Dr. Kevin Most: Sleep Apnea
Most of us take sleep for granted, we are active all day and our body needs to rest to be able to reset and be ready for the next day. As we take it for granted we may not realize how important a good night’s sleep is to our overall health. Poor sleeping patterns has been shown to have major impacts on our heart, our lungs and our overall nervous system. These impacts can be caused by just lack of sleep for periods of time but more importantly can be caused by a condition known as sleep apnea. This is a condition where the body will stop breathing for a period of time while we are sleeping.
It’s more common problem than most people realize. Approximately 75 million Americans are affected by some type of sleep disorder. We know this is a major cost to the healthcare system, to an individual’s chronic health and also to the health of individuals who are not connected by errors made by individuals with sleep disorders. Drowsy driving causes over 100,000 motor vehicle accidents and 1500 deaths.
Breathing is another thing we take for granted, we don’t have to actively tell our self “breathe” right? It just happens. Why? The brain is receiving information constantly about our demand for oxygen, it takes that information and tells the lungs what to do, this is why we breath faster and heavier when we run and why we don’t breath as often or deep as we sleep as our demand for oxygen is minimal while sleeping. That being said we do still need to breath while we sleep and in some individuals this is impaired. Sleep apnea is a condition where the breathing pattern stops and starts while sleeping. These periods of stopped breathing cause times where our body is not receiving the oxygen it needs and the outcomes can be harmful to our long term health.
What should one look for? As you are the one asleep it is often your partner who notices that you are snoring very loud, that you have long pauses with breathing. That you make choking or gasping sounds. Individual patients may notice they are tired during the day, that they don’t feel refreshed when wakening and many complain of headaches in the am
Health effects on sleep apnea
- Elevated blood pressure
- Heart failure
- Higher incidence of stroke
- Higher incident of heart attacks
- Higher incident of depression
Cause- some of these are caused by anatomical conditions. This condition is noted in many individuals, the soft tissue in the mouth relaxes when sleeping and if there is a lot of tissue this relaxation can cause the airway to become blocked. This blockage stops the air flow and causes the body to get less oxygen. When this occurs the oxygen levels drop down causing issues in the brain, heart and circulatory system. The oxygen levels get to a low point when the body forces more extensive efforts to get the breathing started.
Tonsils- used to be removed routinely, now not so much. This used to be a very routine surgery as children suffered from inflamed tonsils, we have found that tonsils do add some value to our immune system and now tonsils are removed more infrequently. Tonsils actually help us fight infections and when they are sore they are actually doing their job. They help prevent respiratory and stomach infections.
Diagnose-We all have probably heard of someone taking a sleep test or a sleep study. These tests are performed to allow physicians to diagnose if you have a condition that needs treatment. Sleep studies are done in hospitals, free standing centers and now some home studies. There is a difference and patients need to understand why a doctor would want a study done in one site versus another. Studies done in the hospital and sleep centers are equipped to monitor several body functions beyond sleep activity. They measure brain activity, eye movement, oxygen levels, heart rate and rhythm of the heart, air flow and body movements.
Home studies will measure mainly breathing activity and some will measure heart activity as well. The home study is used mainly for sleep apnea where the hospital based studies monitor for other sleeping disorders as well. Home may be used as a screening study and if failed have the more extensive study as the cost between the 2 studies is substantial. Most insurance companies are pushing for the home study to be done first, home studies may be a few hundred dollars where the hospital based studies may be a few thousand dollars.
The results of these tests are reviewed by a sleep doctor, usually a pulmonary doctor who has had additional training, although other specialties do this as well. The results often trigger some type of treatment, it may be as simple as changing your sleep pattern, it may require medication. In some cases more invasive things will be considered. We have all probably heard of CPAP, this is a device that you wear over your mouth and nose that keeps a slight positive pressure allowing for your airway to stay open and prevents the episodes of breathing pauses. It eliminates snoring and in most cases allows you to get a restful night’s sleep. It does take time to get used to the equipment and some have a difficult time getting used to it. CPAP devices are getting smaller and easier to use, but some people can’t tolerate it.
For people who cannot tolerate CPAP, there is a new treatment option called Inspire. The goal is to keep the airway open, with CPAP it is air pressure, with Inspire it is a with electric stimulation to those muscles needed to keep airway open. It is essentially a pacemaker for the muscles needed to keep the airway open. This technology involves the implantation of the device, it is then turned on and off with a hand held device, so the stimulation only occurs when you are sleeping, it is turned off during the day.
We are also seeing a lot of technology in sleeping pillows. Many new pillows attempt to place the neck in a position that helps reduce the positioning that promotes blockage of the airway. This technology is being attempted again by the individuals who cannot tolerate CPAP.
Big message is if you notice your partner snoring excessively or if you note that there are times thru the night where they stop breathing, discuss that and get an evaluation. In the short term you will get a more restful sleep in the long term you will help prevent heart disease, high blood pressure and the other concerns with safety related injuries.