Sleep apnea is a serious health risk to many people as it severely affects the breathing pattern of sleeping people. Recent statistics indicate that 19 percent of the adult population has sleep apnea -- and that includes 23 percent, which are males. But, the good news is that as our understanding of sleep apnea continues to improve, so does our ability to identify and treat the condition with newer and more sophisticated technologies.
While there are a number of new technologies, it’s important to remember that not all sleep disordered breathing is sleep apnea. The severity of the sleep disordered breathing ranges from simple snoring and increased upper airway resistance to air flow to increasing degrees of sleep apnea and its associated blood oxygen desaturations, which happen because of insufficient oxygen getting into the lungs.
With that being said, many factors need to be considered to determine the most suitable treatment, whether it’s through lifestyle changes, the use of oral appliances, the assistance of positive airway pressure machines or even surgery. Sometimes, too, anatomic factors and medications also need to be considered.
First, though, it’s important to see if treating an underlying medical condition could help. A sleep disorders physician obtains from the patient a detailed sleep history, performs a physical examination and in many cases, sends the person for an overnight sleep test - polysomnogram - which characterizes the type and severity of the sleep disordered breathing.
What are some things that could appear in an evaluation? Weight is a major component influencing sleep disordered breathing. Most people who have obstructive sleep apnea -- the airway in the back of the throat becomes totally blocked -- are overweight and weight loss often improves their symptoms. In fact, weight loss from dieting and exercise or bariatric surgery has been shown to improve or eliminate obstructive sleep apnea in 86 percent of patients with the condition. Neck circumferences also correlate with the condition, especially when the neck size exceeds 16 inches in women and 17 inches in men.
Alcoholic beverages are another trigger for worsening obstructive sleep apnea, causing sleepiness and weight gain, and they should be avoided. Certain medications, such as benzodiazepines, and medical conditions, such as acromegaly, Down’s syndrome and Treacher-Collins Syndrome, also can worsen the condition.
Sleep disordered breathing also can be affected by one’s sleeping position. Because the condition is caused by a narrowing of the airway in the back of the throat, avoiding supine sleep and raising the head of the bed helps, as it causes gravity to pull the tongue downward toward the soft palate.
If a lifestyle change can help with the condition, that’s good news. But, sometimes, patients need assistance from oral appliances, positive airway pressure machines and surgery, all things I’ll discuss in upcoming columns throughout the next few months.
For now, though, remember that patients with sleep disordered breathing of any type and/or severity should be aware of safety issues when driving and using tools and machinery.
Dr. Fredric M. Radoff is a neurologist specializing in sleep disorders medicine at The Center for Sleep Medicine, a partnership of Blount Memorial Hospital and East Tennessee Medical Group.