What if you went to bed on time last night, thought you got a good night's sleep, but still woke up feeling tired? You may be suffering from a potentially serious disorder called sleep apnea, says Uday Nanavaty, chief pulmonologist at St. Agnes Hospital.
Sleep apnea can cause people to be drowsy and irritable during the day and have difficulty staying awake at school, work or even while driving.
The name "sleep apnea" comes from the Greek for "without breath." How do you describe the disorder?
Sleep apnea is when people essentially stop breathing - the air flow essentially stops in the middle of the night when you are completely asleep. It can cause severe drowsiness in the day. Some people will say, 'I open up my windows when I drive because at red lights I fall asleep.' Even in the brief 10 seconds at a light, they can fall asleep. Studies show many car accidents are caused by sleep apnea.
What causes this disorder?
Like most things in medicine, we don't know the exact cause. But when we speak about sleep apnea we divide it into two broad categories: an obstructive variety, in which it is thought that because of obesity, muscles in the throat that keep the airways open collapse; and there is also a variety called central sleep apnea, which happens when the brain isn't sending appropriate signals to the muscles that control breathing.
Who is likely to get sleep apnea?
Ten years ago, we thought it was a disease of obese, middle-aged men - males in their 40s, with size 17 or bigger shirts. If they snore, there is a high likelihood that they have obstructive sleep apnea. But over the last 10 years, we have realized that the profile of sleep apnea is different.
Alcohol makes sleep apnea worse, thyroid disorders can make apnea worse or in itself can cause sleep apnea. Obstructive sleep apnea can happen at any age from children to very late ages.
We now are seeing sleep apnea in kids because of the obesity crisis. And we sometimes see it in kids who are not obese, but who have a very short chin and large tonsils.
What happens if someone suffers from sleep apnea?
They are asleep and snoring. Then their snoring suddenly stops and there is silence. Then there is a big burst of snoring. What has happened is that during that time when they were not snoring, no air was going in or out. When the air isn't going in, the body can't pick up any more oxygen and the body is deprived - and the sleep is disturbed. At some point, the body is going to say, 'You know, we can't live without oxygen in our body.' And then there's the big burst of snoring.
During this, the brain isn't getting good sleep, even though the person may think he has been asleep all night. There is even a theory that sleep apnea can result in the death of an individual - in sudden cardiac death. The majority of these cases happen in sleep.
Who should consult a doctor about sleep apnea?
In general, you should consult a doctor if: after a seven- or eight-hour sleep you feel sleepy and tired, you are snoring and you have high blood pressure or have high blood pressure that is hard to control, or if you are an obese man or woman and you have high blood pressure.
Often when consulting a doctor, the first thing that is said is: 'I sleep very well.' But ask the spouse. The spouse often says, 'I hear them snore and they stop and they start with a big burst.'
How is the disorder diagnosed?
First you use a polysomnogram - a detailed sleep study to diagnose sleep apnea. The study is conducted in a lab. You sleep with electrodes attached to your skull and head so that we can look at the brain waves to confirm that you are sleeping.
We measure eye movements (for REM or rapid eye sleep). We look at muscle movements and monitor what position you sleep in - on your back or side. At the same time, we measure or detect the flow of air going in and out of your nose. We record how long you sleep.
... The person goes into the sleep lab around 9 p.m. or so and most people will get close to six hours of sleep in the lab, and in the morning, they are sent home. This produces a detailed analysis of how well you slept.
What is the treatment for sleep apnea?
One way is with something that you wear at night when you go to bed called CPAP (continuous positive airway pressure). This is a mask that fits on the nose or, in some cases, the nose and mouth. It is relatively tight-fitting so that it generates pressure in the throat. But some people cannot use the mask at all, no matter how hard they try. In some cases, surgery or a dental device also can be used.
But the first recommended treatment if you are obese is that you should make all efforts to lose weight because ultimately, that is going to be the most important thing. Not only to treat sleep apnea, but all the other diseases. If you are obese and have sleep apnea, you should focus on losing weight.
Learn more about sleep apnea at baltimoresun.com/expertadvice