Garth Rattray | Do you have sleep disordered breathing?

We used to believe that sleep apnoea is mainly experienced by men over 40 with big beer bellies. Although they are contributory factors, many people, including the elderly, teenagers, children, heavy individuals, skinny females, and even fit people have sleep disordered breathing - obstructive sleep apnoea, central sleep apnoea, mixed sleep apnoea (also called complex sleep apnoea), hypopnoea, and upper airway resistance syndrome. Depending on the severity, sleep disordered breathing can be extremely serious, cause several major health problems, and even lead to premature death.

There are several versions of ‘sleep apnoea’. Obstructive sleep apnoea (OSA) is the most common cause of sleep apnoea. It occurs when there is a complete but temporary occlusion of the upper airway caused by a physical blockage, usually from relaxed throat muscles. Sometimes, when patients’ sleep studies arrive and they think that I am exaggerating the problem, I show them the recorded length of time that they stop breathing then challenge them to reproduce it while wide awake. Some have apnoea for about one minute (some less and some more), but they can only hold their breath for 20 to 30 seconds before giving up. That puts the seriousness of their problem into stark perspective.

Central sleep apnoea (CSA) occurs when the brain temporarily stops sending signals for the body to breathe. Mixed sleep apnoea is the combination of OSA and CSA. Some people with OSA convert to mixed sleep apnoea. OSA and CSA require special devices to treat them.

Others have many periods of hypopnoea. This occurs when there is shallow and/or slow breathing for 10 seconds or longer while sleeping. And like apnoea, these may have obstructive causes, central causes, or a mixture of both. Hypopnoea should not be taken lightly because it can reduce your breathing by 30 per cent or more.

Then there is an entity called upper airway resistance syndrome (UARS). Experts describe this as being akin to patients intermittently breathing through a very narrow straw while sleeping. This disorder of increased upper-airway resistance results in repeated episodes of fragmented sleep. However, it is not as severe as obstructive sleep apnoea. UARS is attributed to the way that your throat and upper airway are made up.

SNORES LOUDLY

I often see couples, and one or the other complains that his/her spouse snores loudly, gasps for breath sometimes while sleeping, sleeps restlessly, stops breathing for a while, and is usually drowsy during his/her waking hours. Sometimes they provide recordings of the snoring that keeps them awake.

Patients may experience several of the following problems: morning headaches, difficulty falling asleep at nights, waking up often during the night, passing urine often at night, tiredness (perhaps even waking up feeling tired / unrested), difficulty concentrating/focusing, falling asleep (even while driving), waking up with a sore or dry mouth, hot flashes (in women or men of any age), and/or feeling generally lousy. Although several other health issues can cause the aforementioned symptoms, sleep-related breathing problems should be kept in mind and perhaps investigated.

Some sleep-related breathing disorders lead to a reduction in the blood oxygen concentration and an elevation of the carbon dioxide. I have seen results showing extreme reduction in oxygen concentrations from a usual of 97-99 per cent to as low as 77 per cent during sleep apnoea episodes. The derangements in blood gases lead to several health problems and can, if left untreated, significantly shorten your lifespan.

Sleep disordered breathing can lead to a reduced quality of life, hypertension, diabetes, cardiac problems (including an enlarged heart, heart failure, arrhythmias, and heart attacks), strokes, pulmonary hypertension, difficulty with weight control, and neurological problems (including cognitive impairment, moodiness, anxiety, and major depression). Sleep disordered breathing renders people susceptible to mishaps and crashes.

RISK INCREASE

The risk of having sleep disordered breathing is increased with age, a family history of the disorder, body weight, smoking, excessive alcohol use, and an existing stroke and/or existing heart disease. If your primary care physician suspects that you have sleep disordered breathing, you will need to be referred to a pulmonologist.

The pulmonologist usually takes a brief look at you, records a detailed history, and performs a sleep study. The more detailed sleep study requires overnight stay, the placing of many sensors, and is called a polysomnography (PSG) study. During this test, the following data is recorded: breathing and heart rates, blood oxygen levels, skeletal muscle activity, brain waves, and eye movement. Home sleep testing may be done. In this case, the breathing is monitored (for pauses, effort, and depth), the heart rate, oxygen saturation, and airflow are recorded.

The overnight PSG is the gold standard and records a lot of information. The home sleep study is more useful for diagnosing OSA. However, several people find it extremely difficult to sleep in uncommon surroundings and opt for the home sleep test despite its limitations.

Depending on the type of sleep disordered breathing diagnosed, several treatment options may be open to you. These may include a change in sleep positioning, weight loss, exercise, cessation of smoking, reducing alcohol intake, mandibular advancement devices, tongue retaining devices, surgery, a range of positive airway pressure devices which use air to splint your airway open, or [perhaps] an implanted hypoglossal nerve-stimulation device (which is not available in Jamaica at this time).

Although they are potentially extremely serious and possibly even life-threatening, research has shown that sleep-related breathing problems are underdiagnosed. If suspected by anyone, it should be investigated.

Garth A. Rattray is a medical doctor with a family practice. Send feedback to columns@gleanerjm.com and garthrattray@gmail.com.