In the US, an estimated 22 million adults reportedly have sleep apnea, accounting for one in every fifteen adults. The issue is further compounded by the fact that four fifths of individuals with the condition remain undiagnosed. The intensity of the condition is broadly classified in to mild, moderate and severe, with prevalence rates of 10 percent, 3.5 percent and 4 percent respectively. One of the adverse fallouts or side effects of sleep apnea that remains undiagnosed is the elevated risk of exposure to cardiovascular events and diabetes. The effect on metabolic health manifests in various conditions and could pose long term implications.
What is sleep apnea and what are the different categories?
Patients with the condition end up with sudden abruptions in breathing while asleep. One of the common indicators of the condition is extreme tiredness despite proper sleep, and heaving snoring in individuals. The condition is known to have a higher rate of prevalence among men, than women. However, women are known to have the condition upon reaching menopause. There are three different types of sleep apnea – obstructive sleep apnea, central sleep apnea and complex sleep apnea. The first condition is more common among the three different types of sleep apnea. The aim of treatment of sleep apnea is to manage the symptoms and to prevent adverse fallouts of the condition – cardiovascular events and impact on metabolic health.
Most individuals tend to regard the condition as affecting only obese individuals. However, it is not entirely true, as the condition also affects individuals who are not overweight. The condition occurs mainly as a result of relaxation of the upper airway muscles which in turn result in lesser intake of air when breathing. This results in lesser oxygen intake during the pause which is known to sometimes be as much as 10 or more seconds. This break in breathing often results in the body’s reflex and response mechanism restoring breathing. Breathing does not fully stop, but experiences a break for a short duration.
Different types of sleep apnea and severity :
Obstructive sleep apnea refers to the pause in breathing attributed to a relaxation of the throat muscles. This is the most common among the three sleep disorder conditions. Central sleep apnea refers to the condition that results in pause in breathing as a result of improper transmission of signals to the muscles from the brain. Complex sleep apnea refers to the combined condition of both obstructive and central sleep apnea.
Severity is broadly categorized into severe, moderate and mild, and this is assessed or evaluated through a metric/measuring system known as AHI, acronym for apnea-hypnopea index. The system calculates the total number of breaks in breathing per hour when the individual is asleep. Severe condition refers to individuals with readings of 30 or more breaks or episodes per hour. Wherever the readings count anywhere between 15 and 30 breaks or episodes per hour, the individual is known to have the moderate condition. Wherever, the AHI readings are below 15 breaks or episodes, the individual is known to have a mild condition. Treatment needs are driven by the condition and the possibility of adverse effects in the future if left untreated. Sleep apnea is known to progress into various health conditions including cardiovascular complications with possible impact on metabolic health, and treatment is typically extended if there is a possibility of such impact.
How can sleep apnea be identified?
There are tell-tale symptoms that help identify the condition. Popular misconceptions link snoring to sleep apnea, though it is incorrect to link the two. For instance, while patients with sleep apnea may snore, it is also possible that patients with the condition may not snore. Importantly, all individuals who snore will not have sleep apnea, and this is reason enough to look at snoring as a symptom only when other symptoms indicate the condition.
There are outcomes of sleep apnea that can help an individual identify or circle back to the causes. For instance, patients are known to experience fatigue during the day, despite having apparently slept for a sufficient duration of time during the night. Other conditions that are indicative include behavior that is slightly unpredictable, with possible changes in mood. The behavior of the individual may differ from behavior seen or witnessed earlier. These conditions are primarily as a result of less quality sleep. While the duration of sleep may appear lengthy enough, the actual quality of sleep may be compromised, resulting in lack of deep slumber that is essential for the body and mind to carry out repair and restorative functions.
Individuals may find themselves with lesser state of alertness or impaired reflexes. Similarly, individuals may also find performance at academics dipping, while professionals at the workplace may be either inattentive or suffer from lesser productivity. The ability to stay focused may be affected, causing issues either at the workplace or in social settings.
Two symptoms help identify the condition easily :
- Experiencing dry mouth in the morning after waking up from sleep. The condition involuntarily forces individuals to sleep with mouths open during the night due to the frequent breaks in breathing. A s a result of sleeping with the mouth open, the individual wakes up with a dry mouth as the saliva dries up during the night.
- Headache in the mornings. Sleep apnea causes a reduction in the amount of oxygen received by the individual. The condition also increases the amount of carbon dioxide as a result of the changed breathing pattern. These two conditions trigger headaches in the patients.
What kind of health issues will a person face as a result of the condition?
Depending on the severity of the condition, the patient may face health issues at a later stage in life, due to progressive degradation of health. The metabolic health of patients are affected and this can result in a reduced life span of the individual. Commonly associated diseases include diabetes, risk of cardiovascular events - heart attack and stroke. Obesity is linked to sleep apnea, and all obese individuals are at elevated risk of diabetes and heart attack and stroke. This automatically places patients with sleep apnea in the category of patients at risk of these conditions. As it gradually affects metabolic health, these conditions worsen, and a large number of patients are known to end up with an increase in blood glucose levels, when the condition is left untreated.
How is sleep apnea treated?
Treatment of sleep apnea begins with a test to determine the severity levels. Equipment that are wired to the individual during sleep are used to assess and monitor the oxygen intake during different phases of sleep. In most instances, portable equipment are used to assess the condition, and in certain cases, it may be necessary to conduct the tests in a laboratory overnight. Specialized equipment in the laboratories carry out a battery of tests to assess the condition.
Treatment options are holistic in nature; and include medication, apart from lifestyle modifications, and weight management wherever necessary. One of the reasons for snoring or breathing related sleep disorders are a reduction in the throat’s diameter as a result of fat accumulation in the neck of obese patients. Obesity also causes the lungs to experience some form of pressure from the force of exertion of the excess fat in the body, which in turn impacts the smooth functioning of the airways. Breathing related sleep disorders occur when the airway collapses during sleep and therefore sleep apnea treatment includes weight management.
Gender wise, more men than women are known to suffer from the condition. However, women slip into the high risk category post menopause as a result of the changes in body after menopause. The increase in weight and fat accumulation around the stomach exposes women to the risk of sleep apnea, and the best preventive method is to work on reducing weight in this stage of life.
What is CPAP used in treatments?
Equipment used for treating sleep apnea includes CPAP (Continuous Positive Airway Pressure) device. This is essentially a device that humidifies air through the nasal passage, and maintains the steady or required amount of air pressure to keep the throat open during sleep. By ensuring that the throat is open during sleep, through steady air pressure the patient breathes normally during sleep, and this also improves the quality of sleep of the individual. Patients with the CPAP device tend to sleep undisturbed by the pauses in breathing, and enjoy proper rest to start the next day rejuvenated.
As mentioned earlier, sleep apnea affects metabolic health and increases blood pressure, blood sugar levels if left untreated. The use of the device has been studied in detail and is known to help control diabetes and blood pressure levels. In addition to offering a rejuvenating night’s sleep, controlling blood pressure blood glucose levels, treatment methodologies help in lowering the risk of cardiovascular events.
Who is at risk of developing the condition?
While the condition can develop in anyone, there are certain categories of individuals who may be prone to higher risk of developing the condition. For instance, obesity is linked to sleep apnea, though it is not necessary that every obese person may have the condition or vide versa. Women in post- menopausal stage are at risk of developing he condition, for reasons mentioned earlier. Sleep apnea is also an age-related condition for a small section of people, and therefore puts the elderly at risk of the condition.
Genetically inherited narrow airways are also a reason for sleep apnea and places individuals at risk. The condition may also be inherited and individuals with a family history of the condition are at elevated risk. Other reasons for possible risk include patients with thick necks. This may have an impact on the airways and end up with possible development of snoring, sleep apnea. Smokers are also at risk of ending up with the condition, while other strong intoxicants are also known to have a possible impact, and result in the development of sleep apnea. Other categories of individuals include those with a history of frequent allergies that result in nasal congestion. Finally, certain ailments are known to be a reason for development of the condition. This includes type 2 diabetes, certain hormonal disorders, and hypertension. The list of ailments that contribute to the risk of sleep apnea includes congestive heart ailments, Parkinson’s disease and patients with polycystic ovary syndrome, asthma and those who have had a stroke in the past.
Family members can help in identifying the condition at an early stage and take suitable remedial measures to mitigate and treat the condition. This is mainly because of the inability of the patient to be aware of a possible snoring problem or to identify the breaks in breathing during sleep. Most patients may not be aware of this break in breathing, and may only experience fatigue, tiredness during the day for unexplained reasons.