Sleep Disorders
Sleep Apnea
Sleep apnea is a serious and very common disorder. It affects 1 in 25 adult males and 1 in 50 adult females. First described in 1965, sleep apnea is a breathing disorder characterized by brief interruptions of breathing during sleep. It owes its name to a Greek word, apnea, which means, “want of breath.”
Who is at Risk for Sleep Apnea
Sleep apnea is typically seen in overweight persons who snore but may be seen in others. The human airway is composed of soft tissues that require muscles to remain open. This is not a problem when one is awake, but when one goes to sleep muscle tone is decreased.
Persons who have a narrow airway to start with (snorers) may have a partial or total collapse of the airway while they sleep. When the airway collapses totally, this is called apnea.
A partial collapse is called hypopnea. Both apneas and hypopneas have very similar health consequences, and anyone obstructive sleep apnea sufferer will usually have both types of airway collapse.
What Happens During Sleep Apnea Episodes
Sleep apnea patients may have more than 100 episodes of airway collapse per hour in the most severe cases. Each episode of airway collapse is terminated by a brief “arousal,” which is a very short change in the level of alertness during which normal breathing is resumed. Most patients don’t wake up enough to remember the arousal and fall right back to sleep. Sometimes, patients will occasionally remember waking up gasping for air and feeling short of breath during the night. The effect of these frequent arousals is that sleep is not continuous or refreshing. Patients frequently complain of inability to stay fully awake during the daytime.
Symptoms of Sleep Apnea
- Snoring
- Frequent awakenings with shortness of breath
- Frequent jerks and leg movements during sleep occur when the patient wakes up and starts breathing again
- Daytime drowsiness regardless of how much sleep is obtained
Oxygen drops accompany the breath-holding spells, and this may result in morning headaches. In long-term apnea patients, we find an increased incidence of cerebrovascular disease. As researchers gather data, it appears that high blood pressure, strokes, and heart attacks occur with increased frequency in obstructive sleep apnea patients.
In patients with heart disease (prior heart attacks or heart failure), the oxygen drops may lead to nighttime cardiac rhythm disturbances that may be very serious and represent a medical emergency. Fortunately, this is uncommon and usually, treatment does not need to be initiated as an emergency.
Diagnosis and Treatment
Diagnosis of sleep apnea requires an overnight sleep study. The sleep study will document the number of apneas and hypopneas that occur during the night as well as how often they cause arousals and drops in oxygen levels. This will guide the doctor in making treatment decisions.
Treatment of sleep apnea is a complex and evolving medical field. The mainstay of treatment is the use of breathing machines (CPAP, BIPAP, and others), which apply small amounts of air pressure to the airway to hold it open during sleep.
Surgical options are available for milder sleep apnea cases if the physician feels this may be right for you. The most frequently performed surgery is a UPPP (uvulopalatal pharyngoplasty), which trims the uvula, the tissues of the soft palate, and the tissues behind the tongue to create more space in the airway behind the tongue.
There are other options that may be offered by your ENT surgeon. Oral airways similar to mouthpieces used by athletes may also be effective in milder cases and can be made by specially trained dentists
