Obstructive Sleep Apnea Syndrome

One out of five people after 30 years old is constant snoring during sleep.

According to popular belief, snoring is an unpleasant, but safe sound phenomenon. However, few people know that the so-called “mighty” snoring is a forerunner and one of the main manifestations of a severe disease – obstructive sleep apnea syndrome (OSAS) or pulmonary arrests during sleep. The first witnesses of this terrible disease are close people who anxiously observe snoring suddenly stop and pulmonary arrest appears, and then sleeping person loud snores, tosses about occasionally, moves his hands or legs and begins to breathe again. Sometimes there may appear up to 300 – 400 pulmonary arrest during night, in total lasting up to 3 – 4 hours.

Respiratory disorders of a sleeping person lead to severe deterioration in sleep quality. Headaches, constant drowsiness, irritability, decreased attention and memory, reduced potency are only a part of symptoms that may appear at chronically not getting enough sleep people. Especially dangerous are acute attacks of drowsiness while driving, when a person painfully wants to close his eyes and go to sleep at least for a few minutes. Canadian Health&Care Mall statistics show that possibilities of car accidents at patients with obstructive sleep apnea syndrome is ten times greater than average accident rate.

sleep apnea

What is Happening?

What causes the disease? Patency of upper airways depend on their inner diameter, pharyngeal muscle tone and value of negative pressure during inhalation. During sleep, when there is a significant reduction in pharyngeal muscles tone, there are conditions for full airways drop. This usually happens on the inhale, when a negative pressure is formed and there is a force that contributes to airway walls apposition.

When a person falls asleep, there is a gradual throat muscles relaxation. One of inhales leads to complete airways drop and pulmonary arrest. To restore airway patency brain activation is required that has to send an impulse to pharyngeal muscles and open airways. After respiration restoration normal oxygen content in the body is restored, brain calms down and falls asleep again… and this cycle is repeated again.

Frequent long pauses in breathing cause sharp oxygen saturation decrease in blood. Thus, primarily those organs are affected that consume large amounts of oxygen: brain and heart. Persistent morning headaches are manifestation of night brain hypoxia. In case of ischemic heart disease, blood oxygen saturation violations can trigger dangerous arrhythmias and myocardial infarction development. Additionally, hypoxia interferes with insulin action, which can exacerbate diabetes.

Each pulmonary arrest is a stress for the body, accompanied by short-term increase in blood pressure to 200 – 250 mm Hg. Regular episodes of nocturnal pressure increase lead to chronic high blood pressure, often having crisis course. This may explain increased risk of blood stroke at these patients. Moreover, in such cases, blood pressure is difficult to treat by conventional antihypertensive drugs.

Hypoxia and deep stages of sleep absence cause decrease in growth hormone production, responsible for fat exchange in the body. As it is known, consumed food is partly converted into energy, partly deposited in reserve in the form of fat. In case of lack of food fat is converted into energy and is consumed by the body. Growth hormone provides migration of fat into energy. What happens in case of this hormone secretion violation? Fat can not turn into energy in spite of its lack in the organism. Thus, a person almost always has to eat food to replenish energy consumption. In this case all excess substance go into “dead weight”, which cannot be used by the body. A person starts to gain weight quickly, and any attempts, diet or medicamental, aimed at weight loss, are unsuccessful.

Furthermore, fat accumulates in neck area, leading to further airways narrowing and sleep apnea disease progression, which in its turn exacerbates lack of growth hormone. Thus, a vicious circle appears, which cannot be broken without treatment. At severe forms of the disease there is a decrease in testosterone production, which leads to libido decrease and impotence at men.

Diagnostics

How to determine sleep apnea disease? Patients suffering from this disease usually have a very distinctive appearance, described by Charles Dickens at his character Joe in “The Pickwick Papers”: “It was a fat man with a short neck and a red face, who always fell asleep and began to snore in the most uncomfortable situations…”

There are enough simple scheme, which help to determine the disease and appoint an additional examination.

When there are three or more of these symptoms (or only the first one) serious examination is necessary:

  • symptoms of sleep apnea;
  • loud or intermittent (with snores) night snoring;
  • frequent night-time urination;
  • prolonged sleep disorders at night (>6 months);
  • increased daytime drowsiness;
  • obesity;
  • hypertension (especially at night and in the morning).

To identify pulmonary arrest during sleep the easiest way is to watch a sleeping man. Usually right after a person falls asleep he begins to snore. Soon, a patient suddenly stops breathing. At this time, no breathing noise are audible, snoring stops. However, patient tries to breathe, as it is evident by movements of chest and abdominal wall. After about 15 – 30 seconds a man loudly snores and makes a few deep breaths. Usually patient’s sleep is very unquiet: he tosses about in bed, moves his arms and legs, sometimes talk in sleep.

Frequency and duration of pauses in breathing depend on disease severity. In severe cases cyclic pulmonary arrests occur almost immediately after falling asleep in any position of the body. In less severe forms, it happens only during deepest stages of sleep, or when patient is sleeping on his back. Breathing disorders are often associated with alcohol intake. Sometimes snoring and pulmonary arrest occurs only after a large dose of alcohol, taken right before bedtime.

Recommendations

Universal tips by Canadian Health&Care Mall that can be applied without consulting a doctor are listed below:

  1. Sleep on only your side. Respiratory disorders are greatly exacerbated in lying on the supine position because tongue falls back. There is a simple and effective way to make a person not to sleep on his back. On pajamas or special jacket between shoulder blades there make a pocket into which a ball is put. In this case, every time a person tries to lie on his back he wakes up. Experience shows that after 3 – 4 weeks a lasting reflex not to sleep on the back appears.
  2. Provide elevated position of the head. It also prevents tongue from falling back and increased snoring. You can tilt the entire bed, setting 10-15 cm thick bars under beds legs, or put under mattress a sheet of plywood on pelvis area (similar to functional medical bed). It is desirable to use special contour pillow that provide optimal head position relative to the body. These methods not only help with snoring, but also with belching with stomach contents, often present at snoring obese people.
  3. Avoid taking sedatives/hypnotics. Sedatives and sleeping pills, as a rule, reduce muscle tone and cause pharyngeal muscles relaxation, which in its turn can provoke airways drop. These drugs are absolutely contraindicated to patients with moderate and severe forms of the disease. In mild cases, the question of their appointment should be decided individually.
  4. Do not drink alcohol before going to sleep. Alcohol also relaxes pharyngeal muscles and provokes snoring and sleep apnea. Human liver processes 10 ml of pure alcohol per hour, so you can calculate what dosage and how long before bedtime you can drink without consequences for health. For example, 100 ml of vodka contains 40 ml of pure alcohol, respectively, negative effect of this dosage will last for about 4 hours.
  5. Lose weight. Statistically it is shown that weight loss by 10% from initial may improve breathing parameters during sleep by 50%.
  6. Quit smoking. Smoking often causes chronic inflammation of pharynx and trachea, accompanied by swelling of walls. This in its turn can lead to airways narrowing and increased risk of sleep apnea.
  7. Provide maximally free nasal breathing. Difficulties with nasal breathing can significantly worsen snoring and provoke sleep apnea. If this is a temporary phenomenon, try to use any vasoconstrictor agents for common cold. At chronic nasal congestion (polyps, deviated septum, hypertrophy of mucous membrane) you should consult ENT doctor and decide on possibility of surgical treatment.
  8. Use intraoral devices for snoring. There is quite an ingenious domestic invention, the so-called “dummy” for snoring. In addition, you can use simulated intraoral devices. In some cases, they actually have positive effect, although, of course, are not a panacea and can only be used in mild forms of snoring.

sleep apnea

Treatment

Currently, the following treatments for snoring and obstructive sleep apnea are available:

  • laser staphyloplasty;
  • uvulo-palatopharyngoplasty. This long term contains names of pharyngeal tissues, which are removed in order to increase airways lumen on throat level (tonsils, palatal arch, uvula). Surgery is used to treat sleep apnea disease. Intervention provides only about 50% of positive result and is very painful. In addition, in 5 – 7 years tissues on throat level may grow again and lead to relapse. Lately time this surgery is used infrequently.
  • creating constant positive airway pressure (CPAP-therapy). Currently, the most common method for severe forms of sleep apnea disease treatment.