Without sleep, we would not be able to survive. The restorative properties that come with sleep are endless and contribute to the homeostatic balance our body needs to be set around in order to maintain physical, mental, and physiological health. However, many people suffer from a wide variety of sleep disorders that disrupt this restorative property of the body. For many, the severity of such pathologies are not enough to be lethal, but are enough to cause serious impact to a healthy day to day life. Arguably, one of the most prevalent sleep disorders in the United States is sleep apnea. According to the American Sleep Apnea Association: 22 million Americans are diagnosed with sleep apnea; with the possibility that 80% of the population are still un-diagnosed (source).
What is sleep apnea?
The textbook definition of sleep apnea is: A sleeping disorder in which breathing repeatedly starts and stops throughout the night. This can range from no breathing at all to very short, shallow breaths (more info: Medlineplus.gov).This disruption of breathing is a sporadic event throughout the night.
There are three main types of sleep apnea that are common and range from moderate to severe – Obstructive sleep apnea (OSA), Central Sleep Apnea and Complex Sleep Apnea.
Obstructive sleep apnea (OSA) is the most common (and most moderate) form seen in Americans. In this form of sleep apnea, your airway collapses or becomes blocked during sleep. Breathing may commence with a snorting or crackling sound. Snoring is also very common in individuals with this form of sleep apnea. (It should be noted that snoring does not necessarily mean you have OSA).
Central sleep apnea occurs when the brain does not send the proper electrical signals to the muscles that drive your breathing. With this type, you would experience trouble in similar ways as OSA of which snorting is a common side effect.
Complex sleep apnea disorder is when an individual suffers from both obstructive and central sleep apnea. (more info: MayoClinic)
What causes sleep apnea?
The cause of sleep apnea is dependent on which specific type of sleep apnea you suffer from. Since Obstructive Sleep Apnea (OSA) is the most common form we will focus mostly on it moving forward.
In OSA, muscles that support the soft palate, uvula, tonsils, and the sides of the tongue all relax. This relaxation causes either a narrowing or complete blockage of the airway as you inhale. This causes a decrease in adequate oxygen levels in the blood. Essentially your brain is being starved of oxygen.
Our body has a backup system for when this occurs – it jerks you awake. It does this so that your airway can fully open and you are able to breathe normally. While it serves it’s function to keep oxygen at crucial levels, it results in very poor sleep patterns. (more info: MayoClinic)
How do I know if I have sleep apnea?
When it comes to knowing if you have sleep apnea or not, it is extremely difficult to “self-diagnose.” Looking through risk factors, signs and symptoms on the internet can be a start, but it is always a good idea to schedule an appointment with your doctor and get them to assign you to a sleep study. During a sleep study, doctors will usually have you sleep overnight in their facility hooked up to multiple monitoring devices. These devices will measure your sleep levels, oxygen levels and so on.
What factors contribute to sleep apnea?
According to the National Heart, Lung and Blood Institute such risk factors for sleep apnea include: age (with the risk increasing in a directly proportional manner to increasing age), family and genetic causes, living an unhealthy lifestyle (such as smoking), as well as your race and ethnicity (with sleep apnea affecting African Americans, Native Americans and Hispanics more than Caucasians (source).
Common signs of sleep apnea include: apnea events, which are events when breathing actual ceases, frequent loud snoring, and gasping for air while sleeping. Common symptoms of sleep apnea include: daytime drowsiness, decrease in vigilance, attention and motor skills, sexual dysfunction, and waking up frequently during the night to urinate (more info). As mentioned above, nothing is better than a doctor visit and/or a sleep study to confirm 100% diagnosis of sleep apnea.
Risk factors you need to know:
If you or a loved one see these signs or symptoms or relate to risk factors, it is of utmost importance to call and schedule an appointment with your doctor immediately. Once you are in to see your doctor, screening for sleep apnea will include many questions such as:
- How tired do you feel during the day?
- Do you high blood pressure that is difficult to control?
- Asking your partner if they notice any of the gasping, choking, or crackling sounds you may make while asleep.
The most effective tool and questionnaire being the S.T.O.P. B.A.N.G. Assessment. The S.T.O.P. B.A.N.G. Assessment is crucial in the beginning stages of coming up with a diagnosis. S.T.O.P and B.A.N.G. are acronyms that represent eight of the major factors that go into the diagnosis of sleep apnea by getting an idea of how often you show signs and symptoms of sleep apnea and how well you fit into risk factor categories. S.T.O.P represents:
- Body mass
Some of the questions you might be asked include: What is your Body mass index or BMI?(This is important because sleep apnea affects overweight individuals more than it does those at a healthy weight)
What is your Age? (Men older than 50 years of age are at higher risk for developing sleep apnea.)
How large is your Neck? (Typical size of a male neck is 43 cm, whereas, for a female it is 41 cm. Large deviations from these sizes could potentially be a cause for your sleep apnea or be a contributing factor to the severity).
After this screening, if your doctor sees it fit, he will refer you to a sleep specialist for further evaluation and sleep studies to confirm or disprove a diagnosis.
Short and long term problems:
Much like all other pathological disorders, there comes short term and long term problems to your health when suffering from sleep apnea. If left untreated, such problems, even ones that can be small, can grow into much larger and increasingly severe problems. Some of the more common short term problems one sees in sleep apnea include: depression, excessive daytime drowsiness/fatigue, worsening of ADD/ADHD symptoms, headaches, and high blood pressure (source: WebMD).
While these may not seem like they will impact your life significantly, think again. Many of these can lead to long term problems that become far worse. For example, high blood pressure can cause long term cardiac changes, both electrically and physiologically, and manifest in more serious problems such as: heart failure, stroke, myocardial infarction, and heart palpitations. Daytime drowsiness can manifest and start to mimic that of narcolepsy, which could ultimately result in a misdiagnosis. Also, worsening of ADD/ADHD symptoms could cause significant impacts in academic performance, motor vehicle driving, and a decrease in overall quality of work performance.
Lastly, depression that is left untreated can manifest into a variety of extremely harmful behaviors and attitudes that when paired with non-restorative sleep is a recipe for bizarre and unnecessary mental health issues.
As you can see, both short term and long term problems are related, with short term problems being exacerbated into other much more severe pathologies you see in the long run. The best thing you can do to prevent all of this: See your doctor and get diagnosed as soon as you can so proper treatment can commence and you can steer clear of all these unwanted and completely unnecessary short and long term problems.
What can I do about sleep apnea?
The options you have for treatment these days are endless and range from things such as lifestyle changes, devices to use at night to help keep breathing steady and if serious enough, even surgery. Each of these can be broken down into extremely efficient ways to treat your sleep apnea so that you can improve your quality of life.
Treatment will also depend on the severity of the sleep apnea and how negatively it is affecting your life. If on the less severe side, lifestyle changes are among the best ways to treat and address your sleep apnea. Some of the most recommended changes include: losing weight, remaining active in your daily life, developing and getting your sleeping schedule more rigid, and most importantly (if you’re a smoker) STOP smoking.
Another form of treatment that is seen in individuals with sleep apnea are CPAP machines. These can be prescribed by a physician for moderate to severe forms of sleep apnea.
CPAP or Continuous Positive Airway Pressure therapy is used for individuals with obstructive sleep apnea. The ultimate goal and reason for the use of a CPAP machine is to create and increase air pressure in your throat so that the airway does not collapse when you breath in. Two different kinds of these machines are in use as a treatment. One uses the same fixed pressure throughout the night, and another machine, known as an APAP, uses different air pressures when you breath in and out and thus being more comfortable to use.
If you can’t get a doctor referral or need a solution over the counter, you can look at mouthpiece devices. These types of devices are inserted into the oral cavity every night in order to allow the airway to remain open when you breath. Two popular mouthpieces that are in use include: the mandibular positioning mouthpiece, which covers the upper and lower teeth and holds the jaw in position; and the tongue retaining device, which holds the tongue in a forward position and thus prevents it from blocking the airway.