All About Sleep Apnea

SLEEP APNEA IS A COMMON SLEEP PROBLEM THAT CAN BEGIN AT ANY AGE. BREATHING IS REPEATEDLY INTERRUPTED DURING SLEEP. 

THE TIME PERIOD FOR WHICH THE BREATHING STOPS OR DECREASES IS USUALLY BETWEEN 10 AND 30 SECONDS.  WHEN THESE EPISODES OCCUR REPEATEDLY, SLEEP APNEA CAN SERIOUSLY DISRUPT THE QUALITY OF SLEEP.

 IT AFFECTS MILLIONS OF PEOPLE AND HAS BEEN LINKED TO HIGH BLOOD PRESSURE, HEART ATTACK, AND STROKE, and JUST LAST WEEK, CANCER (SEE ARTICLE LINK BELOW).

DR. CHARLES BAE TREATS SLEEP APNEA PATIENTS AT CLEVELAND CLINIC’S SLEEP DISORDERS CENTER .

HE SAYS MANY PEOPLE WITH SLEEP APNEA DON’T EVEN KNOW THEY HAVE IT.

“There is, throughout the night, a collapse of the upper airway. So, essentially you stop breathing multiple times, while you’re sleeping, even if you’re not aware of it.”

DR. BAE SAYS PEOPLE WHO HAVE SLEEP APNEA DON’T ALWAYS WAKE UP WHEN THEY STOP BREATHING.

HE SAYS OFTENTIMES, PEOPLE MAY NOT EVEN KNOW THEY HAVE IT, AND THAT THEY’RE USUALLY TOLD BY THEIR SLEEP PARTNER THAT THEY EITHER STOP BREATHING OR SNORE LOUDLY.

DR. BAE SAYS ONCE SLEEP APNEA IS DIAGNOSED, TREATMENT USUALLY INVOLVES A CONTINUOUS POSITIVE AIRWAY PRESSURE, OR CPAP MACHINE.

Dr. Charles Bae says, “Depending on how serious the sleep apnea is that would determine when you need the machine, but it really, oftentimes, doesn’t matter. Someone with severe sleep apnea may not be sleepy, but they definitely need the machine. Someone with mild sleep apnea may be super sleepy, so certainly, that would be the time to consider it.”

DR. BAE ALSO SAYS IF YOU’RE GETTING 8 HOURS OF SLEEP, BUT STILL FEEL TIRED, OR ARE WAKING UP FOR UNKNOWN REASONS, TALK TO YOUR DOCTOR.  For more information, visit: www.clevelandclinic.org

English: The Cycle of Obstructive Sleep Apnea ...
English: The Cycle of Obstructive Sleep Apnea – OSA (Photo credit: Wikipedia)

NEW TREATMENTS FOR SLEEP APNEA

The Center for Minimally Invasive and Robotic Surgery at The Mount Sinai Medical Center—a pioneer in robotic surgery—now offers a procedure to patients with sleep apnea, whose obstructive breathing prevents them from sleeping normally.

Mount Sinai is one of only a few programs in the world to use transoral robotic surgery (TORS) to remove excess tissue or fix a collapsed airway that causes sleep apnea.

Through the robotic procedure, a laser removes the extra tissue in the throat that contributes to the airway obstruction in sleep apnea patients.

Patients typically return home the next day, and are back to work in 10 days, sleeping and breathing normally.

During sleep apnea, a person’s breathing is blocked and then restored when the brain sends a signal that awakens the patient to a lighter level of sleep.

This process can happen hundreds of times each night, leaving the patient exhausted during the day and at risk for many health complications, including cardiovascular disease and hypertension.

Many patients opt for a treatment called continuous positive airway pressure (CPAP), delivered through a mask that the patient wears at night to force his or her airway open for the duration of sleep.

However, some feel the mask hinders their quality of life, and look for better options.

“Over time many patients grow frustrated with CPAP or stop using the device, causing their sleep apnea to return and leaving them anxious for a better solution,” said Fred Lin, MD, Assistant Professor of Otolaryngology and Director of the Mount Sinai Sleep Surgery Center.

 “In the past, surgery had been a last resort. Now, using robotic surgery, we can remove the tissue that contributes to the airway blockage in a brief procedure with no external incisions and have patients home the next day, sleeping healthfully.”

During the robotic procedure, a surgeon sits at a console directly controlling a robotic arm that extends a small surgical instrument through the patient’s mouth. Using a high-powered 3-D camera, he or she has a clear view of the surgical field.

The previous surgical technique was less precise and potentially less effective because the surgeon was only able to use one hand, and had limited maneuverability.

“Mount Sinai is one of the original adopters of robotic surgery and we have seen first-hand the dramatic quality of life improvements it provides our head and neck cancer patients,” said Eric Genden, MD, Professor and Chair of Otolaryngology, Mount Sinai School of Medicine.

Causes

There are three types of respiratory events:

  • Obstructive apnea—caused by a temporary, partial, or complete blockage of the airway
  • Central apnea—caused by a temporary failure to make an effort to breathe
  • Mixed apnea—combination of the first two types

Risk Factors

These factors increase your chance of developing sleep apnea. Tell your doctor if you have any of these risk factors:

  • Sex: male
  • Overweight
  • Large neck circumference
  • Age: middle to older age
  • Family history of apnea
  • Structural abnormalities of the nose, throat, or other part of the respiratory tract. Examples include:
  • Hypothyroidism
  • Medicines: sedatives and sleeping aids
  • Alcohol consumption
  • Smoking

Symptoms

Symptoms include:

  • Fatigue and sleepiness during waking hours
  • Loud snoring
  • Breathing that stops during the night (noticed by the partner)
  • Repeated waking at night
  • Unrefreshing sleep
  • Morning headaches
  • Poor concentration or problems with memory
  • Irritability or short temper

People with chronic untreated sleep apnea may be at risk for:

Diagnosis

An overnight sleep study is used to help diagnose sleep apnea.

Overnight Sleep Study (Polysomnography)

This testhelps detect the presence and severity of sleep apnea. During sleep, it measures your:

  • Eye and muscle movements
  • Brain activity ( electroencephalogram)
  • Heart rate
  • Breathing (pattern and depth)
  • Percent saturation of your red blood cells with oxygen

Other Studies

In addition to sleep studies, your doctor may order:

Treatment

There are a number of treatment options for sleep apnea, including:

Behavioral Therapy

  • Lose weight if you are overweight.
  • Avoid using sedatives, sleeping pills, alcohol, and nicotine, which tend to make the condition worse.
  • Try sleeping on your side instead of your back.
  • Place pillows strategically so you are as comfortable as possible.
  • For daytime sleepiness, practice safety measures, such as avoiding driving or operating potentially hazardous equipment.

Mechanical Therapy

Continuous positive airway pressure (CPAP) entails wearing a mask over your nose and/or mouth during sleep. An air blower forces enough constant and continuous air through your air passages to prevent the tissues from collapsing and blocking the airway. In some cases, dental appliances that help keep the tongue or jaw in a more forward position may help.

Surgery

In some cases, surgery may be recommended. It is most often beneficial in pediatric patients.

Types of surgery that may be done to treat severe cases of sleep apnea include:

  • Uvulopalatopharyngoplasty—The doctor removes excess soft tissue from the nose and/or throat.
  • Maxillomandibular advancement—The jawbone is repositioned forward.
  • Tracheotomy—For life-threatening cases of sleep apnea, an opening is made in the windpipe to allow for normal breathing.

Bariatric surgery may help with weight loss in some people who are obese. This surgery may reduce many of the complications that are related to obesity, including sleep apnea.

Medications

Only used in central apnea, acetazolamide (Diamox) may help improve the ability to regulate breathing. Overall, there is not a lot of evidence to support the use of medicines to treat sleep apnea.

Supplemental oxygen may be given if blood levels of oxygen fall too low during sleep, even after opening the airway.

Prevention

You may be able to prevent the onset of sleep apnea by maintaining a healthy weight . Avoid alcohol, nicotine, and sedatives, which may contribute to airway obstruction.

RESOURCES:

American Academy of Sleep Medicine

http://www.sleepeducation.com/

American Sleep Apnea Association

http://www.sleepapnea.org/

National Sleep Foundation

http://www.sleepfoundation.org/

CANADIAN RESOURCES:

Canadian Lung Association

http://www.lung.ca/home-accueil_e.php

Canadian Sleep Society

http://www.css.to/

References:

American Academy of Sleep Medicine. The International Classification of Sleep Disorders. 2nd ed. Westchester, IL; American Academy of Sleep Medicine; 2005.

American Sleep Apnea Association website. Available at: http://www.sleepapnea.org. Accessed July 9, 2009.

Smith I, Lasserson TJ, Wright J. Drug therapy for obstructive sleep apnea. Cochrane Database Syst Rev. 2006;19:CD003002.

Obstructive sleep apnea. DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Accessed October 22, 2007.

Kushida CA, Littner MR, Hirshkowitz M, et al. Practice parameters for the use of continuous and bilevel positive airway pressure devices to treat adults with sleep-related breathing disorders. Sleep. 2006;29:375-380.

Littner MR, Kushida C, Wise M, et al. Practice parameters for clinical use of the multiple sleep latency test and the maintenance of wakefulness test. Sleep. 2005;28:113-121.

Morgenthaler TI, Kapen S, Lee-Chiong T, et al. Practice parameters for the medical therapy of obstructive sleep apnea. Sleep. 2006;29:1031-1035.

Pack AI, Maislin G. Who should get treated for sleep apnea? Ann Intern Med. 2001;134:1065-1067.

Sleep apnea: treatment and drugs. Mayo Clinic website. Available at: http://www.mayoclinic.com/health/sleep-apnea/DS00148/DSECTION=treatments-and-drugs. Updated June 29, 2010. Accessed April 4, 2011.

Last reviewed September 2011 by Marjorie Bunch, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

Copyright © 2012 EBSCO Publishing. All rights reserved.

 “This minimally invasive procedure has the potential to fundamentally change the treatment paradigm for people battling sleep apnea.”

For more information, visit http://www.mountsinai.org/.

Find Mount Sinai on:
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Twitter: @mountsinainyc
YouTube: http://www.youtube.com/mountsinainy

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