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Sunday, October 18, 2009

Sleep apnea, do you have it?

More than 18 million Americans have sleep apnea, and almost everyone knows someone who has it. Many cases go undiagnosed for years. But what is sleep apnea, how do you make the diagnosis, and how is it treated?

There are three basic types of sleep apnea: Obstructive Sleep Apnea (OSA), which accounts for most cases, Central Sleep Apnea (CSA), and a mixture of the two. Here, only OSA will be addressed.

Sleep apnea was first described in medical literature in 1965, as a breathing disorder characterized by numerous brief interruptions of breathing during sleep. But don’t be misled; it’s been described quite accurately by Charles Dickens in his Pickwick Papers in 1837-1938, when he portrayed Joe as the fat, red faced boy who was repeatedly falling asleep during the day.

Sleep apnea is defined as the presence of more than 30 episodes of apnea (cessation of breathing), each lasting more than 10 seconds. In severe cases, apnea periods may last longer than 60 seconds, and may recur hundreds of times a night. Obstructive Sleep Apnea occurs mostly in the obese person, typically with a short neck. It may occur in persons who have abnormalities in the nose and throat, such as enlarged tonsils, polyps or excess adenoid tissue, which obstruct the flow of air while asleep. Most OSA patients are heavy snorers. During an apnea episode snoring stops, then breathing resumes with a typical “snort.” While sleeping, the tongue and throat muscles relax causing airway blockage. When the apnea period ends, these muscles tighten up temporarily, allowing breathing again until the next episode.

Full blown OSA leads to irritability and lack of concentration; learning and memory difficulties; sexual dysfunction, and the development of high blood pressure, headaches, irregular heart beats, premature heart attacks and sudden death. In sleep apnea there is a major disturbance of the sleep cycle. Sleep quality is poor, and in reality you are sleep deprived. As a result, you may fall asleep irresistibly during the day, even while driving. You may not realize that you fell asleep during the day while in a meeting or at lunch; but your friends notice it, and will hopefully tell you about it.

While you may strongly suspect sleep apnea, the definitive diagnosis is made in a sleep laboratory, where the severity of the disorder can be quantified, and treatment suggested.

Treatment is individualized, usually consisting of a pressurized face mask at night to allow better airflow and to minimize the number and severity of apnea episodes. Surgery to remove excess tissue in the throat is occasionally recommended. Alcohol and caffeinated beverages have to be kept to a minimum, and sleeping medications must be avoided.

Most importantly, the long term therapy of Obstructive Sleep Apnea must include weight management. Reducing weight to normal or near normal range frequently eliminates the sleep apnea altogether, allowing you to return to normal life.

If you suspect that you have sleep apnea, have it formally diagnosed and, above all, take care of your health, no one will do it for you...

Twitter / Dr. Staw