Insomnia Answers. If only I could get some sleep!

Sleep Apnea: It's a lot like dying ... and it can kill you!

Sleep apnea is the phrase used for the condition of interrupted breathing during sleep. The breathing may be interrupted for as little as ten seconds, or as much as a minute or more. These episodes of apnea (from a Greek word meaning "without breath") may occur a few times an hour or hundreds of times over the course of a night.

The National Institutes of Health states that sleep apnea is as common as adult diabetes, affecting millions of Americans. Though most common among men over 40, it can affect women and children too. Among the problems and consequences associated with sleep apnea are stroke and a 30% higher risk of heart attack or early death. Recent research seems to indicate that those who suffer from obstructive sleep apnea lose tissue in the brain regions that store memory; in short, OSA may contribute to long-term memory loss. Those suffering from OSA are also at higher risk for diabetes and mini-strokes (transient ischemic attacks or TIAs).

In addition to increasing your risk for stroke and heart attack, the consequences of sleep apnea can kill you if you doze off when you should be wide awake. Recent news items have included instances where an airline pilot drifted off to sleep while flying a Boeing 767 jet. Fortunately for his 184 passengers, the jet was on autopilot at the time and his co-pilot noticed the problem after the pilot had been asleep only a few minutes. Similarly, the driver of one of Japan's "bullet trains" was diagnosed with sleep apnea syndrome after he transported 800 passengers at 185 miles-per-hour for 15 miles while asleep.

People with sleep apnea are five times more likely to suffer from depression than is the general population. Existing depression may be worsened by apnea episodes. Research shows, however, that treating sleep apnea actually reduces depression in some subjects.

If you are going to be having surgery of any type - including oral surgery - you must let the surgeon know if you have or suspect sleep apnea. Assorted anesthetics may have a life-threatening effect on those with OCA. Additionally, tissue swelling following surgery can also be life-threatening to those with breathing problems, so you should discuss with your doctor any indications you may have that sleep apnea could be an issue.

Side effects associated with sleep apnea include excessive sweating at night and a need to arise multiple times during the night to urinate.

Both you and your bed partner are likely to be affected by sleep deprivation. Your bed partner may lose an hour or more of sleep each night just through sleeping next to you. This lack of sufficient sleep by you and your bed partner can lead to "trickle down" effects such as poor mental and emotional health, irritability, slower reaction time, and a less effective immune system.

Types of Sleep Apnea

There are basically three types of sleep apnea:

Obstructive Sleep Apnea - OSA - occurs when there is a physical obstruction of the airway during sleep. Because your body tends to relax during sleep, and because your airway consists of walls of soft, collabsible tissue, it's understandable that your breathing can be physically obstructed while you sleep. Many people suffer mild, occasional sleep apnea during the course of an upper respiratory infection; this is of little consequence. But those who suffer chronic, severe OSA need to seek treatment to prevent or resolve sleep deprivation and other effects.
Central Sleep Apnea happens when the brain fails to send a signal to the diaphragm that "it's time to breathe again." This is a rare form of sleep problem, occurring in fewer than one-half-of-one-percent of those with sleep disorders.
Mixed (or Complex) Sleep Apnea is an even rarer combination of the first two types.

Risk Factors

Most at risk for OSA are those who have poor muscle tone generally and higher-than-usual soft tissue around the airway due to being overweight. Structural features - such as larger tonsils or adenoids, deviated septum, receding chin, or a larger-than-usual neck size - that tend to lead to a narrowed airway also increase the risk.

Men, particularly overweight men above the age of 40, are most likely to have OSA, as are the elderly. Nonetheless, women and even children do suffer from obstructive sleep apnea and should be aware of its symptoms and consequences.

Symptoms of Sleep Apnea

Many times sleep apnea remains undiagnosed. There are no laboratory tests that will reveal it, and your doctor generally cannot determine during a routine office visit that you have difficulty sleeping. Suspicion about and diagnosis of sleep apnea most often occurs because a family member of bed partner notices the symptoms.

Among the things that suggest you might be suffering from sleep apnea are loud snoring, failure to sleep "peacefully," and sleepiness during the day. If you are frequently drowsy or sleepy during the day, even after having "sufficient" sleep, you should consider whether sleep apnea might be the cause of this drowsiness.

Snoring is nearly universal among those with sleep apnea. But the reverse isn't true - you don't necessarily have sleep apnea just because you snore. And the loudness with which you snore - the sound of the air moving through the back of the nose, mouth, and throat - does not indicate the severity (if any) of airway obstructions. What to watch for - or what to have your spouse watch for - is when the snoring stops! If snoring stops, along with breath, while your body keeps trying to breathe, then sleep apnea should be strongly suspected. When you start breathing again you'll probably issue a deep gasp and then continue snoring.

Tossing and turning is common among those with sleep apnea. But, as it's also very common among those not suffering from this problem, it's not necessarily indicative that you have this problem.

What Can You Do

Avoid alcohol. While you want to be relaxed at bedtime, you don't want the walls of your airway to be so relaxed that they prevent you from breathing properly.
Avoid muscle relaxants. Same reasoning. If you are prone to sleep apnea, it's important not to add additional relaxation to muscles that are already relaxing "too much."
Lose weight. OK, you didn't want to hear that one. I understand! But excess weight, especially in around your airway, greatly increases your risk of obstructive sleep apnea.
Quit smoking. You're already having difficulty breathing at night. Smoking decreases the efficiency of what little breathing you are managing to accomplish.
Establish a firm schedule for sleep. When you don't have a regular sleep schedule, this can disturb your sleep cycles, which can result in breathing difficulties just when it is most important that you sleep undisturbed. Eliminating environmental distractions, such as noises and unwanted light, is also helpful in reducing apnea episodes.
Elevate your head. Many people find that they can breathe better if they sleep with their head and chest inclined above the body at a 30-degree-or-greater angle, as if sleeping in a recliner or on an adjustable (hospital-type) bed.
Sleep on your side, rather than on your back. When you sleep on your side, gravity has less opportunity to constrict your airway.
Talk to your doctor about:

Breathing machines, such as the CPAP (Continuous Positive Airway Pressure) technology that can help keep your airway open.
Surgical procedures to remove excess tissue and tighten muscules so that your airway is more open.

Treatment Options

A common - and commonly effective - means of dealing with obstructive sleep apnea is the use of a CPAP (continuous positive airway pressure) device. This device maintains a flow of pressurized air into the airway, keeping it open while you sleep.

A dentist who specializes in sleep disorders may prescribe oral appliance therapy (OAT). This is a mouthpiece designed to shift your lower jaw forward, and thus to open your airway. This is, unfortunately, effective only in cases of mild-to-moderate sleep apnea. It is currently used more often in Europe and Canada than in the United States.

Neither CPAP technology or oral appliance therapy is helpful for central sleep apnea or mixed sleep apnea.

Obstructive sleep apnea may also be treated through the use of a pillow designed to promote airflow through keeping your body parts properly aligned.

The British Medical Journal published a study in 2005 which indicated that learning and practicing the didgeridoo - a wind instrument of aboriginal Australians - aided some in reducing snoring and sleep apnea, as well as reducing daytime drowsiness. It was theorized that learning and practicing the didgeridoo strengthened upper-airway muscles and consequently lessened their tendency to collapse during periods of sleep. There didn't appear to be any speculation as to whether similar results could be attained by learning and practicing the clarinet or saxophone.