Quality Sleep

Quality sleep is one of the foundations of good health. We all should spend roughly 30% of our lives sleeping. We should not only want to spend enough time asleep but also ensure our sleep is uninterrupted and provides our body with all the benefits it is meant to have.

In some cases, we are at fault. We do not follow the correct framework to facilitate quality sleep. We may not allow ourselves enough hours to sleep or do not provide an appropriate environment to fall asleep or stay asleep. However, there are sleep disorders that interfere with our sleep that are not caused by issues entirely under our control.

Obstructive Sleep Apnea

Sleep apnea occurs when breathing is disrupted during sleep. Obstructive sleep apnea (sometimes referred to as “OSA”), which is present in 5-10% of the population, is caused by a physical obstruction in one or more locations of the airway from the nose to the back of the tongue. As an individual attempts to enter the deeper stages of sleep, muscle relaxation occurs. However, if a part of the airway is too narrow or too “floppy,” it will close off the breathing passage. Luckily, in most cases, this obstruction to breathing is recognized by the brain, which then shifts the patient into a more superficial level of sleep, reinstituting muscle tone and opening the airway. Unfortunately, this disrupts the normal sleep cycle.

Additionally, oxygen levels in the bloodstream can drop, and chemicals such as adrenaline are released in response to the obstruction of breathing. The heart and brain are two organs that can be damaged by this combination of low oxygen and increased needs stimulated by adrenaline. Heart attack and stroke risk have increased in individuals with even moderate untreated sleep apnea. Therefore, sleep apnea symptoms can be caused by disrupted deep sleep and the physiologic response to these interruptions.

Central Sleep Apnea

Clinically significant central sleep apnea is fortunately very rare. In this disorder, the cause is the lack of a “drive” to breathe from the brain. With this, the breath is initiated. The risk caused by this disorder is severe because an external treatment must then provide breathing. More commonly, some episodes of central sleep apnea may occur in a setting of obstructive sleep apnea. Symptoms in these cases can include those listed below. Treatment can consist of treating obstructive sleep apnea; in many cases, the central sleep apnea events will disappear. 

Know the Signs of Sleep Apnea in Yourself or Your Partner

The signs and symptoms of obstructive sleep apnea can be due to the interruption of sleep or the body’s response to the obstruction – or a combination of both. Understanding that not all signs must be present to suspect obstructive sleep apnea is essential. Instead, if even one of these symptoms is present and there is no genuinely identifiable cause, the patient should seek information and care from a trained health professional. The symptoms of sleep apnea include the following:

Fatigue

Feeling tired, especially after sleeping adequately, is a common sign of untreated sleep apnea. However, since fatigue is a subjective complaint, it is not always acknowledged by the patient. In many cultures, admitting fatigue can be perceived as laziness. Therefore this symptom can be minimalized or even denied by the patient. Fatigue can also be blamed on other factors such as stress, lack of exercise, or age. In addition, sometimes, a significant amount of time is spent investigating other health causes, such as anemia or hypothyroidism. Some patients are labeled with Chronic Fatigue Syndrome before their sleep is evaluated. While all these issues can contribute to fatigue, it is essential to rule out sleep apnea, as untreated sleep apnea has serious health consequences.

For the reasons above, as well as other issues, the lack of fatigue should not be considered a reason to rule out the diagnosis of obstructive sleep apnea. In some patients, this chronic disruption of restorative sleep is manifested in alterations in attention span, concentration, cognitive function, and memory. In the pediatric age group, as many as 40% of all children diagnosed with attention deficit disorder or attention-deficit/hyperactivity disorder are found to have sleep apnea as a cause or contributor.

Depression

Depression may be the only sign of undiagnosed sleep apnea. A patient diagnosed with depression may exhibit poor sleep, weight gain, difficulty concentrating, and altered mood- all symptoms that can be caused by disruption of deep, restorative sleep. At the very least, restoring quality sleep will allow the patient to have an increased ability to deal with the side effects of these disorders. 

Anxiety

Anxiety may be caused or worsened by obstructive sleep apnea. The interruption of deep sleep and lack of recovery of specific brain areas can lead to heightened irritability and difficulty coping with daily routine issues. Also, due to similar side effects of undiagnosed and untreated sleep apnea, the obsessive-compulsive disorder can be encountered.

Hypertension

Difficult to control- sometimes referred to as refractory- hypertension can be due to untreated sleep apnea. The National Institute of Health estimates that 50% of all patients with hypertension have obstructive sleep apnea and labeled sleep apnea as a critical secondary cause in 2003. However, this association is still commonly missed. Therefore, if a patient has newly diagnosed high blood pressure and does not respond to typical treatment, evaluation for sleep apnea should be performed.

Headaches

Headaches, especially first thing in the morning, can signify untreated sleep apnea. It is presumed that these headaches can be due to the disruption of deep sleep and the intermittent decrease of oxygen to the brain.

Obstructed Breathing-Apnea and Hypopnea

One likely has sleep apnea if one’s bed partner observes obstructed breathing during sleep. This can be true apnea- the stoppage of breathing for longer than 10 seconds- but can also include gasping or struggling to breathe. Partial obstructions, some of which can be missed by a bed partner, are called hypopneas and may impart as much risk as true apnea. Snoring can also be a sign of sleep apnea. 

In children, snoring is always an indication of airway obstruction during sleep and should be evaluated. In adults, loud snoring is likely to indicate sleep apnea in 80% of cases. It should be noted, however, that the absence of snoring does not rule out sleep apnea. Even health information shows that snoring without a finding of obstructive sleep apnea can increase the risk of heart disease and stroke. If there are other signs or symptoms, an evaluation with a doctor should still be considered.

Teeth Grinding

Bruxism, or grinding one’s teeth, can indicate sleep apnea. If one is aware of this issue or evidence is apparent on a dental examination, a thorough evaluation of the patient’s airway and questions regarding other possible signs or symptoms should be undertaken.

Frequent Urination at Night

Nocturia, awakening during the night to urinate, may indicate untreated sleep apnea. Over 84% of patients with sleep apnea reported it as a symptom. Indeed, this symptom is more frequent as we age; however, care should be taken to assume it is not a sign of obstructive sleep apnea.

If You Suspect Your Life is Being Affected by Sleep Apnea, Don’t Wait to See a Doctor

Quality sleep is vital for health. However, untreated sleep apnea will destroy good sleep and increase the chances of other potentially life-threatening diseases, such as heart disease and stroke. Therefore, awareness of the potential signs and symptoms of sleep apnea is essential for your doctor and you so the diagnosis is noticed.

Some Sleep Apnea Statistics

• Sleep apnea affects an estimated 22 million Americans (7-8% of the population).
• Approximately 80% of people with sleep apnea are undiagnosed.
• Men are twice as likely to have sleep apnea than women.
• People who are overweight or obese are at a higher risk of developing sleep apnea.
• People aged 40 and older are more likely to have sleep apnea.
• Snoring is the most common symptom of sleep apnea, occurring in 90% of cases.
• Other common sleep apnea symptoms include daytime fatigue, morning headaches, and difficulty concentrating.
• Sleep apnea can lead to an increased risk of stroke, heart attack, and high blood pressure.
• Untreated sleep apnea can reduce life expectancy by up to 10 years.
• People with sleep apnea can experience up to 30 episodes of apnea per hour during sleep.

The post Common Signs You Have Sleep Apnea appeared first on Jerome Hester, MD.

Snoring is no laughing matter. It’s more than just an irritant or annoyance. In fact, snoring affects sleep in such a negative way that chronic snoring increases your risk for a range of health issues, and compromises the wellbeing of others. It is our hope that learning how snoring negatively impacts sleep will inspire you into action.  

Schedule an appointment with your physician to discuss your snoring patterns to determine whether or not you need support from an ENT or an accredited sleep expert. While sleep apnea is one of the most common causes of snoring, there are many other potential causes. And, contrary to what most people think, you may not need a CPAP machine to breathe easy – and sleep well again.  

Click Here to learn more about CPAP machines as well as other treatment options for sleep apnea. 

So, read up to learn more about how snoring is the enemy of sleep, and then work toward finding your best solution.  

Snoring Affects Sleep And Interrupts Vital Sleep Cycles 

The longer the body is deprived of oxygen via snoring, the more it “wakes itself” to get a good breath in. As a result, continuous snoring means consistent disruption of vital sleep cycles. The average non-snorer spends the night moving in and out of various sleep cycles, ranging from 90- to 110-minutes long, forming a sleep rhythm. We call this the ultradian sleep cycle, and it varies between rapid eye movement (REM) cycles and non-rapid eye movement (NREM).  

Over the course of a good night’s sleep, you go through four different stages of sleep, and four separate REM cycles. Each of the cycles and stages of sleep is responsible for different physiological processes. Any interruptions in these cycles mean compromising your body’s biochemical processes – including things like hormone balance, metabolism, mood regulation, and so on. We recommend visiting snoringhq.com’s article, Understanding Sleep Stages and How Snoring Affects Them, to learn more about sleep cycles and what they’re responsible for in terms of physical, mental, and emotional health.  

You (And Your Sleep Partner) Are More Restless 

As anyone who sleeps with a snorer is aware, snoring is a sleep disruptor in its own right. However, snoring also has an effect on your body’s physical motions while you sleep. Someone in the midst of deep, healthy sleep barely moves at all outside minor position changes. However, those who snore often jolt awake, which then causes them to toss and turn until they fall back to sleep. Note: If you sleep with a restless partner, and you are on an old mattress, consider investing in a mattress with memory foam technology, which reduces motion transmission from one side of the mattress to the other. 

Those who sleep with snorers wake up due to the high volume level of the snores, as well as their partner’s active body motions. This, in turn, makes the non-snorer a more restless sleeper. It becomes a vicious cycle where the two of you are waking due to snoring, and then waking up even more due to restless sleeping. 

Studies have shown that those who sleep with people who snore wake up almost as much as their partners. For example, a Mayo Clinic study showed that those with sleep apnea woke up an average of 27 times, and their partners woke up at least 21 times. Another study by the British Snoring and Sleep Apnea Association (BSSAA) estimated that when you measure the amount of sleep a snorer’s partner loses, and you factor that out over an average span of a 24-year marriage, the non-snorer loses about two full years of sleep! 

Diminished Sleep = Diminished Health 

Snoring leads to lost sleep, leading to diminished health. That’s where the snoring pavement hits the road, so to speak. While you may downplay your notorious snoring reputation, there are serious consequences from all that consistently lost sleep. 

Blood pressure goes up 

When your body loses oxygen, as it does when you snore, it immediately begins to compensate. An article by the sleep experts from SleepFoundation.org writes: 

As oxygen levels fall, receptors in the brain are triggered. The result: Your brain sends a message to the blood vessels to increase the available oxygen to the heart and brain so the body can keep functioning. This increase in blood flow puts pressure on the blood vessels’ walls, elevating levels to higher than normal.  

Unlike high blood pressure caused by a poor diet or being overweight, high blood pressure caused by sleep apnea can only be lowered by successful treatment. 

You gain weight 

We mentioned above that interrupting sleep patterns means interrupting essential, biochemical, and physiological processes. This includes the hormones responsible for your body’s metabolic processes as well as stress. The combination of a slower metabolism, combined with increased cravings for sugar (a common response to stress), leads to unhealthy weight gain.  

That becomes a slippery slope since weight gain affects every aspect of your health. In addition to exacerbating existing sleep apnea, weight gain also increases your risks of developing other weight-related health issues such as heart disease and type 2 diabetes. 

You may experience abnormal heart rhythms 

Similarly, chronic snorers often experience abnormal heart rhythms, such as atrial fibrillation. When left undiagnosed and untreated, atrial fibrillation can lead to blood clots, stroke, and other heart complications. Anyone with atrial fibrillation also has an elevated risk of heart failure. 

By getting your nighttime breathing and heart rhythm in check, you give your heart a much-needed break, and that benefits your body as a whole.  

Increased risk of auto- or work-related accidents  

Lack of sleep causes a lack of mental clarity, not to mention excessive daytime sleepiness. After a while, those suffering from lack of sleep become unaware they’re “suffering” at all. Being tired, foggy-brained, and less able to focus on the task(s) at hand begins to feel like the norm. As a result, those with untreated sleep apnea are more prone to automobile and work-related accidents. 

Several studies have been done along these lines. In one 2007 study, the researchers evaluated 316 male truck drivers and their driving records. Of the nearly 100 drivers who were involved in an accident, 20% reported falling asleep at the wheel. Of that 20 %, nearly 80% of them were chronic snorers or had symptoms of sleep apnea.  

Another, more recent article published findings from a meta-analysis that reviewed obstructive sleep apnea (OSA) and work accidents. Researchers noted that the risk of a work-related accident doubled for employees exhibiting symptoms of OSA. As a result, many employers are beginning to make OSA assessment and treatment a part of their hiring process for drivers, heavy equipment operators, or other jobs where work-related injuries can lead to serious or fatal accidents. 

Compromised immune system 

A healthy adult immune system relies on an average of seven to nine hours of sleep per night. Anything more or less than that begins to throw things out of balance. 

Sleep experts from Mayo Clinic write: 

During sleep, your immune system releases proteins called cytokines, some of which help promote sleep. Certain cytokines need to increase when you have an infection or inflammation, or when you’re under stress. Sleep deprivation may decrease the production of these protective cytokines. In addition, infection-fighting antibodies and cells are reduced during periods when you don’t get enough sleep…your body needs sleep to fight infectious diseases.  

In addition to fighting infectious diseases, your immune system manages the body’s inflammatory response. A compromised immune system leads to a heightened inflammatory response, which negatively impacts any existing health issues you may have. Treating your sleep apnea may even help to reverse some of the symptoms of existing health conditions by boosting your body’s natural ability to take care of itself. 

Snoring affects sleep and your intimate and personal relationships

The American Sleep Apnea Association (ASAA) has a wealth of information about how snoring and lack of sleep impact both your intimate relationships as well as other personal relationships. Losing sleep impacts mood regulation, which means you can become moodier than usual and may suffer from a shorter temper. You may have a harder time being patient with those around you or you may find yourself falling asleep at the dinner table or in the middle of a long-anticipated movie date, all of which detract from both personal and romantic relationships.  

In an article titled, Is Your Intimate Relationship Suffering Due to Untreated Apnea?, the ASAA writes: 

“…untreated sleep apnea may reduce sexual quality of life (QOL) because of reduced libido and intimacy, erectile dysfunction, and several other mechanisms. People who suffer from sleep debt due to untreated sleep disorders can also experience poor moods, mental health issues, not to mention exhaustion. What’s more, both men and women can become less in tune or cognizant of the needs of their partners.” 

A study conducted by the Sleep Disorders Center at Rush University Medical Center studied whether treating sleep apnea improved the couple’s relationship and quality of life. The following example of how treating sleep apnea can improve marital relationships is common across the board: 

Following treatment, the wife’s quality of life measure jumped from a 1.2 to a 7, meaning the sleep apnea was no longer bothering her at all. Her sleepiness scale, which measures how tired she feels during the day, dropped from 12 to 6. Marital satisfaction scores improved from 3 to 5.8 and the wife’s sleep efficiency jumped from 73 percent to 82 percent. 

And there’s more… 

Those are six of the most negative and potentially damaging effects of chronic snoring and apnea. Additional issues or symptoms of how snoring affects sleep include: 

• Increased headaches, particularly in the morning 
• Moodiness and irritability 
• Dry mouth, which increases your risk of dental issues and gum disease 
• Chest pain  
• Depression 
• Acid reflux 
• Mental confusion and memory loss 
• Liver problems in the form of higher-than-normal levels of liver enzymes 
• Breathing troubles and adult asthma 

Imagine being able to erase or notably diminish all of the above risks and potentials. The great news is, you can. Schedule an appointment with us today so we can evaluate any anatomical causes for your snoring and determine if you have sleep apnea. The sooner you find out why you’re snoring and how snoring affects sleep for you, the sooner we can treat the problem.

We’re Here For You When You’re Ready

Contact the office of Dr. Jerome Hester and schedule an appointment for a comprehensive evaluation and discussion of all potential treatments by an expert in the area of snoring and sleep apnea. We’re excited to show you (and your partner) how great it feels to get a good night’s sleep. 

The post Snoring Is Not Harmless: How Snoring Affects Sleep appeared first on Jerome Hester, MD.

Snoring in an adult can be a humorous or societal issue. However, snoring in a young child actually more commonly is a significant medical issue. Snoring occurs when there’s obstruction of the airway, and this leads to narrowing of the airway and obstruction to air flow, causing vibration of tissue.

In an adult, approximately 80% of all habitual snorers have sleep apnea. However, that number approaches 100% in children who are habitual snorers. Therefore, this truly demands that if a child is a snorer night in and night out, or at least most nights, that they truly should be evaluated by a specialist.

Many times, such issues are attributed to allergies or nasal congestion. Although those issues may play a role occasionally in children, they are rarely the cause of the issue. The most common cause in children is the enlargement of tonsillar or adenoidal tissues. The adenoids are tissue very similar to tonsils, but behind the child’s nose, and therefore out of view of most routine examinations.

If one does have a child who snores, remember that the presence of sleep apnea in a child is rarely accompanied by the typical signs of poor sleep such as fatigue or complaints about sleep. Actually, in the younger person, if anything, it is actually much more common that the child will have issues with attention span, concentration issues, perhaps even behavioral issues, and in fact, many times will actually have decreased growth because of the lack of deep sleep. Therefore, the recommendation for any child who snores regularly is an evaluation by an individual who specializes in sleep medicine and evaluation of the airway. In adults, we commonly recommend for all patients that they obtain a sleep study, a test where a patient is monitored overnight to look for obstruction. That still is a very useful test in a child, but it is not as diagnostic in a child as it is in an adult, and therefore, consideration by your physician may be that evaluation just by a physical examination and a history is enough to warrant proceeding with treatment.

Treatments in children can involve non-procedural treatments such as CPAP, although tolerance of this treatment in a child is very, very low. The procedural treatments indicated are most commonly removing the tonsil tissue, removing the adenoid tissue, and shrinking inflammatory tissue in the nose known as turbinates. That surgery is very common and is very effective for treating these individuals, but full evaluation of the patient should be made before any treatment is initiated.

The post Why Does My Child Snore? appeared first on Jerome Hester, MD.

Although society’s attitude toward snoring is usually somewhat humorous, this can be a major issue for individuals. Aside from the fact that it itself can happen and cause couples not to be able to share the same bed, it also may be a sign of a much more serious health issue. Snoring occurs routinely when the soft tissues of the airway, especially the roof of the mouth or what’s known as the soft palate, vibrates due to narrowing of the airway and therefore vibration of that tissue as air passes by it. The most common time for this relaxation to occur is when one gets into deeper sleep. At that time soft tissues in the body, including muscles, generally relax.

It is likely to be true that almost any adult can snore occasionally in certain indications such as perhaps when they’re extremely fatigued, had an extra glass of red wine with dinner, or have a bad cold. However, any individual that is a routine snorer, snoring most nights, should really be evaluated. About 80% of those individuals will be found to have sleep apnea, and sleep apnea has a myriad of very serious medical side effects and potential complications, some of which are even life-threatening.

An individual who denies any other symptoms of sleep apnea but just snores still is at risk for this very real diagnosis. On top of that, more recently there have been at least one or two studies that have demonstrated individuals who have only primary snoring, who have a normal test for sleep apnea, who still show an increased risk of heart attack and stroke. Therefore, snoring itself may actually be its risk by itself. Any individual who snores routinely should have a sleep study. A sleep study is a diagnostic test ordered by your physician that can either involve a night stay at a sleep center or can actually be taken home and performed in your own bed. This will measure whether or not there is significant enough obstruction to provide the diagnosis of obstructive sleep apnea.

It is very important to do this before treatments are initiated because the type of treatment that may be safe for that individual who’s snoring and also the predicted success rates of treatments vary on whether sleep apnea is present or not, and if it is present, the severity of sleep apnea. If, in fact, a sleep study is normal, and the patient does not have sleep apnea and still wishes to have their snoring treated, there are a variety of mechanisms to treat that, both non-surgical and procedural. The non-procedural treatments include the use of CPAP, which is typically used for sleep apnea, even mild to moderate sleep apnea, where positive-pressure air is used to stent the airway open.

There are other options now available that are slightly less invasive but are based on the similar techniques, and then there are devices known as dental devices or mandibular repositioning devices similar to a teen’s orthodontic retainer that is used instead to pull the lower jaw slightly forward to open the airway. These have the benefit of not being invasive but do have to be worn each night to prevent the snoring. There are office-based procedural treatments that can involve using heat energy to tighten the tissue, using implanted devices that will strengthen and tighten the tissue, or even surgical treatment that basically removes the redundant tissue to relieve the snoring. All of which have their place in the treatment of snoring but really demand an evaluation to determine whether any other issues are present in order to maximize their potential for success.

The post Can Snoring Indicate Major Health Issues in Adults? appeared first on Jerome Hester, MD.

Recently, the National Transportation Safety Board found that two separate fatal train accidents, one in New York and one in New Jersey, were likely the result of untreated obstructive sleep apnea. It is well known that untreated sleep apnea will lead to fatigue, which is not always obvious to the individual suffering from the disease. The government has put in restrictions on the diagnosis and testing for this disease among train engineers, pilots and even captains of large vessels. However, these guidelines are not always followed. This has led to other issues where sleep deprivation, and in many cases, sleep apnea itself have been blamed for these accidents.

This includes the Exxon Valdez, the incident involving a large tanker hitting the Bay Bridge here in the San Francisco Bay Area leading to a large oil spill, and even airplane accidents leading to fatalities. As worrisome as all these are, it brings to light a much more common and probably imminent danger to the rest of us, which is the same issues that lead to fatigue playing a role in these accidents leads to a significant role in automobile accidents. It has been estimated that an individual with even mild to moderate sleep apnea has somewhere in the realm of four to seven times the baseline risk of being involved in a fatal car accident. This means that that individual who is fatigued behind the wheel can cause the death not only of themselves but of other innocent individuals as well.

Attempts to regulate this have not been easy for governmental agencies. Therefore, I believe all of us should understand that if there are signs and symptoms of sleep apnea, that not only should one pursue these for the risks such as heart disease, stroke and just the fatigue itself, but also the fact that this provides a significant risk to others on the road who are innocent. Once again, the recent episodes bring to light any incident that shows us that sleep apnea or sleep deprivation may be there should be considered a true risk factor when operating any kind of motor vehicle.

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I’d like to talk about the treatment options for obstructive sleep apnea. Obstructive sleep apnea occurs when the airway from approximately the level of the nose to the back part of the tongue collapses during sleep due to the lack of tone in the musculature. Obstruction can occur at any of the levels in this space or all of the levels and therefore, any treatment needs to be aimed at correcting the levels of obstruction. Failure to correct all the levels of obstruction will lead to failure of the treatment.

The first treatment I’d like to discuss is CPAP, which stands for Continuous Positive Airway Pressure. This treatment at this time is considered the gold standard for how to treat the disease as its success rate is very high. The mechanism of action is that through wearing a mask or small device covering the nose, positive pressure air is forced into the airway, therefore, stenting the airway open during sleep preventing it from collapse. It essentially can be effective in only almost any patient by basically titrating the amount of pressure that is delivered. The other advantage besides the high rate of success is the fact that there is no true risk associated with this treatment.

Finally, there really is no reason why this burns any bridges to try a future treatment if this is not successful. However, the downside of CPAP is compliance. Depending on the study one looks at, compliance rates at six months were as low as 40% but generally are believed to be somewhere in the 60 to 70% range. The reason for not being able to tolerate such a treatment are really myriad. There are several reasons from comfort levels to having to get up in the middle of night and having it back on. It can dry the lining of the sinuses or the nose during treatment basically leading to an inability to get a good night’s sleep.

Overall, I believe it is the first-line treatment to try in this process. However, if it is not successful or the patient chooses not to wear it, there are other options. These other options include dental appliances or what are commonly known as mandibular repositioning devices. They look much like a child’s retainer although a little more elaborate and they work by wearing it every night and pulling the lower jaw forward as one sleeps. The advantage here is obviously, that once again, this is not surgical in nature.

However, there are some disadvantages also. First of all, this is not adequate for every patient. It specifically widens the airway in the area behind the base of the tongue and if that is not the predominant area of obstruction, this may lower the success rate itself. In addition, it is very important that these devices are made by someone well-trained in manufacturing such a device. Because they are pulling the lower jaw forward during the night, problems with both the jaw joint and even how the teeth fit together can arise. It is also important, if this device is used as a treatment, that once it establishes itself as being a reasonable choice by the patient, that a sleep study is obtained with the devices in place to determine whether the devices certainly solved the problem or simply improved it slightly.

The next thing I’d like to touch on at least briefly is weight loss. Now, weight loss can certainly contribute to sleep apnea. However, it is rarely the cause of sleep apnea and so therefore, simply proceeding with a weight loss program as treatment is usually not adequate. It has also been shown that once someone has sleep apnea, it is more difficult to lose weight. The suggestion most of the time would be to take on another treatment form such as CPAP, attempt to lose weight while one is wearing the CPAP and then if the weight is lost, a sleep study can be performed to see if the weight loss in fact made a significant difference but otherwise, which is very common for us to see patients going on year after year with untreated sleep apnea with the hope that someday they’ll be able to lose weight to change this scenario.

The final treatment option is a surgical treatment option. As I alluded to at the beginning of the talk, obstruction can occur at any level between the nose and the back of the tongue. It is very important that the individual treating a patient with sleep apnea has the ability to do a comprehensive evaluation of the airway, determining to the best of their ability where the obstruction is. Surgical treatment then needs to be aimed at those levels. A common cause of failure of surgical treatment is inadequate treatment of all the levels of obstruction, therefore leading to only a partial clearance of the airway. Surgery itself can be very simple and it can be very complicated depending on the patient’s anatomy and severity of disease. However, studies have shown that the overall surgical success rate is very high when applied in a comprehensive manner.

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The following is transcript of the video for your convenience:

It is normal for humans as they go through the night to dive into periods of deep sleep. During these periods of deep sleep it is normal for the body to go into complete muscle relaxation. The area from approximately behind the nasal cavity to behind the back of the tongue is a muscular tube and as we go into deep sleep these areas can relax.

In those individuals who have either too narrow of an airway or too floppy, for lack of a better term, of an airway, these areas can close down to the point where breathing is interrupted. This can be a complete interruption, or an apnea, where the breathing stops completely, or a partial obstruction which is known as a hypopnea. Interestingly a hypopnea may not be obvious to an individual watching someone sleep and so therefore just observation of someone sleeping is not an accurate way of measuring sleep apnea.

Both of these issues, however, cause disruption of sleep. The body has a safety mechanism in place where the brain will pull us out of deep sleep into a more superficial layer of sleep, enabling muscle tone to return to the airway and the patient is able to breathe again. However, this leads to disruption of deep sleep over and over again through the nighttime. In the worst cases this can lead to actual fatigue during the day because of the lack of deep, uninterrupted sleep. However, fatigue is a somewhat subjective evaluation by the patient and many times the individual will deny fatigue or put it onto some other reason such as pressure at work or issues at home. Other things can happen that are manifestations of this problem such as lack of attention span concentration difficulties. We especially see these in the younger patients, the children and the adolescents where fatigue actually is absent commonly but problems with cognitive functioning are much more common.

At the same time, issues are going on with the drop in oxygen level when the breathing is interrupted. This can cause long term problems with the brain itself, once again leading to issues with cognitive functioning. But also with the heart and other tissues in the body with repetitive lower oxygen levels happening throughout the night. At the time of obstruction a large release of adrenaline also occurs, which can cause increased pressure on the heart itself and lead to problems such as differences in heart blood pressure which can cause long term problems for the patient.

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