Sleep Apnea
Sleep Apnea is a sleep disorder in which there are recurring pauses in breathing during sleep that last a few seconds to minutes and occurs up to 30 times an hour. After each pause, normal breathing starts again, often with a loud snort and a feeling of gasping for air. These pauses in breathing disrupt the restful, restorative deeper levels of sleep, which can cause daytime sleepiness even if it seems that a full night’s sleep was achieved.
Sleep apnea can easily go undiagnosed because a person with the condition may not be aware of the pauses in breathing. A spouse or sleeping partner may notice these pauses in breathing, or a medical provider may suspect sleep apnea during a review of symptoms. The condition cannot be detected during a routine physical exam, and there are no blood tests to diagnose the condition. A sleep study must be conducted to confirm a diagnosis.
At highest risk for sleep apnea are men, people who are overweight, and people over 40 years old. If sleep apnea goes untreated, it can cause a number of chronic conditions, including hypertension, stroke, heart failure., diabetes or depression. Sleep apnea also increases the risk of have work-related or driving accidents.
Symptoms of Sleep Apnea can include:
- Loud snoring, with episodes where snoring and breathing stop.
- Waking up abruptly with shortness of breath or a sensation of not being able to breathe.
- A dry mouth or sore throat upon awaking.
- Morning headache.
- Difficulty staying asleep
- Daytime sleepiness, especially in the afternoon
- Irritability or difficulty with attention.
Types of this condition
There are 3 types of sleep apnea:
Chronic Obstructive Sleep Apnea – this is the most common form where muscles around the throat relax, causing obstruction of the airway and inability to breathe. Your brain senses this trouble, and awakens you briefly so you can open your airway.
Central Sleep Apnea – this occurs when there is a disruption in the communication between the brain and the muscles that control breathing and the muscles don’t get the signal. Loud snoring is not typically a symptom of this type.
Complex Sleep Apnea syndrome – this is a combination of central and obstructive sleep apnea.
If You Have Been Diagnosed with Sleep Apnea
If you have been diagnosed with obstructive sleep apnea, know that this is a treatable condition, and with proper diagnosis and long-term management, many people have resolution of their symptoms. The goal of treatment will be to restore regular breathing while you are sleeping and relieve symptoms such as loud snoring and daytime sleepiness. Treatment may involve lifestyle changes, a mouthpiece, a device to normalize breathing, and/or surgery.
If your sleep apnea is mild, lifestyle changes may be enough to treat it successfully, and taking these steps can also be helpful in more severe cases in conjunction with other treatments. If you are overweight, losing weight may decrease the pressure on your airway, enabling your airway to stay open. If you smoke, quitting smoking may reduce your symptoms; your doctor can provide information about products and programs in your area that can help you be successful in quitting. Consider avoiding alcohol and any medications that make you sleepy, as these may make it harder for your airway to stay open during sleep or for you to awaken during an episode of apnea. Your airway also is more likely to close when you sleep on your back, so sleeping on your side may help keep it open, and there are pillows and techniques that can help you stay on your side. Lastly, you can ask your doctor if nasal strips or sprays that keep nasal passages open might be helpful in your case.
A mouthpiece, sometimes called an oral appliance, may help with mild sleep apnea. The device is custom-fit by a dentist or orthodontist, and functions by adjusting the lower jaw and tongue to keep the airway open.
The most common device used for moderate to severe sleep apnea is a Continuous Positive Airway Pressure machine (CPAP), which has a mask that fits over the nose and/or mouth and gently blows air into your throat. The pressure from this airflow keeps your airway open while you sleep. During a sleep study, the proper settings for the CPAP machine can be determined, and a technician from your medical supply provider will set your machine to your prescribed settings, so no adjusting is needed on your part. There are many types of machines and masks, so you would work with your doctor to find the right ones to provide relief and comfort for you. Most people with moderate to severe sleep apnea find that they feel significantly better once they start using their CPAP machine.
Surgery is another option for some people. The type of surgery needed depends on the type and severity of the sleep apnea, but generally involves widening the breathing passages by shrinking or removing excess tissue in the mouth or throat, or resetting the lower jaw. If tonsils are chronically enlarged and block the airway, removing them may provide relief.
Central sleep apnea, which happens when your brain stem does not transmit signals to your breathing muscles, may occur for any of several reasons, including stroke, heart failure, exposure to high altitudes, or other medical conditions. Certain medications can also cause irregular breathing. Treatment of this type of apnea usually involves treatment of the underlying condition. Treatment of complex sleep apnea may involve the treatments of obstructive sleep apnea above along with treatment of any underlying condition.
A Whole Health Perspective
Looking at sleep apnea through a Whole Health model, we will explore the individual’s unique presentation from the 5 Aspects of Whole Health™ perspective.
Physical –
During normal breathing, air flows through the nose and mouth, behind the tongue and through the back of the throat (pharyngeal airway) into the lungs. The pharyngeal airway is not rigid and depends on dilating muscles to stay open. Obstructive Sleep Apnea occurs when the muscles relax and the pharyngeal airway collapses. If you think of the airway as a straw and you suck air through the straw, sleep apnea would be like pinching the straw so that no air can get through. When sufficient air doesn’t get into the lungs, the blood level of oxygen decreases and carbon dioxide (waste) increases, until the brain senses this and wakes the person up so that breathing resumes. This happens repeatedly during sleep. Frequent lack of oxygen and interrupted sleep causes wear and tear on the body, as well as daytime sleepiness and fatigue.
The physical stress of frequent drops in oxygen level and sleep deprivation can trigger the release of stress hormones, including cortisol, and activate the sympathetic nervous system, increasing blood glucose levels, insulin resistance, and the risk of type 2 diabetes. Studies also show that sleep deprivation is associated with systemic inflammation, contributing to obesity, metabolic syndrome, and other chronic conditions.
There are some physical characteristics that are common among people with obstructive sleep apnea (OSA). About two-thirds of people with obstructive sleep apnea are overweight (BMI>25) or obese (BMI>30). Large neck circumference (collar size > 17 for men) is also common. Certain head and facial characteristics are also common, such as large tongue or tonsils, small airway behind the tongue, longer and thicker soft palate, low position of the hyoid bone, and brachycephaly (head is wider than it is long). Retrognathia, or having a short lower jaw where the chin does not protrude past the upper jaw, can also be a contributing characteristic with OSA.
Emotional –
Untreated OSA can cause depression, and it is not uncommon for people to be treated for depression for years without knowing that OSA is a contributing factor. One study showed that 73% of participants had clinically significant depressive symptoms, which were reduced to 4% following treatment with CPAP. OSA can also cause memory problems and difficulty with concentration, making it difficult to work and attend to simple daily activities, which could lead to depression and anxiety.
Chemically/Nutritionally –
In overweight adults, the pharyngeal airway is smaller than normal due to excess body fat. Therefore, weight loss can widen the airway and improve or resolve symptoms. A lower calorie, nutrient-rich diet of whole foods and increased daily physical activity can promote weight loss, as well as support the body to deal with the chronic stress associated with repeated lower oxygen levels. According to the stress research conducted by Hans Selye, nutrients needed in greater amounts by the body to combat stress include protein, Vitamins (A,C,E and B complex), cholesterol, essential fatty acids and essential minerals.
Environmental –
A person’s sleeping environment can influence quantity and quality of sleep. Elements such as noise and light levels, temperature, air quality, electromagnetic frequencies and safety are just a few of these environmental factors. The internal environment of the body also influences sleep; hormone levels, nutrition, gut flora and our thoughts all create an internal environment that either promotes or inhibits quality sleep. Mark Hyman, a well-known Functional Medicine doctor, provides several tips for better sleep in his article Sweet Dreams.
Spiritual –
Spirituality refers to the ways that people find meaning, hope, comfort and inner peace in life. These elements affect our lifestyle behaviors and how we take care of ourselves. Considering that there are several lifestyle choices and behaviors that can improve sleep apnea, spiritual strengths and values can help motivate and support sustainable changes such as smoking cessation, weight loss efforts and food/activity choices.
To find a physician with expertise in sleep apnea, contact the National Sleep Foundation or American Sleep Apnea Association.