It is usually sleep partners who notice the problem first. At night, a person with sleep apnea will stop breathing–sometimes for as long as 10 seconds–without waking up fully. Not only do sleep partners become alarmed by the absence of breathing, but levels of oxygen in the blood of those with apnea drop precipitously.
“Imagine that someone stood next to your bed as you slept and disturbed you every few seconds, not enough to wake you up, but enough to keep you from really sound sleep,” says Dr. Robert W. Clark, director of the Columbus Community Hospital Regional Sleep Disorders Center in Columbus, Ohio. “This is a real problem, not only because sleep apnea can increase the risk of cardiovascular problems, but because sleep deprivation makes people vulnerable to accidents, especially car wrecks.”
Airway Shuts Down
When a sleeper’s airway regularly is blocked by an obstruction that prevents inhaling, doctors call the condition obstructive sleep apnea. And apnea’s connection to raised blood pressure has now been well documented in several studies.
“Our work shows that because people stop breathing during apnea, their bodies respond to this stress by increasing the sympathetic nerve function, causing the blood vessels to constrict,” says Dr. Virend Somers, a cardiologist with the Mayo Clinic in Rochester, Minnesota, who was one of the lead investigators on a recent study of apnea and blood pressure. “In normal sleepers, blood pressure falls during sleep, but in people with apnea, blood pressure may be even higher during sleep than in wakefulness.”
Dr. Somers and colleagues found that during the night, the repeated low-oxygen levels also trigger production of endothelin, a vasoconstrictor produced by the blood vessels.
Pressure Rises, Stays High
“During the night, people with sleep apnea have about a 50% increase in endothelin levels,” says Dr. Somers. “And it appears that endothelin has a sustained vasoconsticting effect that lasts several hours after sleep. Along with the increased sympathetic nerve function, endothelin and several other facts are all contributing to raised blood pressure.”
Compelling circumstantial evidence links apnea with an increased risk of cardiovascular disease, especially heart attacks and, possibly, stroke, says Dr. Somers. “The causal link between apnea and these problems has not been proved beyond doubt,” says Dr. Somers. “But based on our findings it is clear that the entire cardiovascular system in sleep apnea is exposed to repeated and severe stresses of low oxygen and very high blood pressures, and it’s not unreasonable to anticipate that this may predispose people to cardiovascular disease, particularly in those people with preexisting, significant cardiovascular problems.”
To arrive at a diagnosis of apnea, your doctor will probably refer you to a sleep clinic for testing. Clinics administer a test called polysomnography. An overnight test can be done either in your home or at the clinic. It measures brain waves, eye movement, muscle tension, breathing, oxygen level in the blood, and snoring.
Treatments Are Available
“Sleep apnea is an odd area of medicine,” says Dr. Clark. “Usually, disorders that kill are hard to treat, but sleep apnea is much easier to treat than something like cancer. We have a wide range of treatment options for patients.”
Some behavioral changes can help mild sleep apnea. Avoiding alcohol or sedatives before bed and losing excess weight can often reduce apnea. Sleeping on your side rather than on your back will help keep your airway open.
“Losing weight is one of the best ways to reduce apnea,” says Dr. Tucker Woodson, an associate professor of otolaryngology at the Medical College of Wisconsin in Milwaukee. “Obesity is closely associated with apnea.”
Dr. Woodson says that a treatment plan for apnea needs to take a number of factors into consideration, including severity of apnea and the specific cause of airway obstruction. This requires sleep tests and examinations with X-ray and fiberoptic devices to determine the exact cause of obstruction.
The first treatment options are the least invasive. These are oral appliances (devices that help keep the airway open) that may help to reduce snoring. These devices bring the jaw forward, elevate the soft palate, or prevent the tongue from blocking breathing.
“You start conservatively and develop a plan that may include surgery in conjunction with a C-PAP device and behavioral changes,” says Dr Woodson. “Apnea is different in every patient. You need to develop a combination of approaches to treat it successfully.”
The next treatment option is the device called a C-PAP, short for continuous positive airway pressure. It blows air into your nose through a nose mask to prevent the airway from collapsing. But some people report discomfort in their inner ears due to pressure differences caused by the air. For them, there is a bilevel C-PAP machine that blows air at two different pressures. When a person inhales, the pressure is higher, and in exhaling, the pressure is lower, to avoid pressure differentials.
If all else fails, surgery is the next option. “Uvulopalatopharyngoplasty, or UPPP, is the most common surgery for apnea,” says Dr. Woodson. “It removes excess tissue of the palate, uvula, tonsils, and upper throat. It tends to be very effective for snoring but less successful for apnea.”
The range of surgeries for apnea is dizzying, including advancement of the jaw, nasal surgery, reduction of the base of the tongue, and many others. Key to effective relief, Dr. Woodson says, is a treatment plan for the individual patient.
Whatever treatment method used, all the doctors agreed that follow-up studies are important to make certain that blood-oxygen levels return to normal. “For someone who is getting surgery for sleep apnea,” says the Mayo Clinic’s Dr. Somers, “I think it would be best for them to have follow-up, postsurgical studies of their blood-oxygen levels and sleeping patterns done to make sure that the problem is really gone.”
Do You Have Sleep Apnea?
The American Sleep Apnea Association has developed a few simple questions that will help you determine if you or someone you know suffers from sleep apnea. If you answer “yes” to any of these questions, you should discuss your symptoms with your doctor or a sleep specialist.
- Are you a loud, habitual snorer?
- Do you feel tired and groggy on awakening?
- Are you often tired and sleepy during waking hours?
- Are you overweight?
- Have you been observed to choke, gasp, or hold your breath during sleep?
Article By: John Casey, Medical Writer