Sleep Apnea

Everyone knows the problems with lack of sleep. One is tired, cannot function or think well, has no energy to do anything and is irritable. This is usually secondary to being busy and just not getting enough sleep.

The remedy? Catch up on your sleep! Right? Wrong…

Imagine for a moment a situation where this fatigue occurs every day and is associated with medical problems such as hypertension, heart attacks, increasing symptoms of diabetes and obesity. It is not unusual to hear that a patient such as this has fallen asleep at the wheel. In fact, as the amount of obesity in this country increases so does the incidence of this disease. The disease is called Sleep Apnea and is the result of the tongue, tonsils and other parts of the upper airway collapsing in when one goes into a deep sleep. There are two types of sleep apnea – central and obstructed, with the obstructed being the predominant type. Symptoms consist of extreme snoring with periods of not breathing. The patient awakes in the morning feeling tired, as having not slept, has a dry mouth and usually a headache. While these symptoms are worse with being overweight, they can occur in non overweight people and the disease does increase with age.

There are two challenges to Sleep Apnea. One is the problem of diagnosing the problems and the other is treatment. History of snoring with periods of apnea associated with daytime fatigue is the first clue. To confirm this, one has to have a sleep study. While there are home sleep studies available, the gold standard is still in laboratory, overnight sleep study done by an American Academy of Medicine approved sleep center. It is an overnight study where one sleeps in a nice bed with nice surroundings and is wired for heart rate, breathing, oxygen saturations, brain function, etc. Once this is done, you are referred back to a physician who specializes in sleep medicine for evaluation. This might be an Internist (who specializes in sleep medicine), or an Ears, Nose and Throat Specialist.

The second challenge is that of treatment. Treatment is based on the level of your disease. Mild sleep apnea might be corrected by simple behavior modification-such as sleeping on your side and avoiding sedatives and alcohol before bedtime. Others include weight loss. The gold standard for treatment is the CPAP (or continuous positive airway pressure) machine. It works by mechanically stenting open the airway and preventing the closure of the airway. While this works all the time many people can not tolerate the mask long term. There are several surgical options for people with distinct anatomical problems. A complete evaluation for obstructed sleep apnea should include an evaluation by a Board Certified Ears, Nose and Throat Specialist. They can also tell you about current research on the subject. What ever one does, it is important to realize that this is a serious disease and that you or others in your family should be evaluated promptly if you suspect the disease.

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