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Sleep Apnea

Obstructive sleep apnea is a potentially serious sleep disorder in which breathing repeatedly stops and starts during sleep. Several types of sleep apnea exist, but the most common type is obstructive sleep apnea, which occurs when your throat muscles intermittently relax and block your airway during sleep. The most noticeable sign of obstructive sleep apnea is snoring, although not everyone who has obstructive sleep apnea snores. Signs and symptoms of obstructive sleep apnea include:

• Excessive daytime sleepiness (hypersomnia)
• Loud snoring
• Observed episodes of breathing cessation during sleep
• Abrupt awakenings accompanied by shortness of breath
• Awakening with a dry mouth or sore throat
• Morning headache
• Frequent urination at night
• Difficulty staying asleep (insomnia)

Many people don’t think of snoring as a sign of something potentially serious, and not everyone who has sleep apnea snores. When the muscles in your throat relax, your airway narrows or closes as you breathe in and breathing may be inadequate for 10 to 20 seconds. This may lower the level of oxygen in your blood. Your brain senses this inability to breathe and briefly rouses you from sleep so that you can reopen your airway. This awakening is usually so brief that you don’t remember it. You can awaken with a transient shortness of breath that corrects itself quickly, within one or two deep breaths, although this sequence is rare. You may make a snorting, choking or gasping sound. This pattern can repeat itself five to 30 times or more each hour, all night long. These disruptions impair your ability to reach the desired deep, restful phases of sleep, and you’ll probably feel sleepy during your waking hours. People with obstructive sleep apnea may not be aware that their sleep was interrupted. In fact, many people with this type of sleep apnea think they sleep well all night. Anyone can develop obstructive sleep apnea. However, certain factors put you at increased risk:

• Excess weight
• Neck circumference. A neck circumference greater than 17 inches (43 centimeters) for men and 15 inches (38 centimeters) for women
• High blood pressure (hypertension)
• A narrowed airway
• Chronic nasal congestion
• Diabetes
• Being male. In general, men are twice as likely to have sleep apnea
• Being black, Hispanic or a Pacific Islander
• Being older than 65
• Menopause
• A family history of sleep apnea
• Use of alcohol, sedatives or tranquilizers
• Smoking. Smokers are nearly three times more likely to have obstructive sleep apnea

Sleep apnea is considered a serious medical condition. Complications may include:

• Cardiovascular problems. Sudden drops in blood oxygen levels that occur during sleep apnea increase blood pressure and strain the cardiovascular system. If there’s underlying heart disease, these repeated multiple episodes of low blood oxygen (hypoxia or hypoxemia) can lead to sudden death from a cardiac event.

• Daytime fatigue. The repeated awakenings associated with sleep apnea make normal, restorative sleep impossible. People with sleep apnea often experience severe daytime drowsiness, fatigue and irritability. Treatment of sleep apnea can improve these symptoms, restoring alertness and improving quality of life.

• Complications with medications and surgery. Obstructive sleep apnea also is a concern with certain medications and general anesthesia. People with sleep apnea may be more likely to experience complications after major surgery because they’re prone to breathing problems, especially when sedated and lying on their backs. Before you have surgery, tell your doctor that you have sleep apnea. Undiagnosed sleep apnea is especially risky in this situation.

• Sleep-deprived partners. Loud snoring can keep those around you from getting good rest and eventually disrupt your relationships.

• People with obstructive sleep apnea may also complain of memory problems, morning headaches, mood swings or feelings of depression, and a need to urinate frequently at night (nocturia).

If you suspect that you have obstructive sleep apnea, you’ll likely first see your primary care doctor. Your doctor may refer you to an ear, nose and throat doctor to rule out any anatomic blockage in your nose or throat. However, in some cases, you may be referred immediately to a sleep specialist. The evaluation may involve overnight monitoring of your breathing and other body functions during sleep. Tests to detect sleep apnea include:

• Nocturnal polysomnography. During this test, you’re hooked up to equipment that monitors your heart, lung and brain activity, breathing patterns, arm and leg movements, and blood oxygen levels while you sleep. This can help your doctor rule out other conditions — such as periodic limb movements or narcolepsy — that can also cause excessive daytime sleepiness, but require different treatment.

• Oximetry. This screening method involves using a small machine that monitors and records your blood oxygen level while you’re asleep. A simple sleeve fits painlessly over one of your fingers to collect the information overnight at home. If you have sleep apnea, the results of this test will often show drops in your blood oxygen level during apneas and subsequent rises with awakenings. If the results are abnormal, your doctor may have you undergo polysomnography to confirm the diagnosis. Oximetry doesn’t detect all cases of sleep apnea, so your doctor may still recommend a polysomnogram even if the oximetry results are normal.

• Portable cardiorespiratory testing. Under certain circumstances, your doctor may provide you with at-home tests to diagnose sleep apnea. These tests usually involve oximetry, measurement of airflow and measurement of breathing patterns.

• To eliminate snoring and prevent sleep apnea, the sleep specialist may recommend a device called a nasal continuous positive airway pressure (CPAP) machine. With this treatment, the pressure of the air breathed is continuous and somewhat greater than that of the surrounding air, which is just enough to keep your upper airway passages open. This prevents apnea and snoring. With some practice, most people learn to adjust the mask to obtain a comfortable and secure fit. You may need to try different types to find a suitable mask.

Don’t stop using the CPAP machine if you experience problems. Check with your doctor to see what adjustments you can make to improve its comfort. In addition, contact your doctor if you still snore despite treatment or begin snoring again. If your weight changes, your doctor may need to adjust the pressure settings but it is important to continue using your appliance until further testing indicates otherwise.

For milder cases of obstructive sleep apnea, your doctor may recommend lifestyle changes, such as losing weight or quitting smoking. If these measures don’t improve your signs and symptoms or if your apnea is moderate to severe, a number of other treatments are available. Certain devices can help open up a blocked airway. In other cases, surgery may be necessary.

Try these tips:

• Lose weight. Even a slight loss in excess weight may help relieve constriction of your airway.
• Avoid alcohol and medications such as tranquilizers and sleeping pills. These relax the muscles in the back of your throat, interfering with breathing.
• Sleep on your side or abdomen rather than on your back. To prevent sleeping on your back, try sewing a tennis ball in the back of your pajama top.
• Keep your nasal passages open at night. If you have congestion, use a saline nasal spray to help keep your nasal passages open.

Also of interest, there is a direct correlation between untreated sleep apnea and weight gain. Interrupted sleep cycles can affect hormone production in the body resulting in a metabolic disorder that causes weight gain. A follow up sleep study isn’t always necessary, especially if your machine is equipped with a memory card that records your oxygen needs at night. This chip can be brought to the sleep center and adjustments can be made from that information without the need for a full follow up sleep study. The Parkwest sleep center also has home monitoring options available for people who cannot come to the sleep center. If you have been requested to follow through with a sleep study, I hope this information details the importance of scheduling that appointment.

Robin H. Saunders, RN, BSN

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