By Vivien C. Abad
Sleep apnea is a disorder characterized by interrupted breathing during sleep. Individuals with sleep apnea often snore loudly at night, followed by pauses in breathing that last 20 to 30 seconds and end with a gasp or sigh. They may also experience a choking sensation or shortness of breath. Sleep apnea can even result in sudden death from cardiovascular complications.
Sleep apnea occurs in people of all ages. It also affects all ethnicities, but is more common in African-Americans, Mexican-Americans and Pacific Islanders.
Individuals with sleep apnea do not get adequate sleep and, as a result, do not awaken feeling refreshed. The most common complaint is daytime sleepiness, which increases the risk of accidents. Other common symptoms are sweating in the neck and chest areas, frequent urination at night, tossing and turning in bed and dryness of the mouth upon awakening.
Almost half of sleep apnea patients have headaches in the morning. Attention, concentration, memory, judgment and performance in tasks requiring dexterity are often impaired. Irritability and personality changes are also common.
Children with sleep apnea may exhibit rebellious and aggressive behavior, chronic shyness or social withdrawal. Other symptoms among children include sleepwalking, night terrors and nocturnal bedwetting in addition to learning problems, attention deficit disorder, hyperactivity and emotional problems.
Certain medical conditions may be triggered or worsened by sleep apnea, including arrhythmia (irregular heart rhythm), congestive heart failure, heart attack, stroke, diabetes and hypertension (high blood pressure). In fact, 30 percent of hypertensive patients have sleep apnea, and 50 percent of sleep apnea patients are hypertensive.
Obesity increases the risk for developing sleep apnea, and sleep apnea also makes losing weight more difficult. Untreated sleep apnea increases the levels of ghrelin, a hunger-inducing hormone, promoting overeating.
Sleep apnea occurs when the upper airway behind the soft palate, behind the tongue or a combination of both narrows. If a physician suspects his or her patient has sleep apnea, the diagnosis is confirmed through an overnight sleep study during which the patient’s sleep stages are monitored. This study is usually performed in a sleep laboratory, or occasionally at the patient’s home.
Lifestyle changes can help, including weight loss, avoiding lying on the back (sleeping on the side is preferred), avoiding alcohol consumption within three to four hours of bedtime and scheduling plenty of time for sleep. A continuous positive airway pressure device is the most effective, specific form of treatment. This device has a mask, tubes and a fan that use air pressure to push your tongue forward and open your throat, allowing air to pass through. The device reduces snoring and prevents sleep apnea-related disturbances.
Sleep apnea is a common condition but can have significant health consequences. As such, it needs to be recognized, diagnosed and treated.
The Palo Alto Medical Foundation and column editor Arian Dasmalchi provide this monthly column.
Dr. Vivien C. Abad is the medical director of the Clinical Monitoring Sleep Disorders Center of Camino Medical Group, a division of the Palo Alto Medical Foundation, in Cupertino.
