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Sleep Apnea

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“Yeah, I snore a lot. Champion snorer in my family. So what’s the big deal?”

Apnea means “without breath.” If apnea continues for four minutes, you will die. It’s a big deal. If apnea occurs while you are sleeping, you will not know it. Fortunately, your body has warning systems and mechanisms that will try to correct the problem, but only after 30-45 seconds of “without breath.”

The result is your body, while you sleep, seesaws between normal oxygen levels and depleting oxygen levels, between normal breathing and increasingly strenuous struggles to breathe. The consequences are: increased adrenaline (sympathetic activity), increased blood pressure, increased heart rate, increased airway swelling, increased fluid in the lungs (negative pressure pulmonary edema),shifts in blood flow away from bowel and liver, loss of deep sleep and REM sleep. The effect on the body is hypertension, congestive heart failure, worsening coronary disease, worsening asthma and COPD, weight gain, worsening bowel and liver function, dangerously severe sleepiness during the day, inability to think logically or creatively, worsening mental clarity.

The cause of sleep apnea is an anatomically closed airway: too much fat pushing in on the airway (overweight), swelling (infection, allergy, edema – like in hypothyroid), muscular relaxation (nicotine, alcohol, pain meds – or old age), looseness of airway tissue (hypothyroid or loss of tissue elasticity in old age), enlarged tongue (hypothyroid and some facial deformities), enlarged tonsils or adenoids (in kids). The diagnostic problem is that the airway extends from the nose (and mouth) all the way to the voice box (larynx). Treatment for the problem depends on the cause AND where in the airway the obstruction is.

Some obvious general treatments include: weight loss, hypothyroid treatment, allergy or rhinitis treatment, avoidance of alcohol and nicotine, adjustment of pain meds. For some mild cases changing the position you sleep in (elevate the head of the bed, small pillow at the back of the neck, sleep on your side) may suffice.

Treatment for more persistent cases requires specific, anatomical interventions. Nasal strips might work for nasal opening obstruction only. Oral appliances in the mouth might work for enlarged tongue or slack throat tissue only. Surgery might work for internal nose, back of the nose, or back of the throat obstruction only. Continuous positive airway pressure (CPAP) machines can be cumbersome, but they work for almost every type of airway obstruction. Therefore, they are usually the first intervention tried by most clinicians. Of course, no treatment works if it is not used every night. You are not treating the snoring or breath loss; you trying to prevent the disastrous results. And caffeine is NOT a treatment.

Do you need to be treated? Ask your family two simple questions, “Do I snore?” and “Do I stop breathing while I am asleep?” If the answer is yes to either question, you need a sleep study to determine how often you stop breathing and how low your oxygen goes when you do. You also need a physical exam to try to determine where the obstruction is before assuming that any one treatment is right for you.

Don’t mess around. Sleep apnea is dangerous and potentially lethal. Find out today.

Author

Max Wayne Hammonds was born Aug 3, 1943, in northeastern Indiana, in the county hospital in Wabash. He attended high school and college in his home town of North Manchester and attended Indiana University Medical School in Indianapolis. Following an internship in South Bend, IN and a year of flight medicine in the Air Force, he took a residency in anesthesiology at Wilford Hall Medical Center at Lackland Air Force Base in San Antonio, TX.