Obstructive Sleep Apnea it's getting Tiring.

Obstructive sleep apnea is one of the least talked about cardiac risk factors and probably one of the most important ones. It affects one in five adults, mostly men, however women can also be affected. It comes about during sleep when the throat muscles relax and the tongue then drops back to occlude or blocks the back of throat. This action suffocates the affected person, in essence it is like being strangled. The person is jolted awake out of REM sleep snorting and gasping for air, very rarely enough to be fully awakened. I have been diagnosed with obstructive sleep apnea. For years, after what I thought was a good nights sleep. I was still tired and it was getting progressively worse so gradual I barely knew it. During this time I rarely dreamt and again it went unnoticed. Years went by I couldn’t focus that well I always needed a nap especially in the afternoon and the coffee consumption was off the charts. It wasn’t until a night shift and one of the doctors and I were talking and my sleep patterns were brought up that she mentioned about obstructive sleep apnea and I needed to get tested. Well, being a typical guy, I ignored it once again for a couple of years until I had children. Having children seemed to have compounded the problem. My head was fuzzy and unable to concentrate. I had chalked it up to my smoking, and consequently lack of energy and exercise, but now I was thinking more assessment was needed. Once I was assessed and treated my sleep has greatly improved and I am dreaming again!

Airway obstruction while sleeping
Snoring, not so good for your partner

Action of snoring

Snoring is simply the noise that is made in the back of the throat. It is a resonating noise from the soft palate. Snoring can be worsened by colds, allergies or dry air. Snoring can also be worsened when the tongue obstructs the throat blocking the air flow. The loud sonorous sounds also jolt or prevent your partner from sleeping. Snoring could simply be a superficial problem rather than obstructive sleep apnea. The difference sometimes too subtle to notice for a regular person, hence, a trained specialist is required to run the test to diagnose the problem.

Symptoms of sleep apnea

Obstructive sleep apnea can be defined as snoring that is interrupted by periods of stopped breathing ( usually reported by the significant other), Gasping or choking during sleep, restless sleep, excessive sleepiness or fatigue during the day, Large neck size (greater than 17 inches for men and 16 inches for women), morning headache, sexual dysfunction, frequent urination at night, poor judgement or poor concentration, irritability, memory loss, high blood pressure, depression and obesity.

If you have just one of the above symptoms I urge to see your doctor and get seen by a sleep specialist. Doing so can definitely change your life, it also could save it.

The stages of sleep

Cycles of sleep

There are 5 stages of sleep. The stages relate to the slow progression of sleep all ending at the REM sleep (rapid eye movement). Stage 1 is the initial stage of relaxation lasting 5 to 10 minutes. Stage 2 lasts around 20 minutes as every body function starts to slow including brain function. Stage 3 is the in between stage of light sleep and very deep sleep. It is during this time we recharge and restore our main batteries and heal any damage. Stage 4 or Delta sleep: the brain continues to slow and produce delta waves this stage can last up to 30 min on average. Finally after approximately 90 minutes the mind is ready to enter REM sleep, the final stage. It is during this stage we dream, our minds become active again but our bodies are paralyzed. The whole process takes us into REM sleep our ultimate goal for sleeping. Babies spend approximately 50% of their sleep time in REM, whereas adults tend to stay 20% in REM sleep. We do not stay in REM sleep all though we come in and out like the ebbing tides of the oceans.

Effects of sleep apnea

Untreated obstructive sleep apnea can have long term effects. Initially the effects are not noticed but after years of compounded restlessness it will affect your heart. You are at risk for high blood pressure, heart disease and heart attack, stroke, fatigue related car crashes, decreased quality of life. Obstructive sleep apnea prevents us from entering REM stage of sleep and prevents us from dreaming, thus setting us up for disaster if left unchecked. The truth is that 60% of people don’t know they have  obstructive sleep apnea and just chalk it up to regular aging process.

How to get tested

Okay, so what do you do about it? It is certainly fine to know all the nitty-gritty details, but ultimately it is up you. You decide when your ready to save your own life and talk to your doctor as your first step. Your doctor will then send you to a sleep specialist doctor. The sleep specialist details all the tests results and compiles them for you into an answer. You will have to go for a sleep study. There they will put electrodes on your head and chest and fingers and send into a darkened strange room and then be watched as you sleep by a camera in the room. Very daunting to say the least, however, you do eventually go to sleep even for a little while. Don’t expect to be fully functioning the next day though. You could be the lucky few people that can sleep through anything. Unfortunately this is the only way to diagnose obstructive sleep apnea.

Possible solutions

After a few days or weeks you will be brought back to the specialists office to discuss the results of your alleged “sleep” study. You will then be told you have mild, moderate or severe sleep apnea. Treatment will be dependant on your severity.

Mouth guards can be made from your orthodontist/dentist who will make a dental impression of your teeth and make a mouth guard designed to thrust your jaw forward while you sleep. The action of the jaw thrust simply lifts the tongue off the back of the throat. People with jaw problems may need to avoid this option. This option may cost thousands of dollars but insurance companies should be up to speed about OSA and the short term costs greatly outweigh any future costs. Mouth guards can also be ordered online and with self made dental impressions cost you far less that you get almost as good a result. That is of course you do not have insurance. I tried this option and it didn’t work for me it hurt my teeth, provided I did it correctly, I’m pretty sure I did an ok job though. The small price tag certainly made up the difference good thing I didn’t go for the big expensive orthodontic work not only for the cost but time spent too.

Chin straps are meant to strap your jaw and support it while you sleep to prevent your tongue from sliding back and occluding your throat. I had trouble with a plugged up nose and I could barely breath through my nose, therefore I was gasping for air prior to falling asleep. Not a fair assessment if you ask me. The strap itself was comfortable to wear all night. The lesser cost certainly makes a small impact on your wallet, especially those without insurance or time constraints preventing them from going through all the steps for a diagnosis.

CPAP machines (continuous positive air pressure) forces air into your throat via your nose or mouth or both by a small puff of air. The pressure is gentle enough to be barely noticeable. You also need to wear a mask of either a nose piece or mouth piece or a full face mask. The soft plastics these days offer greater comfort and you barely know you have it on. The pressure is set by your sleep specialist and the mask fitting is done by your respiratory specialist. There are a lot of machines all designed to do the same thing, some more technical than others. This is the only cure for the disorder and it is well documented. The problem is the hefty price tag, however, most insurance companies know the cost savings over a lifetime and it should be covered.

CPAP machine with full face mask

The most simpliest of solutions, provided you have only mild symptoms of OSA, is to sew a tennis ball in the back of your pajamas. This will prevent you from rolling onto your back and since you’re not on your back your tongue won’t fall back into your throat. By ensuring you sleep on your stomach or side you will prevent OSA. Most of the time it is difficult to ensure such claim without having do a little remodelling of your pajamas.

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