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Sleep Apnea can cause excessive daytime sleepiness. When a person goes to sleep and relaxes sometimes the tissue in the throat also relaxes to the point that it blocks the airway. As the airway, starts to block snoring may begin. When the airway is totally blocked, there is a silence and the chest or the abdominal may not move. The silence is called Apnea and the longer the silence the more dangerous the Apnea. Finally, the brain will take over and cause the person to arouse with a deep gasp or snort to clear the airway. If we did not arouse and the silence continued, death would occur from lack of oxygen because your airway is blocked and you are not breathing.
These many arousals during the night do not let your body rest and they deprive it of much needed oxygen. This deprivation can cause excessive daytime sleepiness, Hypertension, and Heart palpitations.
Obstructive sleep apnea (OSA) is the most common type of sleep apnea in children. In OSA, the muscles in the walls of the throat relax while the child sleeps, so the walls collapse and obstruct the flow of air. After 10 to 30 seconds, the child is in a lighter level of sleep or even a brief wakefulness. The muscles tighten — relieving the obstruction — and the child breathes again.
Child sleep apnea usually occurs between the ages of 3 and 6 because of enlarged tonsils and adenoids. A rare cause of obstructive sleep apnea in children is a tumor or growth in the airway. Certain conditions such as Down Syndrome also can cause OSA. Signs and symptoms of obstructive sleep apnea in children, courtesy of the Mayo Foundation for Medical Information and Research, include:
- Nightly snoring, often with intermittent pauses, snorts or gasps
- Disturbed sleep
- Attention problems
- Chronic fatigue
The most common treatment for children with obstructive sleep apnea is surgical removal of both the tonsils and the adenoids (adenotonsillectomy). After removal of the tonsils and adenoids, the child's upper airway is no longer blocked. Studies indicate that adenotonsillectomy has a high cure rate in children with obstructive sleep apnea.
A person with sleep apnea may have few or many apneic episodes during a night's sleep. 35 individuals suffering from sleep apnea studied at Stanford University's Sleep Disorders Center recorded from 68 to 682 apneic episodes during a seven hour sleep period. The length of time that each apnea lasted ranged from 10 to 190 seconds. The latter figure is not a misprint: some individuals sometimes stopped breathing for as long as three minutes and ten seconds!
For those of you whose significant others are kicking you out of the bed due to snoring, there's hope. More than 300 devices are registered in the U.S. Patent and Trademark Office as cures for snoring.
Some of these devices reposition the lower jaw forward; some open nasal air passages; a few others have been designed to condition a person not to snore by producing unpleasant stimuli when snoring occurs.
But, if you snore, whether it's because you have a cold or sleep apnea, the truth is that it is not under your control. If anti-snoring devices work, it is probably because they keep you awake.
Wondering if you might have sleep apnea? Here are the main symptoms to look for:
- Excessive daytime sleepiness
- Frequent episodes of obstructed breathing during sleep (the patient may be unaware of this, but the bed partner is usually very aware)
- Loud snoring
- Morning headaches
- Unrefreshing sleep
- A dry mouth upon awakening
- Excessive perspiring during sleep
- Reduced libido
- Frequent nocturnal urination (nocturia)
- Restless sleep
- Nocturnal snorting, gasping, choking (may wake self up)
- Rapid weight gain
Obstructive Sleep Apnea is a more common and serious type of apnea. In this type, the onset of sleep does not affect the diaphragm. There is, however, an abnormal loss of tone (healthy elasticity) in the muscles of the tongue, throat, and larynx during sleep. As a result, at the onset of or during sleep, the throat collapses and the air flow is completely blocked. During the apneic episode, the diaphragm continues to contract rhythmically with a progressively greater effort against the closed airway until finally a partial or complete awakening occurs and normal breathing is resumed.
Apneic episodes cause the oxygen content of the blood to decrease and the carbon dioxide levels to increase. This means that the heart, brain, and other vital tissues are periodically deprived of needed oxygenated blood. Furthermore, blood pressure rises sharply in both the pulmonary and systemic arteries, and the heart slows (bradycardia) and may stop entirely (asystole) for as long as 6 to 8 seconds. These changes are temporarily reversed when breathing is resumed.
Those who suffer from central sleep apnea usually complain of insomnia. They often say that they are unable to get a night of continuous sleep. They are unaware of the apneic episodes, but are often aware that they awaken frequently during the night and are unable to to go back to sleep for some time. They also have many awakenings of which they are unaware.
Central Sleep Apnea is a relatively rare central nervous system disorder. When a person suffering from this type of sleep apnea falls asleep, the diaphragm (the muscle separating the chest and abdominal cavity which helps move air in and out of the lungs) stops moving because the sleeping brain fails to send impulses through the nerves which control the movement of the diaphragm. When the diaphragm stops functioning, breathing stops.
The first thing that needs to be done is to determine the cause of your snoring. There are several different kinds of oral appliances available to help, but if the problem is sleep apnea, it could be a lot more serious and some other type of treatment might be indicated. As always, the best advice is to seek a referral to a sleep specialist where you will be able to receive proper diagnosis and treatment.
There are different ways to go about sleep apnea treatment with surgery. These sleep apnea surgeries focus on one or more of the following three areas:
1. The soft palate
2. The uvula, tonsils and adenoids
3. The tongue
More complex sleep apnea surgery can be performed to adjust the mouth, nose and facial bones.
Types of Sleep Apnea Surgery:
Radiofrequency - the volume of soft tissue is reduced. This sleep apnea surgery is usually performed in an office and requires a local anesthetic. A probe is inserted into the tissue, transmitting radiofrequency energy. During the healing process (which takes up to three weeks), scar tissue forms and causes the tissue's overall size to decrease.
Nasal surgery - nasal surgery has proven to be a successful way of improving nasal breathing. However, in patients with moderate to severe obstructive sleep apnea (OSA), this surgery alone does not usually show significant improvement.
Uvulopalatopharyngoplasty - soft palate redundancy is a frequent cause of airway obstruction in OSA. This is the most common surgery to treat the soft palate. The tissue from the soft palate and/or back of the throat is removed to increase airway size.
Genioglossus Advancement - the tongue is a frequent cause of airway obstruction in OSA. The tongue can collapse towards the back of the throat during sleep, creating OSA. The collapsibility of the tongue can be improved with genioglossus advancement. During this surgery, the tongue can be repositioned so that it is less likely to relax into the airway during sleep.
Hyoid Advancement - the collapsibility of the tongue can be improved with hyoid advancement. Several tongue muscles attach to the U-shaped bone located in the neck. In surgery, the bone is pulled forward, which in turn pulls the tongue forward as in genioglossus advancement.
Maxillomandibular Advancement - the airway is confined by the upper and lower jaw. This surgery moves the upper and lower jaw forward so the entire airway can be enlarged. In general, jaws do not need to be wired after surgery. However, chewing is not allowed for 4 weeks.
Maxillomandibular Expansion - patients with OSA often have narrowed jaws, which result in displacement of the tongue towards the back of the throat and airway obstruction. The upper and lower jaws can be widened to improve the airway.
Tracheostomy - used in persons with severe, life-threatening sleep apnea. In this procedure, a small hole is made in the windpipe and a tube is inserted into the opening. This procedure is an extreme measure that is rarely used.
Other procedures: for those who have sleep apnea because of a deformity of the jaw, surgical reconstruction can help. Surgical procedures to treat obesity are sometimes recommended for sleep apnea patients who are morbidly obese.
Early morning headaches are a frequent symptom of sleep apnea, as are hallucinations which occur while the person is awake but feeling extremely sleepy. Adults who experience such hallucinations report that they are usually, although not always, able to correct their perceptions of reality as they become more awake and alert. In addition, a slight disorientation sometimes occurs after awakening. This typically lasts for between 3 minutes to half an hour and can involve difficulties with memory or giving inappropriate answers to questions. Many refer to this as a "foggy mind" state. Children appear to have much greater difficulty than adults in distinguishing between that which is imagined and that which is real. They may experience the "foggy" morning awakenings with accompanying hallucinations and later in the day have great difficulty recalling which was reality and which was an hallucination.
The two types of Sleep Apnea are Obstructive and Central. Obstructive Sleep Apnea in which we call OSA is the process of the tissues, tonsils, or adenoids in the throat relaxing and falling over the airway limiting or blocking the air we breathe at night.
Then there is Central Sleep Apnea or CSA in which the brain forgets to tell us to breath. You see CSA in stroke patients and SIDS in children.
Diagnosis of sleep apnea is not simple because there can be many different reasons for disturbed sleep. Several tests are available for evaluating a person for sleep apnea. Here is a description of them, courtesy of the National Sleep Foundation.
-Polysomnography is a test that records a variety of body functions during sleep, such as the electrical activity of the brain, eye movement, muscle activity, heart rate, respiratory effort, air flow, and blood oxygen levels. These tests are used both to diagnose sleep apnea and to determine its severity.
-The Multiple Sleep Latency Test (MSLT) measures the speed of falling asleep. In this test, patients are given several opportunities to fall asleep during the course of a day when they would normally be awake. Individuals who fall asleep in less than 5 minutes are likely to require some type of treatment for sleep disorders. The MSLT may be useful to measure the degree of excessive daytime sleepiness and to rule out other types of sleep disorders.
Diagnostic tests are usually performed in a sleep disorders center, but new technology may allow some sleep studies to be conducted in the patient's home.
People who have sleep apnea stop breathing for 10 to 30 seconds at a time while they are sleeping. These stops can happen up to 400 times every night. This can be serious and life threatening. 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, though efforts to breathe continue.
Studies have found that sleep apnea is associated with increased blood pressure, a risk for cardiovascular disease and stroke. If any of these symptoms appear, it is important to address them with your doctor. A number of effective treatment approaches are available.
The main characteristic of sleep apnea is snoring. While snoring is a part of many peoples' every day lives - 45 percent of adults snore at least occasionally, and 25 percent are habitual snorers - many of us don't realize how it occurs. Here are some facts about snoring, courtesy of the American Academy of Otolaryngology - Head and Neck Surgery.
The noisy sounds of snoring occur when there is an obstruction to the free flow of air through the passages at the back of the mouth and nose. This area is the collapsible part of the airway where the tongue and upper throat meet the soft palate and uvula. Snoring occurs when these structures strike each other and vibrate during breathing.
People who snore may suffer from:
- Poor muscle tone in the tongue and throat.
- Excessive bulkiness of throat tissue.
- Long soft palate and/or uvula.
- Obstructed nasal airways.
Snoring affects approximately 44 percent of men and 30 percent of women. While most snoring is normal, there is one kind of snoring that can have serious effects - sleep apnea.
People who have sleep apnea stop breathing for 10 to 30 seconds at a time while they are sleeping.
You have Sleep Apnea Syndrome (SAS) when you stop breathing five or more times in 1 hour while asleep. Or, if you stop breathing 30 or more times during a 6 hour sleep period. But if you have bad SAS, you may stop breathing many more times while asleep.
The following are some common problems you may have with your sleep apnea mask or CPAP device, and some possible solutions, courtesy of the American Academy of Family Physicians:
- The sleep apnea mask feels uncomfortable. Because everyone's face has a different shape, you may need to try different masks to find one that fits you well.
- Your nose feels dry and stuffy. You can try using a humidifier to moisten the air from the CPAP device.
- Your nose feels blocked up. Ask your doctor if you have a nose problem that can be treated with a nasal spray.
- The sleep apnea mask bothers your skin and nose. Because the mask must fit firmly over your nose and cheeks, it may irritate your skin. A different size or kind of mask may help. There are also special skin moisturizers made for CPAP device users.
- The mask leaks air. Some people can't keep their jaw closed while wearing the mask. A chin strap can help hold up your jaw to keep the air in (see the picture below).
- You don't like the pressure. You may find that breathing out against the air pressure keeps you from sleeping deeply. Your doctor may ask you to use a bi-level machine that lowers the air pressure when you breathe out. The same mask may be used with CPAP and bi-level machines.
- You take the mask off during your sleep or don't wear it every night. Most people can't wear the mask all night long, every night, right from the start. Keep trying, even if you can only use the mask for an hour a night at first. Once you solve your comfort problems, you should be able to increase the time you wear the mask.
- You just can't get used to the sleep apnea mask. Some people find that wearing a dental device that pushes their tongue forward helps. You may want to talk with your doctor about whether throat or jaw surgery could help.
The severity of sleep apnea is measured by the number of apneas (cessations of airflow) or hypopneas (reductions in airflow) that cause sleep arousal. The number of these events per hour is commonly called the "apnea-hypopnea index" or the "respiratory disturbance index."
One way to treat people who have sleep apnea is a continuous positive airway pressure (CPAP) device. It is actually a mask with tubes and a fan. The sleep apnea mask uses air pressure to push one's tongue forward and open one's throat. This allows air to pass through the throat. It also reduces snoring.
Talk to your doctor if you think you have sleep apnea. Your doctor may ask you to do a sleep study. During your sleep study, you may try different levels of air pressure with a CPAP device to see which level helps. If you need a CPAP device, your doctor will help you choose one that is right for you.
|Sheri Ann Richerson|