When a Night's Sleep is Not Enough

This medical condition is a bit more serious than is supposed, for a variety of reasons, untreated it can lead to the following:

Arrhythmias
Stroke
Heart attack
Decreased growth hormone production
Inadequate school or work performance
Greater incidence of traffic and workplace accidents

Signs the condition may exist are the following.:

Daytime fatigue
Morning headaches
Restless sleeping patterns
Morning sore throat
Choking or gasping during sleep
Insomnia
Heavy, deep snoring
Night sweats
Dry mouth
Mood changes
Heartburn

People with obstructive apnea have been known to fall asleep at the wheel of a car. Some with severe apnea may fall asleep while you are talking to them. You may not be that boring, they are just tired.

If you snore, chances are very good that you have the condition. It is not that uncommon. Patients with Sleep Apnea often report sleep as so un-regenerative, that they feel they'd have been better off not having slept at all. This type of sleep deprivation is cumulative in it's effects, and can often result in poor concentration, memory problems, anxiety, and confusion during the day. Also the degenerative effects and risks mentioned (above) are a big concern. They occur over time.

The mechanics of obstructive sleep Apnea are pretty simple. The muscles in the throat relax during REM Sleep. In people with smaller air ways, the muscles and tissues that have relaxed onto the smaller airway occlude air exchange during sleep- thus reducing oxygen. This causes the sleeper to wake as many as a hundred times during a rem sleep cycle, of which there are - typically- 5 or 6 ninety minute cycles during the entire 8 hours of sleep. That is if you get that many hours, which many of us do not. Normal sleep shortages just add to the problem.

But usually this obstruction occurs during REM sleep (rapid eye movement sleep, or "dream sleep," if the problem is obstructive. (Oxygen Desaturations will occur during deep sleep if the problem is central.)

The function of REM sleep is not clear, except that there are very noticeable changes that occur during the day in terms of cognition, energy levels and mood if REM sleep is insufficient or of poor quality. And there are very negative consequences that occur over time from being deprived of REM sleep.. So, if you have excessive fatigue during the day, and you snore, you may want to go to your primary care physician and ask to see a sleep specialist, as you may have this sleep disorder. It is estimated that four percent of the US population does. There is treatment.

So, describing symptons to primary physician should result in a referal to sleep specialist who will many times order an appointment for an overnight visit to a “sleep lab,” for a "sleep study." It is not a painful experience, however the awkwardness of being wired up may take some getting used to...

There, electrodes are placed on the scalp (quite a few of them so be patient.) A band is placed along the diaphragm area just below the rib cage. A pulse oximeter is placed on the finger. And EKG leads will be applied to the chest. Why?

Well. the electrodes are attached to an EEG machine to measure brain waves. Alpha waves are expected during REM Sleep.

The band around the diaphragm measures respirations, and the finger clip is for oxygen levels. The EKG leads to the chest examine cardiac activity during sleep. All of these parameters and more will measured during sleep. Also, don't be shy, there will be a video camera trained on you all night.

The camera detects restlessness, waking episodes, and other sleep disorders such as restless leg syndrome. There is a microphone in the room as well to detect labored breathing and snoring. A technician applies the devices and monitors you all night, as you sleep. All of your sleep behaviors and dynamics are being recorded.

What is expected in Sleep Apena is a drop in blood 02 levels as shown on the pulse oximeter occuring in tandem with REM, with evidence of obstruction. Oxygen saturation should stay at or near 95%, but during obstructive episodes the person desaturates of oxygen and the percentage of oxygen can drop to 70 percent or lower. (very dangerous, a big strain on the heart, reflected on the EKG.) The obstruction will occur during REM sleep usually (REM is confirmed by EEG and rapid eye movement, oh I forgot, there are leads on your eyelids, not very comfortable or attractive, but very effective to measure rapid eye movement..)

The video will show irregular erratic movements. Movements during REM sleep will suggest strained ineffective breating.The microphone picks up strained sounds during REM (snoring, gasping, sudden breathing cessation.) The band on the waist picks up respiratory rate, and depth. From all of this information comes a sleep profile of sleep anoxia during REM sleep which is suggestive of Obstructive Sleep Apnea. Each device serves a sensible purpose..

. ( Note: In dream sleep, the brain produces alpha waves. If the technician obseves theta waves he knows you're awake.)

The devices are operating all night, recording for the full time. The results are interpreted by a sleep expert MD. If there is evidence of sleep apnea the doc determines when it occurs, how frequently, and rates the severity. (The is a special type of Sleep Apnea called “central apnea," which is far more serious - as the problem is not limited to the airway. The presence of this condition suggests brain involvement. Some researchers believe central apnea is the cause of SIDS. This is why babies should be monitiored by mothers at night. This should be done periodically for irregular breathing patterns in new babies for six months. After that the l the danger of sids is past.

Dads can do this too to get a sense if breathing patterns are normal. ( Note for new parents: A little more vigilance for premies should be applied during the first 6 months as well, No sleeping on the abdomen, and no pillows... head elevated by bracing the mattress up 15 degrees, for a pillow. a soft blanket only.)

Sleep apnea is treatable by several means depending on the severity.

1. Surgery to remove tissue from back of the throat

   that contributes to the obstruction

2. CPAP

3. Weight loss is recommended to the extent that it escerbates the problem

4. And medication Modafinil for treatment of day time fatigue (Generic:Monofrinil. Brand name: Provigil)

CPAP is the usual treatment. That treatment is described very well here CPAP. Positive Air way Pressure is applied to the air way during sleep which literally inflates the airway by blowing it open when obstruction is sensed by the machine, other wise the pressure delivered is normal pressure. (note: these are not fun to wear, but they are necessary.)

Gary Stone BSN, MLT

© Toylanders Press International. September 2009