Sleep Apnea , Snoring and Other Breathing Problems During Sleep

What is sleep apnea?

Repeated pauses in breathing (apneas) lasting at least 10 seconds. In severe cases, hundreds of breathing pauses can occur every night.

Can result from two possible basic causes:

Repetitive collapse of the throat, which sucks shut repeatedly when the patient breathes in during sleep–much like sucking on a balloon. The repeated efforts to overcome the upper airway closure often–but not always–will lead to loud or irregular snoring and/or gasping sounds (OBSTRUCTIVE SLEEP APNEA or OSA).

Repetitive failure to initiate efforts to breathe (CENTRAL SLEEP APNEA or CSA).

Central sleep apnea can arise from many causes. It afflicts 50% of patients with heart failure! Also, it is frequently found in victims of atrial fibrillation, brain damage (for example, in stroke patients), dementias such as Alzheimer’s disease and in the morbidly obese.

CSA also can develop immediately when patients with obstructive sleep apnea are started on treatment with CPAP or bilevel positive airway pressure (“biPAP”). It is vital to understand that this problem (recently termed “COMPLEX SLEEP APNEA ” can occur, since it can render treatment with CPAP or bilevel PAP intolerable–and because there now is an excellent new treatment for CSA).

There is a third type of apnea (MIXED SLEEP APNEAS) which begin as central apneas (from lack of any breathing effort). Then, when breathing efforts begin, the upper airway is sucked shut and the second part of the apnea is the result of upper airway obstruction.

Is regular snoring without pauses in breathing OK?

Not necessarily. Some patients must struggle so violently to get every breath that the resulting dramatic swings in pressure within their chest can even cause collapse of the left side of their heart! This condition, called UPPER AIRWAY RESISTANCE SYNDROME (UARS) can cause severe sleepiness. In fact, one study showed that individuals with UARS are as likely to fall asleep at the wheel as are patients with full-blown sleep apnea–to which it may eventually lead.

UARS often afflicts young women and children of normal body build, and it frequently does not involve significant snoring!

Many patients with UARS are misdiagnosed as suffering from narcolepsy or idiopathic hypersomnia, because this subtle but serious breathing disorder is readily missed by conventional sleep center monitoring techniques. Patients with sleepiness seeking assessment should ensure that the sleep center that they select for help is capable of doing the special monitoring needed to detect this readily treated and common disorder.

And if you have been diagnosed as having idiopathic hypersomnia, realize that it is not very common and that you may have UARS instead. Since it is typically easier to treat UARS than idiopathic hypersomnia, ensure that you were tested for UARS. Click here for more help.

What else can go wrong with breathing during sleep?

Some people who are quite overweight, who have lung or heart problems, or who have medical problems that make them breathe too shallowly (SLEEP-RELATED HYPOVENTILATION) may have repeated serious drops in their oxygen levels during sleep–even though they may never actually stop breathing. They simply do not breathe deeply enough to maintain good blood oxygen levels or to reduce their blood levels of carbon dioxide (a metabolic waste product that can blunt their drive to breathe)–with increasing ventilatory failure. Fortunately, a new treatment for hypoventilation just became available.

CENTRAL SLEEP APNEA refers to repeated failure to initiate efforts to breathe, as noted above.

IMPORTANT POINT: Failure to generate adequate breathing effort–whether due to central sleep apnea or sleep-related hypoventilation–can occur without snoring, breathing pauses or any symptoms…even when severe to the point of causing progressive heart damage from lack of oxygen in the blood.

Wouldn’t I know if I stopped breathing in my sleep?

No Some patients who have over one hundred pauses in breathing per hour never wake up with any symptoms!

What factors increase the risk of having these problems?

  • Being overweight. Obesity is a major risk factor–although some thin people have severe sleep apnea
  • Nasal congestion or obstruction, “sinus trouble”, or allergies
  • Large tonsils and/or adenoids, having a “crowded throat”, large tongue or small jaw
  • Lung disease
  • Atrial fibrillation and heart failure
  • Scoliosis or muscle weakness
  • Sedating medicines and alcohol
  • Hypothyroidism and certain other endocrine (hormonal) disorders
  • Brain disorders that affect the control of breathing

Is sleep apnea common?

Yes, extremely common! It has been found in up to 24% men over age 40 and has been described as more prevalent in men over age 40 than either diabetes or asthma.

It also occurs in women and younger age groups far more often than previously realized.

What symptoms and complications can result?

  • Daytime sleepiness, often underestimated or not even recognized by the person with the problem
  • A resulting seven to twelve fold increased risk of frequently devastating motor vehicle crashes
  • Irritability, depression, personality change and memory problems
  • Restless sleep, night sweats, headaches and dry throat on awakening
  • Frequent urination at night (nocturia). One study found that 40% of men seeing a urologist for this problem had underlying sleep apnea
  • In some but not all people, arousals with choking, chest pain or shortness of breath
  • High blood pressure and abnormal heart rhythms
  • Heart failure, heart attack, accelerated development of coronary disease, strokes, cardiac arrest, sleep-related convulsions and premature death in severe cases. In fact, a recent study by the National Heart, Lung and Blood Institute of the National Institutes of Health (NIH) showed that severe sleep apnea increased the risk of death in middle-aged adults by a startling 46%!.
  • Impotence

It is crucial to realize that some patients have no symptoms at all, even if they suffer from life-threatening degrees of sleep apnea…and one large recent study suggested that the majority of people with sleep apnea may well be asymptomatic!

Should sleep-related breathing disorders be considered an urgent medical problem?

In many cases, yes. Severe sleep apnea can represent an emergent condition warranting rapid diagnosis and treatment: because its potentially devastating and irreversible complications can be prevented.

What treatments are available for sleep apnea and other sleep-related breathing disorders?

Obstructive Sleep Apnea and Upper Airway Resistance Syndrome:

  • This is usually best treated with positive airway pressure (CPAP, bilevel PAP).
  • Some patients respond to surgeries and oral appliances.
  • Medications are not an adequate treatment in virtually all cases.
  • Weight loss is vital in overweight patients to prevent worsening of sleep apnea with age, but it usually does not eliminate the problem to an adequate degree. Also, since it cannot occur overnight, specific and effective treatment is vital to protect the patient during the weight loss process.
  • Positioning during sleep (for example, measures to prevent sleeping on one’s back and elevation of the head of the bed) are usually of only partial benefit…but it is advisable to institute these measures to try to reduce the risk of sudden complications while one is awaiting sleep center assessment.

Central Sleep Apnea

A revolutionary new treatment has been developed that is dramatically effective for the treatment of central and obstructive sleep apnea. Click here for more information.

Sleep Related Hypoventilation Due to Chronic Lung Disease, Muscle Weakness, Severe Obesity and Spine/Chest Deformities:

A new, revolutionary treatment has just become available to treat this difficult and serious problem. Contact us for more information.

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