Sleep Apnea

It has been estimated that thirty million people in America snore. Snoring is the sound that is made when the airway becomes partially obstructed during sleep. Snoring can be harmless, but it can also be a telltale sign of a very serious condition known as obstructive sleep apnea or also known as OSA.

Estimates show that there are between 12-20 million Americans with sleep apnea, the vast majority of whom (approximately 90%) have not been diagnosed. When awake the throat muscles keep the airway open and these muscles usually do the same during sleep. But for people with sleep apnea the muscles relax more than normal collapsing the upper airway in the back of the throat. This can lead to partial reduction in breathing causing a decrease in the amount of oxygen in the blood which is known as a hypopnea. When the oxygen in the blood drops further due to a complete pause in the breathing for at least 10 seconds at a time, this is known as an apnea. Apneas can often last as long as 10-30 seconds, but they may last over 60 seconds. This causes wild swings in the oxygen saturation of the blood with blood levels falling about 40% or more in severe cases.

Typically what happens is the brain will detect the drop in oxygen, arousing the body briefly from sleep. The muscles in the upper airway tighten, the airway is opened and normal breathing is returned. This, in very severe cases, can happen over 60 times per hour and hundreds of times during the course of the night. Often what is heard is loud ongoing snoring followed by pauses of at least 10 seconds or more followed by choking and gasping for air. Over time, the snoring may become more frequent and louder, followed by more frequent pauses, choking sounds, and arousals. Not everyone who snores has sleep apnea and not everyone who has sleep apnea snores.

Since sleep is fragmented multiple times per night, one of the signs of apnea is daytime drowsiness. About 24% of men and 9% of women have breathing symptoms of OSA with or without daytime drowsiness. OSA can occur in any age group and is seen in 2% of children most commonly at preschool age. The severity of apnea can be measured by the number of apneas and hypopneas in one hour known as the Apnea-Hypopnea Index or AHI.

Mild OSA (5-15) events: Involuntary sleepiness during activities that require little attention such as watching TV or reading. MediumOSA (16-30) events: Involuntary sleepiness during activities that require more attention such as sitting in a meeting or a presentation. Severe OSA (31+) events: Involuntary sleepiness during activities that requires a lot of attention such as talking or driving.

What makes OSA so dangerous is that daytime sleepiness can lead to an increased risk of job or motor vehicle accidents often leading to severe injury or death. The rising and falling of blood oxygen levels can also set off hormonal and other changes which can lead to an increased heart rate, increased blood pressure, increased risk of stroke and heart attack, impaired glucose tolerance and insulin resistance, impaired concentration, learning and memory problems, morning headaches, mood changes such as depression, increased gastric reflex, and disturbed sleep of one’s bed partner.
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