Thursday, 14 July 2011
Dangers of Sleep Apnea
Sleep apnea literally means, "without breath during sleep." Clinically, this means that patients are actually stopping their breathing pattern periodically throughout the night. These episodes are brief, and happen before the body protectively wakes up enough to restart the breathing pattern. This leads to several concerns:
No one wants to stop breathing.
For the body to restart the breathing process, it has to wake up, which means that the individual is not getting deep, quality sleep through the night.
This “in and out” sleep pattern puts pressure on the nervous system.
The other organs, such as the brain and the heart, never enjoy full repair and rejuvenation.
Why does sleep apnea happen? Much of the reason is a structural problem. In many instances, the soft tissues of the lower throat and neck are being pulled by gravity while the patient is laying flat. As the tissues are pulled down, the airway gets smaller. They may snore or they may be very restless during sleep. Their partner may notice that breathing stops during sleep, and their body jerks them awake.
Sleep apnea is actually linked to several chronic diseases [Source: Goldman]. An obvious problem that comes from poor sleep is fatigue. This can become dangerous in situations such as driving. Unfortunately, sleep medicines don't offer a cure. Many people with resistant high blood pressure suffer from sleep apnea. Some might try three to four medicines before diagnosing sleep apnea as the problem. This condition is also related to other heart conditions such as coronary artery disease, irregular heartbeats and even stroke [Source: Connolly]. Sleep apnea may also play a significant role in mood and anxiety. Poor sleep will really effect every aspect of life, including one’s vitality and general outlook. It's also easy to see how patients can become anxious since the body is constantly trying to keep the body breathing; a process that should not require much effort. Even loss of sex drive may be linked to sleep apnea.
Another major issue with sleep apnea is weight gain, and the near inability to lose weight. Patients often have very little energy to actually go exercise. This becomes a vicious cycle leading to more fatigue, greater weight gain and worsening sleep apnea. Being overweight may predispose a patient to sleep apnea. Large, thick necks may aggravate the problem, as can extra weight around the mid section of the body.
Sleep apnea is diagnosed by the patient’s symptoms (or by the symptoms described by the partner) and by a sleep study test. A sleep study is done in a hospital setting using monitors that can detect the number of apneic episodes that occur. The sleep study can also follow the depth of the patient’s sleep and can determine possible treatments that might be helpful.
Treatment for Sleep Apnea
The treatment for sleep apnea varies. Typically, patients are treated with a machine called a CPAP, which uses air blown through a mask to keep the airway open. The patient wears this mask each night during sleep and the settings of the airway pressure can be titrated to the patient's needs. This treatment can produce dramatic improvements. Patients who have apnea due to a structural problem can find success surgically.
Typically, an ear, nose and throat specialist can evaluate the nose and throat to see if these areas are the source of the problem. If the patient is obese, they are strongly encouraged to lose weight. Again, this can be very hard, but lifestyle changes need to be initiated to encourage weight loss. Some patients find it very difficult to sleep with the mask and the CPAP machine due to improper settings or a poor fit of the mask. For those who do not use a machine, try to avoid sleeping in a flat position. Sleeping in a reclining chair or propped up on pillows will at least offset the pull that gravity exerts on the soft tissues.
Sometimes the sleep apnea can be improved by appliances worn in the mouth. This may be done by dentists specializing in this area. Oral systemic balance (OSB) is a technique, developed after years of study by Dr. Farrand Robson, that helps keep soft tissues, in particular the tongue, in alignment and out of the way of the airway. OSB will not fix all complications from sleep apnea but it can produce significant results, and may benefit those who do not tolerate the CPAP. OSB has also been helpful in treating other chronic conditions such as chronic pain, fatigue, anxiety and fibromyalgia. More on OSB can be found by calling Robson’s office, 1-800-977-1945.
A recent study on rats did show that an extract from green tea called L-theanine is helpful in preventing some of the decline in performance that may come with sleep apnea and fatigue [Source: Burckhardt]. Theanine has had previous research to support its benefits to the brain [Source: Kakuda]. Theanine should be considered for those who currently struggle with treatment for sleep apnea. The typical dosage is 100-200 mg a day.
Sleep apnea is a growing health concern impacting many other chronic illnesses. Its leaving a billion dollar bill for health care, but fortunately it can be treated and managed successfully.
Goldman: Cecil’s Textbook of Medicine, 23rd Ed., Chapter 101. Obstructive Sleep Apnea-Hypopnea Syndrome.
Connolly, TA. (2007). Sleep-related breathing disorder and heart disease-central sleep apnea. Sleep Medicine Clin, 2(1);107-117.
Burckhardt, IC., Gozal, D., Dayyat, E., et al. (2008). Green Tea catechin polyphenols attenuate behavioral and oxidative responses to intermittent hypoxia. Am J Respi Crit Care Med, 177(10):1135-41.
Kakuda, T. (2002). Neuroprotective effects of the green tea components theanine and catechins. Biol Pharm Bull, 25(12):1513-819(7):457-65.