Snoring: it’s the butt of jokes, the cause of domestic strife and the subject of many an ad campaign. But what, for centuries, has been regarded as simply an annoying noise can be far more ominous – it is the most common sign of a serious, even dangerous condition – sleep apnea.
The Sleep Disorders Center, 705-A Commerce Center Drive, Sebastian, is an off-campus satellite of the Sebastian River Medical Center. Among its services is the diagnosis and treatment of adult sleep apnea. Lauren Butler, Registered Polysomnigraph Technologist, discussed the condition: what it is, who gets it and how it is diagnosed and treated.
OSA or Obstructive Sleep Apnea, Butler explained, is the condition in which a person stops breathing for 10 seconds or more during sleep because of a blocked airway, which prevents air from entering the lungs. Several factors that can cause the airway to collapse include extra tissue in the throat, a decrease in the tone of the muscles keeping the throat open, nasal obstruction and jaw or facial characteristics, such as a recessed chin.
Snoring may be annoying, but is one of the less serious results of OSA. The fatigue caused by lack of proper sleep can have dangerous consequences: Butler tells of a patient whose boss threatened to let him go because he kept nodding off at his computer. Another patient was in a car accident because he went to sleep at the wheel.
Statistics show that OSA occurs most often in middle aged or older individuals, and men are twice as likely as women to have it – 4 in 100 for men, 2 in 100 for women. In the Sebastian area, with a high retiree population, these statistics generally hold true, although, Butler said, people of every age group have been diagnosed by the Center. She adds the Center only sees patients 18 and above. Younger patients are referred to other local specialists. Diabetics are at risk for OSA, and should always be tested, said Butler. Of diabetics tested, she added, about 80 percent are found to have OSA.
The SRMC has a 46-statement brochure an individual can fill out at home to determine the likelihood that he or she suffers from OSA, or from one of the other common sleep disorders – Insomnia, Narcolepsy (uncontrollable sleep attacks during the day), gastro-esophageal reflux or nocturnal myoclonus (restless leg syndrome.)
Of the 14 questions related to OSA, if three or more are marked, the patient is showing symptoms of OSA.
1. I have been told that I snore
2. I have been told that I stop breathing when I sleep
3. I have high blood pressure
4. My friends and family say I’m often grumpy and irritable
5. I wish I had more energy
6. I sweat excessively during the night
7. I have noticed my heart pounding or beating irregularly during the night
8. I get morning headaches
9. I have trouble sleeping when I have a cold
10. I suddenly wake up gasping for breath during the night
11. I am overweight
12. I seem to be losing my sex drive
13. I often feel sleepy and struggle to remain alert
14. I frequently wake up with a dry mouth
Butler explained that, in order to have a sleep study done, an individual must be referred to the Sleep Disorder Center by a physician. When he or she visits the doctor complaining of extreme fatigue, trouble sleeping or snoring, the physician will conduct preliminary tests. These include an upper airway exam to determine whether there are airway obstructions, which can be tonsils, uvula, epiglottis, or even a large tongue. She will do a cardiopulmonary assessment and check neck circumference. A BMI (Body Mass Index) is also taken, because excessive weight can create pressure and obstruct the airway. Finally, before a sleep study is ordered, the patient fills out the Epworth Sleepiness form, based on how likely they are to doze under eight situations, from 0 – no chance, to 3 – high chance.
1. Sitting and reading
2. Watching TV and reading
3. Sitting inactive in a public place (e.g. a theater or meeting)
4. As a passenger in a car for an hour without a break
5. Sitting and talking to someone
6. Lying down to rest in the afternoon when circumstances permit
7. Sitting quietly after lunch, without alcohol
8. In a car, when stopped for a few minutes in traffic
Based on the physician’s assessment, a patient can be referred to the Sleep Center for a sleep study. Butler explains the procedure: The patient will sleep in the Center while a technologist monitors her throughout the night. Eight electrodes are placed on the patient’s head to record brain waves. The heart, oxygen saturation, effort in breathing, amount of air moved during breathing and leg movements are also monitored. If OSA is diagnosed, the patient returns a second night. This time, she is monitored once again, this time adding a CPAP (Continuous Positive Airway Pressure) device. The CPAP is positioned, using a soft, small nasal mask. Gentle pressure, adjusted for each patient, is applied as the patient is falling asleep, and keeps the airway open during sleep, much like air in a balloon keeps it inflated. As the patient sleeps, the technologist continually monitors the brain wave pattern, determining, among other aspects, when the deepest and most nourishing sleep – the REM (Rapid Eye Movement) sleep – begins and ends. Butler explained that, in a healthy sleep cycle, REM sleep typically occurs every 90 minutes. REM sleep can last up to 10 minutes at a time, occupying about 18-25 percent of the entire sleep cycle, depending on the age of the patient. It is here that dreams occur, she added, although people perceive dreams to last far longer.
When left untreated, OSA can result in high blood pressure, heart disease, heart attack, stroke, fatigue-related motor vehicle or work related accidents and overall decreased quality of life.
In addition to the initial sleep study, the CPAP is the most common treatment for OSA, allowing breathing to become regular and the snoring to stop. Blood oxygen levels return to normal, restful sleep returns, and with it quality of life.
“It’s amazing how badly many people sleep, and think it’s only the normal aging process and nothing can be done. We had an 86-year-old lady who suffered from chronic fatigue. She had no energy. She was referred here by her doctor and we found she had OSA. We put her on a sleep CPAP and, later, she told us how much energy she had. She was having fun again, going out to the VFW with her friends and dancing the night away.”
Other, less common treatments can include surgery and oral appliances. Whatever the treatment, Butler emphasized, it should include lifestyle modifications, such as weight loss if necessary, exercise, sufficient hours of sleep, and avoidance or reduced use of alcohol, sedatives and tobacco.
People who have suffered with sleep disorders caused by OSA are thrilled when, with proper treatment, they realize how life-changing regular, quality sleep can be.