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Sleep Apnea
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Also know as Breathing Related Sleep Disorder

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.


DSM Code

780.57 Breathing-Related Sleep Disorder

G47.9 Sleep Apnea

Disorder Sheets

Irish Sleep Apnea Trust
PO Box 8440
Dublin 24
Ireland

Tel: + 353 (86) 605 3891
Email: Click Here
Web: Click Here

Recommended Book

Snoring and Sleep Apnea: Sleep Well, Feel Better - Click Here to View

 

Sleep Apnea

Misc Information

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