Sleep Apnea

Menstuff® has compiled information and books on the issue of sleep apnea. See also Sleep.

Why Are Sleep Disorders So Popular Suddenly?
What Changes Do You Forsee In The Treatment Of Sleep Disorders?
What Is Sleep Apnea, And How Do You Treat It?
Sleep Apnea Takes Its Toll During The Day
Sleep apnea treatment can help snorers' sex lives
Sleep apnea, diabetes increase stroke risk
Sleep apnea tied to traffic accidents
Sleep apnea mistaken for dementia
There Are Simple And Portable Treatments For Sleep Apnea
Sexual Dysfunction Linked To Sleep Disorder
Sleep Apnea Spouses Have Sleep Disorder, Too
Could Snoring Remedy Help Spouse Sleep?
Should I Exercise Before Sleeping?
Sleep Apnea Ups Heart Disease


Strokes are Twice as Likely for People with Sleep Apnea

People who have the nightly episodes of breathlessness called obstructive sleep apnea are at least twice as likely to suffer strokes or die as steady breathers, a study reports.

The study, which involved more than 1,000 patients, confirms a flurry of smaller studies suggesting that apnea increases a person's stroke risk as much as smoking, high blood pressure and diabetes.

Strokes are the nation's third-leading cause of death and biggest cause of disability, according to the American Heart Association. Each year, about 700,000 people have strokes, and 250 die from them.

Obstructive sleep apnea is common, too; about 12 million Americans have it. It has been linked with obesity, high blood pressure, clogged arteries and heart failure.

Most apnea sufferers don't realize they have the condition, which results from a loss of airway muscle tone during sleep. Slack muscles collapse on themselves, choking off the glow of oxygen to the lungs. When oxygen levels drop low enough, the person wakens and starts breathing again.

People with mild apnea may wake up four or five times an hour. Those with severe apnea make wake once every 30 seconds, often without becoming fully conscious. Each night becomes a cycle of oxygen deprivation; adrenaline-fueled wakefulness to restore normal breathing; an increase in blood pressure from surging adrenaline; and then a return to sleep.

These cycles lead to inflammation and clogging of the arteries.

To test whether these cycles can be linked to strokes, the researchers studied 1,022 patients who were referred to the Yale sleep center with sleep problems. Of those, 697 patients were diagnosed with apnea; the rest served as controls.

Researchers fofollowed the patients for a year and a half. They found that those in the sleep apnea group had 22 strokes and 50 deaths, while those in the control group suffered two strokes and 14 deaths. Patients with the most severe apnea were three times as likely to have a stroke or die as the controls. The risk is probably even higher outside the realm of the study, because study participants were given oxygen masks to wear when they sleep. Yet oxygen didn't eliminate the risk of stroke and death, he says. Most apnea patients are not diagnosed or treated.

A companion report by Canadian researchers yielded gloomy results for heart failure patients with apnea. It showed that oxygen failed to reduce their death rate.

One remedy does work, however. Studies have shown that losing 10% to 20% of a person's body weight can cut the severity of sleep apnea in half.
Source: USA Today

Why Are Sleep Disorders So Popular Suddenly?

It began to come to greater public awareness in the mid-to-late 1970s. It was around that time that people became aware of obstructive sleep apnea.

Like most newly discovered medical diagnoses, it was initially assumed to be very rare. That’s because people were only looking for the most flagrant manifestations of it.

As soon as people realized that it could occur in more moderate and milder forms there came the realization that it was a problem that needed attention. We discovered that as much as three to four percent of the adult population was afflicted just with sleep apnea alone.

The second factor in this new awareness of sleep disorders came in the early 1980s with the invention of nasal CPAP therapy as a relatively innocuous but effective treatment for sleep apnea.

These two things, that is, the recognition that sleep apnea was common, and that it can be treated effectively, opened the door for sleep medicine as a specialty.

Narcolepsy, which is one of the other big sleep disorders, was identified for probably 30 to 40 years, but it was assumed to be uncommon. I think we still believe it to be uncommon.

It is a fascinating disorder, but probably no more than 1 in 2,000 Americans has it. In contrast, you have 4 percent of Americans with obstructive apnea. In terms of total public health impact, obstructive apnea is more important.

What Changes Do You Forsee In The Treatment Of Sleep Disorders?

I think there is hope that the genetic underpinning of Narcolepsy will finally be discovered. I think we are within a couple of years of it.

Quite possibly, we will no longer have to rely on symptomatic stimulant drug therapy for Narcolepsy.

I think there is hope that eventually we will have hypnotic medications to treat insomnia that have no potential for escalation of dose or abuse, or tolerance or dependence.

Whether any of the new hypnotics that are already on the market come close to what we are looking for remains to be seen, but I think there is reason to think that the day will come.

What Is Sleep Apnea, And How Do You Treat It?

Obstructive sleep apnea refers to closure of the upper airway during sleep. When we say the upper airway, we mean above the larynx, above the voice box, occurring repeatedly throughout the night, requiring that the patient repeatedly wake up to reopen the airway and breathe again.

For a period of 10 to 20 seconds, the upper airway is closed, and the floppy tissues at the back of the throat simply fall together, creating an obstruction. This is why we call it “obstructive” sleep apnea.

The patient cannot move any air, so it is essentially as if a cork was put in the top of their throat. They labor against this obstruction for a period of time, typically an average of 10 to 20 seconds, until they become so anoxic, they finally have to wake up.

When they wake up, their increased muscle tone pops that obstruction open. The soft tissues open right back up, and the person gets a few breaths and goes back to sleep. So the definition of obstructive sleep apnea is repetitive upper airway obstruction during sleep. And when I say repetitive, I mean that it can be dozens and frequently hundreds times a night.

What is fascinating, too, is that you would think that if you woke up two or three hundred times in one night, you would remember it. But more often than not, patients do not remember waking, perhaps because each awakening is very brief, something on the order of two or three seconds apiece.

Probably the most common complaint these people have is that they are very sleepy during the daytime. They report falling asleep driving, at stoplights, at work, at church – the list just goes on and on. What usually brings them to treatment is the daytime sleepiness. If they are not bothered by it, their employer, their families, or even the police are certainly bothered by it.

For obstructive sleep apnea, the most common treatment is a nasal CPAP device (Continuous Positive Airway Pressure), which basically is an air compressor that pushes pressurized room air. It’s not like oxygen out of a cylinder, it just takes room air and pushes it down a plastic tube, which terminates in a soft mask that is fitted over the patient’s nose with a strap.

It works because the patient’s soft tissue at the back of their throat is analogous to a wet paper straw. You may remember when we used to have paper straws that if you sucked really hard on it, it collapsed. This is what is happening at the base of the patient’s throat. If you take that same wet paper straw and blow a puff of air into it with your mouth, it opens back up.

The more severe the problem to begin with, the more likely the patient will make a happy adjustment to the treatment.

If the CPAP is difficult for the patient to tolerate or ineffective for any reason, then we use other therapies, including dental devices (akin to a retainer, not braces) at night. The device tugs gently on your jaw, bringing the lower jaw forward. This tends to keep the airway open while you sleep.

There are some surgical approaches to treating sleep apnea, including UPPP (uvulopalatopharyngoplasty) surgery, which involves clipping off the uvula, the little thing that hangs down the back of your throat, or a tonsillectomy if the patient hasn’t had one before. Sometimes this can be done as an office procedure with a laser (Laser-assisted uvulopalatoplasty, LAUP).

Most people with sleep apnea are overweight. So in addition to whatever sort of active interventions are undertaken, weight loss is an important component of the overall treatment plan for obstructive apnea.

Sleep Apnea Takes Its Toll During The Day

Comparing test scores of people who suffer from sleep apnea with the scores of healthy people turned up some disturbing results. An examination of driving accidents and the test scores is even more disturbing.

The test was a simple questionnaire used to measure attention. The average error rate in volunteers without a sleep-related breathing disorder was 4.7. In people with apnea it was 10.7, more than twice as high.

The people with apnea who had had at least two driving accidents in five years had an error rate of 15.3.

Once again, we've got the word that sleep apnea is no laughing matter. The loss of sleep cause by this condition takes its toll on daytime attentiveness and the ability to perform tasks like driving.

Source: International Journal of Thoracic Medicine, Vol. 67 No. 5 2000

Sleep apnea treatment can help snorers' sex lives

Impaired sexual function is a common side effect of sleep apnea, a disorder where the patient's sleep is interrupted by breathing problems caused by collapse of soft tissues at the back of the throat. But treating sleep apnea patients with a mask-like device can improve their sex lives, researchers reported this week at the American College of Chest Physicians' meeting in Chicago, Illinois.

Dr. Janet N. Myers of the National Naval Medical Center in Bethesda, Maryland, and colleagues there and at the Walter Reed Army Medical Center in Washington, DC, treated 30 sleep apnea patients with the device, called CPAP (continuous positive airway pressure). The investigators interviewed patients and asked them to rate aspects of their sex lives, including sexual arousal, sexual behavior, orgasm, and sexual drive/relationship.

At baseline, the sleep apnea patients scored worse than other people in all sexual functioning categories. After 3 months of CPAP, the patients reported significant improvements in orgasm and sexual drive/relationship. Myers and her group conclude that obstructive sleep apnea "may be an unrecognized and potentially reversible cause of sexual dysfunction."

"This is the first study to suggest that treatment of sleep apnea may improve sexual functioning," Myers told Reuters Health.

She speculated that sex problems caused by sleep apnea could be due to "not enough oxygen in the blood" or "hormonal changes that are reversed" with treatment of sleep apnea. But she added that "the reasons are probably more complicated than that and probably include other social and psychological issues."

Sleep apnea, diabetes increase stroke risk

People with chronic sleep apnea are more likely to have diabetes, as well as blockages in the arteries of the neck that may increase their risk of stroke, U.S. researchers report.

Nearly 22 percent of men with sleep apnea, a condition in which breathing is repeatedly interrupted during sleep, displayed evidence of calcified atheromas - a buildup of calcified plaques - in their carotid arteries. In comparison, less than 4 percent of men without sleep apnea had such obstructions, according to the study of more than 100 men published in the May issue of the Journal of Oral and Maxillofacial Surgery.

Because the carotid arteries are the major suppliers of blood to the brain, ruptures in these arterial plaques can produce the clots that cause stroke.

"This serves as a warning that people with sleep apnea - especially those with diabetes - are at very high risk for stroke and must be routinely checked for these artery blockages," said study lead author Dr. Arthur Friedlander of the University of California, Los Angeles (UCLA) School of Dentistry in a statement issued by the U.S. Department of Veterans Affairs.

About 58 percent of the men with both sleep apnea and carotid blockages had diabetes, compared with just 19 percent of men without sleep apnea. Diabetes is a major risk factor for cardiovascular disease and stroke.

Friedlander and colleagues speculate that nighttime oxygen depletion due to sleep apnea, as well as a history of diabetes, may both contribute to the buildup of calcified plaques on artery walls.

Sleep apnea occurs when the soft palate or the base of the tongue collapse at the back of the throat, causing loud snoring, temporary obstruction in nighttime breathing, and daytime sleepiness. The condition, which affects 2 percent to 4 percent of middle-aged men and women, is more common in the obese because fat deposits in the neck place an added burden on the throat. Obesity is also a risk factor for diabetes, and was more commonly seen in those with sleep apnea in the study.

"The data suggest that someone afflicted with both diabetes and sleep apnea is more likely to suffer a stroke in the future," said Friedlander in a statement issued by UCLA. He believes that "persons going to the doctor for a sleep apnea exam should request that their blood be screened for diabetes, especially if they are overweight."

Sleep apnea tied to traffic accidents

Sleep apnea - a common disorder where sleep is disturbed many times a night by interrupted breathing - results in daytime drowsiness and increases the risk of traffic accidents, Spanish researchers report.

Their study results show that people with sleep apnea had a more than a sixfold increased risk for traffic accidents compared with people without the sleep disorder. The report is published in the March 18th issue of The New England Journal of Medicine.

Found in 4 percent of men and 2 percent of women, sleep apnea occurs when the upper airway collapses repeatedly during sleep. It is marked by heavy snoring and an apparent struggle to breathe, resulting in poor quality sleep, daytime drowsiness, and concentration lapses.

Daytime drowsiness links sleep apnea to an increased risk of traffic accidents. The National Commission on Sleep Disorders Research reports that drowsiness may be involved in up to 54 percent of all traffic accidents, including 36 percent of fatal accidents.

In the study, 102 drivers who received emergency treatment for car accidents in Burgos or Santander, Spain, between April and December of 1995 were matched for comparison with 152 traffic accident-free "control" patients. The researchers then conducted tests to determine whether the study participants had sleep apnea.

The investigators found that those who had scores of 10 or higher on a standard scale measuring sleep quality (apnea-hypopnea index) were the most likely to have an accident.

And among participants with a score of 10 or higher, those who had consumed alcohol on the day of the accident had an even greater risk for a traffic accident than people with apnea who had not consumed any alcoholic beverages on the day of the accident, the team reports.

"Patients with sleep apnea ... had a greater probability of having a traffic accident than patients without sleep apnea," writes Dr. J. Teran-Santos of the General Yague Hospital in Burgos, Spain, and colleagues.

In an accompanying editorial, Dr. Paul M. Suratt, of the University of Virginia Medical Center in Charlottesville, and Dr. Larry J. Findley, of the Sleep Disorders Center of Northern Colorado in Loveland, advise doctors to educate patients on the dangers of drowsy driving.

"The message that it is dangerous and irresponsible to drive when one is sleepy should be emphasized in all driver-education courses and publicized by state regulatory agencies," they write.

Because it primarily strikes obese men who sleep on their backs, sleep apnea is typically treated with lifestyle modifications including smoking cessation, weight loss, and avoiding excessive use of alcohol. Men who snore are advised to sleep face down or on their side. Devices to keep airways open while sleeping and surgery are also treatment options.

Sleep apnea mistaken for dementia

Telling your physician you snore can be very important, as seen in the case of a British man whose hallucinations and symptoms of confusion and anxiety were first thought to be caused by dementia. But when the patient's wife told doctors her husband snored heavily, further investigation revealed that these symptoms were due to a relatively common sleep disorder, obstructive sleep apnea, according to a report in The Lancet.

When the 65-year-old patient was first admitted to Kings Mill Hospital in Nottinghamshire, U.K., he was suffering from chronic bronchitis as well as drowsiness, confusion, agitation and hallucinations. A CAT scan showed some atrophy of the brain, and his physicians concluded he was suffering from dementia.

But shortly before he was due to be discharged from the hospital, his wife mentioned that he snored heavily and seemed to stop breathing at times during the night. The patient's breathing during sleep was studied by the hospital's respiratory service, and these investigations showed that his blood oxygen levels fell dramatically while he slept. Such falls in oxygen levels can affect the brain.

When the patient was given oxygen at night, his symptoms cleared up.

"The main features of obstructive sleep apnea are snoring and daytime sleepiness, but its presentation with neuropsychiatric symptoms is well recognized," write Dr. N.J. Ali and colleagues from Kings Mill Hospital.

Obstructive sleep apnea is common, especially among people who are overweight, according to the report.

"Our case illustrates the importance of eliciting a history of snoring and daytime sleepiness in patients presenting with respiratory failure and carbon dioxide retention," the research team concludes.

There Are Simple And Portable Treatments For Sleep Apnea

Obstructive sleep apnea is a serious condition, and requires treatment to allow patients to overcome their symptoms and get a good night's sleep. There are a variety of treatments available to help sleep apnea suffers improve their sleeping habits.

While most obstructive sleep apnea patients are put on continuous positive airway pressure treatment (CPAP), a lot of sufferers don’t like that therapy, which involves using an oxygen tank to propel air into the pharynx to keep it open while they sleep.

Surgery is an alternative, but many people get good results with the use of oral appliances. Response rates with these devices vary from 60 percent to 80 percent for patients with mild to moderate obstructive sleep apnea.

Oral appliances similar to orthodontic retainers offer easier portability, cost effectiveness and are appealing as a first line of treatment in younger patients, according to a report in Emergency Medicine.

The devices, similar in size and appearance to athletic mouth guards, are inserted into the mouth before sleeping, removed upon awakening, and don’t have to be plugged in, making them popular for people who travel.

Oral appliances work to keep air passages open so that breathing isn’t suddenly cut off during sleep. If you’re thinking of using these devices, prefab models are available but it’s best if you have your dentist fit them to your jaw.

Source: Emergency Medicine, October 1999

Sexual Dysfunction Linked To Sleep Disorder

Sleep apnea patients often have sexual dysfunctions that may disappear after undergoing treatment for the sleeping disorder.

I know that snoring can have a negative affect on your sex life, but this study says patients with obstructive sleep apnea score lower than most people in the areas of sexual cognition/fantasy, sexual arousal, sexual behavior, orgasm and sexual drive/relationship.

Sexual functions improved in 30 sleep apnea patients after three months of therapy with continuous positive airway pressure treatment (CPAP), researchers told a recent meeting of the American College of Chest Physicians.

The lead researcher in the study, which was done at the Walter Reed Army Medical Center in Washington, D.C., said that it was not clear what mechanism caused the improvement in sexual function. It might be an increase of oxygen in the bloodstream, or the reversal of hormonal changes. Or, she said, it could involve more complicated social and psychological issues.

CPAP is a high-tech approach to treating sleep apnea. One thing you have to put up with, however, is a big oxygen tank near your bed, which isn’t too sexy to me.

It’s good to know the treatment of sleep apnea can improve sexual dysfunctions, but there is another method of therapy that’s been around for awhile and that people should consider, the use of oral appliances.

The major point from this study is that treatment of apnea, regardless of the method, may be a way of reversing some types of sexual dysfunctions for patients who have the sleep disorder.

Sleep Apnea Spouses Have Sleep Disorder, Too

I’ve often talked about sleep apnea, but have you ever wondered about the sleeping habits of the bedmate of a sleep apnea sufferer?

Investigators at the Mayo Sleep Disorders Clinic did a one night study of 10 married couples and found that the wives of men with apnea don’t get a good night’s sleep, which is to be expected if the partner has a snoring and waking problem.

When the researchers monitored the sleeping couples and gave apnea sufferers nasal continuous positive airway pressure (CPAP) to stop the erratic snoring, they found the spouses’ sleep time increased from 75 percent to 87 percent.

In other words, with their husbands getting some corrective therapy, the wives got an extra hour of sleep a night, according to the study published in Mayo Clinic Proceedings.

This is the first study in which the sleep deprivation of spouses of apnea sufferers was looked at. Add this to the list of reasons it is important for someone with sleep apnea to get appropriate treatment - otherwise, both partners have a sleeping disorder. And how well your partner sleeps can be a critical component of your relationship.

Source: Mayo Clinic Proceedings, October 1999

Could Snoring Remedy Help Spouse Sleep?

Q: I've got a home remedy, not for snoring, but for the spouse who is kept awake. Count the snoring person's snores. Also count the breaths which have no snores. You will be keeping two tallies going and you'll become sleepier with the rhythm of the breathing.

The slight effort of keeping two counts prevents your mind from racing off in other directions. With this system I am pleased if I wake up during the night and find my husband snoring. His snoring helps me go back to sleep faster.

A: This is one of the best lemons-to-lemonade stories. You are the first person we have heard from who actually appreciates a spouse's snoring.

Provided that your husband does not have a serious health problem such as sleep apnea, your approach makes a lot of sense. We have rarely heard of snoring remedies that truly work.

Should I Exercise Before Sleeping?

Exercise plays a beneficial role in promoting deep sleep, both in people who describe themselves as good sleepers and in those who describe themselves as bad sleepers. So, virtually anyone can benefit from it.

The type of exercise is what we would generally recommend for cardiovascular fitness – something like 25 minutes at an 85 percent peak heart rate, at least three times a week.

Timing is critical. If you exercise within a couple of hours before bedtime, you can make your sleep worse. On the other hand, if you complete your exercise four to five hours before bedtime, that’s probably a good time to do it.

I tell my patients to make room for exercise on their calendar. Exercise after work, but before dinner is best.

Alcohol may help people fall asleep, but it also causes middle of the night awakenings.

I recommend a trial period of complete abstinence from alcohol and caffeine for persons with chronic insomnia.

Sleep Apnea Ups Heart Disease

Sleep apnea not only prevents sufferers from getting a good night's sleep, the disorder could put their hearts at risk. A new study shows that middle-aged men who have obstructive sleep apnea are five times more likely than those who don't to develop heart disease. But effective treatment of the disorder may help reduce that risk.

The study results are published in the most recent issue of the American Journal of Respiratory and Critical Care Medicine.

Researchers say their findings show sleep apnea dramatically increases the risk of heart disease independently of other risk factors such as age, weight, blood pressure, and smoking.

People with sleep apnea briefly stop breathing during sleep, causing oxygen levels in their blood to drop, which arouses them. It's usually due to a blockage or obstruction in the nose or mouth and can, but doesn't always, cause snoring. According to researchers, the problem affects about 24% of middle-aged men and 9% of women in the U.S.

Although several recent studies have suggested a link between sleep apnea and heart disease, a direct cause and effect relationship has not yet been proved. But study author Yüksel Peker, MD, PhD, of Sahlgrenska University Hospital in Gothenberg, Sweden, and colleagues say many of those previous studies didn't take other risk factors into account or lacked adequate follow-up.

In their study, researchers compared a group of middle-aged men who had sleep apnea and a similar group who did not, tracking their health from 1991 to 1998. At least one heart-related problem occurred in 22 of the 60 men with sleep apnea, compared with only eight of the 122 healthy men.

The researchers say that having sleep apnea was the biggest predictor of whether or not the men developed heart disease, regardless of other known risk factors.

Those men with sleep apnea who suffered from excessive daytime sleepiness were offered treatment -- either a breathing device that provides continuous air pressure during sleep, surgery, or an oral appliance.

The study found that intervention dramatically reduced the risk of heart disease in men with the condition. Twenty-one out of 37 untreated or incompletely treated cases developed heart disease compared with only one out of the 15 effectively treated cases of sleep apnea.

The study authors say effective treatment of sleep apnea can reduce the extra heart-disease risk associated with the condition and should be considered even in milder cases where daytime sleepiness isn't reported.


Antidepressant May Ease Apnea

Small study is first to show a drug can treat disorder.

Sleep Apnea May Help Cause Heart Failure

Researchers say it's not the other way around.

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Laugh and the world laughs with you; snore and you sleep alone. - Anthony Burgess

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