Breathing-Related
Sleep Disorder, also known as sleep apnea, causes the sufferer to
stop breathing during the night for periods lasting from 30 seconds
to 2 minutes. This may happen as much as 400 times per night.
Sleep apnea is
a serious, potentially life-threatening condition that is far more
common than generally understood. There are two types of sleep apnea:
central and obstructive. Central sleep apnea, which is less common,
occurs when the brain fails to send the appropriate signals to the
breathing muscles to initiate respirations. Obstructive sleep apnea
is far more common and occurs when air cannot flow into or out of
the person’s nose or mouth although efforts to breathe continue.
These breathing pauses are almost always accompanied by snoring between
apnea episodes, although not everyone who snores has this condition.
Sleep apnea can also be characterized by choking sensations. The frequent
interruptions of deep, restorative sleep often leads to excessive
daytime sleepiness and may be associated with an early morning headaches.
Early recognition
and treatment of sleep apnea is important because it may be associated
with irregular heartbeat, high blood pressure, heart attack, and stroke.
Obstructive Sleep Apnea
Obstructive sleep apnea is characterized by repetitive pauses in breathing
during sleep due to the obstruction and/or collapse of the upper airway
and followed by an awakening to breathe. Respiratory effort continues
during the episodes of apnoea.
Central Sleep Apnea
Central Sleep Apnea is defined as a neurological condition causing
cessation of all respiratory effort during sleep, usually with decreases
in blood oxygen saturation, if the brainstem center controlling breathing
shuts down there's no respiratory effort and no breathing. The person
is aroused from sleep by an automatic breathing reflex, so may end
up getting very little sleep at all.
Mixed Apnoea
Mixed sleep apnoea, is a combination of the previous two. An episode
of mixed sleep apnoea usually starts with a central component and
then becomes obstructive in nature. Generally the central component
of the apnoea becomes less troublesome once the obstructive apnoea
is treated.
Associated
Features:
Loud
Snoring.
Morning Headaches.
Unrefreshing Sleep.
Dry mouth upon awakening.
Overweight.
Change in Personality.
Depression.
Excessive Perspiring during sleep.
Heartburn.
Reduced libido.
Insomnia.
Frequent nocturnal urination.
Restless sleep.
Differential
Diagnosis:
Some disorders have similar symptoms. The clinician, therefore, in
his diagnostic attempt has to differentiate against the following
disorders which need to be ruled out to establish a precise diagnosis.
Upper Airway
Obstruction
GERD
Asthma
Nocturnal seizures
Cause:
Sleep apnea occurs
in all age groups and both sexes but is more common in men. People
most likely to have or develop sleep apnea include those who snore
loudly and also are overweight, or have high blood pressure, or have
some physical abnormality in the nose, throat, or other parts of the
upper airway. Sleep apnea seems to run in some families, suggesting
a possible genetic basis.
Certain mechanical
and structural problems in the airway cause the interruptions in breathing
during sleep. In some people, apnea occurs when the throat muscles
and tongue relax during sleep and partially block the opening of the
airway. When the muscles of the soft palate at the base of the tongue
and the uvula relax and sag, the airway becomes blocked, making breathing
labored and noisy and even stopping it altogether. Ingestion of alcohol
and sleeping pills increases the frequency and duration of breathing
pauses in people with sleep apnea.
Treatment:
The specific therapy for sleep
apnea is tailored to the individual and is based on medical history
and a physical examination. Medications are generally not effective
in the treatment of sleep apnea. Oxygen is sometimes used in patients
with central apnea caused by heart failure. It is not used to treat
obstructive sleep apnea.
Physical or Mechanical Therapy
Nasal continuous positive airway pressure (CPAP) is the most common
effective treatment for sleep apnea. In this procedure, the patient
wears a mask over the nose during sleep, and pressure from an air
blower forces air through the nasal passages. The air pressure is
adjusted so that it is just enough to prevent the throat from collapsing
during sleep. The pressure is constant and continuous.
Variations of
the CPAP device attempt to minimize side effects that sometimes occur,such
as nasal irritation and drying, facial skin irritation, abdominal
bloating, sore eyes, and headaches.
Dental appliances
that reposition the lower jaw and the tongue have been helpful to
some patients with mild to moderate sleep apnea or who snore but do
not have apnea. A dentist or orthodontist is often the one to fit
the patient with such a device.
Surgery
Some patients with sleep apnea may need surgery. Although several
surgical procedures are used to increase the size of the airway, none
of them is completely successful or without risks. Some
of the more common procedures include removal of adenoids and tonsils,
nasal polyps or other growths, or other tissue in the airway and correction
of structural deformities. Younger patients seem to benefit from these
surgical procedures more than older patients.
Uvulopalatopharyngoplasty
(UPPP) is a procedure used to remove excess tissue at the
back of the throat. The success of this technique may range from 30
to 60 percent. The long-term side effects and benefits are not known,
and it is difficult to predict which patients will do well with this
procedure.
Laser-assisted
uvulopalatoplasty (LAUP) is done to eliminate snoring but
has not been shown to be effective in treating sleep apnea.
Continuous
Positive Airway Pressure (CPAP) appears to be the best and
most effective treatment for OSA. CPAP flow generators develop a constant,
controllable pressure to keep your upper airway open so that you can
breath normally. CPAP is effective on 95% of the patient with OSA.
The pressure acts much in the same way as a splint, holding the airway
open.
Weight
Management and the avoidance of alcohol and sedatives at
bedtime may achieve the desired results in some individuals. If these
measures are unsuccessful in stopping sleep apnea, continuous positive
airway pressure (nasal CPAP) is the next procedure to be utilized.
