News from Dr. Sleep

What Is Sleep Apnea?

Sleep apnea can be caused by either complete obstruction of the airway (obstructive apnea) or partial obstruction (hypopnea), both of which can wake someone up. There are three types of sleep apnea—obstructive, central, and mixed. Obstructive sleep apnea (OSA) is the most common. OSA occurs in approximately 2 percent of women and 4 percent of men over the age of 35.

The site of obstruction in most patients is the soft palate, extending to the region at the base of the tongue. During the day, muscles in this region keep the airway wide open. But as a person with OSA falls asleep, these muscles relax to a point where the airway collapses and becomes obstructed.

When the airway closes, breathing stops and the patient awakens to open the airway. The arousal from sleep usually lasts only a few seconds, but brief arousals disrupt continuous sleep and prevent the person from reaching the deep stages of sleep, such as rapid eye movement (REM) sleep, which the body needs in order to rest and replenish its strength. Once normal breathing is restored, the person falls asleep only to repeat the cycle throughout the night.

Typically, the frequency of waking episodes is somewhere between 10 and 60. A person with severe OSA may have more than 100 waking episodes in a single night.

UARS is similar to obstructive sleep apnea, in that abnormal airway resistance in the upper airway during sleep leads to unwanted physiologic consequences. Increased upper airway resistance leads to an arousal secondary to increased work of breathing to overcome the resistance. Repeated and multiple arousals (which the patient is usually unaware of) result in an abnormal sleep architecture and daytime somnolence (sleepiness).

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What are the Risk Factors?

Anatomic abnormalities
Enlarged Tonsils
Adenoids Excessive weight gain
Family History
Use of alcohol
Use of sedative drugs
Smoking Hypothyroidism
Acromegaly
Amyloidosis
Vocal Cord Paralysis
Neuromuscular Disease
Down Syndrome
Marfan’s Syndrome

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What are the Symptoms?

Do you have difficulty staying awake at work?
Do you fall asleep at inappropriate times (eg, at work or in social situations)?
Do you feel tired even after a good night's rest?
Do you have difficulty remembering things?
Do you have difficulty concentrating?
Do you snore?
Has your bed partner ever said that you stop breathing or gasp for air while you sleep?

These are some of the questions that you should ask yourself to see if you suffer from Obstructive Sleep Apnea.

Symptoms include; excessive daytime sleepiness, personality changes, decreased memory, erectile dysfunction (impotence), depression, morning headaches, frequent urination during the night, snoring, irritability, frustration, overweight, high blood pressure.
Some patients suffering from OSA fall asleep while watching TV, work meeting and even while driving. Patients with OSA often complain of waking up feeling like they had never slept at all. They often feel worse after taking a nap than they did before napping.
The so-called drowsy driver syndrome, which a growing number of law enforcement authorities believe to be responsible for many automobile accidents, may result from OSA, which causes some drivers to fall asleep at the wheel or to suffer from lack of alertness because of sleep deprivation.
Hypertension It has been shown that treating OSA can modestly lower blood pressure.
Not everyone who snores has sleep apnea, but if two or more of the above symptoms are present the person should consider consulting a sleep specialist. It's also worth knowing your score on the Epworth Sleepiness Scale.

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What are the Complications of OSA?

The most obvious complication arising from OSA is diminished quality of life brought on by chronic sleep deprivation.
Some linkage between OSA and coronary artery disease, heart attack, and stroke has been demonstrated, although it is still uncertain whether OSA leads to an increased risk for these conditions or if both OSA and cardiovascular problems are caused by a common problem, such as obesity.
Obstructive sleep apnea aggravates congestive heart failure by placing stress on the heart during sleep. There is a high prevalence of OSA in patients with congestive heart failure.
Recent studies have indicated that there may be a link between OSA and complications following surgery. Post-surgical complications may result from disruptions in breathing caused by obstructive sleep apnea.

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How is OSA Diagnosed?

OSA is diagnosed by a polysomnography. A sleep technician administers and attends the study. To prepare the patient for sleep study, numerous monitors are attached to the patient to record nighttime breathing, brain activity, and physical activity. Several electrodes are pasted to the patient's head to measure brain electrical activity with an electroencephalogram, or EEG. Electrical activity in the brain during the different stages of sleep is distinctly different from that while awake. The EEG allows the physician to see if the patient is reaching all the stages of sleep to the appropriate depth and if the patient is being aroused excessively from these stages.

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How is OSA Treated?

OSA is treated with Positive Pressure (CPAP, BIPAP, APAP), Oral Applications, Lifestyle changes, Positioning and Surgery. CPAP has been proven to have the highest success rate.

1. CPAP

The more common of the three therapy modes, is administered at bedtime through a nasal or facial mask held in place by Velcro straps around the patient's head. The mask is connected by a tube to a small air compressor. The CPAP machine sends air under pressure through the tube into the mask, where it imparts positive pressure to the upper airways. This "splints" the upper airway open and keeps it from collapsing.

Successful CPAP users report improvements in: CPAP Therapy

vitality and motivation
job performance
mood
sexual drive and performance
alertness while driving
quality of life
quality of sleep

A failure to use CPAP therapy may increase one's risk for conditions linked to untreated OSA:

Hypertension (OSA increases your risk of hypertension by five times)
Stroke
Congestive heart failure (CHF)
Approximately 55% of patients who use CPAP do so on nightly bases for more than 4 hours. It is the most commonly prescribed treatment for OSA. The advantages of CPAP are that it is very safe and completely reversible. Generally, it is quite well tolerated. The main disadvantage is that it requires active participation every night; that is, patient compliance is necessary for it to work.

2. Oral appliances

Used for the treatment of OSA generally come in two categories: mandibular advance devices and tongue-retaining devices. A variety of both types exists. Oral appliances may be used to treat mild to moderate OSA.

3. Positional therapy

Can be used to treat patients whose OSA is related to body positioning during sleep. Most people with sleep apnea have worse symptoms if they lie flat on their back during sleep. One thing you could do is to sew or attach a sock filled with tennis balls, length-wise down the back of their pajama top or nightshirt or the Anti-Snore Shirt is available at HomeSleepCare. This makes it uncomfortable for the sleeper to lie on their back, and they usually will move onto their side.

4. Surgical Treatment

Surgical procedures include: uvulopalatopharngeoplasty (UP3), geniotubercle advancement, hyoid myotomy and resuspension, midface advancement, and tracheostomy. In children, where the cause of OSA is usually tonsil and adenoid enlargement, surgical removal of the enlarged tonsils and adenoids is the treatment of choice for OSA. Overall, uvulopalatopharneoplasty (UP3) is the most common surgical procedure for treating OSA. This involves removing the uvula and some of the surrounding soft palate. The idea behind UP3 is to eliminate the area of obstruction or to widen the airway so it does not occlude completely. UP3 eliminates OSA approximately 50% of the time. The complications of UP3 include transient nasal reflux, nasal speech, minor loss of taste, and tongue numbness.

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