Sleep Apnea: The Silent Killer

Sleep is a basic human need and is important for our mind and bodies to function normally.

Sleepiness due to a lack of adequate sleep is a big problem in the United States and affects children as well as adults. In general, children and adolescents need at least 9 hours of sleep each night to do their best, while adults need approximately 8 hours of sleep each night. There are many reasons for inadequate sleep such as anxiety disorders, use and abuse of certain stimulants such as caffeine, medicines for weight loss or attention deficit disorder, and alcohol abuse to name a few. However, there is one problem that, if not addressed, can be a cause of many health related issues. A disorder that often goes unrecognized because it’s happening while the victim thinks he is resting.

This silent killer is called sleep apnea.It is estimated that there are 18 million people in the United States who are living with diagnosed cases of sleep apnea, but many more are undiagnosed.

We all are familiar with National Football League legend and hall of fame honoree Reggie White, actor John Candy, comedian Rosie O’Donnel, and best-selling author Anne Rice. Each suffered from this often missed and under-treated disease.Maybe if more people understood the relationship between sleep apnea, being overweight, and how they all relate to high blood pressure, heart disease, diabetes, and strokes, they would live longer and healthier lives.

Sleep apnea, in its simplest definition, means that a person’s breathing is interrupted while he is attempting to get some Zs. Some individuals will not breathe for 20 - 30 seconds before “coming up” for air. The family and significant others describe the sleep of these individuals with terms like, “loud snoring, restlessness, gasping for air, and sounds of choking”. Most patients complain of daytime fatigue and falling to sleep or dozing off while at work or driving.The short term problems are obvious and range from being kicked out of bed by your spouse, losing your job or killing yourself or another driver. The questions I’m often asked are, “How does sleep apnea happen” and “is it treatable?”

There are two types of sleep apnea: obstructive sleep apnea (OSA) and central sleep apnea (CSA). Obstructive sleep apnea is the most common form and is caused by a blockage of the airways. This usually occurs when the tissues of the neck and throat collapse during sleep. In CSA, there is no airway blockage, but the brain fails to signal the muscles to breathe during sleep.There can also be a mixed picture where both central and obstructive sleep apnea exist together.

Risk factors for sleep apnea include: being male, being overweight, being over the age of 40, having enlarged tonsilshaving a large neck size (greater than 17” in men and 16” in women), or having a family history of sleep apnea.

When a person with sleep apnea stops breathing, the body has a reflex that will wake them up. The patient does this all through the night and rises the next morning feeling tired and sleepy. During these periods of apnea (which means not breathing) the body is deprived of oxygen to the brain and tissues.The response is an increase in red blood cells, that carry oxygen, and over time the blood gets thick and sluggish. If blood flow to the brain or heart is not adequate, a heart attack or stroke can result.To diagnosis sleep apnea, my patients are referred to an ear, nose and throat (ENT) specialist and sent for a sleep study or polysonogram (PSG). The ENT specialist will evaluate the patients for correctable causes of sleep apnea. If the soft tissue in the throat is too thick, the septum in the nose is deviated, or other facial abnormalities exist, these can be surgically corrected.The sleep study is designed to detect other causes of sleep disorders, like restless legs syndrome, and to guide sleep specialist in treatment regimens for the disease. A PSG involves going to a lab and sleeping. Sounds easy, but with electrodes over your body and someone analyzing your sleep, it may be a little uncomfortable.

Once the diagnosis is made, conservative treatment options include aggressive weight loss, avoiding sedatives like codeine, alcohol, and sleeping pills, smoking cessation (smoke increases airway swelling), and avoiding sleeping on your back. If attempts at weight loss are unsuccessful, surgical procedures are often considered. A consultation with a board certified surgeon who specializes in bariatric surgery (weight loss surgery) is the only way to go. One of the most common non-surgical forms of treatment includes wearing a mask at night that will keep the airways open. This treatment is called Continuous Positive Airway Pressure (CPAP).

The mask covers the nose and mouth while you sleep, and is connected to a machine that delivers a continuous flow of air, maintaining an open airway. Special dental devices can be designed to keep the airway open as well as the surgical procedures mentioned earlier.There is even a medication called Provigil that some physicians use to treat the daytime fatigue and tiredness, but this is usually in combination with CPAP and good sleep hygiene. Many people are resistant to using their CPAP machine, and although cumbersome, it could very well save your life.

If you have any of the signs and symptoms above, see your physician right away, improve your sleep, and get back in bed with the one you love.

For more information on sleep apnea visit http://www.sleepapnea.org. (c) 2008 Rani Whitfield. Published May 2008 in New View magazine.