Sleep apnea is a common sleep disorder characterized by pauses in sleep. Apnea literally translates as “cessation of breathing”. These pauses may last anywhere from 10 seconds to longer. During this pause the body may not get enough oxygen, leading to a potential multitude of long-term health problems.
The there are two main types of sleep disorders: obstructive sleep apnea and central sleep apnea.
The most common type of sleep disorder is the obstructive variety. In obstructive sleep apnea the upper airway leading to the lungs becomes obstructed at various potential spots. This obstruction may be caused by excess tissue in the airway as in obesity, enlarged tonsils, a very large tongue, nasal obstruction, and relaxation of the airway musculature collapsing when asleep.
Central apnea is less common and is related to problems with the brain triggering the proper signals to continue with respiration.
We will talk only about obstructive sleep apnea (OSA) here, as it is by far the more common variety.
Obstructive sleep apnea is a serious health problem that is currently under-diagnosed. As many as 20 million Americans may currently have untreated OSA. The symptoms of sleep apnea may be very subtle to very signiﬁcant. The spectrum of symptomatology is broad. With the rise in obesity and being overweight in our country today, a large segment of the population is at risk. It is imperative to get tested for sleep apnea if you have symptoms or risk factors because untreated apnea can lead to serious health problems. Studies have documented people with sleep apnea may have an increased risk of heart attack. Letʼs explore a little further.
Potential Consequences of and associations of untreated sleep apnea:
- High blood pressure
- Coronary artery disease (blockages of the heart arteries) that can lead to heart attack and stroke
- Atrial fibrillation
- Worsening heart failure
- Poor quality of life
Symptoms of Obstructive Sleep Apnea:
- Waking unrefreshed from sleep
- Daytime fatigue and somnolence
- Being drowsy throughout the day
- Fall asleep easily while watching TV
- Feel sleepy while driving
- Difficult to treat headaches
- Increase in anxiety
- Loss of libido
- Restless sleep
- Restless legs
- Hyperactive behavior, especially in children
- Gasping or choking sensation waking you from sleep
- Irritability and impatience
Often patients with sleep apnea may have associated underlying metabolic conditions.
Risk factors for developing sleep apnea include:
- Males over 40 are at a higher risk of developing sleep apnea
- Overweight individuals (a BMI greater than 25)
- Obesity (a BMI over 30)
- Metabolic syndrome
- Alcohol use/abuse
- Narcotic use
Treatment for Sleep Apnea
Treatment for sleep apnea will vary depending on the severity and any other associated conditions. A doctor simply prescribing a sleep device or CPAP machine for sleep apnea is never appropriate in isolation.
Examining and reviewing with a patient potential treatable underlying “root causes” is the best overall approach. For example, a patient who is overweight or obese needs intensive counseling on nutritional and lifestyle changes in order to lose weight. Many cases of sleep apnea will resolve with weight loss and resolution of the metabolic syndrome. Patients must also be counseled on other hormonal disorders, including the thyroid and perhaps testosterone support. If there are oral/dental issues, the patient may beneﬁt from a visit to a dentist experienced in helping with sleep apnea.
Devices that pressurize the air to keep the throat open during sleep are often prescribed. These devices are referred to as CPAP machines. CPAP stands for continuous positive airﬂow pressure. It is safe and effective in sleep apnea for patients of all ages including children.
A CPAP machine is a device that weighs about 5 pounds and may be placed next to the bedside. CPAP machines can be very portable for travelers. The patient wears a small mask that ﬁts over the nose. A tube from the mask connects to the machine supplying a stream of air and pressure to keep the airway open. CPAP is a medical prescription provided by a sleep expert, someone who is well trained and certiﬁed in sleep disorders. CPAP machines and masks should be ﬁtted by a trained and experienced professional. Once CPAP is prescribed, often a repeat sleep study is performed to document the appropriate level of airway pressure to maintain open airways. In other words, you want to make sure it is working correctly.
Sometimes a dental device is all that is needed to keep the airway, and the patient may need to see a dentist or an orthodontist to get ﬁtted for such a device. Mandibular advancement devices (MAD) look like mouth guards and hold the jaw down and forward to permit the airway to remain open. There are also tongue retraining devices (TRD) to keep the tongue from blocking the airway.
Surgery may be necessary for patients is some conditions. For instance, if the tonsils are so enlarged that they are blocking the airway, surgery can be beneﬁcial. Surgery can also be performed to reduce the volume of the palate.
Overall, when sleep apnea is successfully treated there are tremendous health beneﬁts to be gained. It is critical to obtain adequate sleep for overall health and wellness. It is during sleep that we become restored, our hormones reset, and we feel rested and ready to start a new day. By treating sleep apnea we are also practicing prevention, mainly by improving cardiovascular outcomes, hormonal balance, and sense of well-being.
It is imperative in treating that sleep apnea that we not get caught up in the conventional medical paradigm of diagnosis and treatment. The approach to sleep apnea should include not just the treatment, but an integrative and functional medicine approach to root causes. In many cases, once root causes are resolved, the patient may no longer require treatment. That is successful treatment.
For patients with high insurance deductibles, and for those who must pay for their sleep apnea tests out of pocket, Balanced Well-Being Healthcare offers a low cost testing method that will save you a lot of money! For more information about the ARES™ home sleep test, follow this link!