Pulmonary
- Critical Care Associates
of East Texas
Jeffrey M.
Shea, M.D., F.C.C.P.
Venkatesh Donty, M.D.
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Jeffrey M.
Shea, M.D., F.C.C.P. |
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What Is Sleep Apnea? Apnea means interruption of breathing. Sleep apnea is interrupted breathing during sleep for at least 10 seconds at a time. This can happen in severe apnea up to 400 times every night. Studies show that about 2% of women and 4% of men have sleep apnea. They’re two kinds of sleep apnea—Obstructive apnea and Central apnea.Obstructive apnea is the most common. Nine out of ten patients with sleep apnea have this type of apnea. Obstructive apnea is where something is blocking the passage or windpipe (trachea) that brings air into your body. You keep trying to breathe, but you can’t get enough air because of the blockage. Your tongue, tonsils, or uvula (the little piece of flesh that hangs down in the back of your throat) might block your windpipe. It might also be blocked by a large amount of fatty tissue in the throat or even by relaxed throat muscles. In obstructive apnea, ribcage and abdominal movements are still present.Central apnea is rare. It is related to the function of the central nervous system. If you have this type of apnea, the muscles you use in breathing don’t get the "go-ahead" signal from your brain. Either the brain doesn’t send the signal, or the signal gets interrupted. In central apnea, both the ribcage and abdominal movements are absent. When you have this interruption in breathing (apnea) your oxygen saturation decreases. The magnitude of this decrease depends on the time duration of the apnea. Risk Factors Obesity is a strong risk factor for obstructive sleep apnea. A neck circumference greater than 17 inches in males or greater than 16 inches in females is also a positive predictor for obstructive sleep apnea. Lifestyle factors also affect the likelihood of developing obstructive sleep apnea. Cigarette smoking increases the risk, which appears to resolve with smoking cessation. Alcohol intake and the ingestion of muscle relaxants and respiratory depressants can exacerbate sleep-disordered breathing. At first sleep apnea isn’t harmful, but it can cause serious problems if it isn’t treated. Your risk of heart disease and stroke is higher if serious apnea goes untreated.S igns and Symptoms The person you sleep with may notice first. You or that person may notice heavy snoring or long pauses in your breathing during sleep. You may notice excessive daytime sleeping (falling asleep at work, while driving or when talking), irritability or fatigue. Snoring is from turbulent airflow through a narrowed posterior pharynx (back of throat). Apnea occurs when the pharynx closes completely. A history of observed apneas during sleep is strongly linked and the frequency of reported snoring and breathing pauses, the greater the likelihood that the patient has obstructive sleep apnea.
Diagnosis of Sleep Apnea Your doctor is the one to diagnose sleep apnea. Your initial evaluation should include the signs and symptoms, a complete history and physical examination. As part of the clinical history, ask the bed partner whether the patient snores, chokes or gasps for breath, shows restlessness during sleep, or stops breathing. The physical exam focuses on blood pressure measurement, assessment of any nasal obstruction and oropharyngeal narrowing, measurement of neck circumference. Patients that are suspected of obstructive sleep apnea should undergo an overnight polysomnography (sleep study) to confirm the diagnosis of a sleep-related breathing disorder. During this testing the following are being monitored: electroencephalograph (brain activity), electrooculography (eye activity), chin electromyography (chin movement), airflow, arterial oxygen saturation, respiratory effort, and electrocardiograph (heart rhythm). You can use the data from this study to differentiate central and obstructive apnea episodes, indicate the severity of sleep disturbance, oxygen desaturation, cardiac arrhythmia’s, parasomnias, nocturnal seizures, and changes is sleep structure suggestive of narcolepsy.Treatment Behavioral approaches: Lose weight, quit smoking, stop use of alcohol or sleep medicines, and sleep on your side instead of your back.Dental devices: These appliances modify the upper airway by changing the posture of the jaw and the tongue. They improve or eliminate snoring. Nasal CPAP :Continuous Positive Airway Pressure When a CPAP titration study is done either at the time of the original sleep study (SPLIT-NIGHT) or during a separate study, there is a mask that comes from a machine that goes over your nose. This machine is creating a positive pressure within the upper airway to counteract the collapsing pharyngeal pressure; nasal CPAP helps keep the upper airway open while the patient is asleep. CPAP has been shown to be the most effective way for most people to treat sleep apnea by decreasing the number of times the airway is obstructed, improving oxygenation during sleep, and by enhancing daytime alertness. During the sleep study nasal CPAP is generally titrated to the pressure—in centimeters (cm) of water—that relieves apneas, hypopneas, snoring, and oxygen desaturation. Many sleep centers perform what they call "split night" study. The first half of the night is to determine if sleep apnea exists and the second half of the night is applying the nasal CPAP to determine what pressure is necessary to open up the airway if you are found to have OSA. Success of this treatment depends on the patient’s willingness to wear the device. CPAP users report side effects related to the nasal mask. Air leaks near the eyes and over the face that can lead to red eyes in the morning, but working with the patient and the Home Care Company providing the equipment will ensure a proper and good mask fit. Morning dryness of the nose or mouth can occur and this reaction can be averted with humidifiers put in-line with the CPAP machine or nasal saline sprays. Other side effects reported are air swallowing, sinusitis, and epistaxis (nosebleed).Summary Sleep apnea is a treatable and manageable condition. See your doctor with any signs or symptoms. Things will improve once a diagnosis is made. If your sleep problem can be resolved by not using alcohol or sleep medicine, losing weight if you are overweight, and sleeping on your side, you will quickly begin to feel much more rested and energetic. If you must wear the nasal CPAP while sleeping, you should soon feel the benefits.
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