Sleep Apnea: What is it? How is it treated?

Many of you reading this have most likely heard of sleep apnea but have no idea what it is. To put things simply, sleep apnea is the cessation of breathing throughout the night. Sound serious? You bet it is! Sleep apnea has many severe health consequences, however, many of us go undiagnosed and those of us who are diagnosed often don’t adhere to treatment.

A majority of people with sleep apnea will have Obstructive Sleep Apnea(OSA). OSA is caused when the muscles at the back of your throat collapse during sleep and block off your airway. This blockage of your airway may also be caused by fatty deposits or tissue which is irritated and swollen from snoring. Another form of sleep apnea is Central Sleep Apnea(CSA). CSA is caused when the brain fails to send a signal to the lungs to breathe. You can also have a combination of OSA and CSA which is called Complex Sleep Apnea. Along with the different types of sleep apnea there are also varying severities of the disease which are typically rated either mild, moderate or severe. People with mild sleep apnea may stop breathing up to 14 times a hour. Those with moderate sleep apnea may stop breathing up to 29 times a hour. People who have severe sleep apnea will stop breathing 30+ times a hour! Now think about this… in order to be considered a “apnea event” you have to stop breathing for 10 seconds or longer. If you stop breathing 30 times per hour at a minimum cessation of breathing of 10 seconds that equals five minutes of each hour throughout the night that you are not breathing. Can you see now why this disease is a big deal?

Now that you are aware of what sleep apnea is and what causes it let’s have a look at the effects that sleep apnea can have on our bodies. People with untreated sleep apnea will generally wake up in the morning feeling tired and un-refreshed. This leads to a feeling of tiredness throughout the day. Many people feel like they could fall asleep at any minute if they closed their eyes and relaxed. People will have difficulty focusing on tasks, their memory is impaired and they may have issues with their attention span. Headaches, insomnia and irritability are often issues that will develop in people with untreated sleep apnea. Some of you might think that these are all fairly benign symptoms, however, the greater danger lies in the health risks that sleep apnea poses.

Sleep apnea can make you gain weight. It can cause high blood pressure, increases the risk of cardiac arrest, increases the risk of heart failure and increases the risk of atrial fibrillation(irregular heartbeat). Sleep apnea increases your chance of developing diabetes(up to 80% of diabetics have sleep apnea!). Sleep apnea will increase your chance of having a stroke. It can cause depression and can worsen ADHD. And possibly worst of all… sleep apnea, due to yourself feeling overly tired, could cause you to have a car accident leading to not only killing or injuring yourself but someone else as well. To illustrate further how severe sleep apnea can be… if your blood oxygen drops to 78% or lower while you sleep(which it can in people with severe sleep apnea) you are 80% more likely to suffer a heart attack or have heart failure. I bet those symptoms of feeling tired or not having the best memory don’t seem all that trivial any more, do they?

Now let’s talk about a “catch 22” when it comes to sleep apnea. If you’re overweight there’s a good chance it will cause sleep apnea. If you’re not overweight but have sleep apnea, it will most likely cause you to gain weight which will worsen your sleep apnea which will in turn cause you to gain more weight. It seems like no matter if you’re already overweight, or if you simply have sleep apnea, you’re destined to gain weight. Why is this???

When we sleep our body produces two hormones, Leptin and Ghrelin, which have effects on our levels of hunger. When we are sleep deprived(as we are when we have sleep apnea) our body reduces the production of Leptin. Leptin is a appetite supressing hormone. If we are sleep deprived our body also increases the production Ghrelin. Ghrelin is a hormone which stimulates hunger. When we are sleep deprived our body also develops a glucose intolerance which means we don’t process sugars as well as we should.

So let’s recap this now: When we are sleep deprived our body doesn’t produce as much of a certain hormone which in turn makes us hungry. When we’re sleep deprived our body produces more of a hormone which in turn makes even more hungry. When we’re hungry we typically reach for foods high in carbohydrates or sugar. These carbohydrates and sugars in turn don’t get processed properly(because when we’re sleep deprived our body develops a resistance to processing sugars) which leads to us gaining more weight and having higher risks of developing diabetes. This whole process is one large, dangerous, downward spiral.

Being overweight is not the only attribute that can make you predisposed to having sleep apnea. Snoring is a indication that you may have sleep apnea. If you have a family member who has been diagnosed with sleep apnea you are twice as likely to have sleep apnea yourself. Two family members diagnosed with sleep apnea means you are four times as likely to have sleep apnea. Neck sizes of 17 or larger are a indication for sleep apnea. Large tonsils or adenoids can contribute to sleep apnea. The shape of the soft palate and your throat can affect sleep apnea. People over the age of 40 have a higher risk of sleep apnea. Alcohol use shortly before bedtime can contribute to sleep apnea.

So how is sleep apnea treated? The gold standard to treat sleep apnea is by the use of a CPAP(Continuous Positive Airway Pressure) machine. A CPAP machine works very much like a vacuum cleaner in reverse. Firstly there is a mask which is fitted over your nose and strapped to your head. This mask has a hose which comes off of it and attaches to the CPAP machine. The CPAP machines blows air through the hose, to the mask, and then down your airway which in turn keeps your airway open. This lets you breath properly throughout the night and can either stop the sleep apnea completely or greatly reduce it.

Many people have difficulty wearing a CPAP machine while they sleep. It’s not hard to understand why: You have a mask, with a hose, strapped to your head while you sleep and there’s a machine forcing air into your nose. It doesn’t sound overly comfortable and this is the reason why 50% or more of people can’t sleep with a CPAP machine. The alternative to a CPAP machine is to have a oral device made which pushes your jaw forward and in turn opens your airway. The oral devices have a much higher level of comfort which means a much higher acceptance rate. With every treatment, however, comes its risks. Oral devices might cause permanent jaw protrusion(your jaw is pushed forward permanently) or they can move your natural teeth. Choosing between the lesser of two evils… I would personally rather have my teeth shift slightly over having a heart attack any day.

The oral devices that we use to help treat sleep apnea are also the same devices that are used to stop people from snoring. They work the exact same way!

Don’t let this potentially life threatening medical condition go untreated! If you are unsure if you might have sleep apnea or if you have been diagnosed with sleep apnea and can’t use the CPAP machine please contact us immediately. There are some examinations and tests that we can perform to help determine if it would be a good idea for you to have a sleep study performed or to fabricate a oral device for you.

Barry Parisien DD

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