Sleep Apnea Good quality sleep is an indispensable part of maintaining optimal health as it gives the body time to repair and heal. Sleep deprivation can be detrimental to an individual’s wellbeing causing deterioration in the condition of the cardiovascular system, endocrine system, immunity as well as psychological wellbeing. However, a large proportion of the population can be afflicted by a condition which does not allow the body to get restorative sleep despite the person trying to maintain a healthy sleep cycle, commonly known as “Sleep Apnea”.
What is Sleep Apnea? During breathing, the muscles in the pharynx work to keep the airway open. It is normal for these muscles to relax slightly during sleep, however, if they relax too much it may cause the airway to become blocked waking up the individual due to a shortage of oxygen in the lungs. The patient suffering tries to consciously breathe in and re-saturate the blood with oxygen, only to fall back into sleep. This cycle of cessation of breathing is repeated several times during the night resulting in disrupted and intermittent sleep. This condition of interrupted breathing resulting is what is referred to as Sleep Apnea. Sleep apnea is a prevalent sleep disorder in India and often remains undiagnosed. The initial signs of sleep apnea are often observed by a family member who might notice them while the person suffering from Sleep Apnea is asleep. Though there are no routine tests to diagnose sleep apnea, a physician may advise a sleep apnea test based on the symptoms, physical health, and family history described by the patient. Symptoms include but are not limited to persistent snoring, restless sleep, intermittent breathing, and snoring. Sleep Apnea also affects an individual’s waking life. The effects of disturbed sleep are evident in the morning with other common symptoms like headaches, daytime fatigue, poor concentration, decreased attentiveness, irritability, impaired concentration as well as lethargy. The risk of sleep apnea is higher in people with swollen tonsils, receding jaw, and in people experiencing loss of muscle tone with age. The condition of Sleep Apnea can be broadly classified into two types –
- Obstructive Sleep apnea (OSA)– It is the most common form of sleep apnea where the airway gets blocked while sleeping. The blockage is commonly due to collapsing of the soft tissue at the back of the throat.
- Central Sleep Apnea (CSA) – In CSA the airway is not blocked. The brain is unable to signal the muscles to breathe due to the instability in the respiratory control center. It is a less common form of the condition than Obstructive Sleep Apnea.
Untreated sleep apnea can lead to several complications such as high blood pressure, changes in metabolism, chronic fatigue, heart diseases, stroke, diabetes, and increased risk of accidents while awake. Since the risks associated with Sleep Apnea not only affect day to day life of the patient but also increase the chances of developing other diseases, it is vital to be examined by a physician as soon as symptoms start to appear and receive the appropriate treatment to improve prognosis.
Tests to Diagnose Sleep Apnea: A sleep study test, also known as a Polysomnogramy may be recommended by the physician to confirm Sleep Apnea as well as rule out any other sleep disorder. It is a multiple-component test that measures various parameters to produce a result. Electrodes are attached to the scalp and face to record electrical signals measuring brain and muscle activity. An Oximeter probe is also attached to the finger to measure blood oxygen levels while belts placed around the abdomen and chest are used to monitor the breathing. Electroencephalograms, Electromygrams, Electro-Oculograms, and Electrocardiograms may also be used to confirm the diagnosis.
Management options The management options prescribed by the physician depending upon the severity of the condition. The management options for sleep apnea can broadly be divided into the following categories;
- Conservative Therapy – Conservative measures can be helpful to manage and prevent the progression of Sleep Apnea. Some of the recommendations for this form of therapy is avoiding supine positions while sleeping, quitting smoking, avoiding sedatives, and maintaining a healthy sleep cycle.
- Mechanical Therapy – These mechanical measures includes the use of specialized appliances to alleviate the symptoms associated with sleep apnea. This includes nasal Continuous Positive Airway Pressure (CPAP), Bi-level Positive Airway Pressure (Bi-PAP), and Oral Appliance Therapy.
- Pharmacotherapy – Medicines are usually not used in primary treatment, but some medications may be prescribed to supplement treatment.
- Surgery – Surgical intervention may be necessary to treat severe cases of sleep apnea. These surgeries focus on modifying the anatomy of the airway and the tissue causing a blockage. Some surgeries which are performed for the management of sleep apnea include craniofacial reconstruction, uvulopalatopharyngoplasty, and tracheostomy.
- CPAP machines provide a single pressure that remains the same throughout the night. These days some CPAP machines might allow a slight gradual increase in pressure.
- The bi-PAP machine provides two pressure settings – one for inhalation which is high-ipap and one of exhalation which is low-epap.
- The settings of Bi-PAP machines can be adjusted to match the person’s rate of breathing.
- CPAP machines are usually more affordable than Bi-PAP and have simple settings but may not be adequate for people suffering from severe obstructive sleep apnea.
- The use of Bi-Pap machines is usually recommended by the physician when treatment with CPAP fails or is inadequate.