Health column by Dr. Greg Feinsinger. Champion of Whole Food Plant Based Living and righteous person.
Apnea means absence of breathing, and sleep apnea refers to when this happens during sleep. There are two types of sleep apnea: obstructive and central.
OBSTRUCTIVE SLEEP APNEA (OSA) is common in people who are overweight; have a thick neck; have a receding chin; or have other conditions that can obstruct airflow when tissues are relaxed during sleep, such as enlarged tonsils and adenoids in children. Typically, people with OSA snore. Often their bedpartner notices that they periodically stop breathing for several seconds when sleeping Often an OSA sufferer awakens suddenly during the night with a snort.
CENTRAL SLEEP APNEA is common in people who live at or above 3,000 feet, and is more apt to occur as people age. At night, the brain senses that there isn’t enough oxygen in the air, which triggers several deep breaths in a row. This results in a low carbon dioxide level in the blood, and when the brain senses that, breathing stops for several seconds to allow CO2 to return to a normal level. Some people have mixed apnea—obstructive and central.
Apnea sufferers are in and out of a deep sleep all night long, unbeknownst to them, which wreaks havoc on the cardiovascular and several other systems of the body. The classic symptoms of severe sleep apnea are not feeling rested after waking up in the morning, and feeling sleepy during the day, which can lead to accidents, depression, and poor job performance. Other problems associated with sleep apnea are: atherosclerosis; heart attacks; strokes; high blood pressure; cognitive problems including dementia; cardia arrhythmias such as atrial fibrillation; sudden death from heart irregularities; erectile dysfunction; diabetes (diabetes-causing stress hormones are secreted at night in people with sleep apnea); night sweats; and “thick blood,” meaning a high red blood count (hematocrit and hemoglobin) due to the body trying to compensate for the low blood oxygen at night by making more red blood cells. Anyone with any of these problems should be screened for sleep apnea.
Sleep apnea can often be diagnosed from what the bed partner says. It can be confirmed with a simple and inexpensive overnight oximetry—wearing a finger monitor that measures the pulse rate and oxygen level all night. If this test is normal, sleep apnea is unlikely. If it’s abnormal, the next step is a more extensive test called an overnight sleep study. A home sleep study is less expensive, but a hospital sleep lab study is better for diagnosing central apnea. Furthermore, in a sleep lab a “split sleep study” can be done, which involves the following: During the first half of the night, the diagnosis and type (obstructive or central or mixed) of sleep apnea are established. If sleep apnea is confirmed, CPAP is applied and adjusted during the second half of the night.
If sleep apnea is diagnosed, a thyroid blood test test should be done, because low thyroid can cause or contribute to apnea. People with sleep apnea should avoid alcohol, sleep aids, and sleeping on their back—all of which make apnea worse. Losing weight helps in people who are overweight. In some cases, special dental appliances and throat surgery can help. In pure central apnea, moving to sea level is usually curative. However, most people need CPAP (continuous positive airway pressure)—the gold standard treatment. This involves the patient wearing a mask (which usually just covers the nose) at night that is hooked up through tubing to a quiet machine that puts out air at a continuous pressure, thereby preventing the apneic spells.Most people tolerate CPAP well, and start feeling better within a few days of starting it. People who tolerate it find they fall asleep faster, sleep more soundly, and feel better when they wake up and for the rest of the day. Problems such as hypertension and arrhythmias often improve or resolve.
It's estimated that about 18 million Americans have obstructive sleep apnea, with over 90 percent of them undiagnosed. Many more people living at altitude suffer from central sleep apnea, and again most are undiagnosed. If after reading the information above, you or your partner think you could have sleep apnea, it would improve your quality of life, and perhaps save your life, if you sought diagnosis and treatment. Your primary care provider should be able to help you with this. For difficult cases, we’re fortunate to have pulmonologist Dr. Khilnani and The Lung Center at Valley View Hospital.
