Published: March 23, 2008 11:54 pm      

Apnea puts sleepers at risk

Loud snoring and gasping at night may be more than just an annoyance to those around you – it could be the sign of a dangerous sleep disorder.

Snoring is major symptom of obstructive sleep apnea, in which patients stop breathing for short periods during sleep, waking themselves sometimes hundreds of times during the night.

Apnea has been linked to higher risk of heart disease, diabetes, high blood pressure, memory loss, impotency and headaches. In the shorter term, various studies show apnea-caused daytime sleepiness while driving can double or triple the risk of traffic accidents.

It is the most common sleep disorder treated at local sleep labs. Insomnia is the only sleep disorder that is more common, said Dr. Rashid Nadeem, a Johnstown sleep specialist.

Daytime sleepiness and snoring are the symptoms that bring apnea sufferers to the doctor, Nadeem said.

“The spouse is suffering from snoring and is the first to mention it,” Nadeem said.

“Some present as: They can’t sleep – ‘Always in the daytime I’m sleepy.’ They can’t concentrate; they are forgetful; they’re gaining weight; they have personality changes and mood changes.”

The good news is, sleep apnea is easily diagnosed and can be treated.

‘Most people don’t know’

Sleep labs at Somerset Hospital, LifeLine Sleep Center in Upper Yoder Township, Memorial Medical Center’s Lee Campus in Johnstown, Windber Medical Center and Miners Medical Center in Hastings are set up to monitor patients while they sleep.

Sensors check oxygen levels, heart and breathing rates, leg movement, eye movement, chin movement and throat sound.

The printout from 20 sensors tells the tale of a night’s sleep. Doctors and sleep technicians can tell patients exactly how deep they were sleeping, how often the woke up and how they were breathing.

“We do sleep studies because most people don’t know they have apnea,” Nadeem said. “They have no idea how they are sleeping – how badly.”

A sleep study also identifies the type of sleep apnea involved.

• Obstructive sleep apnea is the most common. It is caused by excess soft tissue in the throat or jaw structure that blocks the airway as the neck relaxes. It can be linked to obesity.

• Central sleep apnea, while rare, is the most serious. It is usually a condition of the central nervous system where the brain signals fail to reach the lungs telling them to breathe. It can be life-threatening.

For some obstructive sleep apnea patients, minor surgery can bring relief by opening the airway. Other patients can be helped with a customized oral retainer that pulls the jaw forward at night. Both have very limited use, Nadeem warned.

“We have something that works, but it’s not out there.” Nadeem said. “People don’t know.”

He’s talking about a continuous positive airway pressure mask and pump that forces air into the nasal passage with enough pressure to keep the airway open. It is effective for both obstructive and central sleep apnea.

‘Different people’

Numerous studies show apnea sufferers who use the mask sleep better, lose weight, reduce high blood pressure and daytime sleepiness and improve their lives, Nadeem said.

The trick is getting patients to stay with the therapy. Fewer than half of those put on the therapy continue through five months, a 2007 study shows.

“It’s 100 percent successful if you use it,” Nadeem said. “After five days, it will be very clear to you, but some people don’t even open the box.”

Helping patients to understand their conditions and see the benefit of treatment can lead to success, said Chris Kaiser, a respiratory therapist with Walnut Medical Services in Johnstown.

“After the sleep test, we go into the home and review with them the hard-core numbers,” Kaiser said.

“When we say, ‘You stopped breathing this many times,’ that helps. And we keep following up.”

Persistence is key, said Tanya Zehner, a sleep-study technologist at Somerset Hospital.

“Once they get onto it, the mask really works,” Zehner said. “Then they are different people.”

Sleep apnea affects overall health by interrupting sleep architecture, depriving the body of several important benefits, Nadeem said.

‘Sleeping in daytime’

Normally, a person goes through four phases of sleep soon after going to bed.

Stage one, or light sleep, is a period of reduced awareness that is easily interrupted. “If someone calls your name, you wake up,” Nadeem said. “You can answer questions right away.”

In Stage 2 sleep, heart rate, blood pressure and brain activity all slow. It is quiet sleep. Stages 3 and 4 are deep sleep, where everything slows more.

“This is the best sleep,” Nadeemsaid. “The body is really resting.”

About 90 minutes after falling asleep, most people move from Stage 4 sleep, to rapid-eye-movement sleep, or dream sleep.

Then the heart, breathing and brain-activity levels increase, Nadeem said.

The cycle repeats three or four times a night.

But those with sleep apnea wake up briefly before getting to deep sleep, seldom reaching dream sleep.

“They go to sleep for two minutes, and they wake up again,” Nadeem said.

“These folks are sleeping in the daytime trying to catch up on years of lost sleep.”

It’s more than just rest. Dream sleep is vital to health. Elevated heart and breathing rates raise metabolism like a good workout, while dreaming is an exercise of the brain and human psyche, Nadeem said.

“It’s like exercising while sleeping,” Nadeem said. “REM sleep is like 20 minutes on a treadmill.”

So while obesity can trigger sleep apnea, sleep apnea can cause weight gain by reducing nighttime metabolism and making patients too weary to be active during the day.

“It’s a vicious circle,” Nadeem said.