Is Sleep Apnea Leaving You Tired?

By Heather Guidone Snoring may be more than just an annoyance for your bed partner. It may be an indication of something much worse: a condition known as Sleep Apnea. Imagine a fitful night in which you are involuntarily jolted awake several times, gasping violently for breath. In the morning, your bed looks like a battle zone; you are achy, exhausted and irritable. Throughout the day, you have difficulty concentrating on the task at hand, and you can't seem to remember what you were doing from one minute to the next. For an estimated 18 million Americans, this is routine.

There is more to Sleep Apnea than just "not getting a good night's rest". A person with this condition is at an increased risk for resultant cardio/respiratory changes such as arterial hypertension, coronary artery disease and stroke.

Sleep Apnea is the actual cessation of breathing during sleep. Episodes can occur literally hundreds of time throughout the sleep period and last for up to ten seconds - sometimes longer - until the person is prompted awake and begins to breathe normally again. There are three kinds of Sleep Apnea: Obstructive, Central, and Mixed.

Obstructive Sleep Apnea

The most common type of sleep apnea, Obstructive Apnea is caused by an obstruction in the airway. In the vast majority of patients, it is related to obesity (which decreases the size of the airway), or anatomical obstructions, such as enlarged tonsils or adenoids. Obstructive Sleep Apnea is most common in overweight males between the ages 35-50, but men, women and children of all ages can suffer from this disorder. Obstructive Sleep Apnea also runs in families.

Central Sleep Apnea (CSA)

CSA is a rare form of the disorder, where the airway remains open unobstructed, but the diaphragm and chest muscles momentarily fail. Dropping blood oxygen levels signal the brain and prompt the person to awaken, gasping for breath. Because the airway is typically open, this Apnea sufferer does not snore noisily, but does have daytime sleepiness and other hallmark symptoms of the disorder. Central Sleep Apnea is most common in people over 60 years of age.

Mixed Apnea

Mixed Apnea is a combination of both Central Sleep and Obstructive Apneas. Whether Central, Obstructive or a combination of both, Apnea can be dangerous, leading to hypoventilation, cardiac problems like bradycardia and other arrhythmias, systemic hypertension and even stroke.

Alcoholic beverages and sedative-like medications will worsen the disorder. During the sleep period, a person suffering from Apnea may jolt awake several times, rise repeatedly to urinate, experience "acid reflux" or feelings of choking, suffer from night sweats, and perhaps even experience sleep-related heart attacks or heart rhythm abnormalities.

Upon awakening, the patient will likely find their bed in disarray, exhibit symptoms of daytime sleepiness, suffer from impaired concentration and slowed mental functions, and be irritable and experience mood swings. Patients often have headaches/ dry throat and nasal congestion, and some also suffer from impotence or depression.

The disorder can also negatively affect the body's immune system, particularly in children. According to the Children's Hospital Medical Center of Akron, children with Sleep Apnea may exhibit weight loss or failure to gain weight, have poor school performance, and exhibit behavioral problems. They may also suffer from frequent upper airway infections. Sleep Apnea is common in premature infants whose lungs and breathing capabilities are not yet fully developed.

Sleep Apnea Risk Factors

Though the disorder can affect anyone, overweight men in particular are at an elevated risk of having Apnea, according to the American Sleep Apnea Association; particularly those aged 40 and older. Those with medical conditions like obesity, high blood pressure, Post-Polio Syndrome, kidney disease, hypothyroidism, acromegaly (excess bone growth due to oversecretion of growth hormone), Marfan Syndrome (a disorder in which anatomical structures built of connective tissue are very weak, such as an airway), and patients with anatomic abnormalities such as a nasal obstruction or enlarged tonsils or adenoids are also at an elevated risk.

Though Apnea affects all races, young African Americans may also be at increased risk, according to a 1997 study published in the American Journal of Respiratory & Critical Care Medicine. Results of a 1999 study on sleep-disordered children and teens, reported in the same journal, found that African American children were more than 3 times as likely as children of other races to develop Apnea and related sleep disorders. Another report published in 1995, also in the American Journal of Respiratory & Critical Care Medicine, noted that elderly African Americans were more than 2 times as likely as elderly Caucasians to suffer from sleep-disordered breathing.

Menopause & Sleep Apnea

Research from Penn State College of Medicine also showed a connection between Sleep Apnea and menopause. The 5-year study, conducted by Edward Bixler, Ph.D., involved nearly 2,000 women between the ages of 20-100. Postmenopausal women who did not use hormone replacement therapy (HRT) developed Sleep Apnea at a rate 5 times greater than those women who were on HRT.

Sleep Apnea Diagnosis

Sleep Apnea is very treatable, but only 10-25% of cases are ever diagnosed because the person is either unaware of the snoring, or does not know that loud snoring is a symptom of Apnea.

A definitive diagnosis is made through a battery of tests. The entire procedure, usually performed in a sleep lab, is called polysomnography. During the patient's sleep period, small sensors located on different parts of the person's will measure heart rate, brain wave patterns and muscle activity, as well as leg, arm and eye movements (which indicate the stage of sleep).

Some sleep centers also perform procedures to view the patient's throat area for anatomical distortions. Diagnosis is confirmed when the polysomnography indicates more than 5 episodes of Apnea for 10 seconds or longer per hour of sleep, plus an irregular heartbeat, frequent awakening during the sleep period, and/or dips in blood oxygen levels.

Sleep Apnea Treatments

Treatments range from as simple as not sleeping on one's stomach to medical or surgical. In the case of a physical obstruction, nasal, septal and adenoid surgeries are sometimes performed in order to open breathing passages. A tonsillectomy may also performed in order to reduce obstruction at the level of the throat. If nasal passages are simply congested, decongestants may be helpful. As Sleep Apnea is more common in overweight individuals, the patient's physician may also devise a weight reduction plan.

Serious Sleep Apnea cases may be relieved by a treatment called a nasal Continuous Positive Airway Pressure (CPAP) device. With CPAP, a small mask is held onto the nose by straps and small pouches are inserted into the nostrils. This mask is connected to a motor that regulates the amount and pressure of air sent into the nose, exerting pressure to keep the nasal passages open.

While relief is not immediate, use of CPAP over time can eventually restore normal sleep periods. For those who have mild Sleep Apnea and cannot tolerate CPAP, there are also specific dental devices they can use. These devices bring the jaw forward, hold back the tongue, raise the soft palate, or perform a combination of all three.

In the most rare of cases, a tracheostomy* may be performed in which a hole will be made surgically in the throat and a tube inserted to ease breathing. This procedure is reserved only for the most extreme of circumstances, such as with a person who cannot tolerate CPAP and has severe hypertension with a high risk of heart failure due to their Apnea.

Snoring, while always annoying, doesn't always indicate Sleep Apnea. But if it's combined with other symptoms, talk to your physician - so you and your bedmate can both get a restful night's sleep.

*A tracheotomy is an incision into the windpipe that forms a temporary or permanent opening, called a tracheostomy. Sometimes the terms "tracheotomy" and "tracheostomy" are used interchangeably.

References:
1: Meir H. Kryger, MD, FRCPC, Professor of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada. Clinical Cornerstone 2(5): 2000, Excerpta Medica, Inc.
2. About.com Sleeping Disorders

Heather C. Guidone is a freelance writer and researcher with a special interest in women's health. She has served as the Director of Operations and an Executive Board Member of the Endometriosis Research Center, a 501(c)3 non-profit organization for education, research facilitation and support since the organization was founded. She is a member of the American Medical Writer's Association and the World Endometriosis Society. Heather resides outside NYC with her family. For more information, visit: www.hcgresources.com/endoindex.html