Sleep Apnea Essay, Research Paper
leep Apnea is a disorder that causes the
cessation of breathing during sleep. There are three
types of Apnea: Obstructive, Central, and
Mixed. The most common type of apnea is Obstructive
Sleep Apnea (OSA). The individual suffering from OSA
may stop breathing hundreds of times during the night for
more than a minute at a time. The word Apnea
literally means with out breath in Greek.(1) Like all muscles in the body while sleeping, the soft palate and tongue muscles relax, and end up collapsing causes the airflow to become restricted. For some one who is observing an OSA sufferer they hear heavy broken snoring. “The potential consequences of obstructive sleep apnea are significant and include hypertension, coronary heart disease, myocardial infarction, pulmonary hypertension, congestive hear failure, stroke, neuropsychiatric problems, cognitive impairment, sexual dysfunctions, and injury due to accidents. Finally the Commission estimates that cardiovascular deaths attributable to obstructive sleep apnea alone may be as high as 38,000 annually.” (2)
eople that suffer from OSA have a very distinct sleeping pattern. This cycle may repeat itself over a hundred times an hour.
+ You fall asleep.
+ The muscles in your throat as well as the rest of your body relax.
+ The relaxed muscles allow the air passage in your throat to constrict or collapse in upon itself. Air flow is restricted or blocked.
+ The restricted air flow causes labored breathing accented by loud snoring or snorts. A complete closure may be the cause of pauses in breathing rhythm.
+ The amount of oxygen in your bloodstream begins to drop. Your body is continuing to use it, but it is not being replaced by breathing. The carbon dioxide level in the bloodstream begins to rise.
+ You continue sleep, struggling for air. This struggle may last 10,20,40 seconds between breaths.
+ Your pulse (heart rate) slows.
A center in your brain detects the altered blood chemistry (i.e. high carbon dioxide, low oxygen). This state is called hypoxia.
In order to prevent suffocation, the brain triggers a release of a chemical messenger, adrenalin. This chemical shocks the consciousness centers of the brain and causes a partial awakening.
+
+ The awakening causes the muscles to open the airway, the heart rate races in response to the adrenalin and causes a spike in blood pressure.
+ Several breaths are taken, blowing off the carbon dioxide and restoring oxygen to the blood. The blood chemistry returns to near normal.
+ The brain allows you to return to sleep.
+ The cycle repeats. (3)
he most typical sufferers of OSA are middle aged, obese men. The occurrence of sleep apnea is a common as adult diabetes. The National Institute for Health notes that that as many as 18 million Americans have sleep apnea. The NIH also states that, in the US, 4% of the adult middle-aged male population and 2% of the adult middle-aged female population are affected with OSA to the point where it causes problems with daytime sleepiness. (4) A study of 400 men & women aged 40 – 65 in Busselton, WA revealed that 10% of the men and 7% of the women had Respiratory Disturbance Index (RDI’s) >10. (5)
THE BED PARTNERS OF PEOPLE WITH SLEEP APNEA FREQUENTLY REPORT:
+ “JACKHAMMER” SNORING
+ PAUSES IN BREATHING, FOLLOWED BY GASPING TO GET AIR
+ FREQUENT MOVEMENT IN BED
THE PEOPLE WITH SLEEP APNEA FREQUENTLY REPORT:
+ EXCESSIVE DAYTIME SLEEPINESS
+ MORNING HEADACHES
+ POOR ABILITY TO CONCENTRATE
+ A DESIRE TO FALL ASLEEP WHILE PERFORMING MUNDANE TASKS, LIKE SITTING AT TRAFFIC LIGHTS
+ A SENSE OF CHOKING (A NUMBER OF PEOPLE HAD DREAMS ABOUT BEING CHOKED)
eople that suffer from OSA face many different medical problems. It is much more than annoying snoring. The most serious problems that they can face is the increased risk of strokes, cardiac arrest, and other serious heart conditions. A team at Sleep Disorders Center of the University of Iowa, Iowa City, led by Mark Eric Dyken, M.D conducted research on 24 people who recently had a stroke, and 27 control patients . “There was a strikingly higher incidence of moderate to severe obstructive sleep apnea, compared to age- and sex-matched controls,” the team reports. Ten of 13 male (77%) and 7 of 11 female (64%) stroke patients had sleep apnea, compared to only 3 of 13 men (23%) and 2 of 14 women (14%) without stroke. (6) Within the study half of the stroke patients were suffering with OSA. After a four- year follow up of these patients, 3 men, and 2 women died. 4 of the 5 of these patients had their strokes while they were sleeping, and they all suffered from OSA. The reason that OSA and strokes are believed to be linked is that “hypoxemia (low blood oxygen levels) and autonomic (nerve) responses associated with obstructive sleep apnea may produce acute and chronic changes that predispose patients not only to hypertension and cardiovascular disease but also to stroke.” (6)
Sleep apnea is has also been linked to high blood pressure, weight gain, decreased mental faculties, sexual problems, and psychological problems including depression. Sleep apnea has also been tied to automobile accidents. Researchers from Spain and the US compared 60 people with sleep apnea to 61 people of a similar age and gender who did not have the disorder. A third (33%) of patients with sleep apnea symptoms had at least one automobile accident in the past 3 years, compared with 18% of those without sleep apnea symptoms — a statistically significant difference. (7) Stanford University conducted a study that concluded sleep apnea sufferers are just as, if not more dangerous than drunk drivers. The study compared the reaction times of 113 sleep apnea patients to a group of 80 volunteers who agreed to get drunk. All the participants took a 10-minute test of reaction speed, pushing a button to turn off a randomly set light. Sleep Apnea patients did worse than people that had a blood-alcohol content of .08 percent.(8)
The Berlin Questionnaire
Question Response
Has your weight changed? Increased
Decreased
No change
Do you snore? Yes
No
Do not know
Snoring loudness Loud as breathing
Loud as talking
Louder than talking
Very loud
Snoring frequency Almost every day
3 to 4 times per week
1 to 2 times per week
1 to 2 times per month
Never or almost never
Does your snoring bother other people? Yes
No
How often have your breathing pauses Almost every day
been noticed? 3 to 4 times per week
1 to 2 times per week
1 to 2 times per month
Never or almost never
Are you tired after sleeping? Almost every day
3 to 4 times per week
1 to 2 times per week
1 to 2 times per month
Never or almost never
Are you tired during wake time? Almost every day
3 to 4 times per week
1 to 2 times per week
1 to 2 times per month
Never or almost never
Have you ever fallen asleep while driving? Yes
No
Do you have high blood pressure? Yes
No
Do not know
reatment/therapy for the disorder must be fitted to the individual patient. It may be as simple as Behavioral Therapy: sleeping on the side instead of the back, avoidance of alcohol, tobacco and sleeping pills which cause the airway to be more prone to collapse during sleep and lengthen the times of breathing pauses. A weight loss program may be prescribed. However, until the weight is lost, often Physical or Mechanical Therapy is prescribed using a “breathing machine” to maintain an air pressure large enough to keep the air passage open after you fall asleep. These machines are named after the kind of pressure they provide. The CPAP (Continuous Positive Airway Pressure) device is basically a computerized air pump. It is calibrated by a respiratory therapist to produce the amount of pressure necessary to maintain an open airway.
The BiPAP device is similar (Bi-pap stands for Bi-level positive airway pressure) however, it is used when the prescription is set at two levels, one for inhalation (called I-pap) and the other for exhalation (called E-pap). The difference is that with the Bi-level it is easier to exhale. The E-pap is set at a lower pressure than the I-pap. It still keeps the airway open but it is easier to exhale against that lower pressure. Because it is difficult to exhale/breath when you reach higher pressures, the use of Bi-pap is often prescribed for patients who require significantly higher pressures..
Through the use of a dental appliance, apnea can also be reduced. A dental appliance is a small plastic device, similar to an orthodontic retainer or a athletic mouth guard. It is worn in the mouth during sleep to prevent the soft throat tissues from collapsing and obstructing the airway. Dentists with training in dental appliance therapy can design, construct, and fit these special appliances to meet their patient’s individual situations and conditions.
In recent clinical studies, physicians and dentists have found that, in a majority of patients, a well-made, well-fitted dental appliance will effectively reduce or eliminate snoring, and significantly relieve symptoms of mild and moderate OSA.
Dental appliances work in three ways: by bringing the lower jaw forward, by holding the tongue forward, and by lifting a drooping soft palate. A combination appliance may perform two or more of these functions at the same time. Dental appliance therapy is not a new idea. It was in use as far back as the early 1900s. But it was not until the 1980s that physicians and dentists began to work together to study and develop this alternative form of treatment, enabling more patients to benefit from it.
If you feel that you are suffering from OSA, you should see a doctor immediately. You can find a sleep specialist near you by visiting the American Sleep Disorders Association Accredited Member Centers and Laboratories website at: http://www.asda.org/sleep_study.htm