Sleeping Can Be Harmful to Your Health

The holidays are arriving. Who isn’t feeling fatigued, right? All the shopping, cooking, decorating and entertaining exhaust even the most energetic among us. But it might not be Thanksgiving turkey or thoughts of Christmas sapping your drive and making you drowsy during the day. It could be another culprit—sleep apnea.

Sleep apnea affects four to eight percent of the population, but because it occurs during sleep, a period of suspended consciousness, many people do not realize they have a sleep disorder. Sleep apnea is characterized by several episodes per hour of breathing cessation. A person with mild sleep apnea stops breathing, on average, five to 15 times per hour, while a person with severe sleep apnea may quit breathing up to 120 times per hour, or twice every minute. “Sleep apnea causes a drop in oxygen level resulting in brain reflexive arousals to restore breathing,” explains pulmonologist Dr. A. Lynne Brannen, with University Sleep Associates.

This frequent need for the brain to awaken the body in order to kick-start breathing interrupts the natural sleep cycle and leads to daytime tiredness. Most adults need seven to eight hours of sleep each night. Over the course of those seven to eight hours a person experiences repeating cycles of passing from light sleep to deep sleep to dream sleep. Disruption of these cycles due to sleep apnea affects the quality of a person’s sleep. “These people may never get into deep sleep or dream sleep,” says Dr. Amy Blanchard, medical director of the Georgia Health Sciences University Sleep Disorders Center. “They’re not getting the restorative kind of sleep that a person with a normal sleep cycle gets.”

The most common type of sleep apnea, the one associated with the sleep apnea “poster child”—a middle-aged, overweight male with a big neck who snores loudly and falls asleep while watching television—is obstructive sleep apnea. Obstructive sleep apnea is caused by an anatomical abnormality in the upper airway, nose or throat. When the body relaxes as it falls asleep, this abnormality, which could be big tonsils, a long soft palate, a bad overbite, a deviated septum, irritation from allergies or a large tongue, blocks airflow. Excess fat due to obesity can also narrow and occlude the airway, though not everyone who has sleep apnea is overweight.

Middle-aged men are not the only ones who suffer from sleep apnea. Women, too, at a 1:2 ratio to men, also develop it. As women transition through menopause, their risk of sleep apnea increases, equaling that of men at post menopause. Though men primarily present with the classic symptoms of daytime sleepiness and a bed partner’s complaints about their loud snoring and gasping for breath, sleep apnea symptoms manifest differently for women, making it a little more difficult for physicians to catch. Women with sleep apnea tend to complain about insomnia, restless legs, morning headaches, lack of energy and feelings of depression. The bedmates of women are less likely to report snoring or apnea episodes.

Even infants and children can have sleep apnea. A child receives a diagnosis of sleep apnea if he quits breathing more than once an hour. Just like women, children do not exhibit the classic symptoms. “Many kids don’t present as being tired during the day, but present as hyperactive, and they get labeled with attention deficit disorder,” says Dr. Blanchard. In children under five years old, signs of possible sleep apnea include snoring, mouth breathing, sweating during sleep, restless sleep and repeated awakenings. Children age five and over who have sleep apnea may snore, wet the bed, demonstrate poor academic performance and have issues with attention and behavior. Untreated sleep apnea generally persists into adulthood.

Self-reported symptoms are often the first clue that an individual may have a sleep disorder. A physician seeking confirmation of sleep apnea will write a referral for his patient to complete an overnight sleep study. The patient spends the night at the sleep lab and physiologic measurements are taken, such as airflow, brainwave activity, oxygen levels, heart rhythm and breathing. All of the information gathered throughout the night is then studied in 30-second intervals to determine the number of times the person stops breathing for at least 10 seconds.

A per hour average is ascertained. Anything up to five times per hour is considered normal. Dr. Blanchard explains, “It’s not abnormal at all to stop breathing briefly, especially after an awakening or arousal where the brain wakes up.” This breath holding can happen, for example, when a person emerges from a dream, but it is not the same as obstructive sleep apnea. For those apprehensive about spending the night in an unfamiliar environment under observation, there may be an alternative. Dr. Brannen says, “More recently, portable monitors have become available that measure three to four parameters and can be performed in the home setting.”

Fortunately, there are several treatments available for sleep apnea:

• Continuous Positive Airway Pressure (CPAP). CPAP, what Dr. Blanchard describes as “an air-splint for the throat,” is the most common treatment for adults. During sleep, the individual wears a mask over the face while an air-pump blows air at a certain pressure to prop open the throat, keeping the airway clear of obstruction. CPAP may also be prescribed for children when surgery is unsuccessful.

• Surgery. Surgery is generally the first course of action for children who have large tonsils and adenoids. Removal of those structures usually results in a cure. It is less easy to predict the success of surgery for an adult, however. Surgical procedures for adults include removal of tonsils, adenoids and uvula, repair of a deviated septum in the nose and/or trimming of the soft palate. Not every adult is a good candidate for surgery. A surgeon can help make that decision.

• Oral Appliance. For mild cases of sleep apnea, or for people who cannot tolerate CPAP or surgery, an oral appliance constructed by a dentist may be effective. The appliance fits over the teeth and pulls the tongue or jawbone forward to open the back of the throat. Because children are still growing, this treatment is not appropriate for them.

• Positional Therapy. Positional therapy is a conservative approach to treatment. Sleeping with the head elevated or sleeping on one’s side may help keep the airway open.

• Weight Loss. Because sleep apnea is exacerbated by obesity, exercise and dieting are recommended. Unfortunately, weight loss can often be difficult for patients with sleep apnea, which affects secretion of hormones that alerts the body to feeling hungry and feeling full. A vicious cycle ensues: Obesity leads to sleep apnea which leads to further weight gain which worsens the sleep apnea.

Though sleep medicine is a relatively new field, gaining momentum in just the last 30 to 35 years, researchers and doctors have learned a great deal about the long-term effects of sleep apnea. It is very important for people who have symptoms to seek treatment. “It can affect pretty much every aspect of a person’s life—mental, physical and interpersonal,” says Dr. Blanchard. People with sleep apnea run a greater risk of heart disease, hypertension, stroke, congestive heart failure and death. If you already have any of these diagnoses, ask your doctor about screening for sleep apnea.

Sleep apnea can also impact job performance and the ability to concentrate and focus. It can increase the potential for accidental injury and even death. Falling asleep at the wheel or while operating machinery is a major concern for individuals with sleep apnea. Furthermore, mood disorders and difficulty with memory can result. Relationships with friends, co-workers and family members may become strained. Bed partners of people with sleep apnea usually aren’t getting much sleep either, as they are kept awake by snoring and anxiety over whether their loved one will stop breathing altogether.

As awareness about sleep apnea continues to grow, more and more people address the concerns that they or their partner may have it. Action is taken quicker. The planet is becoming a well-rested place and that’s what everyone needs, especially around the holidays. If you are not one of the well-rested and you struggle to stay awake to check your naughty-nice list twice, see your doctor.