The number of people diagnosed with sleep apnea is continuously rising. Sleep apnea is also called Obstructive Sleep Apnea (OSA) because of upper airway collapse while you sleep.
I have chosen to discuss this disorder because of its importance and the degree of damage that this disease can cause if it remains undiagnosed and not treated appropriately.
According to the news, sleep apnea contributed to the death of Star Wars actress Carrie Fisher.
Central sleep apnea symptoms
Patients who have this condition complain of sleep deprivation, fatigue, exhaustion, poor concentration and sleepiness during the day.
Did you know that males have higher rate of sleep apnea than females?
The statistics show that the rate of sleep apnea in males is 2-3 times higher than females.
Causes and risk factors
There are several sleep apnea causes and risk factors,
- Obesity and overweight
- Airway abnormalities
- Nasal congestion
- Menopausal and postmenopausal women
Stages of sleep
To understand this disease better, you should know about the different stages of sleep.
We have two main stages of sleep: rapid eye movement (REM) and non-rapid eye movement (NREM) sleep.
In the REM (rapid eye movement) stage our brain appears to be active and dreaming.
During this phase the body paralyzes and most muscles don’t move. Therefore, during the REM phase the tongue muscles become paralyzed and airway obstruction worsens.
In the NREM phase, most of brain activities are low, including blood pressure, heart rate and breathing.
Most of the sleep (roughly 80%) is in NREM phase.
Signs of sleep apnea
The most commonly seen signs of this disease are snoring and exhaustion.
Interestingly, the first sign is usually unknown to the patient and the second sign is brought forward by the patients themselves.
Many times close family members report choking and gasping for air.
Diagnosis (sleep study)
To diagnose this disease, a sleep study is necessary. This study can mostly be done at home but a small percentage of people with other health issues, such as heart failure, or patients who would benefit from other forms of monitoring such as an EEG (brain wave monitoring) to evaluate the brain function, might require laboratory sleep study.
Sleep apnea treatment options
The non-invasive treatment of this disease is generally built on a continuous positive airway pressure (CPAP) machine and encouraging weight loss.
For people with mild form of OSA mouth guard (oral appliances) shown to be beneficial.
In patients who don’t respond to non-invasive treatment different kind of surgery options exist.
Patients who have upper respiratory obstruction because of nasal or throat abnormalities might benefit from a correction of these problems.
Surgery remains the last option in the treatment of this condition and isn’t recommended as first line therapy except if a significant improvement of the symptoms can be achieved with a minimally invasive procedure.
OSA in Children
The presentation of sleep apnea in children is a little different than adults.
As mentioned before, fatigue and sleepiness is the most common presentation of an adult suffering from this condition.
In children the most common presentations are the behavioral changes of the child, symptoms such as irritation, poor concentration, attention deficit, cognition impairment and aggression.
Children who aren’t treated might suffer from growth impairment, high blood pressure and heart muscle thickenings.
Many children could benefit from adenoid and tonsil surgery. Some children might also benefit from CPAP and BIPAP (bilevel positive airway pressure [BPAP]).
Here is a list of the most common complications of this disease,
- Poor concentration
- Increase risk for diabetes
- Developing fatty liver
- High blood pressure
- Heart disease
Sleep apnea is another silent killer that should be diagnosed early. It would be naive if we account every fatigue and tiredness during the day to sleep apnea.
There are multiple other conditions such as low blood pressure, depression, lack of good quality sleep or hormonal issues that could result in fatigue during the day.
I think it would be important to try our best in reducing over-testing.
Obtaining a home sleep study in most patients can reduce cost and deliver the basic information that you’re looking for.
If additional testing is required a laboratory sleep apnea test can be ordered later.
There are basic things that you could do to prevent apnea at night, for instance, avoiding smoking and alcohol intake at night, regular exercise, maintaining a comfortable weight, not eating large amounts of foods after 7 PM and elevating the back of the bed.
You should discuss your symptoms with your primary care doctor. There are ways to improve conditions such as nasal congestion, smoking and unhealthy nutrition that may help you to get a more restful sleep.