Obstructive Sleep Apnea (OSA) is a hidden epidemic with Deadly Consequences! Sleep apnea usually is a chronic condition that disrupts your sleep. When your breathing pauses or becomes shallow, you’ll often move out of deep sleep and into light sleep. As a result, the quality of your sleep is poor, which makes you tired during the day. Sleep apnea is a leading cause of excessive daytime sleepiness.
Frequently Asked Questions
OSA is the most common type of sleep apnea and is caused by obstruction of the upper airway. It is estimated to occur in 24% of men and 9% of women over 18 years of age, but the estimated incidence in Diabetes is as much as 40% or more. At least 80% of people experiencing OSA go undiagnosed. OSA is characterised by repetitive pauses in breathing during sleep, lasting 10 seconds or more, despite an effort to breathe (apnea).
Hypopnea is defined as abnormally shallow or restricted breathing where there is a greater than 30% reduction in chest wall movement. It is considered less severe than apnea but produces a similarly negative impact on the outcome of sleep breathing disorders. OSA is diagnosed on the frequent presence of apnea and/or hypopnea. For the diagnosis of OSA the AHI (apnea/hypopnea index) needs to be greater than 5, which means that there needs to be on average more than 5 events of apnea and/or hypopnea per hour. There is an associated reduction in blood oxygen levels. If left untreated OSA can lead to serious cardiovascular disease such as high blood pressure, stroke and heart attack. It can also lead to other metabolic problems such as diabetes type II, insulin resistance, metabolic syndrome, weight gain and obesity.
Sleep apnea results from the upper airway collapsing during sleep, reducing oxygen flow. The resulting low oxygen in the bloodstream arouses the individual, resulting in disrupted sleep (even if they do not fully remember awakening). This is due to poor muscle tone, structural causes or increased soft tissue around airway.
Sleep breathing researches have theorised that human evolution has left us predisposed to sleep breathing disorders for several reasons. The first being the fact that our voice box has descended downwards into the larynx to enable humans to make complex sounds for speech. This has effectively narrowed our airways significantly. Our jaws has become smaller and narrower due to an increase in refined and processed foods in our diets as compared to older civilisations. When the jaw is smaller the tongue takes up to much space in the mouth. This becomes a significant problem when we lie down and the tongue falls back, blocking the airway. Finally humans have relatively shortened and flattened faces when compared to other primates, which has also reduced the size of the airway. When we sleep at night the muscles keeping the airway open relaxes and the tongue falls back, causing a partial obstruction. When there is a further compromise of the airway for any reason such as an increase in weight, chronic sinus problems, alcohol or sedative use etc. Sleep breathing disorders develop which can have a very serious impact on health.
Other contributing factors include:
- Diabetes Type II
- Alcohol and drug use (esp. sedatives)
- Acute conditions of throat e.g. tonsillitis, EBV, Infectious Mononucleosis, respiratory infections
- Increased neck size > 16” (40.64cm) for females and >17” (43.18cm) for males
- Nasal obstruction
- Old age
- Brain injuries
Between 2% and 7% of adults have obstructive sleep apnea, causing poor sleep quality, snoring, and intractable fatigue. Obstructive sleep apnea, when left untreated can lead to high blood pressure, chronic heart failure, atrial fibrillation, stroke, and other cardiovascular problems.
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Sleep apnea often goes undiagnosed because doctors usually can't detect the condition during routine office visits. This is especially true if the patient doesn't volunteer the information . Also, there is no blood test that can help diagnose the condition.
At Health a Renewal, our doctors have the ability to recognise and co-manage obstructive sleep apnea.
The most common type of sleep apnea is obstructive sleep apnea (OSA). In this condition, the airway collapses or becomes blocked during sleep. This causes shallow breathing or breathing pauses.
Most people who have sleep apnea don't know they have it because it only occurs during sleep. A family member or bed partner might be the first to notice signs of sleep apnea.
This is a dangerous disease. If you ignored this vital clue, you may be setting yourself up for chronic disease and even death whilst sleeping.
Anyone who snores should ask their partner to check them while they are sleeping.
When you try to breathe whilst sleeping, especially when lying on your back, any air that squeezes past the blockage can cause loud snoring. The most common form of sleep apnea occurs when the upper airway collapses (partially or completely) for intermittent periods. This results in characteristic gasping or choking during nighttime breathing.
OSA can strike people of any age, including infants and children, but it is most frequently seen in men over 40, especially those who are overweight or obese.
Sleep apnea usually is a chronic (ongoing) condition that disrupts your sleep. When your breathing pauses or becomes shallow, you’ll often move out of deep sleep and into light sleep. As a result, the quality of your sleep is poor, which makes you tired during the day. Sleep apnea is a leading cause of excessive daytime sleepiness.
1. The first question we ask is if they snore.
2. Then we ask if they feel tired during the day.
3. Then we ask if their bed partner has commented that they stop breathing for periods during the night.
4. If so, then we immediately refer our patients to a sleep clinic for evaluation.
5. If their partner haven't commented, then we ask them to have their bed partner stay up and watch them snore.
6. If it appears that they stop breathing whilst sleeping/snoring, then we immediately refer them to have a sleep study done.
7. Even if the bed partner does not notice definite stopping of respirations, we may still refer for a sleep study to be sure.
- Repetitive pauses in breathing during sleep despite effort to breathe, often followed by gasps
- Loud snoring
- Reduction in blood oxygen saturation
- Daytime sleepiness and fatigue (key feature) Assess with Epworth sleepiness scale
- Restless sleep
- Morning headaches
- Difficulty concentrating and forgetfulness
- Mood changes such as irritability, anxiety and depression
- Increased heart rate
- Increased blood pressure
- Decreased sex drive
- Unexplained weight gain/difficulty losing weight
- Heartburn and/or reflux
- Chronic sinusitis and post-nasal drip
- Heavy night sweats
- High levels of inflammation
- Activation of sympathetic nervous system (fight or flight)
- Hyperactivity or failure to thrive in children
- High BMI (but not always)
- Decreased mobility in gastrointestinal tract (Constipation)
One study showed that people with sleep apnea are more likely to die within the first month following stroke than those who breathe normally during sleep. Increased incidence of a Stroke is the biggest risk of chronic and unattended sleep apnea.
- Stroke: Sleep apnea is independently associated with significantly increased stroke risk, ranging from about 1.5-fold to over 4-fold across several studies. This happens because sleep apnea deprives its victims of oxygen during sleep.
- Inflammation, endothelial dysfunction, and oxidative stress are a result of a lack of oxygen during sleep apnea.
- Vessel Integrity: All of these factors compromise the integrity of blood vessels, increasing the likelihood a stroke-causing blood clot will form.
- High blood pressure, atrial fibrillation, and diabetes are aggravated by sleep apnea.
- This under diagnosed and often overlooked sleep disorder represents a major risk factor for cardiovascular disease, the leading cause of death in first World adults. Data indicate obstructive sleep apnea is associated with a 68% increase in coronary heart disease in men.
- Sleep apnea is common among patients with heart failure, and the increased strain on the heart caused by sleep apnea may promote the progression of heart failure.
- Obstructive sleep apnea may also be associated with increased cholesterol, hypertension, cancer mortality, stroke and death.
- Identification and correction of sleep apnea can significantly reduce overall cardiovascular risk.
OSA leads to a massive increase in inflammation and inflammatory problems in the body. Many common skin conditions such as Eczema, Dermatitis, Rosacea, Psoriasis and more are caused by inflammation and OSA could be a contributing factor, or even the cause. High levels of inflammation will also accelerate aging of the skin and drastically affects the quality and appearance of the skin.
Solution – Effective treatment of OSA will bring the levels of inflammation back to normal. Your Health Renewal doctor is also well equipped to treat inflammation with natural supplementation. Supplementation with specialized antioxidants will also protect your skin and has a wonderful anti-aging effect on the skin. These include Glisodin, CoQ10, Lipoic Acid, Pycnogenol and more.
Your Health Renewal doctor will assess you with several questionnaires to determine your day-time sleepiness and fatigue as well as all the other contributing factors for OSA. A thorough case history will then be taken to assess you further which will include a thorough look at your family history. A family history of one or more parents who snore heavily and has heart disease or diabetes puts you at a higher risk. If your Health Renewal doctor strongly suspects that you have OSA you will be sent for a sleep study (Polysomnography) for a definitive diagnosis.
- Avoid alcohol and smoking
- Avoid sedatives and muscle relaxants
- Weight loss
- Sleeping in an elevated position (30 degrees)
- Sleep on the side rather than on the back
- Surgery if required
- Continuous positive airway pressure (CPAP)
- Mandibular advancement devices (MAD)
- Nutraceutical supplementation to treat related conditions such as insulin resistance, blood sugar problems, adrenal stress, anxiety, excess weight, blood pressure etc.
Treatment with the CPAP(continuous positive airway pressure) devices has a reputation for causing discomfort and they are not popular for this reason. However, advances in technology has developed equipment that function very well and causes minimal discomfort. It is the most effective form of treatment for OSA and will add many years to your life by reducing your risk for cardiovascular disease and diabetes.
Once you have become aware that you may suffer from Sleep apnea, participating in a clinical sleep study is the most accurate/definitive diagnostic tool for determining the presence of sleep apnea.
A sleep study is conducted during a patient’s through-the-night visit to a sleep laboratory will include monitoring among other things blood oxygen levels, respiration rate, brain-wave activity, leg movements, and most significant, the apnea-hypopnea index, the number of apnea and hypopnea (partial inhalation) incidents the sleeper experiences per hour.
- Your sleep study measures the time spent in each stage, in minutes and as a percentage, and the latencies between the time you fall asleep and the time you enter Stage 4 and REM sleep, respectively.
- Non-REM and REM sleep
- Once you drop off, you should progress through four stages of increasingly deep, dreamless sleep and into a fifth stage during which dreaming--characterised by rapid eye movement--occurs. Over the course of the night, you will cycle repeatedly between Non-REM and REM sleep. The structure of these cycles--poetically known as "sleep architecture"--reveals whether you are getting the restorative sleep you need to feel and be well. Stage 1, the very lightest sleep, should only be 5 percent of the total sleep time, and should only occur at the beginning of the night. The still fairly light Stage 2 sleep should represent about 55 to 60 percent of the TST. Deep sleep--also known as "slow wave" sleep--takes place in Stages 3 and 4, and should account for about 20 percent of the TST. If Deep Sleep is truncated or absent, you will not feel rested the next day.
AROUSALS AND AWAKENINGS
- Arousals--interruptions of sleep lasting 3 to 15 seconds--can occur spontaneously or as a result of sleep-disordered breathing or other sleep disorders. Each arousal sends you back to a lighter stage of sleep. If the arousal last more than 15 seconds, it becomes an awakening. You are usually not aware of arousals, but may be aware of awakenings. The number of arousals and awakenings is registered in the study, and reported as a total number and as a frequency per hour of sleep, which is referred to as an index. The higher the arousal index, the more tired you are likely to feel, though people vary in their tolerance of sleep disruptions. As few as five arousals per hour can make some people feel chronically sleepy. In the worst cases of SDB, the index can be 100 or more.
MECHANICAL MALFUNCTION/ OBSTRUCTION
- The mechanical malfunction occurs when the soft structures in the back of the throat collapse into the airway, reducing the amount of air that makes its way into your lungs and, as a consequence, the amount of oxygen in your bloodstream.
- In an apnea episode, airflow is reduced by at least 80 percent;
- In a hypopnea episode, the range of the reduction is 50 to 80 percent.
EVENTS PER HOUR
- The report indicates the number of times each occurs, as a nighttime total and as an index of EVENTS PER HOUR. This latter number is referred to as either the apnea-hypopnea index or the respiratory disturbance index.
- An index of 5 to 14 indicates a MILD level of breathing--and sleep--disturbance. From 15 to 30 is MODERATE greater than 30 is SEVERE.
- The associated drops in blood oxygen levels, known as DESATURATIONS, are also measured and categorised.
- NORMAL saturation is around 95 percent.
- A MILD desaturation to 86 percent is mild,
- A MODERATE reduction to 80 to 85 percent is moderate,
- A SEVERE reduction to is a 79 percent or less is.
HEART: In addition to the items covered above, the polysomnogram looks at your heart rhythm, and determines if there are any abnormalities.
LIMB MOVEMENT: Another important part of the study is the assessment of limb movement, since leg movement can constitute another sleep disorder.
SNORING: Someone listens your snoring, which is probably the symptom that got you to the lab in the first place.
At Health Renewal we treat patients who have had numerous visits to health professionals but a diagnosis still eludes them. Many of them have serious brain fog, and neurologic or cardiovascular disease. Many suffer from various toxicities affecting the liver and the central nervous system. We encourage these patients to make an appointment with our Functional/Integrative doctors who will endeavour to improve the quality of life with this very important new approach to chronic illness.
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