Getting a Good Night's Sleep

by Andrew Elias

Sleep apnea affects more than 15 million Americans and too many people suffering from the condition are either unaware of the problem or foolishly not concerned about the health risks, which are serious. Although those who suffer from sleep apnea are more often male, over age 40 and overweight, sleep apnea can strike anyone at any age, even children.

Sleep apnea is a serious health problem and far too many people remain undiagnosed and therefore untreated. If left untreated it can cause high blood pressure and other cardiovascular diseases as well as memory problems, impotency and headaches. It can also affect job performance and is the cause of many work-related and automobile accidents.

Fortunately, sleep apnea can be easily diagnosed and treated. I spoke with Dr. Don McAlpine, Pulmonologist with Internal Medicine Associates, who have recently opened a Sleep Lab in Cape Coral, about sleep apnea.

A lot of people suffer from sleep apnea without knowing it. Why should they care?

Dr. Don McAlpine: People who snore or complain of day fatigue, that may be overweight or have high blood pressure should be concerned. They have a higher risk for stroke, heart attacks and cardiac arrythmias.

What happens when you have an apnea episode?
They experience an obstruction of the upper airway during sleep. Relaxation of the muscles of the throat, tongue, soft palate and the uvula (the dangling portion at the back of the throat) blocks the airway. This increases the intensity of the snoring and can lead to labored breathing. Breathing can even stop altogether. When this apneic episode occurs, oxygen levels are reduced, carbon dioxide levels can increase. The brain is alerted and causes an arousal, and breathing then resumes. A loud snort or gasp is usually heard, and then normal breathing is resumed. With these frequent arousals, normal restful sleep is interrupted. The individual is prevented from getting sufficient restorative sleep, deep sleep.

What causes sleep apnea?
Being overweight, alcohol use, and sedating medications can aggravate sleep apnea. Some apneic episodes are aggravated by sleep position, like sleeping on your back. Sleep apnea is the obstruction of the upper airway, from the nose to the vocal cords. It can be caused by relaxation of the muscles of the neck, tongue, and soft palate—or it can be caused by structural abnormalities including tonsillar enlargement, adenoids, nasal polyps, and nasal turbinates.

What are the symptoms of sleep apnea?
Daytime fatigue, frequent naps, falling asleep at inappropriate times. High blood pressure, sexual dysfunction, and memory difficulties may be the only manifestations. Some symptoms suggesting sleep apnea include depression, irritability, sexual dysfunction, and falling asleep at work, while watching TV, on the phone, or even while driving.

What are the short-term and long term effects/risks?
People with sleep apnea don't get restful sleep. They can sleep 8 hours at night and still feel tired. They have poor concentration, forgetfulness and fall asleep at inappropriate times. These individuals are at higher risk for not being alert enough during the day. It’s estimated that they are three times more likely to be involved in a motor vehicle accident.Recent research has demonstrated an association with high blood pressure, heart attacks and stroke.

How do you treat sleep apnea?
There are a number of treatments available, depending on the severity of the sleep apnea. CPAP (Continuous Positive Airway Pressure) is the most common non-surgical way to treat sleep apnea. The patient wears a mask over the nose which blows air through the nasal passages preventing the airway from collapsing during sleep. There are a number of different CPAP devices available tthat varies the pressure to allow the patient to fall asleep with the apparatus. Some people can be treated with the use of a dental appliance.

Does everyone who snores have sleep apnea?
Not everyone who snores has sleep apnea. People who have symptoms of daytime fatigue, frequent night time awakenings, and witnessed apneic episodes should be evaluated. This is accomplished by performing a sleep study (polysomnography). This test records electrical activity of the brain, air flow, chest and abdominal wall motion, oxygen levels, heart rhythm, body position, and muscle activity. With this data the presence and the severity of sleep apnea can be accessed.

What does a patient experience at a sleep study lab?
Patients are fitted with electrodes to monitor their brain waves (EEG), monitors of airflow from their nose and mouth, heart monitor, oxygen monitor, muscle activity monitors and position monitors. People often ask,“how am I going to sleep with all these wires?” Most people will, eventually. We need only a small window to see what is happening during sleep. Sometimes patients will have to return for a second night to allow us to titrate the CPAP machine.

What advice can you give to someone who suffers from sleep apnea—or to someone who lives with someone with sleep apnea?
Get it checked out. Patients are always amazed at how great they can feel if they actually sleep. •

For more information about the IMA Sleep Lab, call 936-1343.

from the March-April 2005 issue

People who suffer from
sleep apnea are three times
more likely to be involved
in a motor vehicle accident.

American Sleep Apnea Association

National Sleep Foundation

National Heart, Lung & Blood Institute