring by a technician.
The treatments for sleep apnea depend on type and severity. In mild cases, a dental appliance worn in the mouth while sleeping may be effective. The most common treatment of more severe apnea consists of CPAP – continuous positive airway pressure. A mask covers the nose, nose and mouth, or inserted into the nose (nasal pillows) and is connected by a tube to a small pressure pump. The onboard computer monitors airway resistance, and increases air pressure when resistance increases or breathing diminishes. This pressure balance keeps the airway open and prevents the collapse and obstruction.
Untreated apnea may shorten your expected lifespan eight to ten years, as well as make other diseases more difficult to treat. If you have concerns regarding sleep apnea, please contact your health care provider.
Bradford Croft, DO
East Flagstaff Family Medicine