Sleep apnea

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Dr. Tumpati is board certified physician practicing sleep medicine, obesity medicine, aesthetic medicine and internal medicine. Dr. Tumpati’s passion is prevention rather than cure. As a physician with fellowship training in Obesity Medicine, Dr. Tumpati has a unique approach to wellness, weight loss, aesthetics with a focus on prevention rather than cure. Dr. Tumpati believes in educating the public on the true science and art of medicine, nutrition, wellness and beauty.

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Sleep apnea literally mans stopping of breathing during sleep. It can occur when the upper airway becomes blocked repeatedly during sleep, reducing or completely stopping airflow. This is known as obstructive sleep apnea. If the brain does not send the signals needed to breathe, the condition may be called central sleep apnea. Snoring may be more than just an annoying habit – it may be a sign of sleep apnea. Persons with sleep apnea characteristically make periodic gasping or “snorting” noises, during which their sleep is momentarily interrupted. Those with sleep apnea may also experience excessive daytime sleepiness, as their sleep is commonly interrupted and may not feel restorative. The most common type is obstructive sleep apnea. It causes your airway to collapse or become blocked during sleep. Normal breathing starts again with a snort or choking sound. People with sleep apnea often snore loudly. However, not everyone who snores has sleep apnea. In the United States, it is estimated that 22 million Americans suffer from sleep apnea, with 80 percent of the cases of moderate and severe obstructive sleep apnea undiagnosed. Around one in four men over the age of 30 years have some degree of sleep apnoea.

Obstructive sleep apnea

Obstructive sleep apnea

Sleep apnea is characterized by brief interruptions of breathing during sleep. These episodes usually last 10 seconds or more and occur repeatedly throughout the night. People with sleep apnea will partially awaken as they struggle to breathe, but in the morning they will not be aware of the disturbances in their sleep. The most common type of sleep apnea is obstructive sleep apnea (OSA), caused by relaxation of soft tissue in the back of the throat that blocks the passage of air. Central sleep apnea (CSA) is caused by irregularities in the brain’s normal signals to breathe. Most people with sleep apnea will have a combination of both types. The hallmark symptom of the disorder is excessive daytime sleepiness. Additional symptoms of sleep apnea include restless sleep, loud snoring (with periods of silence followed by gasps), falling asleep during the day, morning headaches, trouble concentrating, irritability, forgetfulness, mood or behavior changes, anxiety, and depression. Not everyone who has these symptoms will have sleep apnea, but it is recommended that people who are experiencing even a few of these symptoms visit their doctor for evaluation. Sleep apnea is more likely to occur in men than women, and in people who are overweight or obese.

Risk factors

Sleep apnea is almost twice as common in men as it is in women. Other risk factors include:

  • being overweight, as extra fat tissue around the neck makes it harder to keep the airway open,
  • being over age 40,
  • smoking,
  • having a family history of sleep apnea, and
  • having a nasal obstruction due to a deviated septum, allergies or sinus problem.

Children also get sleep apnea, most commonly between ages 3 and 6. The most common cause is enlarged tonsils and adenoids in the upper airway.

Symptoms of sleep apnoea

People with significant sleep apnoea have an increased risk of motor vehicle accidents and high blood pressure, and may have an increased risk of heart attack and stroke. In the over-30 age group, the disorder is about three times more common in men than women. Some of the associated symptoms include:

  • daytime sleepiness, fatigue and tiredness
  • poor concentration
  • irritability and mood changes
  • impotence and reduced sex drive
  • need to get up to toilet frequently at night.

Causes of sleep apnoea

Obesity is one of the most common causes of sleep apnoea. Other contributing factors include:

  • alcohol, especially in the evening – this relaxes the throat muscles and hampers the brain’s reaction to sleep disordered breathing
  • certain illnesses, such as reduced thyroid production or the presence of a very large goitre
  • large tonsils, especially in children
  • medications, such as sleeping tablets and sedatives
  • nasal congestion and obstruction
  • facial bone shape and the size of muscles, such as an undershot jaw.

Diagnosis

Doctors diagnose sleep apnea based on medical and family histories, a physical exam, and sleep study results. When your sleep is interrupted throughout the night, you can be drowsy during the day. People with sleep apnea are at higher risk for car crashes, work-related accidents, and other medical problems. The apnea hypopnea index (AHI) is equal to the average number of episodes of apnea and hypopnea per hour.

Severity of sleep apnea

The severity of sleep apnoea depends on how often the breathing is interrupted. As a guide:

  • normal sleep – fewer than five interruptions per hour
  • mild sleep apnoea – between 5 and 15 interruptions per hour
  • moderate sleep apnoea – between 15 and 30 interruptions per hour
  • severe sleep apnoea – more than 30 interruptions per hour.

Sleep study

The AHI and/or RDI may be measured by polysomnography (PSG) or sleep study in a facility-based sleep study laboratory, or by a Type II home sleep test (HST) monitor, a Type III HST monitor, or a Type IV HST monitor measuring at least 3 channels. The respiratory disturbance index (RDI) is equal to the average number of respiratory disturbances per hour. Apnea is defined as a cessation of airflow for at least 10 seconds. Hypopnea is defined as an abnormal respiratory event lasting at least 10 seconds with at least a 30% reduction in thoracoabdominal movement or airflow as compared to baseline, and with at least a 4% oxygen desaturation.

Treatment

There are a variety of treatments for sleep apnea, depending on an individual’s medical history and the severity of the disorder. Most treatment regimens begin with lifestyle changes, such as avoiding alcohol and medications that relax the central nervous system (for example, sedatives and muscle relaxants), losing weight, and quitting smoking. Some people are helped by special pillows or devices that keep them from sleeping on their backs, or oral appliances to keep the airway open during sleep. If these conservative methods are inadequate, doctors often recommend continuous positive airway pressure (CPAP), in which a face mask is attached to a tube and a machine that blows pressurized air into the mask and through the airway to keep it open. Also available are machines that offer variable positive airway pressure (VPAP) and automatic positive airway pressure (APAP). There are also surgical procedures that can be used to remove tissue and widen the airway. The U.S. Food and Drug Administration has approved a surgically implantable device placed in the upper chest that monitors a person's respiratory signals during sleep and stimulates a nerve to send signals to a muscle to stimulate and restore normal breathing. Some individuals may need a combination of therapies to successfully treat their sleep apnea.

CPAP Therapy

Continuous Positive Airway Pressure (CPAP) is a non-invasive technique for providing single levels of air pressure from a flow generator, via a nose mask, through the nares. The purpose is to prevent the collapse of the oropharyngeal walls and the obstruction of airflow during sleep, which occurs in obstructive sleep apnea (OSA).

Dental device for sleep apnea

If you have mild to moderate sleep apnoea, another possible treatment is the use of a specially made mouthguard (or oral appliance or mandibular advancement splint). Mouthguards work by holding your jaw forward during sleep.

Surgery for sleep apnea

Although not always effective, surgery to the palate and base of tongue may be useful when other therapies fail. These types of surgeries are best undertaken by otolaryngologists (ear, nose and throat surgeons) who take a special interest and have had training in sleep-related surgery.

prognosis

Untreated, sleep apnea can be life threatening. Excessive daytime sleepiness can cause people to fall asleep at inappropriate times, such as while driving. Sleep apnea also appears to put individuals at risk for stroke and transient ischemic attacks (TIAs, also known as “mini-strokes”), and is associated with coronary heart disease, heart failure, irregular heartbeat, heart attack, and high blood pressure. Although there is no cure for sleep apnea, recent studies show that successful treatment can reduce the risk of heart and blood pressure problems.


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