You May Have a Sleep Disorder If...
Wake up refreshed? Alert throughout the day? If not, you may have a sleep disorder.
There are two types of sleep apnea, obstructive (OSA) and
central (CSA). In OSA the throat collapses during sleep, preventing the flow of
air to your lungs. As your oxygen levels decrease, your brain gets an alert
message to "wake up and breath." These apnea episodes may occur 20 to
60 to 100 or more times per hour.
CSA is far less common, occurring in less than 10% of cases.
Here, the brain fails to send a signal to breath. This can occur in various
heart and neurological disorders.
Present in about 7% of the population, the prevalence of
sleep apnea is on par with diabetes and asthma. It is also a primary risk
factor for high blood pressure. Fortunately, with the proper diagnosis, it can
be treated quite effectively.
There are three categories of treatment for obstructive sleep
- Physical or mechanical therapy
- Non-specific therapy
Which therapy is used depends on your specific medical, lab,
and physical exams and other findings.
Physical or mechanical therapies only work at the time
they are properly used. Apnea episodes return when they are not utilized.
Continuous positive airway pressure (CPAP) is the most common
treatment. With the use of a snugly fitted face mask or nasal plug, air is
blown into the nasal passages, forcing the airway open and allowing air to flow
freely. The pressure is continuous and constant and is adjusted so that it is
just enough to open the airway.
Dental or oral appliances reposition the lower jaw and tongue,
moving them outward, creating something akin to a pronounced
"underbite." Used in mild to moderate sleep apnea, this physically
opens the airway, allowing the free flow of air. They are custom-made devices
usually fitted by a dentist or orthodontist.
Surgery opens the airway by removal of tissues, like
tonsils, adenoids, nasal polyps, and structural deformities that may obstruct
it. There are several types of procedures, but none are completely successful
and without risk. It is also difficult to predict the outcome and side
- One procedure, called uvulopalatopharyngoplasty, removes tissue at
the back of the throat. In addition to having low success rates of between
30%-60%, it is difficult to predict exactly which patients will benefit, as
well as the long-term outcome and side effects.
- Other procedures include tracheostomy (creating a hole directly in
the windpipe, for those with severe obstruction),surgical
reconstructionfor those with deformities, andprocedures to
treatobesity, which contributes to apnea.
Non-specific therapy addresses the behavioral aspects
that may be an important part of a treatment program.
- If you are overweight, weight loss can reduce the number of apnea
episodes. One should avoid depressants, like alcohol and sleeping pills,
which can increase the likelihood of and prolong apnea episodes. Some people
have apnea events only when lying on their back. So placing a pillow or
other device to help keep you on your side may also help.