Obstructive Sleep Apnea

Every night, millions of Americans go to bed and drift into an evening of sleep that is anything but peaceful.  They snore and gasp for air throughout the night, causing chronic sleepiness and increasing their risk of heart disease, hypertension, and Type 2 diabetes.

This condition, known as Sleep Apnea, affects an estimated 22 million Americans, yet most people who have it never get it diagnosed.  They suffer night after night and jeopardize their health.

Here’s what you need to know about sleep apnea, along with some of the best ways to detect and sometimes even cure it:

ARE YOU SUFFERING FROM SLEEP APNEA?

It can manifest itself in different ways.  But some of the hallmarks of sleep apnea are easy to spot.

Because sleep apnea occurs when you’re unconscious, millions of people who have it are not even aware of it.  So how do you know if you’re one of them? 

The American Sleep Apnea Association developed a brief quiz that can give you some insight.  If you answer yes to any of these questions then you might have sleep apnea.

  • Are you a loud or regular snorer?
  • Have you ever been observed to gasp or stop breathing during sleep?
  • Do you feel tired or groggy when you wake up?
  •  Do you wake up with a headache?
  • Are you often tired or fatigued during the day?
  • Do you fall asleep while sitting, reading, watching television or driving?
  • Do you often have problems concentrating or remembering things?

Sleep Apnea Types

The most common type of sleep apnea is known as obstructive sleep apnea.  People who have it experience potentially dangerous pauses in their breathing while asleep, which can occur dozens or even hundreds of times a night, causing them to wake up or snore loudly as they struggle to breathe.  These intermittent gaps in breathing are known as apnea episodes and they occur when your airway collapses in on itself, preventing air from reaching your lungs.

This Sets Off A Cascade Of Problems

  • When breathing stops, oxygen levels plunge, which activates the sympathetic nervous system that controls the fight or flight response. 
  • Adrenaline levels soar
  • Heart rate climbs 
  • Blood pressure rises, constricting blood vessels 
  • Snoring can occur as your body labors to pull in oxygen
  • Instead of being a period of restoration and relaxation, nightly sleep becomes a chaotic and often noisy struggle to breathe
  • GERD: Suction from your obstructed airway forces stomach acid to your lungs.

You’re not getting oxygen, you have this very high level of sympathetic activity, and to make matters worse you’re generating huge levels of pressure in the chest to pull in air, but the air isn’t coming in.  You’re distorting the structures in the chest–like the heart and the atrium–and this is happening hundreds of times a night. When you repeat this insult every night over many years, you eventually get structural and functional changes in the body.

The severity of sleep apnea is determined by the number of times in an hour that a person has a cessation in breathing that lasts at least 10 seconds.  Five to 15 times an hour is considered mild. Fifteen to 30 episodes is moderate. And more than 30 of these events is classified as severe. The prevalence of sleep apnea has been rising in recent years, and the consequences of not treating it can be devastating.

A History Of Snoring

A lot of people snore, and the fact is that not every snorer has sleep apnea.  Some people only snore once in a while, like after they’ve had a few beers or a glass of wine or two.  That’s not exactly abnormal. But most people who have sleep apnea do snore. So it tends to be a marker of the condition. 

There are a few things that can distinguish normal snoring from pathological snoring: the intensity, loudness and frequency of it. 

If you snore once in a while then it probably isn’t a sign of a health issue.  But if you snore loudly every night then the likelihood of it being sleep apnea is much greater.  Some doctors call the snoring associated with sleep apnea “destructive snoring” because of its ear-rattling noisiness.

“I’ve had patients whose kids are on a different floor of the house and they can still hear them snoring.  I’ve also had patients whose neighbors will complain about their snoring from the next building.” ~Dr. Queen

Daytime Sleepiness

If you have to drink several cups of coffee just to get through the day then you might have sleep apnea.  People who have it frequently fall asleep at the wrong time and place – while driving or while working for example – because they are constantly woken up in the middle of the night by their disrupted breathing. 

~“Many people will say they’re not sleepy during the day but if you count the number of cups of coffee they’re drinking, it’s a lot.  While sleepiness is a common symptom, there are plenty of people who don’t fall asleep at inadvertent times because they’re pumped up on caffeine.” ~Dr. Queen 

Witness Apnea

Some people who have sleep apnea only learn about it from their partners.  Doctors call this “witness apnea.” A common reason people get referred is because their bed partner is frightened – not by the snoring, but by the silence in between it.  It can be very scary. It indicates that they’re actually stopping breathing. People see it and think, ‘My God, there is something wrong with this person. They’re not breathing.’

High Blood Pressure

When oxygen levels fall, your body responds by raising your blood pressure to boost the flow of oxygenated blood to your organs.  That’s why high blood pressure and obstructive sleep apnea go hand in hand. 

Research suggests that up to 50 percent of people with high blood pressure also have sleep apnea.  Although the evidence is mixed, many studies have found that the standard treatment for sleep apnea, known as continuous positive airway pressure, or CPAP, lowers blood pressure. 

Some clinical trials suggest that it can have a particularly significant impact on sleep apnea patients with chronically elevated blood pressure, known as hypertension.

There’s a well-known nexus between hypertension and obstructive sleep apnea.  Some experts think the relationship is bidirectional: sleep apnea predisposes you to high blood pressure, and having high blood pressure makes your sleep apnea worse.  It’s a dangerous cycle. 

The two are so entwined that if you have hypertension, there’s a good chance you have sleep apnea, too.

More than half of all people with severe sleep apnea have hypertension.  And in people with resistant hypertension, meaning their blood pressure remains high despite multiple medications, the prevalence of sleep apnea is greater than 80 percent.

The bottom line: If you have high blood pressure, then sleep apnea might be present as well.

Obstructive sleep apnea increases your risk of a host of metabolic diseases, including the following:

Cardiovascular Disease

There’s a striking link between sleep apnea and heart disease, the leading killer of Americans. Obstructive sleep apnea increases the risk of heart disease by 30 percent and heightens your risk of having a stroke by 60 percent.  According to the National Commission on Sleep Disorders Research, sleep apnea contributes to about 38,000 cardiovascular deaths annually and $42 million in related hospital costs.

Type 2 Diabetes

A growing body of evidence suggests that people with obstructive sleep apnea are more likely to develop diabetes, especially those who are overweight.

One explanation for this is that chronic activation of the sympathetic nervous system impairs blood sugar control.  Large studies have found that even after controlling for other risk factors, sleep apnea is independently associated with glucose intolerance and insulin resistance and may lead to type 2 diabetes.

Studies have found that treating sleep apnea reduces insulin resistance and improves blood sugar control in people with diabetes.

Weight Gain

While not everyone who has sleep apnea is obese, there’s a strong link between the two: about half of all people who are obese suffer from sleep apnea.  One reason is that obesity promotes the development of soft tissue in the mouth and throat, which leads to a narrowing of the airway. 

But sleep apnea itself might cause you to gain weight because it disrupts your sleep, making you tired and fatigued.  In recent studies, when people have apnea they tend to have put on a lot of weight in the year before their diagnosis.

If you’re sleepy, you’re not exercising enough and you’re eating the wrong things.  You need energy so you’re eating a lot of carbohydrates. We think that having sleep apnea can potentiate the likelihood of you getting fat.

Remedy For Sleep Apnea May Lift Depression’s Veil

Fatigue, irritability, lack of concentration and loss of interest in enjoyable activities are common symptoms of depression.  But they are also symptoms of obstructive sleep apnea, and a new study suggests that physicians may confuse the two.

Because sleep apnea can cause you to wake up repeatedly throughout the night, it can worsen your psychological health.  Experts say it is the single most important preventable medical cause of excessive daytime sleepiness and driving accidents.

Due to the constant awakenings that happen throughout the night with sleep apnea, your sleep gets fragmented.  So you get sleepiness, lack of energy, and an inability to concentrate.

Scientists at the Centers for Disease Control and Prevention have found that people with obstructive sleep apnea have a significantly higher risk of depression.  They argue that when doctors diagnose either sleep apnea or depression, they should consider screening for the other condition as well.

Sleep apnea can even throw a wrench in your sex life, causing erectile dysfunction in men and loss of libido in women.

IT IMPACTS MORE THAN YOU!

But perhaps the most troubling consequence of the condition is that it can make you a danger to those around you.  Uncontrolled sleep apnea makes you two and a half times more likely to be involved in car accidents, and it nearly doubles the rate of workplace accidents.

In recent years a number of major train, bus and car crashes that resulted in multiple deaths and hundreds of injuries were blamed on untreated sleep apnea.  In addition to being a public safety hazard, sleep apnea can make life miserable for your bedmate: imagine sleeping next to someone who is constantly snoring and waking up throughout the night.

“The spouses of people with severe sleep apnea are clinically sleep deprived.  They’ve got a jet engine next to them all night and they’re not sleeping properly.”
~ Dr. Queen

Many people look at snoring as a joke or a minor nuisance.  But for those who have to put up with it night after night, it is anything but. 

Experts say it is a common cause of marital friction and broken relationships.  Many spouses have to sleep in separate bedrooms because of it. Studies show that at least half of people who have afflicted bed partners complain that their sleep is constantly disrupted.

One study of women who live with heavy snorers found that they frequently experienced insomnia, morning headaches, daytime sleepiness, and fatigue.

“Plenty of patients get divorced over snoring because it can disrupt their partner’s sleep.  It’s shocking how common that is. I have patients saying my wife doesn’t want me in the bed at night, so I sleep on the couch.”~ Dr. Queen

Other signs that you might have sleep apnea:

  • Insomnia or frequent awakenings
  • Waking up with a sore throat
  • Frequent headaches in the morning
  • Daytime grogginess, trouble concentrating, forgetfulness.

GET IT CHECKED!

The most important thing you can do if you suspect you have sleep apnea is see an expert like the Sleep Specialist at Advanced Sleep Solutions of Virginia and explain your symptoms .  Your doctor will likely schedule you for a sleep test, which can be done at home or in a lab.

The traditional sleep study, called a polysomnogram, requires you to spend a night in a sleep lab.  There you’ll be hooked up to a variety of machines that track and record your brain waves, heart rate, breathing and blood oxygen levels while you sleep.

If the study leads to a diagnosis of sleep apnea, you’ll be asked to return to the lab for a second time so you can be fitted for a device that gently blows air into your airway at night to keep it open, called a CPAP machine, for continuous positive airway pressure.

The other method of diagnosing sleep apnea is through a home sleep test. 

The benefit of the home sleep test is that instead of spending a night in an unfamiliar bed in a lab, you’ll be sent home with equipment that you can wear in the comfort of your own bed.  The device you’ll wear at home will capture data on your blood oxygen levels, airflow, and bodily movement. Studies show that a home sleep test is as accurate as a polysomnogram, it’s cheaper, simpler, and a lot more convenient.

TREATMENT WORKS

But treating sleep apnea can make a huge difference.  It can put an end to loud snoring and fragmented sleep.  It can alleviate depression in some cases and reduce the incidence of car accidents by up to 70 percent.

There’s very clear data that treating sleep apnea can make people feel better by causing people to have more energy and less sleepiness.  They can think better, and they’re not falling asleep at the wheel anymore so the risk of car accidents goes down.

According to an update in the Journal of Thoracic Disease, treatment objectives for obstructive sleep apnea are split into two categories: physiological and symptomatic treatments.  Physiological aspects of the disease that need to be treated are obstructive events, sleep fragmentation, and oxygen desaturation. 

Symptomatic aspects are the snoring and sleepiness that treatment works to minimize.  Studies use the apnea-hypopnea index (AHI), which shows the number of apnea and hypopnea events per hour of sleep, to define treatment success.  Usually, anything less than or equal to 5 events an hour on the AHI is considered successful. 

While continuous positive airway pressure machines, known as CPAPs, have long been thought of as the most efficient treatment for obstructive sleep apnea, the CPAP’s difficult upkeep and high intolerance rates undermine its efficacy. 

Newer Alternatives:

Hypoglossus Nerve Stimulation

A relatively new advancement (approved by the FDA in 2014), hypoglossus nerve stimulation (HNS) is an entirely different approach to treating OSA. With HNS, a small device is surgically implanted in the chest, and can be turned on and off by the patient.  While you sleep, the device monitors your breathing and stimulates a nerve that keeps the upper airway open. Initial research has shown that HGS improved patients’ sleep apnea symptoms, and had few side effects and good compliance. Doctors may recommend this therapy for patients with moderate to severe obstructive sleep apnea who are not helped by PAP therapy. 

Expiratory Positive Airway Pressure (EPAP)

The EPAP system uses disposable adhesive valves that are placed over the nose when you sleep.  When you inhale, the valve opens and helps the airway remain unobstructed. When you exhale, the airflow is directed into small channels, which creates pressure and, again, keeps the airways open.  Open airways mean fewer incidences of obstructed breathing and interruptions in sleep. Initial research has shown EPAP therapy has a high level of adherence—a good sign for successful OSA treatment.

Standard Treatments for OSA: 

Positive Airway Pressure Therapy

Positive airway pressure (PAP) therapy is the most common form of treatment for moderate and severe obstructive sleep apnea.  To use the PAP system, the patient wears a nasal or full-face mask that delivers pressurized air to the upper airway, preventing the airway from collapsing during sleep.  There are variations in how and at what level the pressure is delivered, including continuous, bilevel, and auto-titrated systems.

Oral Pressure Therapy 

Oral pressure therapy does not use a mask.  A mouthpiece is fitted to the patient with tubing and a small vacuum console.  During sleep, the light vacuum repositions the tongue and soft palate and keeps the airway open. 

Oral Appliances

These devices look like a mouth guard and are worn during sleep.  Oral appliances move the tongue and lower jaw forward and upward to increase the size of the upper airway and help you breath.  Oral appliances are fitted by dentists who are trained in sleep medicine. They can be used for patients with any severity level of OSA.  Most commonly they are used to help patients with mild to moderate OSA, and those for whom PAP therapy has been unsuccessful.  

Surgery

Surgery can be indicated if you have facial abnormalities that contribute to OSA.  Whether surgery is a good choice depends on the anatomy of each person’s upper airway and the type of surgery performed.  For severely overweight or obese patients, bariatric surgery may be considered as part of the treatment strategy for weight loss, which is tied to OSA symptoms. 

Behavioral Treatments

For milder forms of OSA, changes to your lifestyle and sleep habits can help.  For example, losing weight is known to improve OSA, as is limiting the consumption of alcohol and sedatives. If you only experience OSA when sleeping on your back, there are positioners that will help maintain a side sleeping position, to improve your breathing and promote continuous, healthy sleep.

LEADING TREATMENT FOR SLEEP APNEA

Alternatives are necessary, and oral appliance therapy takes the cake in terms of efficient CPAP alternatives!  In recent years, there has been a strong body of evidence supporting oral appliances in the treatment of obstructive sleep apnea.  Thus, oral appliances have become the leading alternative to the pesty, old-fashioned CPAP that has plagued obstructive sleep apnea users for years.

The More You Know…

Obstructive sleep apnea is a preventable disorder that can be easily treated with sleep aids like an intraoral appliance, which allows you to get the healthy sleep that you need to live a long and healthy life.

Advanced Sleep Solutions of Virginia, an affiliate of the Advanced Sleep Solutions Centers of America, can provide you with an FDA-approved Somnomed intraoral treatment device that will help mitigate the effects of sleep apnea.

We prefer at-home sleep testing over in-lab testing, and our online scheduling feature makes the entire process easy and convenient.  Additionally, we offer secure telemedicine portals for communication with licensed sleep professionals.

We work to make the entire process efficient and easy, so you can get a better night’s sleep as quickly as possible.  Schedule your appointment now or call us at (703) 689-2480.

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