Open your eyes to sleep apnea

April 25, 2018 Providence Health Team

Sleep apnea can obstruct the flow of breath while you sleep

Sleep apnea can pose health risks, but there are several treatments available

A CPAP machine can solve the problem of apnea for most people

 

Sleep apnea is a wide-ranging problem. It affects about 25 percent of American men and 10 percent of women — and those numbers can increase significantly if there are other factors involved, such as illness and medication. Sleep apnea can disturb your sleep and affect your health, but the good news is it’s often treatable, says Richard D. Simon, MD, the medical director of the Kathryn Severyns Dement Sleep Disorders Center in Walla Walla, Washington. Here’s what you need to know about sleep apnea.

 

The definition

Sleep apnea occurs during sleep because in non-dream sleep one’s skeletal muscles are relaxed and in dream sleep they are paralyzed -- and every 90 minutes all night long, humans cycle between non-dream and dream sleep, Dr. Simon says. “In many cases, the cortex, the thinking part of the brain, looks much more active during dream sleep than when you’re wide awake. Then the question comes up, why don’t you act out your dreams every night? And that’s because just before you go into dream sleep another part of the brain paralyzes the skeletal muscles.”

 

Among those muscles are the tongue and the back of the throat. “For most of us, that isn’t a problem,” Dr. Simon says. “But for people with sleep apnea, their throats are configured in such a way that when the back of the throat collapses, the back of the tongue in particular can fall over the breathing tube, partially or completely blocking the flow of air, and they can actually start to suffocate.”

 

The effects

One of the most obvious consequences of sleep apnea is snoring. “The brain has to wake itself up, sometimes hundreds of times a night, to keep you breathing so you get a very fragmented sleep — you get daytime fatigue and sleepiness,” Dr. Simon says.

 

Sleep apnea can take a toll in other areas, too, such as heart health. “Mild apnea is associated with a slightly increased risk of high blood pressure,” Dr. Simon says. “But if you look at the studies of patients who have had heart attacks and strokes — the really bad cardio stuff — typically the sleep apnea has to be more severe, which means you stop breathing during a sleep study more than 30 times an hour. If you stop breathing 20 times an hour, we consider that mild to moderate.”

 

Because apnea can cause sleep deprivation, it also can lead to a higher risk of health issues associated with lack of sleep, such as loss of focus, poor brain function, weight gain and premature aging.

 

The treatment

What you may not know is that a sleep apnea diagnosis doesn’t have to be made after a doctor studies you in a sleep lab. “Quite frequently it can be diagnosed with a simple home study,” Dr. Simon says. “The diagnosis of apnea is not like it was five or 10 years ago, where you had to come in and get hooked up to all these different wires. We still do lab studies on complicated patients, but for the simple patient who’s young and snores, we typically do a home study and treat them.”

 

Typically, that treatment for obstructive sleep apnea involves keeping the throat open at night, since it tends to collapse when it’s relaxed. “So what we usually use is what we call a CPAP machine, which stands for continuous positive airway pressure,” Dr. Simon says.

 

“It’s a mask that fits into your nose or over your nose and mouth. It has a hose that’s hooked to a small machine that’s plugged into the wall, and all this machine does is quietly and gently blow heated, humidified air through the nose and into the throat, providing a mechanical air splint to the back of the throat. So when the throat relaxes at night, the air pressure helps it stay open.”

 

While the CPAP can be difficult for people who tend to feel claustrophobic or are unused to wearing something on their face, it is incredibly effective, Dr. Simon says. “It can cure apnea in over 90 percent of patients as long as they wear it. It’s like putting a pair of glasses on — you put your glasses on, you see, you put your CPAP on and you don’t have apnea.”

 

The CPAP is also inexpensive, as insurance companies cover it, and it can be portable when running on battery power, says Dr. Simon, adding that it works for all degrees of apnea. “And they all have automatic adjusting now, so you don’t need to come to a sleep center to figure out what the settings need to be. Generally, I can see a patient today, do a home study tonight and have him on a CPAP tomorrow.”

 

There is a second line of therapy for people with mild apnea who don’t like the CPAP. These are oral devices that look like football mouth guards. Fitted to your teeth, the device pushes the lower jaw forward a few millimeters, giving the back of the throat more room to collapse when it relaxes. “It doesn’t work as well as CPAP, but for mild apnea patients it can be dramatically effective,” Dr. Simon says.

 

There is also weight loss or positional therapy. “If you lose weight, your neck gets thinner and tends to open up,” Dr. Simon says. “For other people, their apnea is only present when they sleep on their back because the tongue falls straight back.”

 

If those steps don’t work, it may be time to look at surgical options. “There are some simple surgeries where we take the tonsils, adenoids and uvula and pull the chin bone forward, but we’re not doing too many of those anymore because they cure apnea about 15 to 20 percent of the time, and oftentimes the good results aren’t durable,” Dr. Simon says. “We can move your upper and lower jaw 15 to 20 millimeters forward, and it cures apnea about half the time. That’s usually done with patients who have craniofacial abnormalities and can’t tolerate CPAP.” In very severe cases, a tracheostomy can work, where a hole is cut in the neck for easy breathing, but that is usually a temporary measure.

 

“An interesting treatment that’s been promoted over the last couple of years is a 12th cranial nerve stimulator,” Dr. Simon says. “We basically put a pacemaker-type device in and run a wire up the neck and attach it to the nerve that goes to the tongue. You turn it on at night with a magnet, and it stimulates that nerve so the tongue doesn’t relax when you fall asleep. That is showing some promise.”

 

If you think you have sleep apnea, find a physician with experience in sleep disorders or contact a sleep clinic near you:

 

Washington: Kathryn Severyns Dement Sleep Disorders Center

Oregon: Providence Sleep Disorders Centers

Montana: Sleep Center at Providence St. Patrick Hospital

 

 

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