Apnea (Sleep Apnea)

Central Alveolar Hypoventilation Syndrome

Central Sleep Apnea Syndrome

Obstructive Sleep Apnea Syndrome (OSA)

Upper Airway Resistance Syndrome

Obstructive Sleep Apnea Syndrome (OSA)

Jay, is a 50 years old gentleman who came to see me at the sleep clinic because his wife made him “go see a doctor.” She is worried about snoring at night which is like the “sound of train” and he stops breathing and makes gasping sounds. She is afraid he might stop breathing for good, so she gives him a little kick on his back, he breathes again, only to have another apneic episode.  He tosses and turns all night long and sweats a lot during sleep.

He is less concerned about any of this. He thinks everything is fine, but when I probed him, he admitted that he feels exhausted especially in the afternoon. When he comes home from work, has has dinner with his family and then, he sits in his armchair to watch TV but falls asleep and starts snoring. On weekend, he is too tired to do much of anything with his family and kids. His primary care doctor recently told him that he has hypertension and early diabetes.  He is overweight and feels hungry all the time.

Jay has obstructive sleep apnea syndrome (OSA). He shows many of its signs and symptoms: Snoring, witnessed apneas, daytime fatigue, sleepiness, exhaustion, low motivation, hungry and overeating. Hypertension and diabetes can result from untreated OSAS. The 1993 Wisconsin Sleep Cohort Study estimated that 1 in every 15 Americans might have sleep apnea and that in the middle aged population, 9% of women and 24% of men were actually affected.

How do you diagnose obstructive sleep apnea?  It is diagnosed with a sleep study known as polysomnogram which is performed overnight at the sleep laboratory. During this study, we check the number of times you stop breathing (apneas) or have shallow breathing (hypopneas), snoring, any drop in  blood oxygen level (hypoxia) and how all this OSA affects your sleep quality (awakenings, reduced deep sleep, light sleep). The doctor reading your study talks in terms of AHI (apnea-hypopnea index) or RDI (respiratory distress index). They are the average number of apneas/hypopneas/other respiratory events per hour of sleep. Numbers below 5 is considered normal, 5 to less than 15 is mild, 15 to less than 30 is moderate and more than 30 is severe OSA.

What causes obstructive sleep apnea (OSA)? It happens when the throat and tongue muscle tone decrease (relax) so they block the airway (completely or partially). If there is extra soft tissue or fat around the throat it makes it worse. In some people, a small and receded jaw falls way back during sleep and that increases their chance for OSA. In children, the most common cause for OSA is large tonsils and adenoids. This is not a major cause in adults.

What increases the risk of having obstructive sleep apnea (OSA)?

  • OSA can occur in any individual, at any age and in both men and women.  Age is a risk factor. Men are at higher risk than women but menopausal women catch up with men.
  • OSA risks increase with obesity, diabetes and smoking.
  •  OSA is increased with physical features such as a body mass index (BMI) > 30, large neck circumference (> 17 inches men, > 16 inches women) and short and fat neck. Even though obesity is a big risk factor, genetic factors play a role.  That is why thin people can also get sleep apnea and can occur in family members.
  • Children with big tonsils or individuals with craniofacial abnormalities (small and receded jaw, known as micrognathia and retrognathia; large tongue) are also at risk.

Why do you want to treat obstructive sleep apnea (OSA)? Sleep apnea is a detriment to any person’s health because it causes an increased risk for so many serious illnesses over time. Many studies show that treatment can improve (decrease) these risks when you treat the OSA:

  • Hypertension (elevated blood pressure)
  • Diabetes, type II
  • Strokes
  • Heart disease including heart attacks and atrial fibrillation (irregular heart beat).
  • Excessive daytime sleepiness and increased risks for accidents (cars, trucks).
  • Headaches, especially morning ones. It can also make existing headaches or migraines worse.
  • Depression and anxiety
  • Sexual dysfunction.
  • Sudden death in special cases

Treatment options for OSA:

  1. CPAP therapy is one popular and effective treatment option. CPAP is an abbreviation for Continuous Positive Airway Pressure. The individual wears a small mask connected to a plastic tube that is connected to the CPAP machine. The machine takes room air and pumps it through a tube at high pressurized air which travels into the nose and throat and keeps from collapsing.  Another option is the Bilevel (2 levels) machine which delivers a higher pressure on inhalation and a lower pressure on exhalation.
  2.  The oral appliance therapy is also effective if CPAP is not tolerated.  It is indicated for those with just snoring, mild and moderate OSA. It is a mouthpiece made by a dentist and allows the lower jaw to move forward.
  3.  Weight loss if you are overweight can reduce or perhaps eliminate the OSA.
  4.  Surgical procedures are also effective in specific populations. In children, removal of tonsils and adenoids through a surgical procedure called tonsillectomy can eliminate the sleep apnea. Surgical options for adults are available but not every patient is a candidate.
  5.  Positional therapy is one treatment option for those whose sleep study shows that their OSA occurs mainly on their back (supine position). This therapy involves having the patient in the lateral or side position. You can accomplish this through a pillow (Sona pillow) or anti-snore shirt. You check them on-line. Sometimes, if you sew a tennis ball on the back of your shirt, it can keep you from sleeping on your back. Some patients might find benefit from sleeping at an elevation in a recliner; that is ok if you are taking an afternoon nap and your apnea is not very severe, but it cannot be the main treatment.
  6.  Avoid alcohol and sleeping pills if your OSA is not treated because it makes you throat more relaxed. If you are using CPAP and you have some insomnia, a sleeping pill is fine to help you sleep better and perhaps get adjusted to CPAP.  Alcohol can make your apnea worse. You can enjoy a glass or two of wine on weekends within 3 hours of bedtime.

Our friend Jay underwent sleep study which documented that he has severe OSA and that his blood oxygen dropped frequently throughout the night. We initiated CPAP therapy following a CPAP titration study. Jay has never felt any better. He sleeps soundly. His wife sleeps better too. He wake up refreshed and is more energetic during the day. Instead of falling asleep after dinner, he takes walks and reads with his family. He started losing weight through more exercise and motivation to eat healthier. His family is a happier family. Jay is on his way to reduce his risk for future heart disease, stroke, car accident and depression.

STOP-Bang Sleep Apnea Questionnaire

Use this screening tool to test your risk for OSA.Answer yes or no to each of these questions:

  1. Do you snore loudly (louder than talking or loud enough to be heard through closed doors)?
  2. Do you often feel tired, fatigued, or sleepy during daytime?
  3. Has anyone observed you stop breathing during your sleep?
  4. Do you have or are you being treated for high blood pressure?
  5. BMI more than 35?
  6. Age over 50 years old?
  7. Neck circumference > 15.75 inches?
  8. Gender: Are you male?

If you answered YES to more than 3 answers: You have a High-risk for OSA
If you answered YES to less than 3 answers: You have a Low-risk for OSA

The more times you answered “yes”, the more severe the OSA. If you scored for a high risk for OSA, please talk to your doctor to get properly evaluated, diagnosed and treated. Don’t take a chance on your health.

To check your BMI, go to google and put BMI for woman/man and it will calculate it for you (provide your weight and height).

To check your neck circumference, use a measuring tape around your neck.