Sleep Apnea

from Chattanooga HealthScope, Late Summer 2009

Jokes about snoring are common and classic, but if those window-rattling ZZZZs are caused by sleep apnea, then they are no laughing matter.

The American Sleep Apnea Association estimates that 18 million people in the United States suffer from sleep apnea, and of those, 90 percent are undiagnosed. While not all snoring is an indication of sleep apnea, it is one of the most common symptoms. The snorts, snores, gasps, and throttles of a sleeping person may not only be robbing him/her of the restorative powers of sleep, but may also be creating serious health problems.

Apnea, a Greek word for “without breath,” describes the common status of a person with sleep apnea who stops breathing repeatedly during sleep, sometimes five to 50 times per hour, or even hundreds of times throughout the night. Therefore, a person with undiagnosed or untreated sleep apnea will sleep, but the sleep is frequently disturbed and poor in quality. The brain’s trigger awakens the sleeper enough for breathing to resume, but the condition still results in morning headaches and tiredness, as well as fatigue throughout the day.

Obstructive sleep apnea (OSA) – the most common form of apnea – is caused when the airway is blocked, usually because the soft tissue in the rear of the throat collapses during sleep. With central sleep apnea, the brain simply fails to signal the muscles to breathe. Mixed apnea, the third type, is, as the name suggests, a combination of the other two.

Does snoring always equal apnea? While snoring is one of the most identifiable symptoms of sleep apnea, snoring alone does not equal a diagnosis of sleep apnea. However, when additional problems exist, such as high blood pressure, excessive sleepiness in the daytime after six to seven hours of sleep, and the necessity of an afternoon nap, then seeking a physician’s help is strongly advised. Waking up to go to the bathroom and waking up with a dry mouth or headache are also cautionary signs.

Who seeks help? The National Sleep Association considers sleep apnea to be a public health crisis, especially since 90 percent of those with this condition remain undiagnosed. The negative effects of nights without restorative sleep commonly cause one to feel as though he/she could fall asleep at work or even while driving. Despite these nagging and even dangerous symptoms, those suffering from sleep apnea may not seek the help they need on their own. According to Dr. Anuj Chandra, a Board Certified Sleep Specialist with the Advanced Center for Sleep Disorders, very often it is a sleep partner who insists on medical help. A sleep partner is often far more aware of just how often the sleeper‘s rest is interrupted by a gasp for breath. In addition, the partner’s sleep also loses its restorative power because of the volume of the snores and the constant interruption that results. The push from a sleep partner may be the incentive needed for one to seek a doctor’s diagnosis. The partner may also be able to provide important information based on observations of sleep apnea symptoms.

Is sleep apnea just a “guy thing”? As reflected in common jokes about snoring, most often sleep apnea is seen as a male issue; in fact, 24 percent of men are thought to have the condition. However, research indicates that 9 percent of women develop sleep apnea. In women, the problem usually begins after menopause when reduced hormone levels make tissue less elastic, allowing the airway to close during sleep. Associated weight gain is also a factor. But sleep apnea has also been diagnosed in children, so attention to their sleep habits and sleep sounds is important for parents.

What’s the big deal? Early on, the symptoms of sleep apnea may be tolerated by the one with the condition and may prove only a mild irritation to that person’s sleep partner. However, it doesn’t take long for the symptoms that are the source of material for comedians to create serious health threats. Hypertension is chief among the serious medical conditions linked to sleep apnea. Cardiovascular disease, memory problems, weight gain, impotency and headaches are also associated with sleep apnea. The resulting increased risk for heart disease and stroke underlines the need for diagnosis and treatment. Untreated sleep apnea can result in job impairment and is even attributed to motor vehicle crashes. The Department of Transportation has recognized the potential risks and has implemented testing for the trucking industry.

Prevention of DVT To diagnose sleep apnea, studies are conducted in specially designed sleep clinics. Dr. Chandra had this in mind when he opened the Advanced Center for Sleep Disorders in Chattanooga, which is located in a former three-bedroom home. Everything about this center is designed to maintain a home-like atmosphere, and the trained staff and technicians make testing and sleeping away from home as comfortable as possible. Patients are encouraged to bring personal items, such as pillows and normal sleepwear, to make the evening routine seem familiar. Technicians, in a separate room, monitor an electrocardiogram, electro-encephalogram, equipment to monitor breathing and muscle activity, and a video camera. Patients generally arrive at 7:30 p.m. and may leave directly for work the next morning, since each room has its own attached bathroom.

Pam Dalton, RPSGT, Director of the Chattanooga Sleep Center, compares their sleep study setting to a hotel room. When patients come in for their clinical exam, they are given a tour of the eight-bed lab and an explanation of what will happen during the study. “There is some apprehension, and there are a lot of wires associated with the testing, but the technicians do a great job of making people as comfortable as possible,” she says. While the Chattanooga Sleep Center is fully accredited to diagnose and treat sleep issues from insomnia to narcolepsy, 80 percent of their patients come seeking treatment for sleep apnea.

Diagnosed…now what? A huge deterrent to participating in a sleep clinic study is actually being diagnosed. Even though a diagnosis of sleep apnea is the beginning of improved rest and health, Dr. Chandra recognizes that people often have reservations about seeking treatment for sleep apnea. “Awareness of the problem is there, but so is the reluctance,” he states. This is in part related to a negative perspective about treatment, especially about the sleep masks. “Keep an open mind,” Dr. Chandra advises, “because treatments include a wide range of options, depending on the severity and the exact cause.”

Treatments for sleep apnea certainly begin with lifestyle changes. Weight loss can play a role by reducing the stress placed on airways and opening the pathways for better breath; however, weight loss offers only partial improvement. Eliminating smoking, alcohol consumption, and certain medications, such as sedatives before bed, are also positive steps. These lifestyle changes will not only reduce the effects of sleep apnea, but will also provide other health benefits. In most cases, however, the diagnosis of sleep apnea requires more.

One of the most effective treatments of sleep apnea is the continuous positive airway pressure, or CPAP (pronounced SEE-pap) mask. Unfortunately, it is this treatment that often keeps people from seeking the help they need. Great improvement in the design and comfort of these masks has resulted in a much higher tolerance by wearers. Fitting the mask is overseen by the sleep clinic staff, and every effort is made to see that the patient goes home with a CPAP that he or she will be comfortable wearing.

Some patients need only a dental appliance, much like a retainer, to open the air passage and achieve a better night’s sleep. These devices are designed by dentists who specialize in treating sleep apnea.

A person with large tonsils or adenoids or a large uvula may experience sleep apnea. These may cause no problems during the day but can press down on the airway when one lies down at night. For these people, surgery is often the best option. These are also the most common reasons for sleep apnea in children.

Like good nutrition and regular exercise, adequate sleep is necessary to maintain life. Sleep apnea makes restorative sleep impossible until a clear diagnosis is made and an appropriate treatment is found. More than just an annoyance, undiagnosed or untreated sleep apnea is a serious threat to good health.

Pamela Boaz, a writer and editor, earned a BS degree from the University of North Florida and an M. Ed. from UTC. During her more than 30-year career in education, she has served as faculty advisor for student publications and written curricula for a variety of courses. Pam also works as Professor-in Residence for UTC, supervising student teachers.