Sleep Disorders

Sleep Apnea

Sleep disorders affect millions of Americans every year. Disorders such as insomnia, narcolepsy, restless legs syndrome and sleep apnea are common problems. Insomnia or the inability to fall asleep is the most common and is experienced by most people at some point. Narcolepsy is a sleep disorder in which a person has trouble staying awake even when they have had the proper amount of sleep the night before. Some people suffer from narcolepsy during states of nervous system arousal. Restless legs syndrome is a sensory perception problem in which a person feels tingles, “pins and needles”, and the strong urge to move the lower limbs. Sleep apnea is one of the most dangerous sleep disorders, currently affecting 1 in 15 people or 18 million Americans total. A person afflicted with sleep apnea has the potential to stop breathing. Anyone who thinks they may be suffering from sleep apnea should see their physician as soon as possible.

The most common type of sleep apnea is obstructive sleep apnea the other form is central sleep apnea. Obstructive sleep apnea (OSA) as the name implies is an obstruction of the airway passage that leads to a decreased level of oxygen in the blood. The obstructions lead to a choking or gasping along with loud snoring during sleep. These choking and gasping episodes briefly arouses the person and can happen as frequently as 20 to 30 times per hour. For this reason a person with sleep apnea cannot get a good night’s rest. Other than the lacking of restful sleep, it can also cause a headache in the morning, a dry mouth, tiredness during the day, and reduced libido. Central sleep apnea has similar characteristics to OSA, but lacks the loud snoring aspect. In both cases the person awakes suddenly choking or gasping for air.

The exact reason why one person may be afflicted with sleep apnea and another is not is not well understood. There are numerous studies focusing on the cause of sleep apnea and researchers believe there is a genetic aspect to it. Identification of an exact gene is not likely and the current theory points to multiple genes as a plausible cause. One study demonstrated a correlation between obstructive sleep apnea and developing hypertension in the future. The researchers followed individuals with OSA and those that had more than 15 obstructive wake-ups per hour were more likely to develop hypertension within the next 4 years. They also found that those who did not receive treatment had an increase risk for cardiovascular morbidity and mortality.

What are the most common treatments for obstructive sleep apnea? The most common treatment is termed continuous positive airway pressure or CPAP. The positive pressure is generated by a machine that sits next to the bed and has a mask connected to it that the person wears while sleeping. It forces pressure into the nose and mouth so the airway cannot collapse and the person sleeps with no choking or gasping awakenings. While this can increase the quality of sleep a person is getting, excessive sleepiness does not always go away, in these people modafinil or armodafinil may be used as a treatment. These drugs help to maintain wakefulness.

CPAP is the most common type of treatment, but surgery is also an option. Some physicians may recommend weight loss, avoidance of alcohol/sedatives, or sleeping in a position other than the back. During the diagnosis process there is a series of tests and the test scores as a measure of severity will determine which course of treatment should be taken. For those having trouble with CPAP upon exhaling against the positive pressure there is a modified machine called bilevel positive airway pressure or BPAP and this decreases the pressure during exhalation and increases the pressure during inhalation. There have been several pharmacologic treatments tested, but none of them have yielded results similar to treatment with positive airway pressure. If a person is unwilling or unable to use positive airway pressure machines, surgery is an option.

Sleep apnea is one of the most dangerous sleep disorders and is also highly undiagnosed. If a person is experiencing excessive daytime tiredness along with frequent night arousals accompanied by a choking or gasping for air feeling, they should talk to their clinician about sleep apnea. Excessive tiredness can lead to many side effects such as endangering your life or others when driving. Severe mood changes, mental dysfunction, and libido reduction are also associated with sleep apnea. Fortunately, this sleep disorder is very treatable and there are a number of options for treatment.

References:
Foster, B., 2008, Uncovering Sleep Apnea Misconceptions, The Nurse Practitioner, 33(6):23-28

Pagel, J., 2008, The Burden of Obstructive Sleep Apnea and Associated Excessive Sleepiness, The Journal of Family Practice, 57(8):S3-S7
Ballard, R., 2008, Management of Patients With Obstructive Sleep Apnea, The Journal of Family Practice, 57(8):S24-S30

Riha, R., Diefenbach, K., Jennum, P., McNicholas, W., 2008, Genetic Aspects of Hypertension and Metabolic Disease in the Obstructive Sleep Apnoea-Hypoponea, Sleep Medicine, 12:49-63

Smith, I., Lasserson, T., Wright, J., 2006, Drug Therapy for Obstructive Sleep Apnea in Adults, Cochrane Database of Systematic Reviews, Issue 3

Black, J. and Hirshkowitz, M., 2005, Modafinil for Treatment of Residual Excessive Sleepiness in Nasal Continuous Positive Airway Pressure-Treated Obstructive Sleep Apnea/Hypopnea Syndrome, 28(4):464-471

Medication?

The Food and Drug Administration (FDA) said that it would allow four companies to market the first generic kind of the restless legs syndrome drug Requip (Ropinirole). More...

A 2007 article in the Journal of the American Academy of Pain Medicine talks about the connection between opioid medication and sleep apnea. Researchers looked at patients taking opioids for chronic pain and found they had a higher incidence of apnea. This is not surprising as opioids relax the muscles and that includes the throat area. However, these patients did not have the crescendo-decrescendo breath size pattern characteristic of people with central sleep apnea.

There is some evidence that the antidepressant medication mirtazapine (Remeron) helps relieve apnea. This is the most effective drug for apnea found so far, but the evidence is based only on a small trial. Mirtazapine is not used widely in apnea treatment.

Apnea can disrupt memory and thinking

Green Tea May Help Sleep Apnea Sufferers

Apnea also leads to memory problems. For a long time doctors thought the decline in short term memory ability was due to sleep deprivation. New findings indicate the apnea actually causes shrinkage in areas of the brain important to memory. Use of CPAP machines and regular exercise seems to help.