Tuesday, February 2, 2016

What is Sleep Apnea?

Chances are at one point or another you have heard of sleep apnea (ap-ne-ah). But what is it and how can it affect yourself or someone close to you?  Sleep apnea is becoming much more of a hot button topic these days because it often goes undiagnosed and it can have a significant impact on one's health.

Sleep apnea occurs when breathing either stops or becomes excessively shallow during sleep. When this happens the body moves out of deep sleep into a light sleep which consequently means less time for your brain to rest. When your quality of sleep diminishes this can mean daytime sleepiness, difficulty concentrating and overall body lethargy.

Family members are often the first to notice sleep apnea because it is a condition that presents itself during sleep. The most common type of sleep apnea is obstructive sleep apnea where the airway is physically blocked and the restricted passage of air results in shallow breathing or pauses. As air tries to squeeze through a tighter and tighter opening snoring results that can often can wake up others in the room.

Obstructive sleep apnea is more common in people who are overweight but at the same time we see this in children as well who have large tonsils that restrict the airway. It’s important to realize that sometimes obstructive sleep apnea means a restricted air flow but at times this airflow can be completely stopped meaning no air intake at all. This causes a dangerous overall increase in CO2 levels as O2 levels fall.

A second type of sleep apnea is central sleep apnea. If the brain doesn’t send the correct signals to all the the muscles involved in breathing then breathing essentially stops. This type of disorder is more commonly found in people who have certain medical conditions like COPD or use particular medications like oxycodone or morphine.

In the short term sleep apnea can affect your day to day functioning but the effects in the long term are significantly more grave. With the extreme stress put on the body it can lead to an increased risk for a number of serious medical conditions including: High blood pressure, strokes, obesity, diabetes, heart failure, arrhythmias and heart attacks.

Treatment

When obesity is directly related to obstructive sleep apnea the tissues in the throat collapse under their own weight. Realistically the best treatment is to exercise and eat healthier to reduce the pressure on the pharynx. For some with medical conditions that prevent weight loss another option is to use dental mouthpieces called MRD's (Mandibular repositioning devices) whose function is to advance the lower jaw there by widening the airway in the throat to allow for an unobstructed airflow. This is accomplished by essentially stretching the soft palate and decreasing the gravitational force on the tongue opening up the passageway of the pharynx. These MRD devices look like larger versions of a mouthguard

Often I’ll recommend the MRD devices if the sleep apnea is mild to moderate or a patient cannot tolerate a CPAP machine.

CPAP (Continuous Positive Airway Pressure) is a machine that increases air pressure in your throat so that your airway does not collapse when you breathe in. It can have either:
  • A mask that covers the nose and mouth
  • A mask that covers the nose only
  • Nasal prongs that fit into the nose

CPAP is most effective non-surgical solution to obstructive sleep apnea and the most widely used but their can be side effects including nightmares or excessive dreaming in early use, dry nose and throat, nasal congestion, irritation of the eyes and throat, abdominal bloating, leaks around the mask and also nosebleeds.

Still the benefits out weigh the potential complications because they can be managed or eliminated which is why CPAP’s are so popular.

If you think you may have sleep apnea or know someone else who might it's best to mention it to your MD so you can get enrolled in a sleep study to confirm the diagnosis.

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