Sleep Apnea

In February of 2008, two pilots flying from Honolulu overshot their destination by 30 miles because they had fallen asleep in the cockpit.

The flight, carrying 40 passengers, was supposed to land at their destination in Hilo, Hawaii in 45 minutes. When the flight kept going, the air traffic controllers got concerned and tried to contact the pilots, to no avail. Nearly 17 minutes had passed until air traffic control was able to get in contact with the pilots.

Eventually the plane had to circle around and landed safely. But for the captain of the flight, it cost him his job. It was later revealed that the captain had suffered from undiagnosed severe obstructive sleep apnea (OSA), a disorder that causes a person to stop breathing several times during the night – leaving a person sleep deprived, even if they went to bed at a decent hour.

Imagine for a moment that you are finally sinking down into your bed after a long day. Your legs are weary from running around and you can barely keep your eyes open. You are slowly drifting off to sleep as your body starts to relax.

Now imagine someone holding a pillow over your face for several seconds at a time while you are sleeping. You wake up gasping for air. Imagine that this happens between 400 to 600 times throughout the night. Most likely, in the morning, if you haven’t passed out from suffocation, you would report that you had some trouble sleeping.

For more than 20 million adults with obstructive sleep apnea (OSA) this is how they sleep.  

What is Obstructive Sleep Apnea (OSA)?

Apnea literally means “without breath.” While you are sleeping, the body enters a relaxed state. The muscles in your neck that hold your head up during the day loosen up during the night. When this happens, the airway in your throat narrows slightly, which is completely normal.

For people with OSA, as the body starts to drift deeper and deeper into sleep, the muscles become more and more relaxed, collapsing the airway, eventually cutting of the oxygen supply for several seconds at a time. At this time, your body is screaming at your brain to wake up, and breathe again. When you do, you wake up with a loud snore or snort, or gasping for breath.

Eventually, you start to drift off to sleep again, and the throat closes up again. This process can happen hundreds of times during the night. It usually happens so quickly, that you don’t even realize that you stop breathing at night, leaving you feeling exhausted in the morning – even after a full night’s rest.

It would be as if you are going snorkeling and someone threw a ping-pong ball in your breathing tube. You would have to work harder to clear the obstruction so you can breathe again.

What are the causes of OSA?

For people with Obstructive Sleep Apnea, the airway in the throat is completely blocked due to fatty tissue in the neck, enlarged tonsils, jaw deformities, large tongue, or a long uvula (the ball-like thing hanging in the back of your throat). Narrow or blocked nasal passages can also cause OSA.

OSA can occur in both men and women, children and adults. However, it is most common in middle aged, obese men. The more fat you carry on your body, the more at risk you are for OSA, since fatty tissues can block the airways in your throat.  People with a short neck and who have a circumference of more than 17 inches are also at risk for OSA.

Sedatives such as alcohol or sleeping pills cause the muscles to relax and narrow the airways. People with undiagnosed OSA often take sedatives thinking it will help them sleep. This can be a lethal combination since the sedatives worsen the conditions of OSA.

Sleeping on your back, or the supine position as doctors call it, exacerbates OSA because it sends the blockage further down your throat.

What are the symptoms of OSA?

People with OSA are often unaware they have it. They may feel like they never get enough sleep, but never know why.

A bed partner is usually the first to notice OSA. They partner may complain of disrupted sleep due to loud snoring or gasping or choking from the person with Sleep Apnea.

To properly diagnose OSA, your doctor may ask you to complete a sleep study.

Symptoms of OSA include:

• Excessively loud snoring
• Snoring interrupted by patterns of choking or gasping. This is a sign that breathing has stopped, and is usually only noticed by the bed partner.
• Excessive daytime sleepiness and fatigue. Falling asleep at the wrong times, such as behind the wheel or at work.
• Difficulties focusing and concentrating, forgetfulness, anxiety or depression
• Morning headaches or nausea
• Loss of interest in social activities
• Loss of interest in sex
• Impotence in men, and menstrual irregularities in women
• Irritability
• Dry mouth
• Weight gain 

What happens if I don’t get my OSA treated?

While most people regard snoring as a nuisance, it may be an indication of a very serious problem. About half of the adult population snores every now and then, however, 90 percent of habitual snorers show apnea tendencies.

The common complaint among people with untreated OSA is a diminished quality of life. They may not have enough energy to hang out with their friends or family. They can’t seem to stay awake during a conversation with their loved ones. They may be reprimanded for poor work performance due to their inability to focus, or making mistakes they would not normally make.

Here are some other health problems related to OSA:

Cardiovascular problems

People with sleep apnea usually have hypertension (high blood pressure) because the heart never gets any rest while you are sleeping.

Type 2 Diabetes

Studies show a higher prevalence of type 2 diabetes in people with OSA. Doctors are still determining the relationship between the two; however, research suggests that OSA is causing a rise in the need for more insulin (blood sugar) during the day due to low blood oxygen levels at night.

GERD

GERD, or acid reflux, is also something many OSA patients have to deal with. GERD rears its ugly head in the form of heartburn, excessive throat clearing, and chest pain.

Obstructive Sleep Apnea creates a negative pressure or buildup in the esophagus. Since the esophagus is the connector tube between the stomach and the throat, anytime an excessive amount of negative pressure builds up, the esophagus literally works like a straw suctioning up the digestive juices and bacteria from your stomach. This ends up in your throat or mouth instead of staying in your stomach, because of the negative pressure caused by the obstructive sleep apnea.

Brain Damage

Lack of oxygen causes brain damage. This simple fact may seem like a no-brainer (no pun intended) but according to the American Academy of Sleep Medicine, severe OSA causes brain tissue damage, affecting the area of the brain responsible for memory, concentration and cognitive functioning.

News Articles:

To view a recent article in Business Week about the risks of Sleep Apnea, click here.

To view a recent article in The Wall Street Journal about Sleep, click here.