Sleep Apnea

Young-woman-napping-on-the-couch

by Dr. Lorenzo from the Health Center at Auraria

Sleep apnea is a serious medical condition where breathing may stop during sleep. The most common form of sleep apnea is obstructive sleep apnea (OSA) and is due to factors that interfere with the flow of oxygen through the airway while asleep. Examples of these factors include having a deviated septum, nasal polyps, enlarged tonsils, a large tongue or excessive fatty tissue around the neck due to obesity. When an airway gets narrower, the flow of air becomes turbulent which results in snoring. Hence, loud snoring may be a sign of sleep apnea. If a person’s airway becomes significantly reduced or completely obstructed that may result in pauses in breathing (apnea) or breathing that is shallow (hypopnea). In both instances, oxygen level is reduced and results in poor sleep.

While occasional or infrequent snoring may be harmless, persistent snoring due to obstructive sleep apnea can have health consequences. A good night’s sleep is a vital function of living and has restorative effects on our bodies. With sleep apnea, less oxygen is available to vital organs such as the brain, the heart, muscles and many other tissues. If left untreated sleep apnea may lead to such adverse health effects like daytime sleepiness (falling asleep in class, at work, or worse drowsy driving), fatigue, lethargy, morning headaches, reduced concentration ability, and even high blood pressure. Long term, untreated sleep apnea may increase your risk for diabetes, stroke and heart attack.

Diagnosis of sleep apnea relies on a test called nocturnal polysomnogram or sleep study. This test is usually performed at a sleep lab. During a sleep study, several areas of sleep function are recorded such as depth of breathing, oxygen levels, heart rate, loudness of snoring, presence of apnea or hypopnea, stages of sleep (REM and non-REM sleep) and any abnormal body movements such as restlessness. If sleep apnea is detected, a trial of positive airway pressure (PAP) can be done to determine if this treatment helps relieve apnea or hypopnea. The results of a sleep study is typically reviewed by a specialist in sleep medicine and a report is sent back to your primary care physician/provider with recommendations.

Sleep apnea is a treatable condition and there are several approaches to treatment:

  • Lifestyle changes include exercise and weight loss. A small weight loss of 10-15% can improve sleep apnea.
  • Oral appliances or mouthpieces are devices that help sleep apnea by advancing the lower jaw (mandible) forward to open up the airway. Some appliances can also help retain the tongue from falling. While they are available in the retail market without a prescription, consult with your provider first for recommendations. Alternatively, custom oral appliances can be made by a qualified dentist.   Oral appliances are sometimes offered as an alternative treatment to those who cannot adhere to or fail positive airway pressure therapy.
  • Positive Airway Pressure (PAP) therapy is often used to treat moderate to severe sleep apnea. Essentially, a PAP machine gently creates pressure in your airway to keep it open. A PAP machine is typically set up by a technician who will explain the machine settings based on your provider’s prescription, test how well a mask fits your face and discuss cleaning and general upkeep of the device. Newer PAP machines are capable of continually monitoring for apnea and hypopnea during treatment and send these information back to your sleep provider who can then review and analyze if your settings need any adjustments.
  • Surgery is a treatment option that is reserved only for specific indications like fixing a deviated septum, removing enlarged tonsils and excess tissue in the throat. Consult with your provider if you think this might be an option for you.

In summary, sleep apnea is a common but serious medical condition in adults that if left untreated can lead to adverse health consequences such as daytime sleepiness and fatigue, headaches, high blood pressure and long term may increase your risk for diabetes, stroke and heart attack.