Healthy Living News — November 2009

Obstructive sleep apnea (OSA) is a common disorder. If you have sleep apnea, your throat becomes blocked during sleep. You stop breathing for short periods of time. You may snore loudly, then be very quiet. You might also gasp or snort in your sleep. Your breathing may be interrupted over and over again throughout the night, disrupting your sleep. Even though you don’t remember waking up often during the night, you feel tired all day.

Sleep apnea may have serious consequences.  It may be associated with restless sleep/heavy sweating, excessive daytime sleepiness, intellectual deterioration, impotence, short-term memory loss, gastro-esophageal reflux, high blood pressure, and uncontrolled diabetes.

During normal sleep, your throat muscles keep your throat open and air flows into your lungs. However, in obstructive sleep apnea, the throat briefly collapses, blocking your intake of air. This happens when:

• Your throat muscles and tongue relax more than is normal.
• Your tonsils and adenoids are large.
• You are overweight. The extra soft tissue in your throat makes it harder to keep the throat area open.
• The shape of the bones in your head and neck provide a smaller than usual airway in the mouth and throat.

To diagnose sleep apnea, after your initial evaluation, your doctor may refer you for a Sleep Test.  You will stay overnight at the sleep lab and specialists there will use a polysomnogram (PSG) to record information while you sleep. The PSG is a painless, risk-free test. You will go to sleep as usual and a sleep center technician will watch you on a monitor to make sure the equipment is working. The PSG will record certain clinical measures of sleep apnea such as brain activity, eye movement, and the percentage of oxygen in your blood.  You may sleep all night while the test is being conducted or the test may be divided into two parts.

This second kind of test is called a ‘split night study.’ Many doctors prefer the split night study because it provides more information quickly. Patients frequently prefer the split night study, too, because it means keeping just one appointment.  During the first part of the split night study, your sleep is monitored. If you show signs of sleep apnea, the sleep center specialist wakes you to start treatment with a continuous positive airway pressure (CPAP) device. The CPAP is a soft plastic mask connected to a flexible hose and a small air blower. The blower sends a gentle, steady stream of air through your nose into your throat. This keeps the throat structures from blocking your air passage. The specialist will continue to watch you on the monitor as you use the CPAP and make any necessary adjustments to make the CPAP comfortable.

If you have mild sleep apnea, you can make changes to improve or even cure the problem. These changes might be all you need or they may work best when used along with other types of treatment.

• Sleep on your side instead of your back. Sleeping on your side may help keep your throat open.
• Avoid alcohol, smoking and medications that make you sleepy. They can make breathing slower and more shallow. They also make your muscles relax, which can cause or worsen sleep apnea.
• Lose weight if you are overweight. Extra weight puts pressure on your neck tissues and lungs, making breathing harder.
• Exercise regularly. Exercise can help you lose weight, tone your muscles, and make your lungs work better.
• Unblock your nose. If a stuffy nose makes it difficult to breathe at night, treating the problem can help treat sleep apnea. Your doctor can suggest medications for allergies or sinus problems. Nasal strips applied to the bridge of the nose can aid breathing. If physical problems, like a deviated septum or polyps, are blocking your nose, your doctor may recommend surgery.

The CPAP (continuous positive airway pressure)device (described above) is the most common treatment for moderate to severe sleep apnea. CPAP has been shown to reduce daytime sleepiness, risk of heart problems, high blood pressure and car accidents due to sleep apnea. It also improves quality of life for patients with the condition.

If these lifestyle changes and/or devices aren’t enough, surgery can help some people with sleep apnea. A variety of surgeries are used, ranging from removing the tonsils, adenoids or uvula (the tissue that hangs from the back of the roof of your mouth) to restructuring the nose and the lower jaw.

CRMA operates two sleep centers; one located at 600 Worcester Rd, Framingham, and the other at 246 Maple St, Marlboro.  Dr. Meena Mehta is a board certified sleep specialist who runs our program and is available for consultations in addition to sleep tests.  If you’re experiencing symptoms of sleep apnea, feel free to discuss with your primary care physician whether a sleep test would be appropriate for you.