By: Jose R. De Olazabal, MD, FACP, FCCP
The term apnea means interruption of airflow in and out of the lungs. Most apneas during sleep are due to obstruction that results from closure of the throat passages produced by untimely relaxation of the supporting muscles, therefore these apneas are called obstructive apneas. Another type of apnea is called central, produced by cessation of the stimuli from the nervous system to the breathing muscles. The net effect of sleep apnea is the repetitive interruption of the sleep process. Normal sleep is composed of stages (1,2,3,4 and REM or Rapid Eye Movement) that repeat in 90 minutes cycles. Sleep apnea disturbs those cycles many times each night making sleep fragmented and of poor quality, consequently the patient becomes constantly sleep deprived.Sleep apnea is quite common (4% of men and 2% of women). Affects predominantly males over 40 years of age but also postmenopausal females. Most patients are moderately overweight (“stocky built”) but thin people can have it too. The most common symptoms are snoring and daytime sleepiness. The snoring is usually very loud and disturbs the bed partner. It is frequently interrupted by periods of silence (the apneas) that could be very worrisome to the witness. Choking spells are common and sleep becomes quite restless. The patient usually does not feel refreshed in the morning and wakes up feeling groggy with a very dry mouth. During daytime the patient struggles to stay awake, falling asleep very easily at inappropriate times. This can be quite dangerous if the patient is driving or engaged in a hazardous occupation requiring full attention. The patient feels always tired with lack of ambition and progressively gains weight (which in turn makes the neck thicker and the apneas worse). Over time, memory declines, concentration becomes difficult, irritability and depression also may develop. All of this has profound social impact: jobs are lost, divorces occur, accidents happen, etc.
There are also hidden dangers. With every apnea event the oxygen level in blood drops (sometimes to very dangerous levels) and the CO2 rises. This has a very negative impact on many areas, particularly the cardiovascular system. Sleep apnea has been linked to hypertension and heart disease and could become life threatening.The good news is that it is very treatable if it is diagnosed correctly. Although sleep apnea is the most common cause of daytime sleepiness, there are other important causes and problems that may coexist with sleep apnea and need careful exclusion and separate treatment. This is best done by a physician with experience and special expertise in Sleep Medicine.
The diagnostic test is called Polysomnography (“sleep study”) that consists of a complex simultaneous collection of data from different systems (brain, respiratory, heart, muscles). The collected data is then analyzed by the interpreting physician who produces the diagnosis and formulates a treatment. One of the best current treatments for sleep apnea is the administration of nasal CPAP (Continuous Positive Airway Pressure) that requires skillful adjustment and follow up support. Alternative therapies include oral appliances and surgery. It cannot be overemphasized how crucial for success is to assure that the data collection and the resources for follow up are reliable and of the highest quality.
For more information about Sleep Apnea and related problems, please visit us at www.lungspecialistsofpalmbeach.com or email us at DrDe@lungspecialistsofpalmbeach.com or call us at 561-694-1101. Visit our DIRECTIONS page for more instructions
