Sleep apnea plays havoc with people#039;s slumber
Published 12:00 am Wednesday, February 22, 2006
Sleep apnea: a condition that causes people to partially or completely stop breathing during sleep. The interruptions come five or more times in an hour, sometimes occurring hundreds of times in a single night.
The condition plays havoc with their rest – and frequently endangers their very lives.
Sleep apnea is a case of, “if you don't snooze, you lose.” Affecting two percent of women and four percent of men over 35, the condition is linked to a greatly increased risk of stroke, heart attack and cardiovascular disease.
Some 38,000 cardiovascular deaths occur each year as a result of sleep apnea.
“This is a serious medical condition,” Dr. Michael Irwin says. Irwin, an orthodontist based in Montgomery, is certified in the treatment of sleep apnea, the most common of which is obstructive sleep apnea, or OSA.
The orthodontist spoke to members of the Greenville Lions Club on Monday, sharing some of the causes, symptoms, diagnosis methods and treatments of this potentially lethal medical condition.
‘A vicious cycle'
“People who have sleep apnea get caught up in a vicious cycle. They fall asleep; the muscles surrounding the airway relax, and it collapses,” Irwin said.
“The airway is obstructed. Breathing stops for anywhere from few seconds up to two minutes. They wake up, restore normal breathing – and then the same cycle occurs, again and again. Who wouldn't wake up tired and sleepy?”
While everyone who snores does not have sleep apnea, “everyone who has sleep apnea does snore, sometimes very loudly,” Irwin explained.
Consistently waking up tired and unrefreshed, sleep apnea sufferers often experience extreme daytime sleepiness and fatigue. Diminished capacity to concentrate, memory problems and depression often set in.
“It reaches the point where they can fall asleep at red lights, on the phone, at their desk at work, anywhere.”
Sleep apnea can cause personality changes, loss of productivity and “a much higher chance of workplace accidents,” Irwin said.
“The man who caused the spill with the Exxon Valdez turned out to have sleep apnea.”
Often, the first people to realize there may be a problem and encourage OSA sufferers to seek medical help are their significant others.
“It can be scary for the person's spouse when they see that person struggling for breath, suffocating, or not breathing at all,” Irwin said.
Studying your sleep
Physicians can refer patients they suspect have sleep apnea to a sleep study center in a hospital. They will spend the night at the hospital in a motel-like room and be closely monitored with electrodes to determine any interruptions in the sleep cycle. Obstructive sleep apnea is diagnosed if the patient has more than five episodes per hour.
While the condition does not cease and actually gets worse with age, treatment can and does bring OSA patients “back to normality.”
Bringing some relief
OSA patients have been treated successfully with Continuous Positive Air Pressure (CPAP) machines. This bedside apparatus sends positive airway pressure through a hose to a mask closely fitted to the patient's face. The pressure “splints” the upper airway open to keep it from collapsing during the night.
“The CPAP is 98 percent effective for patients; unfortunately, patient compliance is only about 60 percent,” Irwin said.
Potential problems with the CPAP, Irwin said, are feelings of suffocation and claustrophobia, skin irritation and rashes, sore eyes and sinus infections.
“Some people are bothered by the noise the machine makes; others complain of getting tangled up in the hose. You also can't sleep on your stomach with this machine,” Irwin said, adding with a smile, “Ladies tell me this is not a romantic gadget.”
Two Lions Club members, Doyle Sasser and Colin MacGuire, are sleep apnea patients.
They both use the CPAP machine and say they have seen significant improvement from its use.
“I can tell a ton of difference,” MacGuire said.
Prior to diagnosis and treatment, Sasser was involved in a car accident after falling asleep at the wheel. He said, “If I don't use (CPAP) for a couple of days, I do notice a big difference.”
OSA treatment options include a surgery in which excess tissue, including tonsils and adenoids, is removed from the back of the throat.
“This only works in about 30 to 60 percent of cases and there is a 50 percent relapse after the first year,” Irwin said.
A more drastic and much more effective surgery involves moving both the upper and lower jaws forward.
For those with mild OSA who don't elect to have surgery, and can't or don't wish to utilize the CPAP, there is another option.
Made to order
“Oral appliance therapy has been around since the early 1900s…it's just recently that insurance companies have started waking up and seeing the light,” Irwin said.
These appliances, which are molded to fit the individual's mouth, closely resemble the mouth guards used by athletes. “These devices are portable, non-envasive and covered by most insurances,” Irwin said.
For growing youngsters with sleep apnea, a special tongue restraining device works very well, the orthodontist said.
“This uses a suction device to pull the tongue forward and keep it there. Some adults use this, too, with great success,” Irwin said.
Some advantages of oral appliances over the CPAP include ease of portability and no need for electricity for operation.
Irwin said he has patients referred to him by their physicians. Once they have been fitted with their appliances, they return to their M.D. for a follow-up.
“I have had the satisfaction for over 30 years of giving my patients beautiful smiles. Now I am experiencing a real joy from my sleep apnea patients who are feeling so much better,” Irwin said.
The orthodontist recommends anyone suspecting they have this condition to see their doctor.
“ A lot of people could be getting relief. It's so unfortunate this condition is so under-diagnosed.”