| Sleep Apnea: Doctors answer your frequently asked questions |
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You’ve probably heard of sleep apnea—that disorder that makes you stop breathing periodically while you’re asleep. But how much do you know about it? What are the symptoms? Is it dangerous? What can you do about it?
Sleep Apnea 101 Q: What is Sleep Apnea? A: Sleep apnea is a disorder in which your breathing during the night is interrupted. The two types are central and obstructive. Obstructive sleep apnea is the most common. With it, the tongue, soft palate and throat muscles relax during sleep, blocking the airway partially or completely. This usually causes snoring. When your airway is totally blocked, you stop breathing until you wake up just enough to start again.You may not even be aware of these arousals. Pauses can be 10 or more seconds and occur hundreds of times a night! The affected person often awakens in the morning not feeling rested and wondering why. Central sleep apnea is less common and occurs when the brain signal to breathe doesn’t get delivered to the breathing muscles. This can be genetic or caused by things like sedatives, narcotics or a brain injury. Other reasons include severe congestive heart failure and severe muscle disease in the chest wall or diaphragm. Q: Besides snoring, what are some other sleep apnea symptoms? A: Though snoring is the most common symptom, there are many others. They can even contribute to a misdiagnosis. Frequent awakenings may be associated with—and blamed on—nighttime urination, night sweats, palpitations, acid reflux, body or leg jerks, headache or dry mouth. Other sleep apnea symptoms include difficulty waking up; feeling excessively sleepy in the daytime; and problems with concentration, memory and depression. Untreated sleep apnea can be arisk factor for high blood pressure, stroke and cardiovascular disease. Q: What’s the most common cause of sleep apnea? A: Obesity is because with it, the airway is crowded and therefore smaller, with a greater potential for collapse. Obstructive sleep apnea is also more likely if the jaw is small and the tongue or tonsils are large. Q: You diagnose sleep apnea with a sleep study, right? What’s that like? A: Yes, if your doctor suspects you have sleep apnea, you’ll likely need a sleep study. This usually takes place in an accredited sleep center with a comfortable bedroom facility. For the painless test, you’ll have lots of sensors taped to you. Some measure brain waves: They tell when you fall asleep and reveal your sleep stages—like the restorative REM, which is more vulnerable to disruption. The study will also measure your oxygen levels, airflow at the nose or mouth, and effort from the chest and abdominal walls. Q: I’ve heard that you treat sleep apnea with a CPAP machine. What is that? How does it work? A: Since a collapsed airspace causes sleep apnea, the CPAP machine generates an air cushion that keeps the throat open. To do this, it blows air through tubing and into a mask that usually attaches to the patient’s nose. Normally, a small leak from the mask allows exhaled air out. Board-certified sleep specialist Lawrence E. Kline, D.O., F.A.A.S.M., F.A.C.P., F.C.C.P., is medical director of Scripps Clinic Sleep Center in San Diego. He’s also board-certified in internal medicine and pulmonology (lungs).
Sleep Apnea 301 Q: My CPAP mask isn't comfortable. Any tips? A: For many, the hardest part of adjusting to CPAP is adjusting to the mask. Fortunately, CPAP manufacturers and researchers have put enormous efforts into making a variety of masks. There are now masks that go solely over the nose, those that cover the nose and mouth, and a few that just connect with the mouth. If you hate your mask, there are probably more than 20 other models available and most of those come in four to six sizes (petite, small, medium and large) and configurations (wide, medium and narrow). You should have the option of trying on many of these briefly before taking one home. If you find it intolerable at home, bring it back and exchange it for another that feels right for you. I recommend gradually getting used to any new mask. Make sure you can tolerate it for 20 to 30 minutes while awake first.
Q: Are there treatments besides CPAP for sleep apnea? Do they work as well? A: There are many other treatments, but few are as effective, easy to administer and acceptable for most sleep apnea patients. Many years ago, we used something we still use in drastic situations today: tracheostomy. This entails surgically placing a hole into the windpipe at the base of the neck. Although it works almost every time, it has obvious drawbacks, and doctors rarely use it today. Weight loss for people who are significantly overweight can cure sleep apnea. We usually see a 75-percent improvement when people who are at least 33 percent above their ideal weight lose more than 15 percent. Simple upper airway surgery can occasionally be very effective. The best results are on young people who aren’t significantly overweight and have massively enlarged tonsils that are the main source of the nighttime disappointing. Office-based surgeries, such as with lasers, offer no benefit for sleep apnea, although they may help simple snoring. Occasionally, people only have sleep apnea when they lie on their back. They can use specialized shirts with balls sewn into the back to make sure they don’t lie on them. This is very effective for a small number of people. Finally, the most under used treatment for sleep apnea is a dental appliance—basically a device that opens up the back of the throat. It’s similar to the mouth guard football players wear. A dentist needs to make it. For people with mild to moderate sleep apnea, this can be as effective as CPAP. Q: Are there things I can do at home for sleep apnea, in addition to CPAP? A: Yes.
Q: I’m not overweight. Why do I have sleep apnea? A: A significant minority of people don’t have a weight problem. They have an air passage that’s unusually narrow or prone to collapse. In children, this is most commonly because of very large tonsils. A relatively small jaw or an overbite can also cause problems by narrowing the upper airway. Nasal obstruction can aggravate sleep apnea but is never the primary cause. Occasionally, an underactive thyroid can bring out sleep apnea. Rarely, we see patients with cancerous or noncancerous throat tumors that cause airway obstruction. In 25 years, I’ve seen this only once. Q: My sleep apnea is under control. Has my risk of death decreased? A: To the best of our knowledge, yes! All the research done to date strongly supports the fact that patients with significant sleep apnea (moderate to severe) who use CPAP regularly have a markedly reduced risk of death from all causes and specifically from heart attacks and strokes.We’re awaiting further studies that are looking at whether CPAP also protects people with more mild forms of sleep apnea. Until that data is available, the prudent patient will try to get his or her sleep apnea under control even if it’s mild. Louis S. Libby, M.D., is a board-certified sleep specialist with The Oregon Clinic in Portland. He’s also board-certified in internal, pulmonary and critical-care medicine.
Article originally appeared in March/April print magazine. Comments (1)
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