"Obstructive sleep apnea is not just snoring: it's far more serious."
Snoring can be frustrating, especially for our spouses, but what many people don't know is that it can also be dangerous. While snoring itself isn't necessarily an issue, a condition associated with it, called Obstructive Sleep Apnea, can be a potentially serious or even fatal issue.
In today's show with Dr. Keller Wortham, MD, he'll discuss how to recognize the signs and symptoms of Obstructive Sleep Apnea, the potential health impact it can have, and some steps for addressing it.
- 01:16: Obstructive Sleep Apnea
- 03:33: Risks Factors for Sleep Apnea
- 06:32: Signs and Symptoms of Sleep Apnea
- 09:38: Diagnosing Sleep Apnea
- 11:05: Health Risks of Sleep Apnea
- 13:24: Treating Sleep Apnea
- 17:43: Wrap-Up
Obstructive Sleep Apnea
Obstructive sleep apnea is a condition that occurs when your airway closes off, preventing air from getting into your body, and creates what's called an apneic episode. Basically, it's a condition where your throat muscles start to relax and loosen, resulting in a collapse of the airway. When that happens, the oxygen flow into the body gets cut off. If it's mild, it can create some snoring, but if it's more severe, then your oxygen level starts to drop over time and your carbon dioxide levels start to go up, and this is very bad for the body. As we're all aware, oxygen is the main driver of our health and our metabolism, and we need it to survive. So if you're going through long periods during the night where you're not getting oxygen in your body, that’s not good.
With obstructive sleep apnea there can be a pattern of snoring, and then gasping as the airway gets cut off. This can happen up to 30 times per hour the entire night that you're trying to sleep. That means you're preventing your body from going into those deeper levels ofsleep that we need for restoration of our body and brain, and also depriving your body of necessary oxygen levels.
Risks Factors for Sleep Apnea
Anyone can get sleep apnea, but there are certain categories and factors that put you at a higher risk for sleep apnea:
- Excess Weight — Sleep apnea is a condition where the muscles of the airway collapse and close off. So, when people areoverweight, they tend to just have more body tissue and that can include the tissues around the neck. That thickness and the increased tissue mass around the neck can make it more likely for your airway to close off.
- Narrow Airway — The second risk factor is that some people are just born with a naturally narrow airway. This can occur because you've got larger tonsils, which can reduce the space available for air to get by. So, if you're born with a naturally narrow airway, you're at a higher risk of developing sleep apnea.
- High Blood Pressure —High blood pressure is associated with sleep apnea, though it's a little unclear whether it’s the high blood pressure that leads to the sleep apnea or vice versa. It looks more likely that the sleep apnea itself causes high blood pressure. But if you have high blood pressure, you're nonetheless at a higher risk of developing sleep apnea.
- Chronic Nasal Congestion — If you have chronic nasal congestion, chances are that your airways are just more inflamed. As things get congested, they get more narrow, so it's harder for oxygen and air to get in and out through those passages.
- Smoking — Smoking puts you at a higher risk for sleep apnea. If you're a smoker out there, wealways recommend that youquit right away, but if you're not quitting just realize that you might be at higher risk for developing this condition.
- Diabetes — This may be associated with obesity, but it also can be associated with an altering of the nervous system, and a failure of the nervous system to adjust for changes in the musculature of the throat.
- Gender — Men are at a high risk for sleep apnea, while women's risk for sleep apnea increases aftermenopause. Postmenopausal women are also a category with an increased risk.
- Family History — If you have a family history of sleep apnea, you're at a higher risk.
- Asthma — If you suffer fromAsthma, you're at a higher risk for developing sleep apnea.
Signs and Symptoms of Sleep Apnea
So we’ve discussed the groups of people who are at a higher risk for this condition. Now, let’s identify some of the symptoms and signs of sleep apnea.
- Loud Snoring & Gasping —The first symptom, as we already discussed, is loud snoring, or this moment where it seems like you're cutting your airway off. Now, you might not notice that yourself — it might have to be someone else who points it out to you, like your partner, but loud snoring is one of the signs of sleep apnea. Not everyone who snores has sleep apnea but it is certainly a red flag.
- Daytime Sleepiness — If you're tired during the day and all day long, but you slept for eight hours or nine hours during the night, or you’re waking up really tired, and crashing later in the afternoon, that could be a sign. If you're one of those people who sometimes feels like you're actually falling asleep while driving, that is a potential symptom of sleep apnea.
- Abrupt Awakenings — If you wake up in the middle of the night, you're not quite sure why, or maybe you feel like you were choking, that's a symptom of sleep apnea.
- Dry Mouth And Throat Pain — This may be caused by sleeping with your mouth open and allowing air to get in. Basically, if you’re breathing through your mouth instead of your nose at night, that can be a sign of sleep apnea.
- Morning Headaches — If you're not getting adequate oxygen throughout the night because you're cutting off your oxygen supply again and again, your brain does not respond well to that. So, if you're waking up in the mornings with a bad headache, that could be because you haven't given your brain the natural rest cycle that it needs. You're not reaching those deeper levels of sleep and you're not getting the oxygen to your brain that it needs over the course of the night.
- Mood Changes — Maybe you're feelingdepressed or irritable. There can be many causes for this, but one could be that the brain is not getting those proper deeper stages of rest that are so important for detoxifying the brain. So, if you're having mood changes — depression,anxiety, irritability — that can be a sign of sleep apnea.Mental fog is another similar one — if you're just feeling like you're not clear-headed in the day, that can be a sign that you're not getting adequate rest at night.
- High Blood Pressure — If you have high blood pressure or you’re overweight, your doctor may ask you if you snore at night or sometimes stop breathing in the middle of the night. As we mentioned earlier, high blood pressure is certainly associated with sleep apnea and it's thought that it's probably a result of the sleep apnea more than a cause.
- Night Sweats — If you wake up with night sweats, that can be a sign of sleep apnea.
- Decreased Libido — If your sex drive has decreased, that could also be a sign of sleep apnea.
Diagnosing Sleep Apnea
So, we’ve been through a whole bunch of things that might indicate that you have sleep apnea... What do you do if you are experiencing some of these symptoms?
The first step is to talk with your doctor. Let him or her know that you’re waking up feeling really tired despite having been in bed for a long period of time, you’re feeling irritable, falling asleep during the day, your blood pressure is up, and you’re experiencing mental fog or some of the other symptoms. One of the ways that doctors confirm a diagnosis of sleep apnea is with something colloquially referred to as a sleep study. For this study, you might go into a lab where they hook you up to devices and they monitor your heart rate, your oxygen saturation, and of course your breathing rate over the course of the night. They are monitoring to find out if you are cutting off your breathing, if you are snoring really loudly, if your oxygen saturation is dropping in the middle of the night, and how often that’s happening. There are also companies that can help you do this study at home. You can order the kit and it will hook up a microphone, an O2 reader, and a pulse, and track how often you're breathing by the movement of your chest, and if you're snoring, how loud it is. That can help you get a diagnosis right there in the comfort of your own bed.
Health Risks of Sleep Apnea
If you are diagnosed with sleep apnea then you might have to deal with some of the health complications that occur as a result. For example, we talked aboutfatigue being one of them. Fatigue is not just an annoyance; it can be dangerous, especially if you fall asleep while you're driving, putting yourself and others in danger. If you work a job where you have to be alert — like people in the medical field, truck drivers, traffic controllers, or one of many occupations where people are dependent on you — daytime sleepiness can really put you at risk and others at risk.
Cardiovascular problems are also associated with sleep apnea. We talked about the fact that yourblood pressure goes up, and that can also wreak havoc on your heart and your blood vessels. It increases your risk of heart attack and stroke. So, it can have really serious repercussions.
Sleep apnea can also affect medications and surgeries. If you're undergoing surgery they need to know whether you have sleep apnea. It can affect the way that the anesthesia is going to affect you, and put you at risk for complications post-surgery. If you're being prescribed certain medications that could have a sedative effect, your doctor needs to know whether or not you have sleep apnea because it could make the situation worse.
Sleep apnea can also lead toeye problems, especially glaucoma. Glaucoma is a condition of increased eye pressure that can lead to blindness and sleep apnea can increase the pressure in the eye. That’s another really important reason to figure out whether or not you have sleep apnea.
Finally, on a slightly lighter note, sleep apnea can result in sleep-deprived partners. If you have sleep apnea, and you're snoring really loudly and cutting off your airway, you could stress out the person who is sharing a bed with you. These are all reasons to get sleep apnea diagnosed so that then you can take care of it.
Treating Sleep Apnea
If you're diagnosed with sleep apnea, there are a lot of things you can do. The first steps involve lifestyle changes:
- Weight loss —excess weight is a risk factor.
- Exercise —exercise can improve the muscle tone around your throat and help keep the airways open. It can also help reduce weight.
- Reducealcohol consumption, especially at night. If you're having glasses of wine before night, that is going to really relax your airway and that can increase your snoring and sleep apnea, and certainly a lot of other brain fog issues in the morning.
- Quit smoking — smoking is very irritating to the airways, and can cause swelling, which will result in the airways closing even further. So, reduce your smoking or cut it out completely. Obviously, there are a lot of reasons toquit smoking but you can add sleep apnea to the list.
- Use a nasal decongestant — if you have stuffed nasal passages, you can use a steroid spray or nasal decongestant to open the nasal passages, and that also can help open the rest of the airway to allow oxygen to get in and out of your body.
- Sleep on your side — A lot of times when you are sleeping on your back, the muscles have a higher tendency to collapse. If you're someone who deals with a partner who snores, you know that usually occurs when they're sleeping on their back, but if you can get them to roll over, those symptoms usually get better. Of course once you're asleep you have little control over how you're sleeping. Some people even go so far as to get an Ace wrap and use it to secure a tennis ball to the small of the back, to prevent them from rolling onto their backs while they sleep.
If those steps don't reduce the sleep apnea that you're experiencing then you can go on to further measures:
- CPAP — this is one of the more common options. CPAP stands forContinuous Positive Airway Pressure. It sounds a little unpleasant but is probably less unpleasant than a lot of the risks that we just talked about. A CPAP is a mask that sits over your face and blows air into your airway. That's the continuous positive airway pressure that's going in, and that air blowing into your face helps prop your airway open. A lot of people don't really like this at first, but after some time they get used to it. Unfortunately, it's loud, and it can be disruptive to your partner. It can also dry out your airways, and can be uncomfortable sitting on your face. So you definitely want to start with the lifestyle options we discussed above.
- If CPAP is not for you or you can't tolerate it, there are oral devices that an ENT or a dentist can make, that basically fit inside your mouth and help adjust the jaw and prop the airway open.
- If those things aren't working, there are surgeries that you can undergo with a professional surgeon, usually an ENT, who will remove some of the bulkier tissues in the back of your throat that might be causing the airways to collapse.
So, you do have some options there that are more invasive. We always recommend starting with the things that you have control over, which are less invasive. If those don't work, then move on to the other options.
Obstructive sleep apnea is not just snoring: it's far more serious. If you have someone in your life who snores all the time, or if you're experiencing daytime sleepiness, fatigue, high blood pressure, or the other symptoms we mentioned, then ask your doctor if you may have sleep apnea, especially if you fall into some of those risk categories we discussed. It's really important to get that evaluated with a sleep study, and if you have it, take some of these steps to help get rid of it. Your body and your spouse will thank you!