Sleep On It

Early to bed and early to rise does not necessarily make you healthy, wealthy and wise—especially if you su er from sleep apnea. In fact, you might end up early to bed and late to rise with a long afternoon nap sandwiched somewhere in between.

BY JIM GIBSON

What is sleep apnea? It’s a sleep disorder characterized by long or short pauses in breathing while asleep. Some people could have 20 such pauses in an hour and some could have 20 every two minutes.

The problem with diagnosis is in the name. A person has to be asleep to have sleep apnea, and if he or she is asleep, then, if someone else doesn’t witness the actual incident, it usually goes by completely unnoticed. The only signs that this person might have sleep apnea would be a set of symptoms that gradually increase in intensity over time. For this reason, most incidents of sleep apnea are initially discovered by a sleeping partner.

It’s vitally important to understand that sleep apnea isn’t confined to a certain type or group of people. It can occur in any gender, at any age, with or without accompanying illness and in obese or very thin people.

“I had no idea I had a problem,” says Richard Smith of Ocala. “If my wife hadn’t noticed that I wasn’t breathing for long periods of time, I would never have known. She would punch me to wake me up and tell me that I needed to breathe. I’ve snored for years, but I just figured that most men snore and it wasn’t that big of a deal. I told my regular doctor about not breathing at night, and he sent me to a specialist for a sleep study.”

Testing confirmed that Smith is one of more than 20 million Americans who su er from sleep apnea. He has begun treatment to help alleviate the symptoms and prevent any further health problems.

There are two types of sleep apnea: obstructive and central.

Obstructive sleep apnea (OSA) occurs when the muscles of the body relax during sleep. The soft tissue in the upper respiratory airway relaxes and collapses, thereby narrowing or completely obstructing the airway.

OSA can be caused by several di erent factors. Loss of muscle tone is the primary factor, and this can come from advancing age, lack of physical activity, alcohol use, sedatives or other medications, injury or illness. It can also be caused by a malformed upper respiratory tract or an increase in tissue mass due to weight gain. However, it cannot be stressed enough that, although the majority of people su ering from obstructive sleep apnea are obese, body mass is not a direct indicator of the disorder. This is especially true in children, where the child could very well be underweight due to the physical stress imparted on the body from having OSA.

Central sleep apnea (CSA) occurs when the brain simply doesn’t signal the body to breathe. Normally, increased carbon dioxide levels in the bloodstream would naturally trigger the breathing response, but with CSA, the brain sends no signal to the larynx or rib cage and diaphragm muscles to initiate a breath. Most episodes last less than 30 seconds but can last as long as two minutes.

CSA can be caused by brain injury due to stroke, illness or physical trauma; opioid use; heart conditions, such as atrial fibrillation or congestive heart failure; the aging process; or the use of a continuous positive airway pressure device used to treat OSA.

The principal sign of CSA is that the person makes no attempt or does not struggle to take a breath, the breathing cycle simply ceases. Persons with OSA “struggle” to breathe in fresh oxygenated air to overcome the buildup of carbon dioxide in their bloodstream.

Pulmonologists (lung doctors), neurologists, cardiologists or otolaryngologists (ear, nose and throat doctors) that are board-certified in sleep medicine can perform sleep studies in their labs to determine whether a person is su ering from sleep apnea and which type of sleep apnea is present.

“The first night I spent in the sleep lab, the results showed that I definitely had sleep apnea,” says Smith. “The doctor asked me to come back again, so he could try me on a CPAP machine and evaluate its e ectiveness. He found out I had obstructive sleep apnea, and I’ve been on my CPAP machine ever since. At first, I really didn’t think I’d be able to do it, but it’s gotten much easier over time. It’s been almost a year now, and I hardly even notice it at all. It’s already become second nature to me, and I probably couldn’t sleep without it.”

Most persons who use CPAP machines wear a facemask much like the ones used with oxygen therapy, but the mask is usually sturdier and must be strapped snugly to the wearer’s face. Smith says that was the hardest part in using the machine, getting used to the feel of the mask on his face and having to readjust it periodically when he turned from side to side while sleeping. However, the results of its use won him over.

“After about a month, I began to notice that I wasn’t nearly as tired during the day, and I could just feel that I was thinking clearer,” he says with a smile. “In fact, I felt like a new man. I love Sudoku, and I think I’m a lot sharper.”

Smith, who is in his 50s and works as a carpenter, says he feels that he doesn’t get as tired during the day and that his sleep schedule is better than before treatment. He says that he regularly gets between seven and eight hours of sleep each night and maintains the same sleep schedule on the weekend.

A CPAP machine is a ventilator that provides a constant source of air pressure, which keeps the upper respiratory tract open, assuring adequate airflow to the lungs. The machine consists of the air pump unit, a length of air hose and a facemask. Masks range from the ultralight nasal pillow to a full facemask. Most CPAP machines today have humidifiers to help moisten the air and can provide heated air for comfortable breathing.

For some patients, the CPAP air pressure required to overcome the obstruction in their upper respiratory tract is so great that it makes exhaling against the constant airflow strenuous. The person feels as if they are laboring to exhale. For these persons, their physician may suggest a bi-level positive airway pressure machine (BIPAP).

BIPAP looks and works much the same as CPAP but does not supply a continuous pressure. The pressure is higher as the person inhales but then drops as the person exhales, making it easier to push air out of the lungs.

Not all persons adapt as easily to CPAP or BIPAP therapy as Smith. For those who can’t tolerate wearing a mask while sleeping, there are other options.

The simplest option is an oral device that looks like a sports mouth guard. It is called a mandibular advancement device and is placed in the mouth between the teeth while the person sleeps. It helps advance the lower jaw forward and lifts the soft palate tissue up and away from the pharynx. This may help in slight to moderate sleep apnea cases.

For more severe cases, surgery may be an option. Because the obstruction can occur anywhere in the upper respiratory tract, each surgical procedure must be customized for the individual. Surgery can include the nose, tongue or throat and will deal with the immediate obstruction.

Surgery addresses nasal obstruction or congestion, removal of soft tissue from the soft palate or pharynx, removal of the tonsils and adenoids, soft palate implants, tongue advancement or reduction, or lower jaw advancement. Some procedures are fairly extensive, while some are minimally invasive.

If no other treatment works, the surgical options are a viable alternative. According to the American Sleep Apnea Organization, more than 75 percent of the cases of sleep apnea in children can be cured simply by the removal of enlarged tonsils and adenoids.

Treatment of CSA can be more complicated and usually involves treating the underlying physiological problem that is a ecting signals sent to and from the brain. Check with your physician to see what the best course of action is if you su er from CSA.

Left untreated, sleep apnea puts a tremendous strain on the entire body. Research has shown that people with OSA, no matter what age, gender or body weight, are much more likely to su er from hypertension, cardiovascular disease, type 2 diabetes and stroke. Recent evidence has shown that OSA may even be linked to Meniere’s disease.

The good news is that every one of these illnesses was alleviated to some degree when measures were taken to treat the OSA. This is why it’s important to diagnose and treat any form of sleep apnea as soon as possible.

One of the simplest signs of possible sleep apnea is snoring. If you or a sleeping partner snore, the odds are great that you have sleep apnea. If you are sleepy during the day, have trouble concentrating or are generally fatigued, check with your doctor and determine if sleep apnea might be a problem.

Sources: sleepapnea.org, nhlbi.nih.gov, sleepassociation.org

ADULTS

› Snoring

› Daytime sleepiness

› General fatigue

› Night sweats

› Morning headaches

› Inability to concentrate

› Irritability or depression

› High blood pressure

› Heart disease

› Heart arrhythmias

› Heart failure

› Metabolic syndrome

› Abnormal liver function

› Diabetes

› Stroke

› Possible link to Meniere’s disease

Source: mayoclinic.org

› Dry mouth and sore throat on awakening

› Frequent nighttime urination

CHILDREN

› Hyperactivity

› Behavior problems

› Poor grades

› Breathing through mouth during the day

Source: nhlbi.nih.gov

BY CYNTHIA MCFARLAND

All it takes is one emergency. Your widowed mother has a stroke, and this once fiercely independent woman can no longer live alone.

In other cases, it happens slowly over time. Your aging parents su er cognitive decline, can no longer drive and need help managing medication and doctor visits.

In both situations, adult children—and sometimes other relatives—find themselves taking on the role of caregiver. After all, it’s what you should do. Right?

Experts caution that one of the biggest mistakes you can make is leaping into the role of caregiver based purely on emotion without thinking it through, yet people do this on a regular basis. Caregiving for a loved one is an enormous undertaking and should be a decision you choose willingly—not something you take on out of obligation or guilt.

“I think family members should be the ‘first line of defense.’ If it is planned and prepared for properly, there can be wonderful benefits in a multigenerational household, but as the caregiver, you have to set the tone,” notes Carol O’Dell, a certified caregiving wellness expert and contributing editor at caring.com, an online resource for caregivers.

O’Dell has hosted hundreds of caregiver workshops around the country and is also the author of Mothering Mother: A Daughter’s Humorous and Heartbreaking Memoir, which she wrote about caring for her elderly mother who had Parkinson’s and Alzheimer’s.

O’Dell says that the first step is deciding if you can actually a ord to become a caregiver. “A ordability” refers to more than just finances—it also includes your health, relationships and career.

“It does take some soul searching and an honest, hard look at your life,” she notes. “If you are in a relationship, you owe it to your partner and/or family to sit down and have many discussions before committing to doing this.”

These discussions should include not just you and the person you will be taking care of but everyone involved. This is the time to lay everything on the table: everyone’s expectations of the living and care arrangements, what each person is willing to contribute and one of the most important topics—boundaries. Setting boundaries in the beginning is crucial.

Let’s say your aging father can no longer drive and is moving in with you. Are you going to take on the responsibility of driving him to the twice-weekly card games he’s been playing for years, or will he need to give them up or agree to a di erent schedule? It sounds trivial, but such scenarios can morph into frustration and hurt feelings if boundaries are not set and discussed from the start.

“There were times when my mom was hospitalized and I was sleeping on the vinyl chair by her bed while my husband was home taking care of our kids,” recalls O’Dell. “But if you do that all the time, you lose your sense of balance. Your job as a caregiver is to be left with a life when it’s all said and done. It sounds harsh, but if you’re