It seems that talk of sleep deprivation and its ill effects is rampant. As Mick Jagger sings, “Lose your dreams and you will lose your mind.” Not to mention your health. For some, the cause of interrupted, poor-quality sleep may be a treatable condition known as Obstructive Sleep Apnea (OSA).
OSA occurs when the soft tissue in the throat collapses into the airway during sleep and interrupts breathing. You may not even realize you have woken up to take a breath multiple times during sleep, failing to achieve that deep, restful sleep we all need.
It is estimated that 25 percent of men and 10 percent of women have OSA. Ladies, we catch up to the men when we reach the peri- and post-menopausal period of life. There is a genetic component to OSA, so you are more likely to have it if you have a close relative who has been diagnosed with OSA. The most common risk factor for OSA in both men and women remains obesity.
OSA is slightly more prevalent in those of Black, Hispanic, Chinese and American Indian descent. It can also affect babies and children, but its incidence increases as we age. Many people go undiagnosed and untreated, to their detriment.
Do you find yourself frequently sleepy in the daytime or falling asleep during mundane tasks such as watching TV or driving a car? Have you been told you snore loudly or have periods of not breathing? Do you wake up gasping or choking? Are you irritable, anxious or have trouble concentrating? Do you wake up with a headache? Has your sleeping partner moved to a different room in the home to sleep? These could be signs that you should be evaluated for OSA.
Why would I want to do that, you ask? Untreated OSA can lead to several preventable health problems including high blood pressure, stroke, enlarged heart, heart attack and heart failure, diabetes and obesity. Sleep apnea occurs in as many as half of those with heart failure or atrial fibrillation.
Evaluation for OSA involves a history and physical exam. Patients tend to be male, overweight or obese and their neck will often measure more than 16 inches in diameter. The mouth may be crowded with a large tongue or tonsils, for example. A nasal obstruction from polyps or a deviated septum could be present. A sleep study at a sleep center can determine if you have OSA, as well as its severity – mild, moderate or severe.
There are many supportive therapies that may improve OSA, but continuous positive airway pressure, or CPAP, remains the mainstay of therapy because of its safety and efficacy. This bedside device delivers airflow through a face and/or nose mask at bedtime to keep the airway open during sleep. Some people may benefit from sleeping on their side or wearing a fitted mouth guard to reposition the jaw and relieve obstruction. Getting regular exercise may improve OSA. Weight loss might ease this condition, but it takes time, so CPAP should be used in the meantime. Avoiding alcohol, sedatives and muscle relaxants near bedtime can improve OSA.
Surgery may be beneficial for those with a tight airway due to excess tissue in the mouth or throat or to alleviate nasal passage obstruction. An implantable device that stimulates the tongue during sleep can maintain an open airway. Your doctor may present one of these as an option if CPAP trial fails.
Most people with OSA adjust to CPAP and discover how good they feel after a night of proper sleep. Talk to your primary care physician about OSA if you recognize any of these groups of symptoms in yourself or in someone you love. You could finally get that great night’s sleep you have been hoping for!
Dr. Julia Whitaker is a critical care specialist and the medical director of the Lutheran Medical Center Sleep Center.
