Sleep Disorders

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General Information about Sleep Disorders


What is sleep apnea?
Sleep apnea is the lack of adequate breathing during sleep, most often due to collapse of the throat and upper airways. This leads to low oxygen levels, arousals from sleep and frequently sleepiness during the day. Sleep apnea can lead to early onset heart disease and to stroke as well as high blood pressure, and poor diabetes control. Problems with depression, memory, and functioning well at work or school are commonly reported.  Accident rates rise five-to-seven fold for people with moderate to severe sleep apnea.

Who is at risk?
Adult men are at highest risk for sleep apnea. To a lesser extent women and children are also at risk. It is conservatively thought that at least 4% of men, 2% of women and 2% of children in the USA have significant sleep apnea. With growing girth and obesity in the world's population, sleep apnea may become a problem for the majority of people during the next 20 years.

Sleep apnea develops slowly and is often missed. It is thought that most people with moderate-to- severe sleep apnea are undiagnosed. Unfortunately, there is no perfect way to diagnose sleep apnea before getting an all night sleep study; however there are several findings that should focus attention on this problem. Snoring, daytime sleepiness or fatigue, a story of stopping breathing at night and high blood pressure can target people at risk. Further assessment of age (greater than 50), neck circumference (greater than 40 cm), male gender, and a body mass index (BMI) above 35 can be used to pinpoint people at highest risk.

A diagnosis is made with an overnight sleep study (polysomnography) usually in a sleep

laboratory but sometimes at home. Monitoring of airflow, oxygen levels, chest and abdominal movements, heart rate and sleep staging can determine how many times a person stops breathing (apnea) or has partial reduction in breathing (hypopnea) at night. An apnea-hypopnea index is used to look at how severe the problem is for each person, with stopping breathing over 5 times an hour considered abnormal.

How can sleep apnea be prevented?
Prevention of weight gain and obesity can lower the risk of sleep apnea. Weight loss can reduce the severity of sleep apnea. Identifying and treating nasal obstruction can help some people with this condition. Stopping smoking, and avoiding alcohol and sedative medications can lessen the severity of the problem.

Treatment can improve how patients feel during the day and can improve control of disease. It can sometimes improve thinking/cognitive function, mood and severity of conditions such as diabetes and hypertension. Treatment leads to lessening of risk for drowsy driving.

Treatments work by increasing the size of the upper airway. The best treatment for most people is continuous positive airway pressure (CPAP). This is a machine that delivers air under pressure to the upper airway by a nose or face mask, keeping the airway open during sleep.  There are many mask types, covering nose or nose and mouth, and most people can use these machines when fitted. The sleep study provides information about whether the masks fit and what pressure needs to be used.  Other treatments include surgery to widen the upper airway or dental appliances to splint the airway open when muscles relax during sleep.

Source: Carolyn Welsh, MD, Chair, ATS Council of Chapter Representatives
Four Facts About Sleep Apnea
  1.  At least 18 million Americans suffer from obstructive sleep apnea (OSA).  Of these, at least 75% are undiagnosed. 
  2. Although obesity, age, and male gender are among the risk factors for OSA, this common disorder affects many women, children, and people of all sizes.  In women, OSA is often misdiagnosed as depression.  In children, it can lead to hyperactivity.
  3. Sleep-apnea related car crashes caused 1,400 deaths in the year 2000 alone.  Not everyone with untreated sleep apnea falls asleep in the daytime, but people with OSA are six times more likely to have a crash and seven times more likely to have multiple accidents.  Most importantly, accident risks return to normal when individuals are diagnosed and treated for OSA.
  4. Treatment changes people’s lives.  Even for people whose OSA is not severe, the better quality sleep that available treatments provide can help improve other health conditions that people with OSA tend to have.  These associated conditions include diabetes, obesity, anxiety and depression, sexual dysfunction, and high blood pressure.