Do you or someone you know complain of:
- Excessive daytime sleepiness
- Loud snoring
- Observed episodes of stopped breathing during sleep
- Abrupt awakenings accompanied by gasping or choking
- Awakening with a dry mouth or sore throat
- Morning headache
- Difficulty concentrating during the day
- Experiencing mood changes, such as depression or irritability
- High blood pressure
- Nighttime sweating
- Decreased libido
- Need to urinate frequently at night (nocturia).
- Memory issues
- Restless sleep
- Sleep deprived partners
Although other issues can be the cause, this could all be due to sleep apnea. Once thought to only impact obese patients, we now know it has a myriad of underlining causes and is probably significantly under reported and diagnosed.
Public health and safety are threatened by the increasing prevalence of obstructive sleep apnea, which now afflicts at least 25 million adults in the U.S, with 80 percent of the cases of moderate and severe obstructive sleep apnea undiagnosed. OSA, when left untreated, can lead to high blood pressure, chronic heart failure, atrial fibrillation, stroke, memory issues, type 2 diabetes, depression and even death. It can even be a factor in traffic accidents owing to the persistent drowsiness suffered by many OSA patients before the disease is recognized and treated. We all know obesity has reached epidemic proportions but few are aware that too little good sleep appears to be as much a factor in obesity as too much food and too little exercise.
There are several types of sleep apnea, but the most common is obstructive sleep apnea. This type of apnea occurs when your throat muscles intermittently relax and block your airway during sleep. A noticeable sign of obstructive sleep apnea is snoring. OSA arises from what is basically a mechanical problem. During sleep, the patient’s tongue falls back against his or her soft palate, and the soft palate and uvula fall back against the back of the throat.These muscles support structures including the back of the roof of your mouth (soft palate), the triangular piece of tissue hanging from the soft palate (uvula), the tonsils and the tongue.
When the muscles relax, your airway narrows or closes as you breathe in and breathing may be inadequate for 10 seconds or longer, effectively closing the airway. When the sleeper expands the chest to inhale, no air enters the lungs. This may lower the level of oxygen in your blood and cause a buildup of carbon dioxide. Your brain senses this impaired breathing and briefly rouses you from sleep so that you can reopen your airway. This awakening is usually so brief that you don’t remember it, correcting itself quickly, within one or two deep breaths. You may make a snorting, choking or gasping sound.This pattern can repeat itself 5-30 times, or more, each hour, all night long. These disruptions impair your ability to reach the desired deep, restful phases of sleep, and you’ll probably feel sleepy during your waking hours. People with obstructive sleep apnea may not be aware that their sleep was interrupted. In fact, many people with this type of sleep apnea think they slept well all night.
Why this blockage occurs in some people and not others is unclear. The condition appears to develop more frequently among people who sleep on their back, are middle-aged, overweight and male. The differences are relative, however. OSA is seen in both sexes and in patients of all ages, body types, and favored sleeping positions. I once diagnosed a thin woman with sleep apnea after she had a significant finding on a sleep study to have her psychiatrist tell her it must have been a false positive just because she was thin.
Anyone can develop obstructive sleep apnea. Anyone can develop obstructive sleep apnea. Here are a few more factors that can lead to OSA:
- Narrowed airway: You may inherit naturally narrow airways. Or your tonsils or adenoids may become enlarged, which can block your airway.
- Chronic nasal congestion: Obstructive sleep apnea occurs twice as often in those who have consistent nasal congestion at night, regardless of the cause. This may be due to narrowed airways.
- Smoking: People who smoke are more likely to have obstructive sleep apnea.
- Excessive overbite. If the upper teeth cover the lower teeth by more than 50%, the lower jaw can sit far back and cause narrowing of the upper airway with intermittent obstruction.
- A family history of sleep apnea: If you have family members with obstructive sleep apnea, you may be at increased risk.
- Asthma: Research has found an association between asthma and the risk of obstructive sleep apnea.
Polysomnography is the test used to diagnose sleep apnea. During this sleep study, you’re hooked up to equipment that monitors your heart, lung, and brain activity, breathing patterns, arm and leg movements, and blood oxygen levels while you sleep.
You may have a full-night study, in which you’re monitored all night, or a split-night sleep study. In a split-night sleep study, you’ll be monitored during the first half of the night. If you’re diagnosed with obstructive sleep apnea, staff may wake you and give you a continuous positive airway pressure (CPAP) device the second half of the night to see if it helps.
This sleep study can also help rule out other sleep disorders that can cause excessive daytime sleepiness but require different treatments, such as leg movements during sleep (periodic limb movements) or sudden bouts of sleep during the day (narcolepsy).
If your concerns are mild and not intrusive to sleep or daily activities you can try some simple options to improve sleep:
Sleep Differently: One of the easiest changes to make is altering your sleep position. Sleep apnea is most common in people who sleep while lying flat on their backs because gravity can cause the tongue and surrounding tissue to fall back into the throat and disrupt normal breathing. Sleeping on one side, or even on your stomach, can eliminate this from happening. Many experts suggest stitching an uncomfortable but harmless object, such as a small ball or stuffed toy, into the back of your pajamas to encourage side sleeping until it becomes a habit. Shifting positions may be all up you need.
Lose Weight: Recent clinical studies have demonstrated that excess weight is the strongest risk factor associated with OSA in adults. A recent study showed that even a 10-percent weight gain increased the odds of developing moderate to severe OSA by six times. Another reason to eat healthy and lose weight.
Use a Humidifier: One common cause of sleep apnea is a congested nasal passage. Humidifiers can help with this. At night, we primarily use our noses for breathing. Snoring and sleep apnea occurs when the nose is too congested to properly function, and breathing must be done through the mouth. Humidifiers add moisture to the room, which can loosen dried mucus that is blocking nasal passages. Blowing your nose can then help to clear these passages completely, allowing you to breathe normally again.
Eat Honey: Honey can be beneficial for people who suffer from sleep apnea. First, it is an anti-inflammatory agent so that it can decrease swelling in the nasal passages and the throat. It also is a natural moisturizer, so it can help to lubricate a dry throat and allow for easier breathing. Before bed, swallow a tablespoon of honey. You can do this before brushing your teeth, but make sure it is close enough to bedtime that you will be lying down soon. The honey should reduce inflammation and congestion, allowing you to breathe without difficulty. Doing this every night can help to fight sleep apnea long-term.
Use Cervical pillows: These are designed to raise your head above the shoulders. This allows drainage to run down, rather than blocking your throat and nasal passages, which decreases sleep apnea symptoms. You can also try raising your bed, either by using more pillow or by placing bricks under the headboard to raise it up a few inches. Sleeping in a recliner is not a good long-term solution due to the back issues it can cause, but it may be beneficial for short flares of sleep apnea, such as during allergy season or when you have a cold.
Try Lavender: A very calming scent that’s often used as a sleep aid. One common issue that complicates sleep apnea is the use of sleep aids. If you feel fatigued, you may turn to sleep aids in the hopes of getting a good night of sleep. However, these can worsen the condition and can even be fatal, if your body is unable to wake up to start the breathing process again. Lavender, on the other hand, will help you to relax enough to sleep naturally, without chemically altering your body. This makes it a good alternative to sleep aids in the treatment of sleep apnea.
Decongest Nasal Passages: Nasal sprays are designed to work as decongestants, moistening the nasal passages to relieve blockages, but they are only short term. They are highly addictive and overuse can actually caused dependency on them leading to rebound nasal inflammation causing the very issue you’re trying to avoid. Better option are devices that allow you to irrigate the nasal passages using a saline solution, which then moistens and flushes out mucus that may be prohibiting you from breathing properly. If you use nasal irrigation, be certain to follow the package directions correctly since improper use can cause the nasal passages to become dry and irritated.
Use Snore guards or strips: These are designed to help the mouth to stay in anatomical alignment overnight. Nasal strips are another common remedy designed to open the nose, reducing congestion. However, they would not be beneficial for all types of sleep apnea, so it may be best to consult a physician about your condition before using them.
Treat allergies or colds : One of the most important things that can be done to treat sleep apnea is to treat any underlying conditions that may exacerbate it. These temporary conditions can make symptoms worse since they result in stuffy nasal passages and swollen throats. Getting rid of them quickly is beneficial, and will aid in sleep apnea treatments.
Many people think snoring isn’t a big deal, and not everyone who snores has obstructive sleep apnea, but it can be a sign of something potentially serious. Be sure to talk to your doctor if you experience loud snoring, especially snoring that’s punctuated by periods of silence. With obstructive sleep apnea, snoring usually is loudest when you sleep on your back, and it quiets when you turn on your side.
Ask your doctor about any sleep problems that leave you chronically fatigued, sleepy and irritable. OSA left untreated is a serious matter. Over time it can lead to life threatening and life-shortening diseases.
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