Causes, Health Affects, and Treatment of Sleep Apnea
Sleep Apnea is involved with the respiratory and central nervous systems. The respiratory system allows a person to breathe in oxygen and excrete carbon dioxide (Deepak 116). After entering the mouth or the nose, oxygen travels into the pharynx, the larynx, and then the trachea. The trachea splits into two branches which then split into smaller tubes called bronchioles. Hair-like projections called cilia cover the bronchioles and protect them from foreign particles. From the bronchioles, air enters tiny air sacs called alveoli, each of which is surrounded by capillaries containing the blood that gathers oxygen to be transported throughout the body and releases carbon dioxide so that it can be exhaled. Contractions of the diaphragm cause the lungs to be inflated and deflated.
According to Janet Fricker, sleep apnea is ?the periodic reduction or cessation of breathing caused by temporary oropharyngeal collapse during sleep?; in other words, it occurs when a person literally stops breathing while asleep (Fricker 122). There are two main processes that produce sleep apnea. The first, known as central sleep apnea, involves the level of brain activity during sleep. The nighttime failure of the part of the brain that controls breathing, located in the brain stem, results in unmonitored oxygen
levels during sleep. When oxygen levels become too low and carbon dioxide levels become too high, stimulation becomes strong enough to temporarily awaken the brain to do its job. The brain triggers a snorting or sucking of air in order to restore the balance of oxygen and carbon dioxide in the body. The episodes recur as the brain returns to its sleep state (Coren 147-48).
The second form of sleep apnea, known as obstructive sleep apnea, is characterized by a severe relaxation of the tongue, throat, and pharynx.(Deepak 116). The severe relaxation of the tongue causes it to cover the opening to the trachea, stopping the flow of oxygen into the lungs. After ten to ninety seconds of an apnea respiratory centers alert the brain of its oxygen-deprived state, causing the repeated sleep/wake cycle of the sufferer (Fricker 122).
Sleep Apnea affects about 4 percent of middle-aged men and 2 percent of middle-aged women (Walling 851). Symptoms of sleep apnea include loud snoring, gasping, and choking. It causes breathing problems that cause a person to cough and gasp as many as several hundred times a night (Pressman 65). Because a build up of fatty tissues in the mouth tends to flow over the opening of the trachea, it is most common in middle aged, overweight males (Coren 148). About sixty percent of sufferers are overweight. However, it is not actual poundage but the thickness of the neck that affects breathing. Men often develop thicker throat tissues and gather more fat in their abdomen, neck, and shoulders than women. Men with a neck circumference of seventeen inches or more and women with that of sixteen inches or more are most likely to have sleep apnea, as well as
those with a double chin or a lot of excess fat around the waist. Sleep apnea will worsen with age as throat tissues become looser and people gain weight.(Barone 81).
(Barone 81). More serious problems can occur, such as drowsiness in the daytime, oxygen scarcity, and respiratory arrest while struggling to breathe during sleep. Because there is less oxygen going to the heart, it has to work harder; adrenaline is released and blood pressure rises rapidly. Repeated bursts of nighttime blood pressure may cause hypertension during the day, leading to increased risk of heart attack, stroke, and heart rhythm disturbances (Barone 82).
Diagnosing sleep apnea has become common only in recent years, since the disorder was not officially defined until 1965. Snoring, daytime fatigue, and a short attention span can be clues for diagnosis. If these symptoms persist for a prolonged period of time it may become necessary to be placed under the care of a pulmonary specialist, or an ear, nose, and throat doctor. Diagnosis is made possible by examinations of the nose, throat, and jaw. It is also helpful for a sufferer?s mate to answer questions about snoring and sleep habits. The best way to make an accurate diagnosis and determine the severity of the disorder is a polysomnography exam, usually involving an overnight stay in a sleep clinic. There specialists are able to monitor blood oxygen levels, heart rate, body temperature, brain waves, and the number of times breathing stops. The sleep apnea rate, or the number of apneatic episodes per hour of sleep, determines the severity of the disorder. Rates of fifteen or fewer indicate only mild sleep apnea,
may not even be considered clinically significant. Rates of fifteen to thirty indicates moderate sleep apnea, and rates of thirty or more disturbances per hour indicate severe sleep apnea (Pressman 204). While effective for determining treatment, polysomnography can cost approximately two thousand dollars, but is usually covered by
insurance. A second option is a home monitoring device, costing about half as much as lab observations but not usually covered by insurance (Barone 84).
Continuous positive airways pressure (CPAP) is the most commonly recommended treatment for sleep apnea. It was first described in 1981 by University of Sydney, Australia researcher Colin Sullivan (Fricker 122). CPAP stops snoring and allows the sufferer to breathe without colapsation of the throat (Stradling 201). It consists of an airflow generator, tubing, and a mask that goes over the nose. Air is supplied at slightly above atmospheric pressure, holding the airways open (Fricker 122). Many patients find CPAP masks to be uncomfortable, but without them would relapse into their pretreatment state within only twenty-four hours (Stradling 201). Studies indicate reductions in daytime drowsiness and general health improvements as a result of CPAP, but have not shown improvements in morbidity, mortality, or quality of life (Walling 851).
Along with CPAP treatment, personal health measures can be taken in order to help reduce the symptoms and risk of sleep apnea. Dr. Richard Millman of the Sleep Disorders Center at Rhode Island Hospital suggests avoiding alcohol and sleeping pills near bedtime because they slow breathing , laying on one side while sleeping, and using
nasal strips while suffering from congestion (Barone 84). Smoking is also a major contributor to sleep apnea because it can swell the throat tissues and worsen the already low oxygen levels that accompany it. Since being overweight is a leading cause of sleep apnea as well as many other health problems, it is a good idea to be as physically fit as possible. Even a ten percent weight loss can affect the number of apneatic episodes that occur each night (Barone 84).
Though CPAP is the most commonly recommended and utilized treatment of sleep apnea, there are other options. Oral devices similar to a retainer can be used to reposition the tongue and jaw. These are effective because moving the jaw forward also pulls the tongue forward, reducing obstruction of the trachea. However, these devices can be expensive and may not be covered by insurance. Surgery is a last resort option. Uvulopalatopharyngoplasty, or UPPP (UP3 ) widens the airway by reducing the size of the uvula, the soft palate, or both. UP3 has only a fifty percent success rate, is very expensive, and involves a painful recovery. Laser-assisted uvulopalatoplasty, or LAUP, utilizes lasers to remove excess throat tissue. It is less expensive and painful than UP3, but it may require several treatments (Barone 84).
Sleep apnea does not have to control a sufferer?s life. It is important to realize that the affects of sleep apnea on a person?s respiratory system can be devastating. Being able to identify the causes, health effects, and treatment of sleep apnea can help to prevent problems before they arise. The constant drowsiness, headaches, and incessantly loud snoring affect work habits, overall health, and even cause problems between married
couples who cannot sleep in the same bed together due to snoring. Because some people may not even realize that they are suffering from obstructive sleep apnea, it is important to be aware of the symptoms and steps necessary to confront the problem. Avoiding smoking, alcohol, and excessive weight gain are valuable factors for prevention, as well as basic principles of good health.
Psychologists study sleep disorders such as sleep apnea in order to understand their effect on sleep as a state of consciousness. Consciousness is defined as a state of awareness. Going to sleep does not mean that a awareness ceases; instead, sleep changes the type of consciousness that is experienced. Sleep is also necessary to maintain a balance of the body?s functions and to allow the body to rest and restore itself. Prolonged periods of sleep deprivation for any reason result in fatigue, irritability, and inefficiency throughout the day. Being able to identify and treat sleep apnea and other sleep disorders provides more restful and fulfilling sleep, allowing for a productive and satisfying lifestyle.