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Obstructive Sleep Apnea

Breathing is impaired (hypopnea) or completely stopped (apnea) due to an obstruction in the upper airway. Usually this is caused by the tongue. One of the most common sleep disorders, a single event usually lasts at least ten seconds.

A typical sufferer has hundreds of events per night. Approximately 30 million Americans (nine percent of men and four percent of women) suffer from some form of OSA.) Less than ten percent (Approx. three million Americans) of OSA sufferers have been diagnosed. Of those, less than 25 percent have been successfully treated.

What happens during the night?

There seems to be two different events that occur. The one that is called apnea occurs when you stop breathing for at least ten seconds. The other, called hypopnea, occurs when your normal breathing is reduced. These events decrease the amount of oxygen in your blood and can have severe consequences. Repeated breathing stoppages inhibit the body’s ability to process oxygen. Most hospitals will put patients on oxygen masks if they drop below 92 percent. It is not uncommon to see people with OSA drop into the 80’s, 70’s 60’s and even 50 percent range.

Consequences  of  low  oxygen  saturation  (hypoxemia)  range  from irreversible brain damage to heart attack and stroke.
How long do you have to hold your breath to drop down to 90% saturation? 30 seconds? One minute? Two minutes? It’s almost impossible to get someone to drop to 90 percent by simply holding their breath—further emphasizing the point of how severe sleep apnea is.

Did you know that:

  • You can live three weeks without
  • You can live three days without w
  • But you can only live three minutes without o This is life threatening!

Some more interesting facts:

  • Untreated OSA can take up to eight to ten years off your life. Smoking takes only seven to ten (men)
  • Type II Diabetes takes five to ten years off your life
  • OSA increases risk of death by 46%

Central Sleep Apnea:

Central Sleep Apnea is a breathing stoppage caused by a neurological condition. It is less common but just as dangerous as Obstructive Sleep Apnea. In short, during CSA the brain functions that trigger muscles to initiate breathing ‘forget’ to do so.

The result is a stoppage of breathing not due to an airway blockage. The patient will stop breathing for several seconds during which there is not any choking, gasping or any struggle to breathe as is the case with Obstructive Sleep Apnea. After a period of stillness with no breathing, the patient will begin breathing again sometimes at a more rapid rate because of elevated CO2 levels in the blood.

Sleep apnea patients use healthcare resources at approximately twice the rate of controls as far back as ten years before their diagnosis…”

—  Source: Ronald, Kryger et al, 1997 APSS

Sleep Apnea Raises Death Risk 46 Percent:

WASHINGTON (Reuters, Aug. 18, 2009)—Severe sleep apnea raises the risk of dying early by 46 percent, U.S. researchers reported Monday, but said people with milder sleep-breathing problems do not share that risk.

They said people with severe breathing disorders during sleep were more likely to die from a variety of causes than similar people without such sleep disorders. The risks are most obvious in men aged 40 to 70.

The Most Common Symptoms of Sleep Problems Are:

  • Snoring
  • Excessive Daytime Sleepiness
  • Hypertension (High Blood Pressure)
  • Acid Reflux (GERD—Gastro Esophageal Reflux Disease)
  • Morning Headaches
  • Diabetes
  • Sexual Dysfunction
  • Social Problems
  • Memory Problems—Alzheimer’s / Dementia
  • Dental Symptoms (Abfractions from nocturnal bruxism)
  • Contributing Factors
  • Obesity & Large Neck Circumference
  • Menopause
  • Mouth Breathing

Why is excessive sleepiness, lack of energy & fatigue a symptom?

Frequently when your body pulls you out of an apneic event it is accompanied by a micro-arousal. A micro arousal doesn’t necessarily wake you up from sleep, but it pulls you out of whatever sleep stage you were in.

The result is a disrupted sleep pattern and insufficient amounts of sleep. OSA patients spend significant amounts of time at night in a ‘fight or flight’ state with elevated blood pressure, heart rate and respiration. People do not feel rested in the morning because they spent the night fighting to breath.

Impact of Excessive Sleepiness

When you wake up tired you have not had the rest your body needs to function properly. Mood changes such as irritability and lack of energy are common. People with untreated sleep apnea are twelve times more likely to be involved in an automobile accident. Tired driving is the number one cause of car accidents and is statistically more dangerous than drunk driving.

Depression or “chronic fatigue syndrome” is readily diagnosed in patients with the primary complaint of fatigue. Accordingly, these patients are treated with antidepressant medications although unrecognized sleep apnea may be present.”

Why is high blood pressure a symptom? Two reasons:

There is a sympathetic (emergency) response in the body every time an apnea or hypopnea occurs. This causes your heart rate and blood pressure to increase. When this happens all night you have hundreds of events per night, so your body remains in a constant state of elevated blood pressure.

Because the body is not getting sufficient oxygen, it is not converting enough oxygen into nitric oxide, which is a vasodilator.  Without nitric oxide blood vessels narrow.

The endothelial lining of the arteries breaks down, making them more susceptible to plaque and fatty tissues building up. Narrow arteries with high risk of blockage = High Blood Pressure, heart attack and stroke. OSA increases hypertension risk by 45 percent.

 

 

So what can be done

First you should fill out an Epworth Sleepiness Scale (ESS) form.

 

Your score will determine if you have mild, moderate or severe sleep apnea.

0 = no chance of dozing

1 = slight chance of dozing

2 = moderate chance of dozing

3 = high chance of dozing

SITUATIONCHANCE OF DOZING
Sitting and reading____________
Watching TV____________
Sitting inactive in a public place (e.g. a theater or a meeting)____________
As a passenger in a car for an hour without a break____________
Lying down to rest in the afternoon when circumstances permit____________
Sitting and talking to someone____________
Sitting quietly after a lunch without alcohol____________
In a car, while stopped for a few minutes in traffic____________