Living with Sleep Apnea
Over the last ten years or so the issue of sleep apnea and its potential health effects have been widely publicized and discussed. It is not uncommon today to know someone who has been diagnosed with this sleep disorder.
My particular case of sleep apnea was discovered about fifteen years ago and I've been living with the disorder and the treatment ever since. In my particular case it was my wife who suggested that I get tested. This is often the case with sleep apnea as the person with the disorder rarely realizes what is going on and is not aware that their breathing is being disrupted or that they are waking up periodically during the night.
What is Sleep Apnea?
Sleep Apnea is a sleep disorder where pauses in the breathing process occur, or abnormally low breathing is occurring during sleep. The pauses in the breathing process can last anywhere from just a few seconds to many seconds.
There are three generally accepted forms of sleep apnea; Central (CSA), Obstructive (OSA), and mixed (combination of the two). In central sleep apnea one’s breathing is characterized by a lack of respiratory effort. This form comprises less than one percent of all sleep apnea cases. In obstructive sleep apnea, which is the form that I have, your breathing is disrupted by a physical block to the flow of air. OSA accounts for 84% of all sleep apnea cases. Mixed sleep apnea is simply a combination of the two and accounts for the remaining 15% of cases.
Central Sleep Apnea
Central sleep apnea occurs when the neurological signals for breathing malfunction and fail to signal the body to inhale. This causes the individual to miss one or more breathing cycles. The breathing cycle does start again but due to this pause the oxygen level in the blood can drop and the level of carbon dioxide can increase to abnormally high levels.
Obstructive Sleep Apnea
Obstructive sleep apnea occurs when the soft tissues in the throat relax to the point that they obstruct the airway. This can happen to individuals who have low muscle tone and an excess of soft tissue around the airway. It is more likely to happen to the elderly and to men, but it is not uncommon for women and children to suffer sleep apnea.
Some factors that can contribute to OSA include smoking, body weight and age. While snoring is a possible symptom of OSA it does not always mean the OSA is present and excessive snoring does not correlate directly to the severity of OSA. However, combined with other factors such as obesity or having a large neck, it can be a reliable predictor of OSA.
Some of the other factors that increase one's risk for sleep apnea include having large tonsils and/or a large tongue, sinus issues such as allergies or having a deviated septum, and family history.
In my particular case I am not overweight, do not have a large neck, do not smoke, but do snore and have sinus allergies. For some reason my particular anatomy in the throat area lends itself for the airway to become obstructed especially when I sleep on my back.
Individuals with sleep apnea may go for years or even decades without a proper diagnosis and may become so conditioned to the symptoms of fatigue and sleepiness that they have no idea that there is a problem. While more prevalent in adults, sleep apnea can also affect children as well.
In addition to daytime fatigue, sleep apnea can also lead to vision problems, impaired alertness, low blood oxygen, and slower reaction times, all of which can be dangerous especially when getting behind the wheel of a car. There is also mounting evidence that sleep apnea can cause impairment to one’s liver function. If left untreated, there are a number of health problems that can develop over time including diabetes, high blood pressure, stroke and heart issues.
Some of the more common symptoms of sleep apnea that may be more noticeable to others include restless sleep, loud snoring and sleepiness during the day. In my particular case it was my wife who alerted me to some of the symptoms. In addition to snoring, which was keeping her up at night; she also noticed that I seemed to stop breathing for short periods of time. I was also experiencing periods of extreme tiredness during the day. This prompted a visit to our doctor and eventually to a sleep specialist.
The formal diagnosis of sleep apnea in my case was made following a formal sleep study. This involved an overnight stay in the hospital where I was hooked up to enough apparatus that I wondered if I would be able to sleep at all.
The test is called a polysomnography (PSG) and it’s a comprehensive recording of any biophysiological changes that are occurring while you sleep. The test monitors numerous body functions including heart rhythm, eye movement, brain activity, muscle activity, respiratory airflow and blood oxygen level. The results of the PSG test give an indication of the number of apneic events occurring per hour and this is used to gage the severity of the sleep apnea.
Some of the things that contribute to sleep apnea can be dealt with as part of a possible treatment. Losing weight, avoiding alcohol, and learning to sleep on ones side as opposed to one’s back can all help with the disorder. An oral appliance can also be prescribed which can help with mild cases of sleep apnea. The appliance, similar to a mouthpiece, shifts the lower jaw forward thereby opening the airway.
For more moderate to severe cases the treatment of choice is to use a CPAP machine. CPAP stands for continuous positive airway pressure, and works by supplying pressurized air into the throat to force the airway open. The pressurized air is supplied via a flexible plastic tube that has a face mask at one end that fits over the individual’s nasal area. The other end of the tube connects to the CPAP machine which supplies the pressurized air.
While the use of a CPAP machine has proven to be extremely effective in reducing sleep apnea some patients find the face mask to be uncomfortable. My personal experience with the CPAP found the mask to be uncomfortable initially, but eventually I did get accustomed to it and have been using this method for over 15 years.
For patients who are not helped by the CPAP or who refuse to use it, a surgical procedure can be performed to correct the nasal airway or to reduce excessive soft tissue in the throat. As every case is different any surgical procedure would need to be highly individualized to address that person’s particular obstruction issues.
As with any medical issue you should consult with your doctor if you think you may have sleep apnea. A sleep study (PSG) can be ordered to determine definitively whether or not you have this condition. I was diagnosed with sleep apnea over 15 years ago and having been using a CPAP for that entire time. There are absolutely no side effects to using a CPAP. I put it on when I retire for the evening and take it off when I get up. I run, bike, hike, swim, travel and have absolutely no restrictions due to the sleep apnea.
© 2012 Bill De Giulio