Healthy Manhattan: Waiting to Exhale (and Inhale)

Written by Dr. Cynthia Paulis on . Posted in Breaking News, Posts.


If you wake up in the morning exhausted and find yourself drowsy, unable to concentrate and irritable during the day, you may be experiencing sleep apnea.

Sleep apnea occurs when a person’s breathing is interrupted during sleep. The word apnea comes from the Greek language and literally means "without breath." People with sleep apnea stop breathing repeatedly during their sleep, sometimes hundreds of times during the night and often for a minute or longer.

Obstructive sleep disorder, the most common form of apnea, is a mechanical problem caused by the blockage of the airway when the soft tissue in the back of the throat collapses during sleep.

Another form, known as central sleep apnea, is not a mechanical problem but a signal failure. The brain fails to signal the muscles to breathe while you are asleep. The third form of the disease, complex apnea, is a combination of obstructive and central sleep apnea.

According to the National Institute of Health, more than 12 million Americans suffer from sleep apnea, and many may not be aware of it. Left untreated, it can cause high blood pressure, cardiovascular disease, memory problems, weight 

gain, impotency,
headaches and even death. Sleep apnea has been responsible for
automobile accidents and behavioral problems in children.

Men
are more likely to have obstructive sleep apnea than women before the
age of 50. After 50, the risk is equal. Physicians are seeing a rise in
sleep disorders, especially in obese patients. As patients gain more
weight, fat deposits around the neck, which can narrow the airway. Neck
circumferences of greater than 17 inches are at increased risk for
obstructive sleep apnea.

Alcohol,
sedatives or tranquilizers can relax the muscles in your throat during
the night, which can contribute to obstructive sleep apnea. Smokers have
three times the risk due to the inflammation and fluid retention in the
upper airway.

If
you sleep alone, you may not even be aware you have sleep apnea (unless
your cat smacks you in your face in the middle of the night for
disturbing him when you awake multiple times to go to the bathroom,
another symptom of sleep apnea). If you sleep with a partner, you may be
receiving complaints that you are snoring, which is the most common
complaint and the typical reason someone will seek treatment.

I
recently visited with Dr. Michael Weinstein, the director of the Sleep
Disorder Center at Winthrop University Hospital on Long Island. He
explained that, along with snoring excessively, other reasons patients
seek treatment are feeling tired all the time, poor quality sleep,
waking up through

the
night and "nocturia," the technical term for going to the bathroom
frequently through the night. "Sleep apnea is a stress experience,"
Weinstein says. "It is asphyxiation and the body responds to this
stress."

As we
toured the center, Weinstein explained to me how patients being tested
check in overnight for a polysomnography, the contraption that they are
hooked up to with equipment that measures heart, lung and brain
activity, breathing patterns, arm and leg movements and blood and oxygen
levels while sleeping. The patient is recorded— both video and
audio—through the night, and monitored by a sleep technician.

Treatment
Options One treatment for obstructive sleep apnea is CPAP (continuous
positive airway pressure). CPAP, used for moderate to severe sleep
apnea, delivers air pressure through a mask placed over your nose while
you sleep. It takes some getting used to and will have to be adjusted if
the patient loses weight.

Ron
and his wife Janine, a husband and wife I spoke with recently who asked
that their last names not be used, had a sleep crisis. Janine
complained that she was only getting two hours of sleep because of Ron’s
snoring. "It saved our marriage by being able to sleep in the same
bedroom," Ron said. "This was a positively transforming experience for
the both of us."

Ron
explained that before treatment, he would sometimes "wake up with my
heart racing, feeling dizzy or my tongue was stuck to the roof of my
mouth. I was falling asleep at work and not getting any good rest. Since
the CPAP, we both sleep through the night."

Oral
appliances are another means of keeping the throat open and are easier
to use. "They have been fairly successful," according to Weinstein, who
uses it for patients with mild to moderate sleep apnea.

Another
option is surgery, a radical approach called uvulopalatopharyngoplasty.
In the procedure, tissues are removed from the rear of your mouth and
the top of your throat, along with your tonsils and adenoids. This
surgery has some risks and a long recovery time.

A
friend of mine named Mike (who also requested that his last name not be
used) had the surgery done last year because he couldn’t tolerate the
CPAP. His recovery time was four weeks, which he described as
"unbelievably painful." He was forced to eat broth for a month because
he couldn’t swallow or tolerate other foods.

Mike’s
doctor told him: "I can decrease the number of episodes but I can’t get
rid of the sleep apnea, so don’t think you are going to have the
surgery and it will be magically better, because it’s not…" "I don’t
sleep as well as I would like to, but I sleep better than before the
surgery," Mike says. "I still snore, which wakes my wife, but not as
often."

Would he
recommend the surgery to other apnea patients? "If I wasn’t married, I
probably wouldn’t have the surgery again. I’d live with the sleep
apnea—and die early."

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