ARTICLE FEATURES . Sleep Apnea
The signs and symptoms of obstructive and central sleep apneas overlap, sometimes making it difficult to determine which type you have. The most common signs and symptoms of obstructive and central sleep apneas include loud snoring, episodes in which you stop breathing during sleep — which would be reported by another person, gasping for air during sleep, awakening with a dry mouth, morning headache, difficulty staying asleep, excessive daytime sleepiness (hypersomnia), difficulty paying attention while awake and irritability. Factors that increase the risk of this form of sleep apnea include excess weight, neck circumference, a narrowed airway, family history, use of alcohol, sedatives and tranquilizers, smoking and nasal congestion. Sleep apnea is a serious medical condition. Complications can include daytime fatigue, hypertension or heart problems, type 2 diabetes, metabolic syndrome, complications with medications and surgery and liver problems.
Diseases caused by sleep apnea There’s a wealth of research suggesting that sleep apnea and high blood pressure are a dangerous pair. Obstructive sleep apnea, which occurs when breathing is briefly and repeatedly interrupted during sleep, has been shown to increase risk for high blood pressure. Research also shows that high blood pressure, often referred to as the “silent killer,” can cause sleep apnea or worsen breathing in patients already affected by sleep apnea. Sleep apnea and high blood pressure have both been linked to significantly increased risk for serious complications, such as stroke and heart attack.
Research suggests that anywhere from 30–50% of patients with high blood pressure have sleep apnea. However, sleep apnea is much more common in patients with resistant hypertension, who have tried a variety of high blood pressure treatments but can’t get their condition under control. Patients with sleep apnea had a significantly higher prevalence of atrial fibrillation and ventricular arrhythmias. Sudden drops in blood oxygen levels that occur during sleep apnea increase blood pressure and strain the cardiovascular system. Researchers from the Sleep Heart Health Study (SHHS) report that the risk of stroke appears in men with mild sleep apnea and rises with the severity of sleep apnea. Men with moderate to severe sleep apnea were nearly three times more likely to have a stroke than men without sleep apnea or with mild sleep apnea.
Treatment Options Losing excess weight could be a good first step in treating obstructive sleep apnea. In addition to lifestyle changes that promote weight loss, other health changes could help a person reduce the symptoms of sleep apnea. Some examples of healthful lifestyle changes include refraining from smoking, which can lead to swelling in the upper airways, resulting in sleep apnea, refraining from drinking alcohol as it can relax the throat muscles and increase the likelihood of snoring and taking over-the-counter allergy medications or nasal decongestants to increase airflow by reducing swelling and fluid buildup in the nasal passages. Sleep apnea can be a serious condition. When a person stops breathing, the heart works overtime to pump
blood through the body to provide the oxygen that the body does not get during apnea episodes. This extra work can damage the heart and lead to high blood pressure and heart rhythm problems. Traditionally, doctors treat sleep apnea by having a person wear a special device called a continuous positive airway pressure (CPAP) machine. This machine fits over the mouth or nose and provides extra positive airway pressure to keep the airways from collapsing while a person sleeps, preventing apnea and snoring. An oral appliance, often called a mandibular repositioning device (MRD), is an effective additional therapy option and can be considered a first-line* of therapy for patients with mild to moderate sleep apnea. It is a custom-made, adjustable oral appliance available from a dentist that holds the lower jaw in a forward position during sleep. This mechanical protrusion expands the space behind the tongue, puts tension on the pharyngeal walls to reduce collapse of the airway and diminishes palate vibration. Another option is wearing an oral appliance designed to keep your throat open. CPAP is more reliably effective than oral appliances, but oral appliances might be easier to use. Some are designed to open your throat by bringing your jaw forward, which can sometimes relieve snoring and mild obstructive sleep apnea. A number of devices are available from your dentist. You might need to try different devices before finding one that works for you. Once you find the right fit, you’ll need to follow up with your dentist repeatedly during the first year and then regularly after that to ensure that the fit is still good and to reassess your signs and symptoms.
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