Why a Sleep Apnea Diagnosis May Save Your Life

by Yoni Freedhoff, MD (assistant professor of family
medicine at the University of Ottawa) in U.S. News&
World Report – Feb 7, 2013

It’s one of the most under diagnosed conditions around, and I’d argue that, in a sense, the diagnosis of sleep apnea is more a blessing than a curse.

For those who aren’t familiar with sleep apnea, its most common form, obstructive sleep apnea (OSA), causes sufferers to stop breathing periodically throughout the night, or breathe so shallowly that the oxygenation level of their blood plummets, leaving their bodies in an almost nightlong state of metabolic panic.

In severe cases, a person may wake up dozens of times an hour, yet these micro-awakenings aren’t usually conscious ones, and so sufferers might well have no idea they’re even happening. More than just a tiring nuisance, people with OSA are at greater risk of developing a myriad of medical conditions including heart disease, heart attack, obesity, depression, and sudden death.

While weight itself is a tremendous risk factor for the development of OSA, neck architecture is also involved, consequently, simply because you might be at a lighter weight doesn’t exclude you from the possibility of having OSA.

Symptoms of sleep apnea vary, but the most common ones include never feeling well rested, even after a good night’s sleep; excessive daytime or afternoon sleepiness; and morning headaches. Partners of individuals with OSA may complain that they snore excessively; they may also note hearing pauses in their partner’sbreathing, which often resumes with grunts, gasps or snorts.

he gold standard of screening tests involves spending a night in a sleep lab hooked up to more electrodes than you can imagine. And while being hooked up to electrodes does make it more challenging to sleep, you only need to be out for an hour or so to get a definitive reading.

The reason I suggest the diagnosis is more a blessing than a curse is how incredibly effective OSA’s non-drug treatment can be, and how life changing it often is. People who’ve suffered unknowingly with OSA will sometimes report, even after a single night of treatment, that they feel more energetic than they have in years. So besides reducing the risk of sudden death, treatment markedly improves quality of life.

Treatment options vary from devices that help to keep a person off of their back (where OSA is often worst) to dental devices as well as CPAP machines, which use air to keep the airways open, and even surgeries.

If you’d like to take a simple test to determine whether or not you might want to consider testing for sleep apnea, just answer the following eight questions. If you reply with three or more yeses, I’d strongly encourage you to ask your physician to organize a night for you in the sleep lab.

1. Do you snore loudly?
2. Do you feel tired during the day?
3. Has anyone ever told you that you stop breathing during your sleep?
4. Do you have high blood pressure ?
5. Is your BMI greater than 35?
6. Are you older than age 50?
7. Is your neck size greater than 15.75″?
8. Are you male?

STUFFY NODE?

(Reprinted from the Spring 2010 Sound Sleeper)

One of the most frequent complaints of CPAP users is of nasal congestion using CPAP. An examination of this problem proved it is far more complex as to the cause and solution than first imagined.

There have been only a few studies of this specific problem but these suggest that CPAP itself is not the culprit and, in fact, CPAP results in a reduction in nasal resistance 2 to 3 hours after commencing use due to the mechanical splinting effect and/or reduction of vascular fluid in the nasal membrane. Therefore the cause of nasal congestion must be due to something else. Chief among the causes identified are; mouth breathing, the change to a more recumbent posture (i.e. lying down), nasal dryness, allergy, and/or the “rebound” caused by the use of decongestants, or Rhinitis/Sinusitis.

Examining each of these potential causes of congestion may offer a clue as to what your individual problem is and what steps can be taken to achieve relief.

Mouth breathing is known to increase nasal obstruction and can be alleviated by the use of a chin strap or switching to a full-face mask. A recumbent posture normally causes a slight increase in nasal resistance. If lying down with CPAP causes nasal congestion to the point making it difficult to breath through the nose this would tend to indicate a pre-existing nasal obstruction or structural physical problems with the nasal passages may be the cause. If the stuffiness goes away when you remove your mask and get up the problem is most likely postural. In any case an examination of your nasal passages by a physician is in order. Nose drops or nasal spray may help but rely on your doctor’s recommendation.

Nasal Dryness can be a cause of irritation and resulting swelling of the nasal passages. The solution can be as simple as squirting a saline solution (e.g. Ocean brand) into each nostril before putting on your CPAP mask and again several times during the day. If this doesn’t work than investigate the addition of a humidifier to your CPAP machine.

Allergies can cause inflammation and can cause difficulty breathing. Over-The-Counter (OTC) allergy medications treat the symptom (i.e. inflammation) not the cause (allergy) and even then only for a little while. You need to talk with the physician who is treating your allergy and they need to know that you use CPAP and the breathing problem you are having.

“Rebound” caused by the use of decongestants is perhaps one of the commonest “self-inflicted” causes of nasal inflammation. Most decongestants are designed for short-term use to decrease congestion and they will cause inflammation if used over extended periods. Beware the “OPXs” – look at the ingredients on the package and avoid those containing the following: Oxymetazoline (e.g. Afrin), Phenylephrine (e.g. Neo-Synephrine) and Xylometazoline (e.g. Sudafed or Sinex). They will all cause “rebound” nasal irritation. Your physician can prescribe one of several nose drops that can be safely used for extended periods without causing inflammation or “rebound” in the nasal passages. One of these is the antihistamine Azelastine (e.g. Astelin).

Rhinitis/Sinusitis is really a fancy name for inflammation of the nose and/or nasal passages. Anything that irritates the nose can cause rhinitis. Changes in weather, such as temperature, humidity, and sudden barometric pressure changes often aggravate an already inflamed nose. Many systemic diseases can also impact rhinitis. The most common cause is allergies, but diabetes, high blood pressure, and many medicines can be also effect rhinitis. Treatment first involves getting a diagnosis of the cause of the Rhinitis.

Treatments vary from avoidance of offending substances such as; smoking, symptomatic overthe- counter medicines known to contain an irritating decongestant and prescriptions with similar ingredients. Reducing or eliminating Rhinitis can be a difficult process to resolve alone. What may be tolerable to one not using CPAP may not be tolerable for one on CPAP. Again you need work with a physician with complete knowledge of your problem.

A stuffy nose is not caused by CPAP and abandoning CPAP will not cure a stuffy nose!

day requires adequate healthy sleep at night. It has been said that we sleep so that we will not be sleepy. At this time, we simply do not know what the sleeping brain is doing and why it is doing it, at least not the same way we know what the waking brain is doing and why. When we are awake, the major task of our brain is to orchestrate our behavior in the world. This requires learning, remembering, moving about, projecting ourselves into the future, planning – all those things that concern our interactions with our external environment in the service of our survival as individuals and as a species. Since we have no conscious awareness of what our brains are doing during sleep it is though that period of time is “shut off” and only others can report to us what are bodies were doing during our sleep.

We know that sleep is a primary function of our brains, occupying nearly a third of its activity each day and strongly affects us during the remaining, wakeful two-thirds of the day if we do not obtain optimal sleep quality and quantity. We now realize that a number of medical disorders are specifically related to the sleeping brain and not the waking brain.

Why does sleep overtake us, even under circumstances when nodding off might threaten our very lives? The reason must be that the brain has something else to do – or many things to do – that cannot be done when it is preoccupied with sensing and responding to the environment. It seems highly likely that the functions and tasks of the brain in sleep relate to maintenance of the organism in ways we do not fully understand. Furthermore, it would be absurd to hypothesize that the brain in sleep performs but a single task. We know that the brain in sleep is an active brain; it no more “shuts off” when we fall asleep than the liver, pancreas, heart or lungs do. In fact, in the mode of sleep call REM sleep, brain activity revs up to levels equal to or greater that those attained in the waking state.

Animal studies show that sleep is necessary for survival. For example, while rats normally live for two to three years, those deprived of rapid eye movement (REM) sleep survive only about five weeks on average, and rats deprived of all sleep stages live only about three weeks. Sleep-deprived rats also develop abnormally low body temperatures and sores on their tail and paws, possibly because their immune systems become impaired.

Some experts believe sleep gives neurons used while we’re awake a chance to shut down and repair themselves. Without it, these brain cells may become so depleted in energy or so polluted with byproducts that they begin to malfunction.

(Excerpts from The Sleepwathchers by William
C, Dement, M.D., 2nd ed. 1996).