THE SLEEP THAT CAN KILL YOU (Sleep Apnea)

Masood N. Khan M.D.

Sleep apnea (AP-ne-ah) simply means cessation of breathing during sleep. This occurs as pauses in breathing during sleep lasting from a few seconds to minutes. Such pauses can be quite frequent during the entire sleep. The most common effects of sleep apnea are two. The oxygen level in blood may become dangerously low during the pauses causing adverse effects on the functions of various organs, importantly of heart and brain. Secondly, the sleep gets disrupted and is of poor quality, causing excessive tiredness and sleepiness in the day time.

Unfortunately this condition often goes undetected because neither the patient is aware of the pauses during sleep nor the doctor has any test available to diagnose this condition in office. Only a high level of suspicion based upon the symptoms could lead him to a specialized test called ‘sleep study’ to diagnose it. Sometimes a family member or bed partner will notice the abnormal pauses during sleep and may inform the doctor.

There are two types of sleep apnea, 1. The central, caused by neurological disorders in which the area of brain that controls breathing doesn’t send the correct signals to breathing muscles resulting in abnormal pattern of breathing including pauses during sleep 2. The obstructive sleep apnea in which the airways become blocked during sleep because the muscles in the back of throat and other structures relax and consequently collapse during sleep narrowing the air passage. In addition there may be other structural abnormalities of air passage which might contribute to obstruction.

There are some risk factors that make people prone to sleep apnea. These are:

1. Excess weight that causes fat deposits around upper airway and throat.
2. People with a short and thicker neck may have narrow air passage.
3. Any kind of birth defect may cause air passage to be narrower than normal.
4. Being male makes one twice as likely to have sleep apnea than females.
5. Elderly people are more prone to have sleep apnea.
6. Race may also play a role. African Americans are more likely to have sleep apnea than whites.
7. Use of sedatives, tranquillizers and alcohol can aggravate sleep apnea by excessive relaxing effect on throat muscles.
8. Smokers are three times more likely to develop sleep apnea than non-smokers.

What is most concerning is the fact that sleep apnea may result in devastating effects on health. Since this condition, not infrequently, goes undetected the treatment of the consequent diseases often remains inadequate and difficult. Following serious consequences could give an idea as to how dangerous sleep apnea could be:

1. It causes hypertension. Depending upon the degree of sleep apnea the blood pressure could be severer and more difficult to treat.
2. The risk of stroke is more in people suffering from sleep apnea.
3. The long term effects of sleep apnea on heart are alarming. Dangerous irregularities of heart rhythm, heart attack, congestive heart failure and sudden death are the most serious complications.
4. People with sleep apnea are also observed to have abnormal results of liver function tests.
5. Repeated spells of lack of oxygen and poor quality of sleep have serious effects on brain function as evident in the loss of memory, irritability, depression, inability to concentrate, declining cognition and even dementia.
6. Day time fatigue and excessive sleepiness may result in poor performance on job, lay-offs and driving accidents.

The approach to treatment will have following components:

1. the first step is to be aware of the symptoms of unexplained fatigue and sleepiness experienced in the day time and/or if any member of the family mentions about the snoring and pauses in breathing during sleep. Such person should seek medical consultation discussing with the doctor the problem of snoring and possibility of sleep disorder.

2. Should try to sleep on the side avoiding flat on back position. Most forms of sleep apnea are less in intensity in this position.

3. Those who suffer from this condition should avoid sedatives and alcohol close to bedtime and also avoid driving when feeling sleepy in daytime.

4. Nocturnal Polysomnography (Sleep Study): This is a special test to monitor heart, lung and brain activity, breathing patterns, arm and leg movements and blood oxygen levels during sleep.

5. Continuous Positive Airway Pressure (CPAP): Depending upon the severity of the condition and the results of somnography test doctor may prescribe a machine that delivers pressured air through a mask placed over the nose while asleep. The air pressure is just enough to keep upper airway passages open. Such machines are now advanced in technology to provide comfortable sizes and adjustable pressures.

6. In mild sleep apnea oral devices of various sizes and designs are available that can be used more comfortably and easily than CPAP machines. They are devised to bring the jaw forward and open the throat passage while asleep.

7. SURGERY: Uvulopalatopharyngoplasty: Surgery is an option if other treatments have failed. In selected cases the tissue in the back of the throat and other structures like tonsils and adenoids are removed surgically to make room in the airway passages to prevent obstruction.