Many Americans sleep really badly. They toss and turn in the bed, wake up multiple times to go to the bathroom, and need a pot of coffee to help them function throughout the day. I am sure that the rise of coffee shops in the US in the past twenty years is directly related to how poorly we are sleeping. Much of this is from poor sleep practices like going to bed at different times, eating and drinking alcohol right before bed, and having a television in the bedroom. However, for some people they can do everything perfectly and still sleep terribly. Many people suffer from sleep apnea and do not even know it. To understand sleep apnea, I would like to explain what apnea is, how it is diagnosed, and treatment options.
Sleep apnea is when breathing stops while sleeping and comes in two types. The more common is obstructive apnea where the airway in the throat is closed and a person cannot breathe. The soft tissue around the neck collapses and blocks the throat. The less common way is central apnea where the airway is open but the muscle that helps with breathing, the diaphragm, does not contract properly. In both situations, the oxygen level in the blood drops and the brain signals to the body to wake up and start breathing. The body releases adrenaline which wakes the person up and they get a breath in. The body will do whatever it can to get precious oxygen we cannot live without it. This is much like the small panic that sets in if a person stays under water for too long. In some cases, the entire airway is not blocked, but it is obstructed so that it is harder to breathe. It is like trying to drink a soda using a small straw; it is doable but difficult. This is also bad because our bodies are spending more energy to just survive when we should be resting. For people with severe apnea, these events can occur 60 to 70 times per hour of sleep and can greatly affect sleep.
Often times, it is assumed that only big fat old men who are heavy snorers get sleep apnea, but it can be found in all ages and all body types. I have seen apnea in small children to triathletes. While it is more common as we get older and more common as well in people who are overweight, no one is immune to it. Usually the most telling sign that a person might have apnea is snoring followed by needing to wake up throughout the night to use the bathroom. This happens because when the body does anything it can to try to push air in and out of the lungs, it compresses the bladder and makes a person need to go to the bathroom. While these signs may all point to apnea, the standard for diagnosis is a sleep study. A sleep study can either be done in a sleep lab or be done with a home sleep test. Many patients opt for the home sleep test simply because it is easier to do and less expensive. After the sleep study is done, a sleep physician interprets the results and gives a diagnosis. Usually the number of times per hour a person has an event like those mentioned above are measured by the monitoring equipment. For adults, fewer than 5 events per hour is considered normal, 5 to 15 is considered mild apnea, 15 to 30 is considered moderate apnea, and over 30 is considered severe. For children, anything over 1 is considered to have apnea.
After diagnosis there comes treatment options. For many people it may be life style modification and losing weight. Especially on people with thicker necks, losing weight can help the airway stay more open during the night and reduce apnea events. For non-surgical treatment options, the best known treatment is a CPAP or continuous positive airway pressure which works by putting pressure in the airway to keep the throat open. CPAP is often used as first line treatment for people with severe sleep apnea. The second option is to have an oral appliance made which helps reposition the jaw and pulls the lower jaw forward to help keep the soft tissue off of the back of the throat. Oral appliances are often made for patients with mild to moderate sleep apnea as the first line. Some patients also benefit from a combination of oral appliance and CPAP as the two work well together. The final option is to have surgery to remove obstructions such as tonsils and adenoids as well as to make the airway larger. For children especially, surgically removing the tonsils works exceptionally well and is common, and for adults it does help though it is a rougher surgery to have the older a person is. I had my tonsils removed when I was 31. While I am glad that I had them removed as I breathe and sleep much better now, it took me about 2 weeks to recover enough to work again on patients and then another 3 months to fully recover.
Sleep apnea is a common problem in the US, and it is predicted that around 90% of people who suffer with it are not diagnosed. As it can impair quality of life significantly, I screen for it often and try to help my patients the right diagnosis and the right treatment for them. With modern technology and techniques, there are more comfortable and easier ways to be treated and tested. If you or your loved one do not sleep well or snore, call us at 504-392-5104 and we will help you out.