Sleep Apnea

Sleep apnea is pauses in breathing during sleep. The muscles in your throat relax when you fall asleep causing your breathing passages to narrow and soft tissues in your throat to collapse. This obstructs airflow. Pauses in breathing can occur hundreds of times a night and last 10 seconds to over a minute. The brain sees these pauses and notes the drop in oxygen, and sends signals to the nervous system while pressure is building up in the back of the throat. This causes you to gasp for a breath, wake up, open your airways and then fall back asleep. This can happen hundreds of times a night. These pauses cause your heart to work harder.

Snoring is the main symptom of sleep apnea. This is caused by air passing through a narrowed airway which causes soft tissue in the back of the throat to vibrate. Apnea can be seen by others or you may awaken during sleep with gasping, choking or snorting. You may also feel tired or fatigued during the day or have daytime sleepiness and catnapping. Upon waking up in the morning, you may feel un-refreshed or un-rested. People with sleep apnea may feel more anxious. Irritability can occur because of lack of sleep

There are 2 TYPES of SLEEP APNEA: Obstructive sleep apnea (OSA) is the most common type, while the other type is called Central sleep apnea (CSA).

  • Obesity
  • Male
  • >65 years old
  • Menopausal or post-menopausal women
  • A family history of sleep apnea
  • African American, Mexican or pacific island decent
  • Congenital syndromes such as Down's syndrome
  • Craniofacial abnormalities
  • Enlarged tonsils and/or adenoids
  • Thyroid disorders
  • Growth hormone disorders
  • Sleeping pills/sedatives
  • Alcohol ingestion
  • Sleeping on your back
  • Allergies/sinusitis
  • Neuropathies
  • Diabetes
  • Tobacco abuse

Sleep apnea is diagnosed by doing a sleep study called a polysomnogram.

In a sleep study you may be asked to stay overnight so the healthcare team can see if you are breathing well at night or, if you stop breathing during your sleep.

Sleep apnea that is not treated can lead to high blood pressure or worsen high blood pressure.

Heart failure (HF) like Sleep Apnea triggers the nervous system. That is why HF patients are given beta blockers such as carvedilol (coreg), metoprolol succinate (toprol xl), bisoprolol, or metoprolol tartrate. Sleep apnea that is not treated can make HF symptoms worse. If treated though, HF symptoms can improve.

High blood pressure is the most common cause of stroke. Sleep apnea that is not treated can lead to high blood pressure or worsen high blood pressure.

Heartbeats that are too fast, too slow, or irregular are more common in patients with sleep apnea. This may be due to the problems of high blood pressure and HF listed above. Treatment of OSA can decrease heart rhythm problems.

OSA is often treated by giving positive airway pressure (PAP) into your lungs during sleep. This is done by special machines. Continuous positive airway pressure (CPAP) gives a fixed amount of air into your lungs that is under pressure through a nose device, mouth mask or both nose and mouth device. Bi-PAP is a two level system where higher pressure goes into the lungs, but less pressure goes in when breathing out. Self-adjusted PAP will adjust to your breathing pattern.

  
CPAP with humidification        full mask                    nasal pillow

 

  • Wear your CPAP. It will make you feel better.
  • It may take a few weeks to get used to.
  • Start off slow and keep trying, it will get better.
  • Use with naps at first to get used to it.
  • If the pressure is too high, use a ramp up approach.
  • Make sure your device fits right, is sealed and not leaking to receive the correct treatment.
  • Call your sleep clinic if you are having problems with wearing it. Your success will make you feel better during the day.
  • It may take a few attempts to get the right device and the right fit.
  • People who wear their PAP gain feel the benefits the next day..
  • If you have trouble breathing out against the air pressure, a two-level PAP may be best for you.

Nasal congestion is the most common side effect. This will often go away over time. For nasal dryness, make sure to increase the humidification on your machine. You can use nasal saline (salt and water) in each nostril before wearing your mask but need to avoid too much saline use due to the salt content if you have HF. You can also adjust the heat on most machines. Warm air may feel better than cool air. Nasal sprays that can ease nasal discomfort are : beclomethasone, budesonide, trimcinolone, fluticasone, or cromolyn sodium

Make sure there are no air leaks. You may need to use air cushions if the mask is causing skin redness and irritation.

  • Avoid alcohol
  • Do not use sleeping pills for more than 2-3 weeks
  • Napping in the early afternoon is better
  • Stay on a normal schedule with the same bed and wake times
  • Try to get at least 8 hours of sleep
  • Exercise in the morning, not before bedtime
  • Avoid caffeine within six hours of bedtime
  • Eat meals and take medications around the same time every day
  • Sunlight in the morning can help reset your clock
  • Avoid eating a large meal before going to bed
  • Do not go to bed hungry
  • Avoid tobacco and alcohol
  • Sleep in a darkened cool room
  • Find ways to minimize noise. Try earplugs, "white noise" or soothing background music
  • Sleep separately from your bed partner if he or she snores, sleep talks or has other restless sleep habits
  • Try building a sleep routine. For example, read a book, listen to relaxation tapes, or practice slow breathing
  • Avoid stimulating mental activity for 2 to 3 hours before bedtime. This may include using the Internet or watching certain films or television shows
  • Create a stress free zone—do not try to problem solve too close to bed time
  • Do not lay awake tossing and turning. If you cannot sleep for more than 20 or 30 minutes, get up and do something boring for a little while; then go back to bed
  • Remember your bed is for sleeping, resting and sex. If you are not doing any of these, get out of bed

Make sure you tell your providers prior to having surgery that you have sleep apnea.
You may need to be treated during and after surgery.