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. It is called obstructive sleep apnea when associated with collapse of the throat and upper airways. It is called central sleep apnea when there is no effort to breathe.  Both forms of sleep apnea can leads to low oxygen levels, arousals from sleep, insomnia and sleepiness or fatigue during the day.

Who is at risk?
Obstructive sleep apnea:  Adult men are at highest risk for sleep apnea along with women after menopause.  The other major risk factor is obesity, which is a body mass index >30 (BMI Calculator). In children, obesity and enlarged tonsils are the major risk factors. 
Central sleep apnea:  Patients with congestive heart failure and atrial fibrillation.

What are the consequences?
Obstructive sleep apnea:  Daytime sleepiness or fatigue, difficulty at school or work; increased risk of driving accidents; worsened control of diabetes; cardiovascular diseases such as hypertension, heart disease, congestive heart failure and stroke.
Central sleep apnea: Daytime sleepiness or fatigue; decreased physical functioning, increased risk of early death.

What are common symptoms?
Sleep apnea develops slowly and is often missed. It is thought that most people with moderate-to- severe sleep apnea are undiagnosed. See table (below) for the most common symptoms of sleep apnea.  You should tell your physician if you have any of these symptoms.

How is the diagnosis made?
A diagnosis is made with an overnight sleep study (polysomnography) usually in a sleep
laboratory but sometimes at home. During these studies, airflow, oxygen levels, chest and abdominal movements, heart rate are monitored to 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. An apnea-hypopnea index >5/hr is considered abnormal.

How can sleep apnea be prevented?
Prevention of weight gain and obesity can lower the risk of obstructive 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. For patients with congestive heart failure, aggressive medical therapy of their condition is often sufficient to prevent central sleep apnea.

Treatment can improve how patients feel during the day (specifically, the patient feels more rested and less sleepy) and can improve control of conditions such as diabetes and hypertension. Treatment leads to decreased risk of motor vehicle accidents.  For both obstructive and central sleep apnea, the best initial 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, with the patient helping choose which type will work best for them. Other treatments for obstructive sleep apnea include dental appliances to splint the airway open and surgery to widen the upper airway. For central sleep apnea, wearing oxygen during sleep is another possible therapy.

Common Symptoms at Night

Common Symptoms during the Day

  • Snoring: usually loud and bothers other people trying to sleep the person.  Snoring can come and go through the night.
  • Wake up feeling like you have not had enough sleep even after sleeping many hours
  • Gasping or choking sounds
  • Morning headache
  • Breathing pauses observed by someone watching the person sleep.
  • Dry or sore throat in the morning from breathing through your mouth during sleep
  • Sudden or jerky body movements
  • Sleepiness during the day
  • Restless tossing and turning
  • Fatigue or tiredness through the day
  • Frequent awakenings from sleep
  • Problems with poor memory or unable to concentrate

Source: James Rowley, MD, Chair , Assembly on Sleep and Respiratory Neurobiology

Quick 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.

(Source:  SleepApnea.org)