About Sleep Apnea - Sleep Center at Cardiology Associates of New Brunswick

Insomnia

Insomnia is defined as an inability to fall asleep or an inability to stay asleep. It affects one third of the population at some point in their lives, with roughly one third of these people experiencing chronic insomnia. A variety of psychological and physiological factors can cause insomnia. The disorder may be worsened by consuming alcohol, stimulants such as caffeine or amphetamines, or by certain drugs or medications.

Movement Disorders

Periodic limb movement disorder (PLMD) and restless legs syndrome (RLS) are two common movement disorders. Movement disorders often either prevent or disrupt sleep. PLMD only affects people during sleep. RLS affects people while they are awake and is characterized by an irresistible urge to move the legs while awake.

Narcolepsy

Narcolepsy is characterized by excessive sleepiness during the day and interrupted sleep at night. It affects roughly one in 2000 individuals. While very debilitating, narcolepsy is highly treatable.

Other Sleep Disorders

We also diagnose and treat night terrors, sleepwalking, REM behavior disorders and other sleep-related disorders.

Sleep apnea is a common disorder, affecting up to 20% of men and 9% of women. Typically occurring in people who snore, sleep apnea results from obstruction of the upper airway, most often at the base of the tongue. Sleep apnea can prevent a person from reaching deep, restorative sleep. The apneas can cause numerous arousals from sleep during the night, resulting in excessive fatigue or sleepiness during the day. Sleep apnea is associated with other health effects, such as high blood pressure and heart disease.

Causes

Normally, the muscles of the upper part of the throat help keep the airway open and allow air to flow into the lungs. Even though these muscles usually relax during sleep, the upper throat remains open enough to let air pass by.

However, some people have a narrower throat area, and, during sleep, relaxation of the muscles causes the passage to completely close. This prevents air from getting into the lungs. Loud snoring and labored breathing occur. During deep sleep, breathing can stop for a short period of time (often more than 10 seconds). This is called apnea.

An apnea episode is followed by a sudden attempt to breathe, and a change to a lighter stage of sleep. The result is fragmented sleep that is not restful, leading to excessive daytime drowsiness.

Older obese men seem to be at higher risk, although as many as 40% of people with obstructive sleep apnea are not obese. The following factors may also increase your risk for obstructive sleep apnea:

1Certain shapes of the palate and jaw
2Large tonsils and adenoids in children
3Large neck or collar size
4Large tongue
5Narrow airway
6Nasal obstruction
7Recent weight gain

Drinking alcohol or using sedatives before sleep may make you more likely to have an episode of apne

Symptoms

It is important to emphasize that, often, the person who has obstructive sleep apnea does not remember the episodes of apnea during the night. The main symptoms are usually associated with excessive daytime sleepiness due to poor sleep during the night. Often, family members, especially spouses, witness the periods of no breathing.

A person with obstructive sleep apnea usually snores heavily soon after falling asleep. The snoring continues at a regular pace for a period of time, often becoming louder, but is then interrupted by a long silent period during which there is no breathing. This is followed by a loud snort and gasp, and the snoring returns. This pattern repeats frequently throughout the night.

Symptoms that may be observed include:

1Abnormal daytime sleepiness, including falling asleep at inappropriate times
2Awakening unrefreshed in the morning
3Depression (possibly)
4Episodes of no breathing (apnea)
5Lethargy
6Loud snoring
7Memory difficulties
8Morning headaches
9Personality changes
10Poor concentration
11Restless sleep

Additional symptoms that may be associated with this disease:

1Hyperactive behavior, especially in children
2Leg swelling (if severe)

Exams and Tests

The health care provider will perform a physical exam. This will involve carefully checking your mouth, neck, and throat. You will be asked about your medical history. Often, a survey that asks a series of questions about daytime sleepiness, sleep quality, and bedtime habits is given.

A sleep study (polysomnogram) is used to confirm obstructive sleep apnea.

Other tests that may be performed include:

1Arterial blood gases
2Electrocardiogram (ECG)
3Echocardiogram
4Thyroid function studies

Treatments

The goal is to keep the airway open so that breathing does not stop during sleep.

The following may relieve symptoms of sleep apnea in some individuals:

1Avoiding alcohol or sedatives at bedtime
2Dental devices inserted into the mouth at night to keep the jaw forward
3Weight management or weight loss

If these measures do not help, your doctor may recommend continuous positive airway pressure (CPAP) therapy. CPAP is the first-line treatment for obstructive sleep apnea. For information on this treatment, see:CPAP

Surgery may be an option in some cases. This may involve:

1Uvulopalatopharyngoplasty (UPPP) to removing excess tissue at the back of the throat
2Tracheostomy to create an opening in the windpipe to bypass the blocked airway if anatomical causes are present (rarely done)

Surgery to remove the tonsills and adenoids may cure the condition in children; it does not seem to help most adults.

Outlook (Prognosis)

When treated correctly, obstructive sleep apnea may be controlled. However, many patients are unable or unwilling to tolerate CPAP therapy.

Possible Complications

During the nonbreathing episodes, blood oxygen levels falls. Persistent low levels of oxygen (hypoxia) may cause many of the daytime symptoms. If the condition is severe enough, pulmonary hypertension may develop, leading to right-sided heart failure or cor pulmonale.

Other complications include: