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Sleep Apnea

What is sleep apnea?

Sleep apnea refers to episodes of apnea (not breathing) lasting more than 10 seconds that occur while sleeping. These episodes, which can occur hundreds of times per night, lead to transient awakening with resulting fragmentation of sleep. During these apneic periods, the levels of oxygen can drop to dangerously low levels and can result in cardiac arrhythmias (irregular heart beats), which can at times be fatal. Additionally, individuals with sleep apnea are much more prone to heart attacks and strokes. Over 20 million Americans suffer some degree of sleep apnea.

There are two basic subtypes of sleep apnea:

Central sleep apnea occurs in about 10% of patients with sleep apnea. In central sleep apnea, the center in the brain that controls respiration fails to cause the muscles that are used in breathing to respond. What usually occurs is that carbon dioxide (the gas that you exhale) increases in your blood stream, while the oxygen level decreases to very low levels. At dangerously low oxygen levels, your brain transiently causes you to "wake-up" and breath. This process is repeated throughout the night.

Obstructive sleep apnea is much more common. It (or a combination of central and obstructive sleep apnea) occurs in 90% of patients with sleep apnea. In this condition, the airway becomes obstructed by the tongue, tonsils, uvula, or a large amount of fat tissue in the neck. This results in the cutoff of airflow and the subsequent snoring sound.

What are the symptoms of sleep apnea?

Individuals with sleep apnea are frequently overweight and have large necks (collar size over 17 inches in males or 16 inches in females). The most common symptom of sleep apnea is heavy snoring that may occur after pauses in the breathing pattern. Typically, the first person who notices this is the bed partner or other individual in the household. Other symptoms of sleep apnea include falling asleep at inappropriate times, such as at work, while driving, sitting in a chair, or watching T.V. (although the latter may be indicative of the wasteland that is on the tube!). You may also notice morning headaches, memory difficulties, low energy, agitation, shortness of breath, or leg swelling. Frequently, individuals with sleep apnea will have high blood pressure that is either exacerbated or precipitated by their sleep apnea.

How is sleep apnea diagnosed?

The most important diagnostic tool in any medical condition is for the physician to take the time to obtain a good history and physical examination. A chest x-ray along, with laboratory tests, is usually performed to evaluate for other possible contributing factors, such as diabetes or hypothyroidism. The definitive diagnostic exam is a polysomnogram (sleep study) wherein you stay in a sleep laboratory overnight while measurements of your brain activity, respiratory activity, oxygen levels, and cardiac activity are performed.

How is sleep apnea treated?

The treatment of sleep apnea usually involves the following:

• Weight reduction (over 95% of individuals suffering from sleep apnea are obese).
• Avoid alcohol and sedatives.
• Medications to stimulate the respiratory center of the brain to keep you breathing while asleep.
• Masks (CPAP) that force your airway to stay open, thereby allowing you to breath.
• Mandible (jaw) positioning devices that help reposition the tongue to help prevent the airway obstruction.
• Surgery to relieve any obstructions.

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