What is Sleep Apnea?

by Rob Lamberts, M.D.

Today we are going to cover the very important subject of breathing. Breathing is very important, and I recommend each of you practice it every day. You might think you already do this but some of you--a significant percent, actually--are not breathing at times; and let me tell you that it is causing all sorts of trouble.

Before I move on, let me mention that the podcast version of this article is brought to you by Audible.com, the best place on the Internet to find spoken word entertainment. I’ll give you another recommendation for a book at the end of the podcast.

What is Sleep Apnea?

Today’s topic comes from a fellow named Richard, who wanted me to cover some of the topics of middle age--specifically sleep apnea. I am actually somewhat surprised that it wasn’t Richard’s wife that sent me the email, as usually they are the ones first alerted to the presence of this condition by the sound of a freight train emanating from the other side of the bed.

The topic of today’s podcast is sleep apnea.

The word apnea comes from Greek words that mean, “not breathing.” The word sleep comes from the English word meaning “sleep.” That one’s tricky. So, putting the two together, sleep apnea is a condition where a person stops breathing while sleeping. 

What are the Two Types of Sleep Apnea?

There are two main reasons a person would stop breathing while asleep: the first is when the brain forgets to tell the body to breathe. That is known as central sleep apnea. The other reason is that the person’s airway is blocked by something, making it difficult to breathe. That is known as obstructive sleep apnea, and is by far the most common of the two, and hence will be the focus of the rest of this podcast.

What Causes Snoring?

The first sign of airway obstruction is snoring. When a person is lying down, the easiest way to breathe is usually through the nose. That has to do with the anatomy of the airway, and basically comes down to the fact that air can move better through the nose than through the mouth. Nasal blockage, either from congestion or anatomy, makes a person mouth breathe. That results in vibration of the soft palate and uvula (the dangly thing at the back of the throat) with the final result being a sound rivaled only by heavy machinery.

When Snoring Turns into Apnea

When the obstruction gets bad enough, the snore turns into episodes of apnea, where the person has periods of such bad airway obstruction that they stop breathing. The apnea episode is then followed by a gasp for air, as the brain gives the breathing muscles an urgent request to start breathing again. The person may wake up with the feeling of not being able to breathe, but more commonly they are simply aroused to a less deep sleep.

Most people would assume that apnea is dangerous because the person may stop breathing permanently. But this is not the case; the dangers of sleep apnea come from other things that are caused by not breathing.

The Danger of Sleep Apnea

Sleep apnea affects not only the quality of a person’s life, but also the quantity of that life.

Sleep apnea affects not only the quality of a person’s life, but also the quantity of that life. People with sleep apnea are three to six times more likely to die from all causes than people without it. It’s a serious problem. Here’s why it is so dangerous:

Sleepiness – Awakening multiple times through the night--even if it is not complete awakening--has a huge effect on the quality of sleep. People with significant disease will never feel rested. They will often fall asleep frequently throughout the day--not being able to make it through movies, meetings, and even fascinating podcasts. They also are at much greater risk of getting in automobile accidents, either from poor judgment due to fatigue, or from falling asleep while driving.

Low oxygen levels – When a person doesn’t breathe, the oxygen level in the blood drops. Spending a lot of time with low oxygen can have serious consequences, including:

Children can snore and even have sleep apnea. The main cause for this is enlargement of the adenoids, which is tonsillar tissue that lies on top of the soft palate.

How is Sleep Apnea Diagnosed?

Most sleep apnea is first brought to medical attention by an exhausted spouse or significant other. The witnessed cessation of breathing can often cause great concern. People who live alone are at a disadvantage here, so suspicion needs to be high.

The gold standard for diagnosing sleep apnea is the polysomnogram, or sleep study. In a sleep study, people are hooked up to a bunch of wires that monitor chest wall movement, brain wave function, and oxygen levels in the person’s blood. Then they are told to relax and go to sleep while someone watches them. That is really hard for most people, but it doesn’t take much sleep to get the needed information.

What are the Treatments for Sleep Apnea?

Since it has such serious consequences, aggressive treatment for sleep apnea is the norm. The first line of treatment can be as simple as sewing a pocket on the back of a nightshirt and putting a tennis ball in it. That makes it impossible for the person to sleep on their back, and can eliminate snoring and apnea in some people.

Losing weight and treating underlying issues, such as thyroid problems, can also fix milder sleep apnea. Improving the movement of air through the nose can also help. The strips you put on your nose to open your nasal passages can actually help mild snoring and apnea. Surgery to fix nasal problems like deviated septum can also improve nighttime breathing.

Those with serious problems with apnea can be successfully treated by using a CPAP machine (which stands for Continuous Positive Airway Pressure). This device resembles a squid attacking the person’s face, but works by pushing a constant pressure of air into the nose throughout the night. That is very effective in eliminating snoring and apnea.

It may seem hard to believe that someone would hook this kind of device to their nose while they sleep, but the improvement people feel when they finally sleep well is so dramatic that they don’t mind the nightly squid attack of their face.

Still, there are those who don’t tolerate CPAP, and so end up requiring a surgery called a uvulopalatopharyngoplasty, which is mercifully referred to as a UP3 (although I have heard it called “Roto-Rooter” more than once). This procedure involves removal of the back of the palate, including the uvula, and a widening of the upper airway. It is generally effective, but not without risk.

Quick and Dirty Tips for Sleep Apnea

This brings us to my quick and dirty tips regarding sleep apnea:

Don’t forget to go to Audible.com and check out the great audiobooks they have to offer. A serious book I’ve recently listened to is The Anatomy of Hope, by a physician named Jerome Groopman. In it he discusses the reason some people have hope and some seem to give up. He gives some very moving stories in it and makes important observations. You can get this book or any other of the thousands of audiobooks free when you sign up for a subscription at audiblepodcast.com/doctor, that’s audiblepodcast.com/doctor. It’s really worth it.

If you have questions you want answered, send them to housecalldoctor@quickanddirtytips.com or call 206-337-5895. You can find me on Twitter as @housecalldoc and on Facebook under “House Call Doctor.”

And feel free to visit my blog, Musings of a Distractible Mind, at distractible.org.

Let me remind you that this podcast is for informational purposes only. My goal is to add to your medical knowledge and translate some of the weird medical stuff you hear, so when you do go to your doctor, your visits will be more fruitful. I don’t intend to replace your doctor; he or she is the one you should always consult about your own medical condition.

Catch you next time! Stay Healthy!