1. Sleep Apnea is a disorder where you stop breathing during sleep for at least 10 seconds to 2 or more minutes at a time up to several hundred times a night. This results in lowered oxygen levels reaching the heart and brain and higher carbon dioxide levels during sleep. This causes the brain to arouse you from sleep for a couple seconds, just enough to start breathing again. This results in never really getting a good night's sleep causing sleep deprivation symptoms. Since a person is asleep when this is going on and they arouse for only a couple seconds, the person usually doesn't remember the apnea episodes or waking up frequently during the night. In my case, I've gotten so used to the arousals from sleep that don't seem to have a cause that I just go back to sleep without bothering to open my eyes (this happens 5-10 times a night that I remember).
Hypopneas are also part of sleep apnea. A hypopnea is a significant reduction of air flow (usually seen as 50% reduction or more of normal) while sleeping. These also have to last at least ten seconds or longer to be considered clinically significant. Hypopneas also lead to lower oxygen levels while sleeping. A clinical diagnosis of sleep apnea is usually made if there are 5 or more apneas and hypopneas per hour of sleep (40 or more per 8 hrs. sleep), though this is a somewhat arbitrary cut-off. The number of apneas and hypopneas per hour is called the apnea/hypopnea index or AHI, also called the Respitory Distress Index or RDI. Many are now including the amount of desaturation of oxygen in the blood during sleep in determining apnea and its severity.
There are two types of sleep apnea: obstructive sleep apnea and central sleep apnea. You can also get a "mixed" sleep apnea which is a combination of both. Obstructive sleep apnea, the most common by far, is caused by an obstruction of the airway usually due to the tongue, soft palate and uvula relaxing and collapsing together, closing the throat off or being sucked closed after loud snoring.
In central sleep apnea, the person doesn't even try to breathe at times while sleeping. This is sometimes caused by a serious cardiovascular or central nervous system problem (brain tumor, etc.). It's thought that the brain simply doesn't send the electrical signals to the chest muscles to breathe, thus it is viewed as a central nervous system problem, thus the name central sleep apnea.
Sleep apnea causes or is associated with numerous health problems. The blood pressure rises quickly during apnea episodes as the heart tries to compensate for the lack of oxygen by pumping harder. Over 90% of apnea patients experience "arrythmias" or irregular heartbeats such as Bradycardia. High blood pressure during the day results in about 50% of apnea patients. It is associated with higher rates of diabetes, heart disease , 3 times the rate of stroke as well as 20 times the rate of heart attacks in one study (Lancet, 336: 261-4, 1990. See Snoring and Sleep Apnea, New York: Demos Medical Publishing, 1996, 2000, pp. 16, 17.).
Looking back, I've had obstructive sleep apnea symptoms at least when sleeping on my back for 15 or more years. I have been having many symptoms of apnea (probably mixed sleep apnea) for the past couple years, especially this year. One website described some of the common symptoms of sleep apnea as follows:
Most prominent symptoms are snoring, not breathing while asleep, excessive daytime sleepiness and obesity. Other symptoms include lack of concentration, forgetfulness, uncharacteristically irritable, anxiety, depression, mood and/or behavioral changes, morning headaches, disorientation at awakening and loss of sexual interest.
One website has a questionnaire on sleep apnea that asks the following questions (among others):
Do you wake up in the morning tired and foggy, not ready to face the day?
Do you have headaches in the morning?
Are you very sleepy during the day?
Do you fall asleep easily during the day?
Do you have difficulty concentrating, being productive, and completing tasks at work?
Do you carry out routine tasks in a daze?
Are you afraid that you may be out of touch with the real world, unable to think clearly, losing your memory, or emotionally ill?
Do your friends tell you that you're not like yourself?
Are you depressed?
Are you irritable and angry, especially first thing in the morning?
Why yes, that would be me. As a result of reading this material on sleep apnea on the web earlier this year, I became fairly convinced this was my problem and maybe not burn out. These are quite a lot of symptoms to be caused by something as simple as not breathing well while sleeping, but I guess it's understandable if you're not getting enough oxygen to the brain off and on for 7 hours each night.
I saw my doctor in June about my apnea symptoms and to get my cholesterol levels checked. She had me take a couple blood tests, one for glucose levels to see if I was developing Diabetes and one for my Thyroid to see if my fatigue etc. could be caused by one of these. She sent me to a Pulmonologist for further questioning about my apnea symptoms and refereal for a sleep study. My cholesterol turned out to be low (total = 141, etc.) and the other tests were negative (normal). When I saw the Pulmonologist, he said sleep apnea sounds like what I have and he set me up for the sleep test in September. This was in June also, sleep disorder centers are routinely booked several months in advance.
The irony of all this is my wife had been complaining for a couple years that I stopped breathing when I slept and she said I might have sleep apnea. I finally decided to see what apnea symptoms were earlier this year after I woke up with my throat closed on two occasions, gasping for air. It was only at that point I decided to look into sleep apnea. I may have saved myself some time if I listened to her a couple years ago and saw my doctor. Takes us guys a while, doesn't it?
When I went to my doctor's office to let them know I was referred for a sleep study and to get my doc's approval for my medical insurance, the receptionist at the counter said, "That's the test I'm having my husband take! He stops breathing at night! I mean, he stops breathing!!!" Yeah, that's what I hear.
See:
Sleep
Disorders and Snoring Several good articles on Apnea and its
treatment.
Sleep
Apnea UCDavis. Comprehensive article on Sleep Apnea.
Google.com
search for "sleep apnea" 163,000 web pages on Apnea! Take yer
pick.
Best Available
Guide to Understanding Sleep Apnea SleepQuest.com.
When
to suspect Obstructive Sleep Apnea Syndrome Postgraduate
Medicine (For doctors)
Systematic
Review of the Literature Regarding the Diagnosis of Sleep
Apnea
http://www.sleep-solutions.com/phys/phys_clinical_signs.htm
Sleep
Apnea
See also:
Getting
the 'nitty gritty' on sleep apnea
USA Today story about Nitty Gritty Dirt Band founder John
McEuen's diagnosis of sleep apnea and how he believes his father had
it and that it contributed to his father's early death (he died in
his sleep of a heart attack).
Apnea
Patient Stories Several individuals' stories. Gives first
hand accounts of the symptoms of apnea and its effects on lives.
2. A Polysomnograph test is where they hook you up with electrodes, etc. for various measurements to check your respiration through chest and abdomen movements(EOG), heart rate(EKG), blood oxygen levels, brain wave activity (EEG), etc. This gives information on what happens to the respiration and heart rate, blood oxygen levels, etc. at what stage of sleep. It shows how often and severe the hypopnea and apnea episodes are. It takes an hour or so to get you all wired up.
I will be having a "split-night" sleep study. This is where they check you for two or three hours while you sleep to get an idea what your apnea/hypopnea index is. If the first two hours indicate you have sleep apnea, they wake you up and fit you for a CPAP mask to wear the rest of the night, adjusting the air pressure as they go to see what works in eliminating the apneas and hypopneas and what level keeps your blood oxygen at normal levels. (See footnote 3 for a description of CPAP)
See:
Wired
for Sleep! A photo essay on a polysomnogram test for sleep
apnea(at Stanford's sleep center, one of the country's first). 6
pages of text and photos of a patient getting all hooked up.
Kingston
Hospital Sleep Disorders Labratory Text and photos of
polysomnogaphy sleep study.
Polysomnography
Polysomnography
Your
polysomnogram
3. A CPAP machine pumps pressurized air through your nostrils to your throat to keep it open while you sleep. You wear a mask that fits over your nose that is connected to the machine by a hose. Primitive, but effective. Many have a hard time at first adjusting to using a CPAP while sleeping. One person compared it to trying to breathe while sticking your head out of a window of a car going 60 MPH. I'm not looking forward to it, but I am looking forward to getting my mind and energy back, so I'll give it a try.
See:
Heavenly sleep brings reward About the development of the CPAP by Prof Colin Sullivan in the early 1980's.
CPAP A single photo of a patient being hooked up with a CPAP.
CPAP Photos A couple photos of apnea sufferer with their gear on. Stylish!
Subsequent health updates:
Update #4 I Finally Got a CPAP! Feb. 8, 2003
Update #3 My Home APAP Test and Sleep Study Results Nov. 15, 2002
Update #2 My sleep study Sept. 10, 2002
Update #1 My Health August 10, 2002
