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Snooze or lose: obstructive sleep apnea 101

With all of the distractions in our day-to-day environments, it’s no surprise we often have trouble sleeping when nighttime comes and our heads hit the pillow. However, if you’re consistently waking up exhausted, it could be a sign of an underlying problem like changes in your breathing during sleep that can cause long-term health consequences. 

Tryon Medical Partners sleep medicine specialist Dr. Jacob Coleman weighs in on one of the sleep disruptors that may affect long-term health quite negatively: obstructive sleep apnea. Dr. Coleman shares some key information around what sleep apnea is, common signs of sleep apnea, as well as opportunities for diagnosis and treatment to give your heart and blood vessels the rest they deserve.

What is sleep apnea?

Dr. Coleman describes sleep apnea as a condition in which parts of the upper airway relax during sleep, causing the airway to narrow or close and impact other bodily processes, namely increased blood pressure. High blood pressure, in turn, can cause even more complications, such as increased risk for cardiovascular disease, like heart attacks, arrhythmia, and stroke. 

“Obstructive sleep apnea is a potentially serious sleep disorder in which the blood pressure may spike as high as 200-300 throughout the night, high above the average of 130,” Dr. Coleman explains. “While snoring may be a sign of airway narrowing and sleep may be disrupted by abnormal breathing, snoring alone does not predict sleep apnea, and many patients with sleep disordered breathing may have increased cardiovascular risk without associated excessive daytime sleepiness.”

What causes sleep apnea?

It’s important to note that sleep apnea can affect anyone, children included, but there are certain factors that increase your risk.

  • Weight. Obesity greatly increases the risk of obstructive sleep apnea. Fat deposits in the tongue and around/within the upper airway can obstruct breathing.
  • Neck circumference and/or a narrowed airway. People with thicker necks might have more airway narrowing.
  • Airway anatomy. Some may have inherited a narrow throat or large tongues. Tonsils or adenoids also can be enlarged and block the airway, particularly in children. However, adults may benefit from removal only in more extreme cases of tonsillar enlargement.
  • Male gender. Men are much more likely to have obstructive sleep apnea than women are. However, post-menopausal women and those who are overweight are at increased risk. 
  • Older age. Sleep apnea occurs significantly more often in older adults.
  • Family history. Having a family history of sleep apnea could increase your risk of developing it. 
  • Use of substances (alcohol, sedatives, or tranquilizers). These substances relax the muscles in your airway, which can contribute to sleep apnea.
  • Smoking. Smoking can increase the amount of inflammation and fluid retention in the upper airway.
  • Nasal congestion. Whether it’s caused by an anatomical problem or allergies — difficulty breathing through the nose may marginally contribute to sleep apnea.
  • Medical conditions. Congestive heart failure, high blood pressure, arrhythmia (ex. atrial fibrillation), and type 2 diabetes are some of the medical conditions that are often seen in cases of obstructive sleep apnea. 

“Many medical conditions are highly associated with sleep apnea,” Dr. Coleman cautions. “Folks that have untreated sleep apnea have a higher prevalence of stroke, heart disease, high blood pressure, abnormal heart rhythm, type 2 diabetes, and a number of other disorders. After development of a stroke and heart disease, patients often have worsening or more complex sleep apnea because of the interplay of the disease mechanics and sleep disordered breathing.” 

What are sleep apnea symptoms?

Although sleep apnea can occur without symptoms, it often presents with some warning signs. Dr. Coleman encourages his patients to look out for: 

  • Loud snoring
  • Breaks in breathing during sleep that might be noticed by someone with whom you sleep
  • Gasping for air during sleep
  • More frequent urination at night without hydration before bed
  • Morning headaches
  • More frequent arousals from sleep
  • Daytime sleepiness (hypersomnia)
  • GI reflux that occurs more overnight

“If you notice any of these symptoms, it is reasonable to discuss with your doctor,” Dr. Coleman emphasizes. “Sleep apnea can be difficult to identify but can have massive impacts if it goes untreated.”

How is sleep apnea diagnosed?

Primary care doctors often start with a screening questionnaire called the STOP-Bang. If the screening indicates increased risk for obstructive sleep apnea, it’s important to follow up with your clinician for additional testing. Dr. Coleman advises that there are several different test options available and it depends on the individual patient’s situation, as well as their insurance, to determine what is right for them. 

Some of the tests a clinician could conduct are those that monitor the following while you sleep: 

  • Airflow testing at home – limited to airflow monitoring, only without sleep data
  • Blood vessel activity at home – some medications and medical issues may prevent accurate testing
  • Heart rhythm, air flow, body movements, and brain activity in a sleep lab – the most accurate, allows for additional testing for better treatment decisions in a single night

“Although at-home tests are often offered by pharmacies, websites, and dentists, I don’t recommend using them without knowing that the interpreting doctor is dedicated to treating sleep apnea if found,” Dr. Coleman warns. “Tests that are purchased without seeing a physician are lower quality, have no clinical context for interpretation, and often are not critically evaluated by a qualified provider. It may be convenient but the results won’t do very much to help make decisions about how your medical condition would be best treated.” 

How is sleep apnea treated?

Sleep apnea will be treated differently depending on the severity and type of sleep apnea, as well as the patient’s goals. 

Obstructive sleep apnea

For obstructive sleep apnea, in which breathing is impaired because the throat and tongue muscles relax to narrow or block the airway, Dr. Coleman advises that working with your healthcare team to lose weight first may benefit many forms of obstructive sleep apnea. If patients have sufficient improvement in their apnea after weight loss, no further treatment may be needed. If patients have more significant apnea or associated medical issues, other treatment options may be recommended while trying to lose weight:

  • Mouth guards to help hold the jaw and tongue forward may improve some forms of obstructive apnea but may not resolve all apnea or snoring
  • PAP devices, which use humidified air pressure to hold the whole airway open 
  • Surgical options, although these are often a last resort

Central sleep apnea

For central sleep apnea, the brain is not providing the signal to breathe. With this type of sleep apnea, Dr. Coleman recommends getting to the bottom of why the brain is not sending that signal, for it may indicate an underlying issue that is more significant. Treatment of obstructive sleep apnea may also be made much more difficult when significant central sleep apnea is present.

“There are many ways to treat sleep apnea, but it really depends on the patient’s situation,” Dr. Coleman emphasizes. “Some aspects of sleep apnea are out of your control because of your anatomy or how your respiratory system and airway are wired.” 

What happens if sleep apnea goes untreated?

Although patients do not suffocate in their sleep due to untreated obstructive sleep apnea, there are two primary risks: 

  • Excessive daytime sleepiness. When your sleep is frequently disrupted due to apnea, it’s possible to experience impaired functionality during the day, which can make activities like driving unsafe. 
  • Cardiovascular damage. Stress hormones are activated during sleep apnea episodes that activate downstream effects for other illnesses. For instance, those with untreated obstructive sleep apnea are at higher risk for metabolic syndrome, cardiac strain, and atherosclerotic disease, which can lead to arrhythmias and heart disease down the line. 

If you worry that you have medical issues associated with sleep disordered breathing, use MedChat to schedule an appointment with a Tryon sleep apnea specialist today.