Apnea is a medical term taken from the Greek word for “without breath” and refers to a temporary cessation of breathing by an individual. Sleep apnea, as is implied by its name, is simply the cessation of breathing during sleep, and more usually, during the deep REM sleep. The more common form of this affliction is known as obstructive sleep apnea, which occurs when the soft tissues of the throat lose muscular rigidity and collapse, cutting off the airway. Less common, but far more insidious, is central sleep apnea, where central brain functions instructing the individual to breathe temporarily desist, and the lungs shut down.
Symptoms of apnea in general include :
• drowsiness or somnolence that is more pronounced after eating
• headaches or backaches upon arising
• a general feeling that the sleep you received was not restful, although you cannot consciously remember awakening
• a feeling that time is lost or disjointed during the day (caused by drifting off to sleep and not realizing it)
• a tendency to drift into slumber during meetings, long periods of relative inactivity or similar circumstances.
Snoring is also usually considered one of the symptoms of apnea, especially heavy or chronic snoring that is not alleviated by changing positions of sleep. However, central sleep apnea sufferers may not show this sign, and indeed, may not snore at all. While these symptoms can occur in individuals who are not experiencing apnea, chronic or recurrent appearances of these symptoms should be a warning sign. In severe apnea sufferers, these symptoms can escalate to the point where the individual afflicted will fall asleep while driving or operating machinery, or other similar opportunities for catastrophe.
Sleep apnea is known to affect at least one person in 100 in the United States, and may affect as many as one in five, making it roughly five times as common as adult onset diabetes. Specialists in the disorder have declared their suspicions that the disease may be responsible for half or more of the traffic accidents on US roadways every year, although no reliable studies have ever been produced to affirm or deny this contention.
Who gets sleep apnea?
Scientists who study the disorder have stated that it is difficult to obtain a complete profile of central sleep apnea sufferers. The relative rarity of the disorder (about one in thirty apnea sufferers have the central form) makes it difficult to study, and the fact that most apnea patients are never diagnosed or studied does not improve the situation. However, they note that it is more common among males than females (75% of apnea sufferers are male), and generally is seen in individuals in their late twenties to mid-thirties, although the disease can strike at any age. This is in itself a striking departure from the norm: most patients with the obstructive form of sleep apnea generally manifest symptoms between age 35 and 50. Other risk factors for central sleep apnea include:
• Obesity
• Trauma to the head (such as concussion)
• Trauma to the pneumothoracic area (such as a punctured lung, open heart surgery, or injury to the diaphragm)
• Abnormal muscle spasms or failures to activate muscles
• Stroke
Central sleep apnea can only be confirmed by somnologram (sleep study), which measures brain activity, respirations, chest and abdominal expansion, heart rate and oxygen saturation levels in the blood, among other items. Individuals who have undergone this testing procedure, however, relate that sleep is in short supply for the night of the test. The lack of familiar surroundings, of course, contributes, however, the most common complaint was the number of wires, sensors and tubes necessary for the study (for the record, sleep technicians at John Hopkins stated that it encompassed twenty-two sensors, 35 wires, two tubes and an average of thirty minutes to put the sensor suite on). Participants are video-taped by special low-light cameras, and the entire six-hour study is recorded onto about two reams of paper. Results and interpretations are forwarded to the doctor who ordered the study.
Treatments
Central sleep apnea has few treatments currently available, which is one reason that it can be so devastating to sufferers. The conventional constant positive airway pressure (CPAP) therapy (essentially a machine that blows hydrated air into the nasal passages to prevent airway collapse) works well on the majority of obstructive apneas, but is successful also in treating a small percentage of central cases. Even the more advanced bi-level machines, which use sensors to determine breath flow and adjust airway pressure accordingly, are largely ineffective. Surgical remediation is possible for some people, which involves the implanting of a pacemaker-like device behind the sternum to stimulate the diaphragm into contracting and thus cause breathing. However, in cases where the central nervous system fails to stimulate the thoracic muscles (which inflate the chest) as well as the diaphragm, surgical remediation may be impossible.
Dieting and exercise to lower weight is generally advised, as is quitting use of artificial stimulants, alcohol and tobacco. Other lifestyle management changes, such as yoga, breathing exercises and similar efforts have proven efficacious in some cases.
What should I do if I think I might have central sleep apnea?
Speak with your primary care physician or an ear, nose and throat specialist (generally found in the yellow pages under Physicians-Otolaryngology) about your symptoms. If there is enough evidence, he or she will order the sleep study and then will discuss treatment with you. If you are a sufferer, there are support groups and other help available for you; if your doctor does not know who provides this support in your area, a quick web search should reveal several promising sources. The National Sleep Apnea Association (http://www.sleep-apnea.org) maintains chapters across America and can point you toward assistance.
Above all, remember that the disorder does not define you. Many people, perhaps many more than we even suspect, suffer from the same illness that you do. And, over time, as our knowledge of the human brain and human nervous system improves, we will develop effective and permanent treatments for central sleep apnea. Like so many diseases, we know it can be cured. We just don’t yet know how…
Reference:
- The Mayo Clinic webpage on sleep apnea www.mayoclinic.com/health/sleep-apnea/DS00148/FORCESSL=false The American Sleep Apnea Association www.sleepapnea.org/info/ ; The National Sleep Foundation www.sleepfoundation.org/hottopics/index.php?secid=8&id=70
