Adult Sleep Disorders
What is sleep apnea?
During normal sleep, our airway muscles remain open permitting air to flow properly. However, with sleep apnea, the airway muscles can relax and become totally blocked resulting in diminished air flow or complete obstruction. This repetitive process is described as sleep apnea.
While many people have signs of snoring, not all snoring is related to sleep apnea. On the other hand, if snoring is associated with certain symptoms, such as sleepiness or non refreshing sleep, this may be an indication of sleep apnea which requires further evaluation.
Common symptoms associated with sleep apnea include restless sleep, awaking with a choking, gasping, smothering, or snorting sensation, morning headaches, dry mouth, frequent need to urinate during the night, sweating during sleep, waking up unrefreshed, daytime sleepiness, and memory impairment.
Who gets sleep apnea?
Risk factors for sleep apnea include:
- increasing age
- male sex
- sedating medications or alcohol
- abnormal upper airway or jaw shape.
- Neck Size?
- Men with neck sizes of 17”, or greater have a higher risk of sleep apnea.
- Women with neck sizes of 16”, or greater have a higher risk of sleep apnea.
- Patients with poorly treated high blood pressure requiring at least two or three medications are at higher risk for sleep apnea.
- Patients with cardiac rhythm problems, such as atrial fibrillation in particular, are at increased risk of having sleep apnea.
- If a bed partner specifically identifies pauses in breathing, this is a very sensitive indicator of having this disease.
How Do I Know if I have Sleep apnea?
The best way to identify this particular disease is by performing an overnight sleep test called a polysomnogram. The test is performed in a comfortable hotel-like atmosphere with highly trained technicians that monitor breathing, brain, leg movements, and heart parameters throughout the night. It is a painless test and can provide invaluable information on how to proceed with further treatment. In some cases, a home sleep study can be arranged as well. It is advisable to have a board certified sleep physician review these results for the most accurate interpretation.
Treatment – CPAP and More
If one is diagnosed with obstructive sleep apnea, the severity of the disease can dictate the potential treatment options.
CPAP, BiPAP, VPAP – Most people are familiar with CPAP, a device that produces air pressure using a soft and pliable nasal mask placed over the nose which provides mild pressure support to prevent the throat from collapsing throughout the night. While it may take several weeks or months to get used to this particular treatment, it can be particularly rewarding as it can improve sleep and reduce multiple risk factors discussed above.
Alternatives to CPAP? Your sleep physician may also discuss alternative treatments.
- Dental Treatments – With mild or moderate sleep apnea, an oral appliance which is a modified dental guard may be suggested. This is usually a custom designed dental guard that helps maintain an open airway throughout the night and is generally well accepted. It does require at least 10 native teeth.
- Nasal Valves – Newer alternative treatments for sleep apnea continue to develop including a novel nasal device called “Provent. “ Board certified sleep physicians are well versed on this newer form of therapy.
- Surgery – On occasion, surgical treatment may be an alternative form of therapy or as additional therapy to help remove excess tissue in either the nasal area or the throat area which may improve airway movement. The success rate with surgery is roughly about 50% and sometimes is used in combination with other forms of treatment.
- Weight loss – Other forms of treatment for sleep apnea include weight loss. Weight loss can reduce the severity of sleep apnea and in some cases of mild sleep apnea can actually eliminate the disease. But one cannot assume that weight loss alone will cure the problem without retesting after weight loss has been achieved. Avoidance of alcohol and sedating medication can also decrease the severity of sleep apnea. Sometimes avoidance of sleeping on your back can reduce the severity of sleep apnea. Unfortunately this is difficult to achieve throughout the entire night on a consistent basis.
A board certified sleep physician is the best resource to determine which optimal treatment you should pursue. It is important to find an acceptable form of therapy. Consider sleep apnea as a chronic illness that requires control. No real cure currently exists. Just as in conditions such as high blood pressure or diabetes mellitus, it requires regular follow-up and treatment to help reduce complications and improve symptoms.
What is Insomnia?
It is a sleep disorder that results in a difficulty to fall and/or stay asleep. People with insomnia have one or more of the following symptoms:
- Difficulty falling asleep
- Waking up often during the night and having trouble going back to sleep
- Waking up too early in the morning
- Tired upon waking
Causes of insomnia include:
- Significant life stressors such as a death in the family, moving or job loss
- Emotional or physical (pain) discomfort
- Environmental factors such as light, noise and extreme temperatures (hot or cold) that interfere with sleep
- Some medications (for example those used to treat colds, allergies, depression, high blood pressure and asthma) may interfere with sleep
- Changes in normal sleep schedule such as jet lag or shift work (switching from a day to night shift)
- Depression and/or anxiety
- Chronic stress
How Is Insomnia Treated?
Mild Insomnia can be cured by following good sleep habits (See healthy sleep section). Acute insomnia may not require treatment. Moderate to severe Insomnia requires following good sleep habits and treatment of any underlying medical conditions. Additional treatment may include the use of sleep aids and behavioral modification techniques. Sleep aids should only be prescribed by your doctor. Over the counter sleep aids may have undesirable side effects. Behavioral techniques include relaxation exercise, sleep restriction therapy, and reconditioning.