Mr. R is a 64 year old man who is experiencing fatigue. He maintains a busy schedule both at work and home, but makes sure that he gets eight hours of sleep each night. Despite setting aside this time to sleep, Mr. R does not feel well rested when he awakens each morning. He becomes tired by the early afternoon and often naps in his office. Mr. R’s wife has observed her husband snoring at night, but has also seen him choke and gasp in his sleep. Mr. R meets with his physician who recommends a sleep study to evaluate for the possibility of obstructive sleep apnea.
What is obstructive sleep apnea?
Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder. Under normal conditions, the muscles of the throat maintain airway patency. For people with OSA, the muscles promoting this patency are overcome by forces that lead to transient collapse or blockage of one’s airway.
Estimates suggest that up to 15 percent of males and 5 percent of females in North America meet criteria for OSA. Risk factors include advancing age, obesity, male gender, and upper airway abnormalities. Smoking, alcohol consumption, and use of sedating medications are other potential contributors.
What are the symptoms of obstructive sleep apnea?
Snoring is one of the most common presenting symptoms of OSA. Restless sleep, frequent awakenings, choking, and gasping are often reported. Those with OSA sometimes feel fatigued upon awakening in the morning and may note excessive daytime sleepiness.
How is obstructive sleep apnea diagnosed?
When OSA is suspected, a physician may order a polysomnogram (sleep study). During this study, the number of disordered breathing events per hour of sleep is measured and is called the apnea-hypopnea index (AHI).
Apnea is characterized by the complete cessation of airflow that is brief and resolves on its own. Hypopnea is distinguished by a reduction in airflow without total stoppage of breathing.
Why should I treat my obstructive sleep apnea?
Untreated moderate to severe OSA is associated with a greater risk for developing high blood pressure, heart failure, coronary artery disease (CAD), and stroke. An increased incidence of diabetes has been reported. Untreated OSA may also contribute to difficulties with concentration, impaired cognition, and may escalate one’s risk for a motor vehicle accident.
How do I treat obstructive sleep apnea?
There are several strategies available to treat OSA. The goal of therapy is to open one’s airway and, thus, restore normal airflow during sleep. When developing a treatment plan, many factors are considered including the severity of the diagnosis (as measured by the sleep study), potentially reversible causes, and an individual’s medical history.
Mild obstructive sleep apnea:
For those with mild OSA, lifestyle changes may be all that is necessary. Some of these interventions include:
- Weight loss. Overweight individuals may benefit from weight loss. Extra weight applies increased pressure to one’s airways, making it more difficult for air to pass through.
- Side vs. back sleeping. Sleeping on one’s side may promote airway patency. Use pillows and other devices to help maintain a side position.
- Exercise regularly. Exercise may help one lose weight and improve lung function.
- Avoid alcohol and sedating (sleep) medications which may relax the airway muscles and thus contribute to sleep apnea.
- Treat nasal congestion. Those with allergies and a stuffy nose may benefit from a spray or allergy medication to unblock their nasal passages.
Moderate to severe sleep apnea:
CPAP (continuous positive airway pressure) is the gold standard for those with moderate to severe OSA. The CPAP device blows constant and continuous air through one’s nose and/or mouth. This positive air pressure prevents airway collapse while sleeping. For those who struggle to find a comfortable fit with their CPAP device, a mask fitting at a local sleep clinic may be beneficial.
Are there other treatment options?
Some individuals with mild sleep apnea may benefit from using an oral appliance made by a dentist. These dental appliances help keep one’s airway open by advancing the mandible and preventing blockage by the tongue. Oral appliances are not as effective as CPAP for treating OSA, but are an option for those who have difficulty tolerating CPAP.
Lastly, surgery is available for those with moderate or severe sleep apnea whose symptoms do not respond to the lifestyle changes and measures described above.
I encourage you to speak with your physician if you feel you are experiencing symptoms of sleep apnea.
Wishing you a happy and restful New Year,
Brad Weiner, MD
This blog is for informational purposes only. It does not replace medical care from a licensed physician. Please contact your doctor if you have any questions or concerns.