What Is Sleep Apnea?

QUESTION: A friend of mine, a notorious snorer, has told me his condition was
do to a life threatening situation he called "sleep apnea". Is this an
exaggeration of the facts? What is sleep apnea, what causes it, and how do
you treat it? There are a few more snorers in this building that would like
to know more about this.
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ANSWER: Sleep apnea, a condition which affects up to 4 percent of the adult
population, is a sleep disorder in which the sufferer actually stops breathing
for several seconds during sleep, and during which the heart slows down. This
may be followed by a jerky body movement, respiration resumes and the heart
speeds up considerably.
Subjective symptoms not withstanding, these patients experience no
difficulty sleeping through the night, though they usually complain of fatigue
and headache upon awakening. Objectively, their sleep partners testify that
the symptoms of these disorders are more life-threatening than the patient
suspects.
For instance, while sleeping, apnea sufferers often stop breathing for 15
seconds to as long as 60 seconds, and these episodes may repeat as frequently
as 4 to 30 times an hour. During this time the oxygen content of the blood is
reduced, taxing both the heart and lungs. They then may seem to fight to
regain their breathe, and then continue with a more quiet sleep. And while
personal problems such as divorce are sometimes credited for the onset, it may
rather be the result of the noisy, on and off pattern of loud snoring that is
so frequently associated with this condition.
Snoring, a sign of temporary and incomplete obstruction of the upper
airway, is very common in patients with sleep apnea syndromes. Obesity,
tonsillitis, and pulmonary problems are only a few of the contributory factors
a physician will be on the alert for.
An accurate diagnosis, however, can best be obtained by requesting that
the patient spend a night or two in a sleep laboratory, where his sleep cycle
can be electronically monitored through polysomonography.
Once a clear picture has been established, a conservative course of
treatment can begin. In obese subjects, unless life-threatening abnormal
heart rhythms are present, weight loss is a good first step. Studies have
shown that even small reductions in weight in grossly obese patients greatly
improves sleep disorder symptoms. Eliminating depressants such as alcohol,
hypnotic drugs, and sedatives also improves control.
If these initial efforts prove unsatisfactory, the use of respiratory
stimulants (such as medroxyprogesterone) or surgery may be necessary. Such
successful surgical procedures range from removal of obstructive tissue to
tracheostomy. However, recent advances in sleep apnea management (Nasal CPAP
or Continuous Positive Airway Pressure) are yielding some dramatic results.
Nasal CPAP involves the use of a tight fitting nasal mask and small
compressor which generates enough constant air pressure to keep open the air
passages and prevent obstruction. The increased pressure takes just a bit of
getting used to, but is rapidly achieved. Admittedly, this "deep sea"
equipment is not the most alluring nightwear, but for many patients it's a
most acceptable alternative to surgery.