Sleep apnea – How to get the help you need

ACCORDING TO Dr Khia Josina Duncan, ears, nose and throat (ENT) surgeon and general practitioner, sleep apnea is a potentially serious sleep disorder in which breathing repeatedly stops and starts. If you snore loudly and feel tired even after a full night’s sleep, you might have sleep apnea.

The main types of sleep apnea include obstructive sleep apnea (OSA), which is the more common form that occurs when throat muscles relax and block the flow of air into the lungs. Obstructive sleep apnea also referred to as obstructive sleep apneahypopnea, is a sleep disorder that involves cessation or significant decrease in airflow in the presence of breathing effort.

“It is the most common type of sleep-disordered breathing and is characterised by recurrent episodes of upper airway collapse during sleep. These episodes are associated with recurrent oxyhaemoglobin desaturations and arousals from sleep. OSA that is associated with excessive daytime sleepiness is commonly called obstructive sleep apnea syndrome, also referred to as obstructive sleep apnea-hypopnea syndrome,” Dr Duncan said.

Central sleep apnea occurs when the brain does not send proper signals to the muscles that control breathing. “The repeated awakenings associated with sleep apnea make typical, restorative sleep impossible, in turn making severe daytime drowsiness, fatigue, and irritability likely. You might have trouble concentrating and find yourself falling asleep at work, while watching television, or even when driving,” Dr Duncan said.

The symptoms of sleep apnea include excessive daytime sleepiness; loud snoring; observed episodes of stopped breathing during sleep; waking during the night and gasping or choking; awakening in the morning with a dry mouth or sore throat; morning headaches; trouble focusing during the day; mood changes, such as depression or being easily upset; frequent urination, especially at night-time; and in children, hyperactivity and poor concentration.

According to Dr Duncan, sleep apnea is diagnosed by including the family history of the patient, physical examination, and diagnostic tests. An examination includes an endoscopy, which may also include drug-induced sleep endoscopy, if indicated.

“Tests to detect obstructive sleep apnea include polysomnography. During this sleep study, you are hooked up to equipment that monitors your heart, lung, and brain activity and breathing patterns while you sleep. The equipment also measures arm and leg movements and blood oxygen levels,” Dr Duncan said.

This can be done in the hospital. There are also other home sleep study tests, which include overnight oximetry to determine decreases in oxygen level, a relatively good indicator of sleep apnea. The results of these tests will determine your apnea/hypopnea index and the severity of sleep apnea, which will guide treatment.

There are various treatment options, depending on what is found on physical examination and diagnostic tests. Treatment is as simple as losing weight. The examination of the patient is very important, especially by an ENT specialist. The patient may benefit from an oral appliance if sleep apnea is mild. There are also various surgical procedures.

“Surgery is done by an ENT surgeon who specialises in sleep surgery, and the aim is to increase the diameter and airway and to relieve obstruction. Surgery includes pulling the tongue or jaw forward. Removing tonsils along with surrounding tissue. The newer type of surgery which I am trained to do is the Inspire technique, where a nerve stimulator is used to essentially move the tongue forward at periods of obstruction during the night,” Dr Duncan said.

A CPAP machine, she said, delivers just enough air pressure to a mask to keep the upper airway passages open, preventing snoring and sleep apnea. This is an extremely effective way of treating sleep apnea without surgery. There are also various modifications, and the newer machines are more comfortable.

“The time it takes to recover or feel better after treatment for sleep apnea depends on the treatments themselves. For example, if surgery is done, the period of recovery may be longer due to wound healing and swelling post-surgery. Some people will feel better almost immediately, while others may need three to six months of consistent nightly treatment to see the full benefits .Several patients have benefited almost immediately, but that will not happen in every case,” Dr Duncan said.

If left untreated, sleep apnea can have devastating effects on almost every single organ system, including the risk of stroke, cardiovascular diseases such as hypertension and heart attacks. Having sleep apnea also increases your risk of developing insulin resistance and type two diabetes.

“People with sleep apnea are more likely to have irregular results on liver function tests, and their livers are more likely to show signs of scarring, known as non-alcoholic fatty liver disease. Loud snoring can keep anyone who sleeps nearby from getting good rest. It is common for a partner to have to go to another room, or even to another floor of the house, to be able to sleep,” Dr Duncan said.

Dr Duncan’s advice for people diagnosed with sleep apnea is to take the condition seriously, as too many people have had sudden death from untreated sleep apnea.

“Please get an evaluation and get treatment as soon as possible. The treatment will help you to feel refreshed in the days and allows you to enjoy life with your family. The assessment is pretty simple,” she said.

Dr Duncan has also partnered with the Courts (Unicomer) Jamaica BEDucation campaign, that is designed to promote the benefits of quality sleep and choosing the right mattress for optimal rest.

keisha.hill@gleanerjm.com