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Sleep Apnea
On this page: About Sleep Apnea | Symptoms | Diagnosis | What You Can Do | Sleep Tips | Treatments | News | Melatonin

Other pages: Find out if you might have sleep apnea with the Epworth Sleepiness Scale

About Sleep Disorders... courtesy of the National Institute of Neurological Diseases(1)

 

Man who can't sleepAt least 40 million Americans each year suffer from chronic, long-term sleep disorders, and an additional 20 million experience occasional sleeping problems. These disorders and the resulting sleep deprivation not only interfere with work, driving, and social activities, but can lead to chronic medical conditions and can even be life-threatening.   Many of these conditians can be managed effectively once they are correctly diagnosed. Yet because of the lack of awareness by the public and healthcare professionals, the vast majority remain undiagnosed and therefore untreated, despite the fact that this serious disorder can have significant consequences.


About Sleep Apnea

News

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There are more than 70 sleep disorders, with sleep apnea being one of the most common types. This potentially serious sleep disorder occurs when a person's breathing repeatedly stops and starts for short periods of time during sleep. This abnormal breathing pattern only occurs during sleep, therefore, the person with the disorder may be the last to know he or she has a problem.

You may have sleep apnea if you snore loudly and you feel tired even after a full night's sleep.

There are two types of sleep apnea: Obstructive and Central.

  • Obstructive Sleep Apnea (OSA) is the more common of the two. It is caused by a blockage of the airway, usually when the soft tissue in the rear of the throat collapses the upper airway during sleep. Usually this occurs in association with fat buildup, loss of muscle tone with aging, or enlarged tonsils. During an episode of obstructive apnea, the person’s effort to inhale air creates suction that collapses the windpipe. This blocks the air flow for 10 seconds to a minute while the sleeping person struggles to breathe. When the person’s blood oxygen level falls, the brain responds by awakening the person enough to tighten the upper airway muscles and open the windpipe. The person may snort or gasp, then resume snoring. Patients with severe sleep apnea might have episodes lasting more than ten seconds each and occurring more than seven times per hour, having as many as hundreds of these episodes each night. Apneic episodes can reduce blood oxygen levels, causing the heart to pump harder.(4) This condition, called obstructive sleep apnea (OSA), is usually associated with loud snoring (though not everyone who snores has this disorder). Risk factors for obstructive sleep apnea include being male, overweight, and over the age of forty. This condition occurs two to three times more often in older adults and is twice as common in men as in women.(2) However, sleep apnea can affect anyone at any age, even children.
  • Central Sleep Apnea, is a less common condition where the airway is not blocked but the brain fails to signal the muscles to breathe. This is due to instability in the respiratory control center and is related to the function of the central nervous system. Central sleep apnea is usually observed in patients with central nervous system dysfunction, such as following a stroke or in patients with neurmusclular diseases like amyotrophic lateral sclerosis. It is also common in patients with heart failure and other forms of cardiac and pulmonary disease.

Symptoms of sleep apnea

Some people with obstructive sleep apnea complain that they wake up with a very sore or dry throat. They may on occasion wake up with a choking or gasping sensation and sometimes seem to wake themselves up with their own snoring. A person with obstructive sleep apnea often reports sleepiness during the day due to fragmented sleep. Other symptoms may include morning headaches, forgetfulness, mood changes, and a decreased interest in sex.

People with central sleep apnea more often report recurrent awakenings or insomnia, although they may also experience a choking or gasping sensation upon awakening.

Untreated sleep apnea can cause...

The frequent awakenings that sleep apnea patients experience leave them continually sleepy and may lead to personality changes such as irritability or depression. Sleep apnea also deprives the person of oxygen, which can lead to morning headaches, a loss of interest in sex, or a decline in mental functioning. It also is linked to weight gain, impotency, liver disease, high blood pressure, cardiovascular disease and stroke. Patients with severe, untreated sleep apnea are two to three times more likely to have automobile accidents than the general population. In some high-risk individuals, sleep apnea may even lead to sudden death from respiratory arrest during sleep.

Children and adolescents may also experience sleep apnea and suffer depression, behavior problems and poor academic performance. (3) A chronically snoring child should be examined for problems with his or her tonsils and adenoids. A tonsillectomy and adenoidectomy may be necessary to return the child to full health.(4)

Diagnosis

To diagnosis sleep apnea, your doctor or health care provider will ask you about your symptoms. A screening tool, The Epworth Sleepiness Scale is often used by health care professionals to determine if a patient has the symptoms of a possible sleep disorder. If there is a strong suspicion of a disorder, the health care provider may recommend a sleep evaluation in a sleep disorder center.

In a sleep lab, a patient spends the night in a quiet and comfortable room where their sleep is monitored by a polysomnogram (PSG). During the test, a variety of body functions, such as the electrical activity of the brain, eye movements, muscle activity, heart rate, breathing, and blood oxygen levels are monitored and recorded while the patient sleeps. After the study is completed, a sleep specialist reviews the recordings and determines the presence and severity of the condition as well as what effect the apnea has on the patient's long-term health.

In some cases, a multiple sleep latency test (MSLT) is performed on the day after the overnight test to measure the speed of falling asleep. In this test, patients are given several opportunities to fall asleep during the course of a day when they normally would be awake.

Sleep Labs in Pinellas County, Florida

If there is evidence of a primary sleep disorder, your physician may refer you to a sleep lab

Mease Dunedin Sleep Lab, 601 Main Street, Mail Stop 432, Dunedin, FL 34698-5848, Phone: 727-734-6718, www.measehospitals.com

Mease Hospital
, 1840 Mease Drive, Suite 120, Safety Harbor, FL 34695, Phone: 727-725-6454; www.measehospitals.com

Bayfront Medical Center, Diagnostic Sleep Services, 701 Sixth Street South, St. Petersburg, FL 33701, Phone: 727-893-6176; www.bayfront.org

Edward White Hospital Sleep Disorder Center
, 2323 9th Avenue, N., St. Petersburg, FL 33733, Phone: 727-328-6232; www.edwardwhitehospital.com

What you can do at home for mild sleep apnea...

In mild cases of sleep apnea, conservative therapy may be all that is needed:

  • Losing weight if you are overweight: a 10% weight loss can significantly reduce the number of apneic events for most patients.
  • Cut the cholesterol and fats from your diet if you are eating in excess of the recommended dietary allowance. In general, limit saturated fat to 15 to 20 gms/day (doctors recommend those with diabetes or heart disease limit saturated fat to <10 grams/day and for people with elevated LDL-cholesterol, limit to 15 gms/day). In general, limit cholesterol to <300 mg/day.  One large whole egg is about 212 mg of cholesterol.
  • Avoiding alcohol and sleeping pills which make the airway more likely to collapse during sleep and prolong the apneic periods. Avoid alcohol for 4 hours before bedtime.
  • Changing sleep positions: In some patients with mild sleep apnea, breathing pauses occur only when they sleep on their backs. Positioning pillows behind the back and between the knees often helps people remain in a comfortable, side-lying position while they sleep.
  • Tilt the head of the bed upwards 4 inches.
  • Good sleep habits and avoiding sleep deprivation is important for all patients with sleep disorders.

Tips for Better Sleep

  • Keep a regular sleep-wake cycle. Try to go to bed and wake up at the same time every day, even on the weekends. Sticking to a schedule helps reinforce your body's sleep-wake cycle and can help you fall asleep better at night.

  • Avoid caffeine for at least eight hours before your desired bedtime. Your body takes many hours to eliminate the stimulant and its effects. Some people are more sensitive than others to caffeine and need to stop drinking it as early as noon. Be aware that even decafeinnated coffee has a small amount of caffeine.

  • Avoid alcohol in the four to six hours before bedtime. Alcohol may help you get to sleep, but there is a rebound, wakefulness effect once it wears off in the middle of the night.

  • Avoid nicotine in the four to six hours before bedtime. Nicotine is a stimulant and can keep you awake.

  • Review any medications or herbal supplements you might be taking with your primary care provider or local pharmacist and be sure you're taking them at the right time of the day. Many preparations can be sedating or energizing and thus have a significant effect on sleep.

  • Regular physical activity, especially aerobic exercise, can help you fall asleep faster and help your sleep more restfully. Avoid exercising within two hours of bedtime.

  • Avoid large meals and drinks within two hours of bedtime.

  • Avoid naps or at the very least, don't nap later than 3 p.m. and limit daytime naps to less than 1 hour. Avoiding naps altogether is one of the best cures for insomnia. If you've had a sleepless night, the best way to assure a good night's sleep the following night, is to get up at the usual time, stay awake all day, and then go to bed exhausted the next night.

  • Sleep in a dark, quiet room with a comfortable temperature. Sunlight has a natural waking effect on the body and significantly influences the body's internal clock. Keep all light out of the bedroom at night and open the curtains in the morning to wake up. Avoid turning on bright lights during any trips to the bathroom.

  • If you can't fall asleep within 20 minutes, do a quiet activity somewhere else and return to bed when you're sleepy.

  • Wind down in the 30 minutes before bedtime with a relaxing pre-sleep ritual such as a warm bath, soft music, or reading.

What about melatonin?

A 2006 Harvard study found that melatonin, taken during the daytime, can relieve daytime insomnia for night-shift workers or jet-lagged travelers, but it didn't appear to do much for other causes of insomnia. In this study, oral melatonin helped participants fall asleep during the day, when their bodies weren't normally producing melatonin, but the oral supplement was not helpful at night, when their bodies were already producing the hormone themselves. Journal Sleep, April 2006

The hormone melatonin, normally produced by the brain's pineal gland, helps regulate sleep cycles and the circadian rhythm. In the evening the level of the hormone in the bloodstream rises sharply, reducing alertness and inviting sleep, and in the morning it falls back, encouraging waking. Melatonin has long been proposed as a way to help people sleep, but exactly who might benefit and when has been debated. Millions of Americans take the hormone to improve sleep, however an extensive review two years ago by the federal Agency for Healthcare Research and Quality said there was little or no evidence of melatonin's efficacy. It appeared to be safe when used over a period of days or weeks, "at relatively high doses and in various formulations. However, the safety of melatonin supplements used over months or even years was unclear". Agency for Healthcare Research and Quality

Treatment for sleep apnea: Mechanical therapy

Positive airway pressure (PAP) is a treatment in which the patient wears a mask over the nose and/or mouth during sleep. An air blower forces air through the upper airway. The air pressure is adjusted so that it is just enough to prevent the upper airway tissues from collapsing during sleep. The consistent and correct use of Positive Airway Pressure (PAP) is associated with improvement in daytime-sleepiness, quality of life, blood pressure control, and cardiac function. If the PAP is stopped or it is used improperly, episodes of apnea will return. Other types of devices that vary in the way in which pressure is delivered are also available for people having difficulty tolerating one particular method. For questions or problems with your PAP device, see the CPap Trouble-shooting Guide

Surgical treatments for sleep apnea:

Specific causes of OSA may be helped by surgery, but surgical correction is usually performed only after the measures described above have failed. People who might benefit from surgery include those with upper airway obstruction such as a deviated nasal septum, markedly enlarged tonsils or small lower jaw with an overbite causing the throat to be abnormally narrow.

  • Somnoplasty: A minimally invasive procedure that uses radiofrequency energy to reduce the soft tissue in the upper airway.
  • Thermal Ablation Palatoplasty (TAP) refers to procedures and techniques that treat snoring and some of them also are used to treat various severities of obstructive sleep apnea. Different types of TAP include bipolar cautery, laser, and radiofrequency. Laser Assisted Uvula Palatoplasty (LAUP) treats snoring and mild obstructive sleep apnea by removing the obstruction in the airway. A laser is used to vaporize the uvula and a specified portion of the palate in a series of small procedures in a doctor's office under local anesthesia. Radiofrequency ablation—some with temperature control approved by the FDA—utilizes a needle electrode to emit energy to shrink excess tissue to the upper airway including the palate and uvula (for snoring), base of the tongue (for obstructive sleep apnea), and nasal turbinates (for chronic nasal obstruction).(4)
  • Uvulopalatopharyngoplasty (UPPP): is surgery for treating obstructive sleep apnea. It tightens flabby tissues in the throat and palate, and expands air passages.(4)
  • Mandibular maxillar advancement surgery: A surgical correction of certain facial abnormalities or throat obstructions that contribute to sleep apnea. This is an invasive procedure that is reserved for patients with severe sleep apnea with craniofacial abnormalities.
  • Genioglossus and hyoid advancement is a surgical procedure for the treatment of sleep apnea. It prevents collapse of the lower throat and pulls the tongue muscles forward, thereby opening the obstructed airway.(4)
  • Nasal surgery: Correction of nasal obstructions such as a deviated septum.

Interactive Video Tutorials

Sleep Disorders from Medline Plus.  Scroll down through "Diseases and Conditions".  Select "Sleep Disorders" and follow the directions for the interactive tutorial.  Medline Plus is a service of the National Library of Medicine and the National Institute of Health

References

(1) "Brain Basics; Understanding Sleep" from the National Institute of Neurological Diseases
(2) Sleep apnea from the MayoClinic.com
(3) Sleep apnea from the American Sleep Apnea Association phone: 202-293-3650
(4) "Snoring, Not Funny, Not Hopeless" from the American Academy of Otolaryngology -- Head and Neck Surgery
(5) American Academy of Sleep Medicine
(6) "How Well are you Sleeping?"
from the FDA
(7) Women and Sleep from the National Sleep Foundation
(8) Teens and Sleep from the National Sleep Foundation
--Written by N Thompson, ARNP in collaboration with M Thompson, MD, Internal Medicine, Last updated April 2010

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