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Sleep apnea can have fatal consequences


Although the woman in her 50s was treated effectively for depression, she remained plagued by symptoms that often accompany it: fatigue, drowsiness and lethargy, even though she thought she was getting enough sleep.

With depression no longer causing her persistent symptoms, her psychiatrist advised her to see a sleep specialist.

Sure enough, one night in the sleep lab at the University of Pennsylvania’s Perelman School of Medicine found that while the woman was supposed to be sleeping, she experienced micro-awakenings about 18 times per hour, resulting in sleep that restored neither the body nor the brain. All night long she would stop breathing for over 10 seconds at a time, followed by mini arousal and snoring as she gasped to increase the level of depleted oxygen in her blood.

Diagnosis: Obstructive sleep apnea, an increasingly common but often overlooked or untreated disease that can lead to poor quality of life, risk of developing heart disease, stroke, diabetes and even cancer, and perhaps most important of all, a three times higher risk of often fatal road accidents.

Obstructive sleep apnea affects about 9% of women and 24% of men, most of them middle age or older, but up to 9 in 10 adults with this treatable condition go undiagnosed, according to the American Academy of Sleep Medicine.

The disease is on the increase because the most common cause is obesity, which continues to rise steadily among American adults. Sleep apnea affects more than two in five people with a body mass index over 30, and three in five adults with metabolic syndrome, wrote Dr Sigrid C. Veasey and Dr Ilene M. Rosen in the New England Journal of Medicine. in April.

Although sleep apnea sometimes affects thin people who may, for example, have a small jaw or a large tongue, in overweight people, excess fatty tissue in the tongue and throat can block the airways when the throat muscles relax during sleep. This is more likely to happen when people sleep on their backs.

Losing weight helps but doesn’t always correct the problem. Dr. Rosen told me about a man in his forties who had been treated for congestive heart failure and had lost 40 pounds. Still, he remained tired the entire time, and his wife said he snored so loudly that she had to wear earplugs at night. Then she read an article about sleep apnea in a magazine and insisted he go to the sleep lab, where a nighttime study showed his breathing was disturbed 45 times per hour, causing his rate to drop. oxygen in the blood at night to 65% of normal.

This man’s story prompted me to ask Dr. Veasey, “What about those of us who don’t have a bed partner?” How do we know if we have obstructive sleep apnea? “

She replied, “There is a constellation of symptoms, starting with non-restful sleep no matter how long you sleep. Even if you try to get more sleep on the weekends, you still wake up restless. Fractured sleep feels like you’ve been awake all night.

Then she added a list of other clues. Perhaps the most telling: you are sleepy during the day, especially when you are sedentary. Be careful if you fall asleep within 10 minutes in front of a movie, play or concert, or while watching TV. You get up four or more times a night to urinate (men, it might not be your prostate!). You wake up in the morning with a very dry mouth or a headache. You are moody, irritable, and have difficulty concentrating. Your reaction time and speed of completing tasks slows down like you’re five years older than you actually are.

Those with even a few of these symptoms would be wise to bring them to the attention of their doctor, Dr Veasey said.

And if you’d rather not base your suspicions on symptoms alone, you can invite a close friend to share a room with you for a night or two and ask them in the morning if they’ve heard or been woken up by your friends. snoring and noticed if your inhaling noisy air followed apparently prolonged respiratory arrest. Snoring doesn’t have to be loud to be a symptom of sleep apnea, but it is likely to be irregular and interspersed with calm pauses.

Correct diagnosis can be a problem for the millions of Americans who do not have easy access to a sleep laboratory, often located in large medical centers, or who do not have insurance coverage for a sleep study. necessary.

There is also the option of a home test, which costs between a third and a half less than a sleep laboratory study. It uses an electrodeless device that records breathing effort, air flow, and blood oxygen levels while sleeping.

Sleep apnea can be treated effectively with a nighttime machine called CPAP, for Continuous Positive Airway Pressure, a machine that provides constant positive pressure as the sleeper inhales and exhales. He uses a mask that must be properly applied to form a tight seal around the nose and mouth.

[Read more: A Guide to Sleep Apnea]

Unfortunately, many of those who could benefit from CPAP do not use it consistently, if at all. Many find the device bulky. Still, about a third of regular users say it has completely transformed their lives and no longer want to go anywhere without it because they feel so much better with it, Dr Veasey said. One of his patients even bought a generator so he could use it while on vacation in the Amazon.

Dr Rosen’s patient also received a CPAP machine, which improved not only his own life, but also that of his wife, who was now able to get a full night’s sleep without being interrupted by hoarse snoring.

Another treatment option is a hypoglossal nerve stimulator which is surgically implanted to advance the tongue and keep the airways open during sleep. While this doesn’t completely reverse apnea, Dr Veasey said it improves the condition enough to make patients feel much better. However, insurance coverage can be a problem for some people.

Other options include a splint placed in the mouth to push the lower jaw forward and the use of obstacles, such as tennis balls inserted into the back of pajamas, to discourage patients from sleeping on their backs.

For those in need, weight loss is important even if a device like CPAP is used. More than half of overweight people with mild sleep apnea improve with a loss of just 22 pounds, the doctors wrote. But they cautioned against using substances like alcohol, benzodiazepines, and opioids that can make apnea worse.


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