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Sleep Apnea

more about Sleep Apnea

  • Sleep Apnea means there are intermittent periods during sleep where the individual stops breathing.  By definition, the not breathing episode needs to last at least 10 seconds, an average of 20 to 30 seconds, and can last up to 3 minutes.  Generally, there are 10-15 episodes per hour.  There are three types (causes) of Sleep Apnea: central, obstruction, or mixed.  Central Sleep Apnea occurs because the respiratory drive in the brain is suppressed, or the muscles and nerves that control respiration are functioning abnormally.  Usually, the carbon dioxide level, which normally causes respiratory drive, is higher than normal (so it does not kick in when it should).  Obstructive Sleep Apnea is where the throat-pharynx narrows during sleep and obstructs airflow to the lungs.
  • Sleep Apnea results in insufficient oxygen, and can affect thinking ability, which causes behavioral changes.  The apnea Spells also can cause the heart rate to slow, become irregular, or have dangerous heart arrhythmias.  In addition, the low oxygen levels "wakes" the individual, causing them to start breathing again.  This results in poor quality sleep and daytime sleepiness.

  • Episodes of apnea (stopping breathing) as described above
  • Snoring
  • Daytime sleepiness
  • Confusion
  • Behavioral changes
    1. Slow thinking
    2. Fatigue
    3. Memory loss
    4. Impotence

  • Central:

    1. Metabolic control of the airway is impaired e.g., respiration does not "kick in" when carbon dioxide levels in the blood rise.
    2. Respiratory drive center in the brain is not working properly e.g., from a Stroke, heart disease, or lung disease
    3. Neurological reflexes (undesirably) inhibit the central respiratory drive in the brain, e.g., esophageal Reflux or aspiration
  • Obstructive:
    1. Increased airway muscle tone (so less air gets in)
    2. Increased airway lumen tone
    3. Decrease upper airway pressure (below atmospheric so upper airways collapse)
    4. Obstruction of part of the airway

  • Sleep study called polysomnography-measures the stages of sleep, ventilation, oxygen saturation, and the heart rate.
  • Evaluation by an Ear, Nose, & Throat Specialist may be needed in obstructive Sleep Apnea

    1. Increased airway muscle tone: Mild -- avoid alcohol and sedatives, Severe -- tricyclic antidepressants
    2. Increased airway lumen size: Mild -- avoid sleeping flat on back, weight loss, oral prosthesis device, Severe -- Uvulopalatopharyngoplasty (procedure where the uvula and part of pharynx are opened surgically)
    3. Decreased upper airway pressure: Mild -- improve nasal patency, severe -- CPAP (continuous positive airway pressure) which forces the airway open
    4. Occlusion: Severe -- tracheotomy
    1. Supplemental oxygen
    2. Acetazolamide
    3. Nasal CPAP (continuous positive airway pressure)

more about Sleep Apnea

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