Sleep Matters

When Lack Of Sleep Becomes A Serious Condition Called Sleep Apnoea

May 18, 2009 Snigdha Taduri

Sleep deprivation is not always a consequence of stress. It can be due to 'Sleep Apnoea' and needs treatment. Read on to know more about this condition.

Sleep is our body's natural way of shutting off and recuperating from the entire day's activities. Sleep keeps our brain healthy by giving rest to parts that control emotions and social interactions and maintain cognitive skills such as speech and thinking. Lack of sleep can have the absolute opposite effect on brain functioning with controls like memory, concentration, planning and sense of time being severely affected. In more serious cases, lack of sleep is manifested as a sleep disorder that is intimately related to various psychological disorders like depression and anxiety.

What Is Sleep Apnoea?

According to the National Sleep Foundation, sleep apnoea may affect between 20 and 40% of adult snoring population, topping the list of sleep disorders. The more common form is referred to as “Obstructive Sleep Apnoea” (OSA), which occurs due to an obstruction that prevents air from entering lungs. Lack of muscle tone in the upper airways during sleep causes their collapse and blocks the airway. The brain senses this lack of oxygen and automatically wakes you up, usually with a loud snore in order to breathe again. OSA becomes clinically significant only if the stopping of breathing lasts more than 10 seconds and occurs more than 10 times in an hour.

The more serious form of sleep apnoea is referred to as “Central sleep apnoea” wherein the brain 'forgets to breathe' during sleep. Brain cells live on oxygen and a long pause in breathing reduces the blood level of oxygen, eventually causing severe brain damage and even death.

Symptoms

Disturbed sleep, excessive sleepiness during the day along with irritability and restlessness are common symptoms. Surprisingly though, patients are unaware of the lack of a proper night's sleep caused by these repeated interruptions. The other common symptoms are:

Snoring
Impaired concentration
Restlessness during sleep
Decreased libido
A personality change
Choking during sleep

Snoring And Insomnia- Their Correlation With Sleep Apnoea

Snoring does not always mean “difficulty in breathing” and does not confirm sleep apnoea. On the contrary, blocked airways hardly allow any air to circulate diminishing the possibility of a snore. However, snoring coupled with obesity could be a strong indicator for OSA, the reason being, fat deposition around the upper airway cause obstruction.

By definition, insomnia and sleep apnoea are rather paradoxical. Interestingly, insomnia is a frequent complication in sleep apnoea occurring in about 20% of the population. Such patients have “sleep apnoea plus” and are found to suffer from disturbances such as anxiety, depression and stress. Experts opine that a combination of sleep apnoea and insomnia is extremely complicated, leading to extreme sleepiness during the day and an inability to sleep at night.

Sleep Apnoea-A Risk Indicator

While sleep apnoea by itself is a difficult condition to deal with, ongoing research states that it can be an indicator for various other diseases such as:

Hypertension

Blood pressure is generally high during the day to help us cope with the day's activities and falls during the night when we sleep. In a way, sleep is very essential for blood pressure to mellow down. In people suffering from sleep apnoea, blood pressure does not get its much needed break thereby increasing the risk of cardiovascular disease, heart failure and stroke.

Diabetes

Patients with this disease are prone to type II diabetes, the reason being that most type II’s are obese. With obesity, more tissue develops in the throat and the back of the mouth causing obstruction to airways leading to sleep apnoea. Another theory suggests that the body of such patients is in stress and hence releases hormones like cortisol and adrenaline, which lead to insulin resistance, an early indicator in type II diabetes.

Metabolic Syndrome

Metabolic syndrome is defined as a cluster of metabolic risk factors such as hypertension, insulin resistance and cholesterol abnormalities coming together in a single individual leading to a cardiovascular disease. Sleep apnoea is associated with hypertension, diabetes and obesity, hence suggesting the likelihood of these patients to develop metabolic syndrome.

Treatment Options

Continuous Positive Airway Pressure (CPAP)

This is by far the most efficient treatment and is also referred to as nasal CPAP (nCPAP). This works as a pneumatic splint by applying the right air pressure to prevent the collapse of airways. CPAP alleviates symptoms of sleep apnoea and restores normal sleep patterns, improves mood, increases work productivity and concentration and reduces excessive sleepiness.

Intra Oral Devices

A newer treatment called Oral Appliance Therapy (OAT) is available wherein a custom made oral appliance shifts the lower jaw forward which opens up the airway. Patients with mild to moderate OSA respond to this therapy.

Surgery

This option is exercised for patients who cannot tolerate CPAP and would involve surgical alteration of airways. This is best for OSA wherein the site of obstruction includes the nasal passage, throat, and base of the tongue and facial skeleton.

Behavorial Changes

Certain lifestyle factors influence the severity of sleep apnoea. A change in lifestyle needs to be implemented to manage the condition better.

Obesity

Weight loss is essential to reduce episodes of sleep apnoea, snoring and improve day time sleepiness.

Smoking And Alcohol

Smoking and alcohol cause the collapse of upper airway during sleep thus predisposing individuals to sleep apnoea. Smoking is known to cause upper airway inflammation and alcohol relaxes throat muscles, both of which worsen the condition. Reduction in alcohol consumption and cessation of smoking is recommended.

Change In Sleep Position

Gravity causes throat to narrow and tongue to flip back in people sleeping on their back, increasing chances of an obstruction and episodes of sleep apnoea. Therefore, sleeping to the side could be beneficial.

Sleep matters! Lack of sleep makes us sluggish, impairs our ability to logic and reason and function normally. In short, sleeplessness can wreak havoc in our lives. If you think you are suffering from this disorder, you must seek help from your doctor at the earliest.

The copyright of the article Sleep Matters in General Medicine is owned by Snigdha Taduri. Permission to republish Sleep Matters in print or online must be granted by the author in writing.

Sleep Apnoea

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