Sleep apnea is a common disorder that can be very
serious. In sleep apnea, your breathing stops or gets very
shallow while you are sleeping. Each pause in breathing
typically lasts 10 to 20 seconds or more. These pauses can
occur 20 to 30 times or more an hour.
The most common type of sleep apnea is obstructive sleep
apnea. During sleep, enough air cannot flow into your lungs
through your mouth and nose even though you try to breathe.
When this happens, the amount of oxygen in your blood may
drop. Normal breaths then start again with a loud snort or
choking sound.
When your sleep is upset throughout the night, you can be
very sleepy during the day. With sleep apnea, your sleep is
not restful because:
These brief episodes of increased airway resistance (and
breathing pauses) occur many times.
You may have many brief drops in the oxygen levels in your
blood.
You move out of deep sleep and into light sleep several
times during the night, resulting in poor sleep quality.
People with sleep apnea often have loud snoring. However, not everyone who snores has sleep
apnea. Some people with sleep apnea don’t know they snore.
Sleep apnea happens more often in people who are
overweight, but even thin people can have it.
Most people don’t know they have sleep apnea. They don’t
know that they are having problems breathing while they
are sleeping.
A family member and/or bed partner may notice the signs of
sleep apnea first.
Untreated sleep apnea can increase the chance of having
high blood pressure and even a heart attack or stroke. Untreated sleep apnea can also increase the risk
of diabetes and the risk for work-related accidents and
driving accidents.
How Is Sleep Apnea Treated?
Treatment is aimed at restoring regular nighttime
breathing and relieving symptoms such as very loud snoring
and daytime sleepiness. Treatment will also help associated
medical problems, such as high blood pressure, and reduce
the risk for heart attack and stroke.
Changes in Activities or Habits
If you have mild sleep apnea, some changes in daily
activities or habits may be all that are needed:
Avoid alcohol, smoking, and medicines that make you
sleepy. They make it harder for your throat to stay open
while you sleep.
Lose weight if you are overweight. Even a little weight
loss can improve your symptoms.
Sleep on your side instead of your back. Sleeping on your
side may help keep your throat open.
People with moderate or severe sleep apnea will need to
make these changes as well. They also will need other
treatments, such as the following.
Continuous Positive Airway Pressure
Continuous positive airway pressure (CPAP) is the most
common treatment for sleep apnea. For this treatment, you
wear a mask over your nose during sleep. The mask blows air
into your throat at a pressure level that is right for you.
The increased airway pressure keeps the throat open while
you sleep. The air pressure is adjusted so that it is just
enough to stop the airways from briefly getting too small
during sleep.
Treating sleep apnea may help you stop snoring. Stopping
snoring does not mean that you no longer have sleep apnea or
that you can stop using CPAP.
Sleep apnea will return if CPAP is stopped or if it is
not used correctly. Usually, a technician comes to your home
to bring the CPAP equipment. The technician will set up the
CPAP machine and make adjustments based on your doctor’s
orders.
CPAP treatment may cause side effects in some people.
Some side effects are:
Dry or stuffy nose
Irritation of the skin on your face
Bloating of your stomach
Sore eyes
Headaches
If you are having trouble with CPAP side effects, work
with your sleep medicine specialist and technician. Together
you can do things to reduce these side effects, such as:
Use a nasal spray to relieve a dry, stuffy, or runny nose.
Adjust the CPAP settings.
Adjust the size/fit of the mask.
Add moisture to the air as it flows through the mask.
Use a CPAP machine that can automatically adjust the
amount of air pressure to the level that is required to
keep the airway open.
Use a CPAP machine that will start with a low air pressure
and slowly increase the air pressure as you fall asleep.
People with severe sleep apnea symptoms generally feel
much better once they begin treatment with CPAP. When using
CPAP, it is very important that you follow up with your
doctor. If you are having side effects, talk to your doctor.
Mouthpiece
A mouthpiece (oral appliance) may be helpful in some
people with mild sleep apnea. Some doctors may also
recommend this if you snore loudly but do not have sleep apnea.
A custom-fit plastic mouthpiece will be made by a dentist
or orthodontist. An orthodontist is a specialist in
correcting teeth or jaw problems. The mouthpiece will adjust
your lower jaw and your tongue to help keep the airway in
your throat open while you are sleeping. Air can then flow
easily into your lungs because there is less resistance to
breathing.
Possible side effects of the mouthpiece include damage to
your:
Teeth
Gums
Jaw
Follow up with your dentist or orthodontist to check for
any side effects and to be sure that your mouthpiece fits.
Surgery
Some people with sleep apnea may benefit from surgery.
The type of surgery depends on the cause of the sleep apnea.
Surgery may be done to remove the tonsils and adenoids if
they are blocking the airway. This surgery is especially
helpful for children.
Uvulopalatopharyngoplasty (U-vu-lo-PAL-a-to-fa-RIN-go-plas-te)
(UPPP) is a surgery that removes the tonsils, uvula (the
tissue that hangs from the middle of the back of the roof
of the mouth), and part of your soft palate (the roof of
your mouth in the back of your throat). This surgery is
only effective for some people with sleep apnea.
Laser-assisted uvulopalatoplasty (U-vu-lo-PAL-a-to-plas-te)
(LAUP) is a surgery that can stop snoring but is probably
not helpful in treating sleep apnea. A laser device is
used to remove the uvula and part of the soft palate.
Because this surgery stops the main symptom of sleep apnea
(snoring), it is important to have a sleep study first.
Tracheostomy (TRA-ke-OS-to-me) is a surgery used in severe
sleep apnea. A small hole is made in the windpipe and a
tube is inserted. Air will flow through the tube and into
the lungs. This surgery is very successful but is needed
only in patients not responding to all other possible
treatments.
Other possible surgeries for some people with sleep apnea
include:
Rebuilding the lower jaw
Surgery on the nose
Surgery to treat obesity
Currently, there are no medicines for the treatment of
sleep apnea.
Home Test Units
Home testing units are cheaper and less hassle than a trip to a
sleep laboratory but not as reliable in diagnosing the disorder,
which restricts breathing during the night, causing sufferers to
wake up repeatedly.
Medicare currently covers sleep apnea treatment - the most common is
the CPAP, a mask that covers the nose and mouth, increasing air
pressure in the throat during the night - only for those diagnosed
in a sleep lab.
But, in December 2007, it proposed to cover treatment for seniors
diagnosed with home tests. a final decision is expected in March.
The decision will have large ramifications for the booming sleep
apnea devices market, which generated more than $85 million of
revenue in 2005 and is expected to reach $135 million by 2012.
Dr. Lewis Kline, director of the center for sleep disorder at
Western Pennsylvania Hospital, he doesn't have a problem with
home tests, though a 2007 study by doctors at the University of
Pennsylvania concluded that they aren't as reliable as a PSG. The
biggest problem with diagnosing sleep apnea . as Dr. Kline put is,
is "who's reading the squiggles. What are the controls on a home
study? Who is going to determine who's qualified or order or read
these studies?'
A home testing device spits out a "yes" or "no" diagnosis, Dr, Kline
said, but a qualified doctor must read the raw data to be sure the
machine didn't malfunction during the night. He said Medicare should
mandate board certification for doctors looking at the tests.
More Information
American Sleep Apnea Association
1424 K Street NW, Suite 302, Washington, DC 20005
phone: 202/293-3650
he American Sleep Apnea Association is the only
non-profit organization dedicated to educating the public
about sleep apnea and to serving people with this common
disorder. The American Sleep Apnea Association is dedicated to
reducing injury, disability, and death from sleep apnea and
to enhancing the well-being of those affected by this common
disorder. The ASAA promotes education and awareness, the
ASAA A.W.A.K.E. Network of voluntary mutual support groups,
research, and continuous improvement in care.
Source: Marketdata Enterprises, Inc. research, Wikipedia, Natl.
Heart, Lung & Blood Institute
