Sleep apnea is a serious, potentially life-threatening condition that is far more common than generally understood. Sleep apnea is a breathing disorder where brief pauses of breathing during sleep are observed. In Greek apnea means “without breath”. There are two types of sleep apnea: central and obstructive. Central sleep apnea is less common and occurs when the brain fails to send the appropriate signal to the breathing muscles to initiate breathing. Obstructive sleep apnea is far more common and occurs when air cannot flow into or out of the person’s nose or mouth although efforts to breathe continue. Sleep apnea can also be characterized by choking sensations. The frequent interruptions of sleep often lead to excessive daytime sleepiness, excessive daytime fatigue and may be associated with early morning headaches. Sleep apnea may be associated with irregular heartbeat, high blood pressure, heart attack, and stroke therefore early recognition and treatment of sleep apnea is very important.
Sleep apnea is more common in men but can occur in all age groups and both sexes.
Four percent of middle-aged men and 2 percent of middle-aged women have been documented to have sleep apnea. People who develop sleep apnea are most likely to be the ones who snore loudly, are overweight, have high blood pressure, have some physical abnormality in the nose, throat, or other parts of the upper airway. Sleep apnea seems to run in some families, suggesting a possible genetic basis.
Excess amount of tissue in the airway can cause it to be narrowed in obese people. The tongue, the uvula and the throat muscles can relax and cause the airway to become blocked. The person continues the effort to breathe but air cannot flow easily into or out of the nose or mouth due to the blockage. This results in heavy snoring, breathing pauses and frequent arousals from sleep. Alcohol consumption, sleeping pills or muscle relaxant medications can increases the frequency and duration of apneas.
The apneas cause one’s Oxygen levels in blood to drop and Carbon Dioxide levels to increase which in turn arouse the brain from sleep and normal breathing resumes with a loud snort. Frequent arousals from sleep prevent the person from getting enough deep sleep and cause daytime fatigue or daytime sleepiness. The daytime symptoms may include symptoms related to depression, irritability, sexual dysfunction, learning and memory difficulties, difficulty concentrating at work, falling asleep while at work, on the phone, or driving. Up to 50 percent of sleep apnea patients have high blood pressure. It has recently been shown that sleep apnea contributes to high blood pressure and increased risk for heart attack and stroke.
Apneas are usually witnessed by bed partners or family members. Patient’s co workers may notice patient falling asleep at inappropriate times such as meetings or while talking. The patient often does not know he or she has a problem.
- Gasping or chocking in sleep
- Witnessed pauses in breathing (usually by bed partner or family member)
- Frequent trips to the bathroom
- Blocked nose
- Acid reflux
- Leg cramps
- Sexual dysfunction
- Morning headaches
- Feeling unrefreshed upon awakening
- Waking up with dry mouth
- Daytime sleepiness (impaired work performance, decreased quality of life, increased rate of automobile and work accidents.)
- Concentration problems
- Likely to fall asleep in non-stimulating situations
- Memory loss
- Daytime fatigue
- Learning difficulties
- Excess weight / obesity
- High blood pressure
- Irritable mood / crankiness
Insomnia means having problems falling asleep or staying asleep. It may also be associated with awakenings during the night or waking up too early the next morning. Short term stress can cause difficulty sleeping but can get better in less than a month. Chronic insomnia may develop if someone worries about not sleeping well.
Insomnia can be caused by stress, depression, anxiety, poor sleeping habits, changes in your sleep habits or surroundings, pain, breathing problems, restless leg syndrome, and many other health problems. Use of stimulants such as caffeine or tobacco, alcohol, drugs or certain medications can cause insomnia as well.
You may have difficulty falling asleep, wake up and have difficulty falling asleep again or wake up earlier than planned. A detailed medical assessment along with some blood tests and or sleep study may help the treating physician diagnose insomnia. A sleep diary may help the doctor make the diagnosis.
The cause of the insomnia has to be treated. If a medical problem or emotional problem is causing the insomnia, then that has to be treated. Some life style changes such as going to bed at the same time each night, getting up at the same time each day, avoiding caffeine or alcohol for several hours before bedtime, getting regular exercise or avoiding daytime naps may help.
Medications can be used for short term but they can be habit forming and don’t work as well over time as behavioral changes. Counseling may help. Talk to your doctor about your sleep problems and any other health issues you may have.
Insomnia is very common and can affect people at any stage in life but is generally more common in women and older people. Sleep patterns also change with ageing as many older adults sleep less. Sleep quantity and sleep quality can be affected by health problems and medicines as well. If you have trouble getting to sleep or are not sleeping well, discuss it with your doctor at your next checkup.