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Obstructive Sleep Apnea

and you

Sleep apnea

Apnea is a medical term meaning absence of breath. Sleep apnea refers to a medical condition which can have very serious consequences for one's health. Untreated, sleep apnea can lead to excessive daytime sleepiness, and this can lead to an increase in automobile accidents and accidents in the workplace. In addition to sleepiness, sleep apnea may lead to a higher incidence of high blood pressure, heart attack, stroke, short term memory problems, and diabetes. In children, sleep apnea may be a factor in ADHD.

What is sleep apnea?

When people talk about sleep apnea, they are usually referring to Obstructive Sleep Apnea. This is a breathing disorder caused by tissues in the nose and throat which are too large for the airway. These tissues may include simple nasal congestion, nasal polyps, a deviated septum, a large tongue, a narrow pharynx (or airway), an elongated uvula (the punching bag in the back of the throat) and/or inflamed tonsils and adenoids.

 

While awake, muscle tone keeps those tissues active, so they do not block the airway. When we sleep, we lose muscle tone, causing those tissues to collapse into the airway. As you try to breathe against those tissues, they vibrate. These vibrations are snores. If the tissues block the airway enough, your breathing can be significantly reduced or even stopped. These episodes may last a few seconds or a few minutes, and can occur over and over throughout the night. A certain amount of this activity can be considered normal, but if they occur more than 5-10 times an hour, it may be clinically significant.

 

Some people have over 100 of these events every hour that they sleep. Each episode may cause you to wake up briefly, resume normal breathing, fall back to sleep and start it all over again, all night long. Most people aren't even aware they're having breathing problems or waking up. Often, only in the clincial setting are we able to see these disruptions in breathing, and the accompanying disruptions in your sleeping pattern.

Types

Though the word apnea means a "lack of breath", sleep apnea refers to certain disruptions of breathing, and not necessarily a complete absence of breathing.

These disruptions are commonly classified as follows:

- Apnea - No airflow, lasting at least 10 seconds

 

- Hypopnea - Reduced airflow, again lasting 10 seconds, must lead to a certain amount of oxygen level reduction and/or an arousal observed in brainwaves.

 

These two types of events can be further classified according to the cause of the airflow restriction:

- Obstructive - The airway is partially or fully blocked

 

- Central - Respiratory center of the brain actually isn't sending a signal to breath

 

- Mixed - A combination of the above two

In an obstructive apnea, the airway closes off so that no air passes through the obstruction. The body is trying to breathe, but no air can move past the obstruction. Usually, people having apneas will snore before and after the actual event, but not during (since there is no airflow to make the snoring sound). As the body struggles to breathe, breathing movements in the chest and abdomen can become exaggerated as the body fights against the obstruction. During this time blood oxygen saturation may drop, and carbon dioxide in the lungs may build. Eventually, the body alerts to the situation, and does what it can to correct it. The brain may arouse from sleep, the patient will often resume breathing with a large "snort", and they may kick their arms or legs at this time. Once breathing is restored the brain falls back to sleep, and the pattern can start all over again.

 

In our sleep labs, the most common event we see is the obstructive hypopnea. These events are marked by a reduction in airflow, but not a complete cessation as you would see during an apnea. The reduction in airflow is commonly, but not always, accompanied by snoring.

Treatment

Obstructive Sleep Apnea (OSA) is a treatable condition. The following are the most common treatments:

Positive Airway Pressure (PAP) therapy. Also referred to as CPAP, this treatment involves wearing a mask at night which is connected to a small machine which blows pressurized air into the mask. The person breathes in and out normally, but the pressurized air they breathe works as a pneumatic split to hold the airway open so they can breathe properly.

 

Surgery. There are many types of surgical procedures that can help alleviate OSA. Most are geared towards removing or repositioning tissues in the airway to open the airway as much as possible, therefore helping to prevent occlusion.

 

Oral Appliance. This device resembles a bite guard, but acts to reposition the lower jaw forward, therefore helping to open up the airway. Some devices also work to keep the tongue from occluding the airway.

 

In summary, sleep apnea is a serious condition, but once detected, is treatable.

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