Doctor’s Tip: The risks of obstructive sleep apnea
Until a few decades ago, doctors were unaware of obstructive sleep apnea, but now we know it is common and serious. OSA involves obstruction to air flow in the upper airways due to collapse of the soft structures in the throat during sleep. This causes the oxygen level to decrease off and on during the night, which results in the sufferer partially awakening intermittently, often with a loud gasp, usually unbeknownst to them.
OSA is more common in men than women, and is much more common in overweight people, although can occur in thin people, particularly if they have structural abnormalities such as a receding jaw. Many people who snore have sleep apnea, and most people with OSA snore. It is more common in middle-aged and older people, but can occur in children with conditions such as large tonsils and adenoids. Neck circumference is another risk factor: 16 inches or greater in a female and 17 in a male.
Typical symptoms in OSA sufferers are non-restorative sleep (they feel tired when they wake up in the morning), daytime somnolence (falling asleep easily during the day), morning headaches, difficulty concentrating, mood changes such as depression and irritability, and awakening with a dry mouth or sore throat in the morning. Alcohol and sedatives make OSA worse, and drugs that depress respiration such as benzodiazepines (Valium, Xanax) and narcotics (even Vicodin and Percocet) can cause death.
People with sleep apnea tend to have a higher level of stress hormones such as cortisone, which in large part explains their increased risk of high blood pressure, heart attacks, strokes, obesity and diabetes. Other complications include an increased rate of accidents (falling asleep at the wheel), lower job performance and irritable bed partners (from the snoring).
So if you or your partner think you might have sleep apnea, you need to be evaluated. Many experts feel that anyone with hypertension, obesity or diabetes should be checked for OSA. The first test we usually do if we suspect OSA is an overnight oximetry, which is a relatively inexpensive test involving wearing a gauge on your finger all night that measures your oxygen saturation while you sleep. If it is normal, it’s unlikely you have OSA. If this test is abnormal, the next step is an overnight sleep study, which used to entail staying in a hospital sleep lab for a night, but home sleep studies are now available.
If you are proven to have OSA, it’s obviously very important that it is treated. Avoidance of alcohol, sedatives and narcotics is a must. In overweight people, weight loss can be helpful and can even cause the problem to resolve. CPAP is the standard treatment, and involves a machine with a mask that you wear over your face at night, and which makes you breathe when you stop. As you might imagine, some people don’t tolerate this, but many love their CPAP, saying that it gives them the deepest and most restful sleep that they’ve ever had. For people who don’t tolerate CPAP, oral appliance (some dentists have expertise in these) and ENT surgery can be helpful. Sleeping on your side instead of your back often helps as well.
Dr. Feinsinger, who retired from Glenwood Medical Associates after 42 years as a family physician, now has a nonprofit Center For Prevention and Treatment of Disease Through Nutrition. He is available for free consultations about heart attack prevention and any other medical concerns. Call 970-379-5718 for an appointment. For questions about his columns, email him at firstname.lastname@example.org.
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