What's All This Buzz About Sleep Apnea... — What's All This Buzz About....

Most of you have probably heard of sleep apnea, or you know someone who is using a CPAP machine because of being diagnosed with apnea. Maybe you are using CPAP yourself. Maybe you have questions about what it all means. Here is what I have learned about sleep apnea.

Definitions: The word apnea means an absence of breathing, usually temporary unless you have died, then it’s permanent apnea. Sleep apnea means that you stop breathing multiple times during sleep and then spontaneously start breathing again without being aware that the apnea is happening. If you have a sleep partner, they may hear you snoring or gasping for air during the night. There are three types of sleep apnea:

1. Obstructive sleep apnea, 2. Central sleep apnea and 3. Mixed apnea. CPAP stands for continuous positive airway pressure. So a CPAP machine creates pressure in your upper airway, your throat, to keep it from closing off while you sleep. Source: Mayoclinic.com

Central apnea is caused by something going wrong in the part of your brain that controls your breathing, called the respiratory control center. This is a less common form of apnea that is more common in men, people with congestive heart failure, someone who has had a stroke or someone on long acting opioids. With this kind of apnea, the brain doesn’t send the signal to your chest muscles that says “BREATHE!!” I remember coming out of anesthesia one time and had no desire to take a breath. The nurse had to tap my shoulder and remind me to breathe! Anesthesia induced temporary apnea!

Obstructive sleep apnea is more common and is associated with multiple risk factors:

Overweight- excess fat around your neck can restrict your breathing, especially at night
Neck circumference- thicker necks can restrict your airway
Narrowed airway- either as a genetic trait or from tonsils and adenoids blocking the airway (more common in children)
Being male- men are 2-3 times more likely to have apnea, risk for women increases after menopause
Older age- incidence increases as we get older
Family history- relatives with apnea might increase your risk
Alcohol, sedative or tranquilizer use- relaxes the muscles in your throat and they are more likely to collapse on themselves and close your airway
Smoking- smokers are three times more likely to have obstructive sleep apnea because of inflammation and fluid retention in the upper airway
Nasal congestion- if you have trouble breathing through your nose for whatever reason, you are more prone to developing obstructive apnea.

According to www.sleepdisordersguide.com, 2-4% of all Americans have undiagnosed sleep apnea. Most people are not aware that they stop breathing during the night unless they have a sleep partner who tells them. There are significant risks to your health if you have sleep apnea and have not been diagnosed or treated. One thing that happens is that your oxygen level drops when you are not breathing and this has a negative effect on your brain. I recently read about the 2019 Nobel Prize in Physiology or Medicine ( William G Kaelin Jr, Sir Peter J. Ratcliffe, Gregg L Semenza - “for their discoveries of how cells sense and adapt to oxygen availability”) being awarded for the discovery of how cells respond to limited levels of oxygen. It involves a factor called HIF-1 alpha (hypoxia-inducible factor) and the end result is to induce inflammation. Lack of oxygen contributes to cognitive impairment and macular degeneration. Which is why it is so important to know if you are not breathing during the night and experiencing hypoxia, or insufficient oxygen levels in your blood!!

Sleep apnea can result in excessive daytime sleepiness, high blood pressure, heart attacks, strokes, atrial fibrillation, and even sudden death due to an irregular heart rhythm.

The standard method of diagnosis is with sleep studies, called nocturnal polysomnography that is done at a sleep lab. It requires spending the night at the sleep lab hooked up to equipment that monitors your breathing, oxygen levels, brain waves and arm and leg movements. There is also the possibility of a home sleep test that is less complicated than the ones at the lab, but not as detailed. It could be a good way to screen for apnea and if positive, then do the sleep lab for more information if your doctor feels it is needed.

Some at home measurements you can do yourself are checking your neck circumference with a measuring tape. Men should be less than 16.5 inches and women less than 15 inches. Another is called the Mallampati scale that is used to assess your airway. (See photo)

This scale shows the amount of airway obstruction due to the position and thickness of your tongue. Anesthesiologists commonly use this scale to evaluate how difficult it might be to intubate you before a surgical procedure. It can also predict whether you are at risk for apnea. Stand in front of a mirror with your head looking forward. Open your mouth and stick out your tongue. Look in your mouth with a flashlight and see if you can see your uvula hanging down from your soft palate. Refer to the pictures for the scale from 1-4. If you are a 3 or 4 on the scale, you are more likely to be at risk for obstructive sleep apnea. Check in with your doctor for recommendations.

Personal experience:

A few years ago I was evaluated for sleep apnea at a sleep lab. I didn’t fit all the criteria but I was having frequent headaches on waking and I thought it would be worth checking for apnea. My Dad had apnea and my sister has apnea. My sleep study showed mild apnea that didn’t require CPAP, but I decided to get a CPAP machine anyway in case it helped my headaches. I used it for about 1 month and did not notice any difference in my headaches, so I put it in the closet. Fast forward 2 years: I have been having a lot of trouble sleeping and my naturopath looked in my mouth and thought I was a 2-3 on the Mallampati scale and suggested that I start using the CPAP machine again. Then before I got the machine out and running, I developed atrial fibrillation. Remember, that is one of the risks of untreated apnea! Yikes! So I have been using my machine again and have been having better quality sleep most nights. It takes a little getting used to having the head gear in place, but once you get used to it, it is fairly comfortable. And definitely better than having a stroke! Or cognitive issues!

One type of mask that rests under your nose- only works if you are a nose breather

If you have any of the symptoms mentioned above, daytime sleepiness, poor sleep, feeling unrefreshed on waking, atrial fibrillation, snoring or if you have a Mallampati score of 2 or higher, I would encourage you to talk to your medical provider and get a sleep study if recommended.