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.
