SLEEP APNEA

General Information

DEFINITION--Episodes of cessation of breathing, during sleep, that last 10 seconds or longer.

BODY PARTS INVOLVED--Central nervous system.

SEX OR AGE MOST AFFECTED--All ages, but most common in adults over 60.

SIGNS & SYMPTOMS--

• Long periods (up to 1 or 2 minutes) of not breathing while asleep. Sleep apnea must be observed by others--it is most reliably recorded in a sleep laboratory.
• Choking while asleep caused by obstruction in the back of the throat from the uvula and other loose tissue. This causes cycles of sleep, choking, startled awakening, drowsiness and sleep. The cycles often continue throughout the day because poor sleep causes chronic sleepiness.

CAUSES

• Unknown (often).
• Airway obstruction, especially in obese patients.
• Chronic respiratory-system disease.
• Central-nervous-system disorder, such as a brain tumor, viral brain infection or stroke.

RISK INCREASES WITH

• Stress, including anxiety and depression.
• Persons with high blood pressure, cardiovascular or arteriovascular disease.
• Senility; obesity; smoking; excess alcohol consumption; use of mind-altering drugs; hypothyroidism.

HOW TO PREVENT--If you have an underlying disease listed as a cause of sleep apnea, avoid as many risk factors as possible to decrease the chance of triggering the disorder.

What To Expect

DIAGNOSTIC MEASURES--

• Observation of symptoms by someone close to you.
• Medical history and exam by a doctor.
• Laboratory studies to measure oxygen in blood, chest-wall movement and air flow through nose.
• EEG (See Glossary).
• Studies in a sleep laboratory.

> Continuous positive airway pressure (CPAP)--

patient wears a mask over nose and mouth during sleep while a small air-compressor forces air into the nasal passages keeping the airway open. It is an effective treatment for many patients.

• Treatment can include surgery, such as tonsillectomy, uvulopalatopharyngoplasty (to enlarge the larynx) or tracheostomy (rare).

POSSIBLE COMPLICATIONS

• Excessive daytime sleepiness (EDT), due to lack of sleep, may lead to accidents, inattentiveness and lowered work productivity.
• Permanent brain damage caused by recurrent episodes of inadequate oxygen to the brain.
• Heartbeat irregularities and congestive heart failure.

PROBABLE OUTCOME--Treatment measures, other than surgery and weight loss in an obese patient, are directed at controlling the sleep apnea rather than curing it. Lifelong compliance to therapy is usually necessary.

How To Treat

GENERAL MEASURES--

• If sleep apnea occurs only when you sleep on your back, sew a ping-pong ball or tennis ball to the back of your pajamas. This forces you to sleep on your side.
• Drugs such as sedatives, hypnotics, barbiturates, narcotics, and alcohol should be avoided. Get medical advice about withdrawing medications that may be causing sleep apnea.

MEDICATION--Medicine usually is not necessary for this disorder; however, protriptyline may be helpful for a small number of patients to help control daytime sleepiness.

ACTIVITY--

• No restrictions. Engage in regular physical exercise to become physically fit, but don't exercise vigorously before bedtime.
• Be cautious about driving and hazardous activities if you suffer from daytime sleepiness.

DIET--

• Lose weight if you are obese (see Weight Loss Diet in Appendix). Obesity may be the cause of the apnea
• Avoid alcohol.

Call Your Doctor If

• You suspect you have sleep apnea.
• You observe signs of sleep apnea in another family member.