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 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.
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
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 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
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
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.
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.
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
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
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).
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
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.
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.
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
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
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
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.
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
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