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:
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:
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.