Sleep Apnea

Insomnia with Sleep Apnea

What is Sleep Apnea?

This term refers to a group of potentially lethal disorders in which breathing recurrently stops during sleep for long enough periods to cause measurable blood deoxygenation. Sleep apnea can be obstructive (upper airway blockage despite airflow drive), central (decreased respiratory center output), or mixed sleep apnea.

  • Obstructive sleep apnea occurs most often in moderate to severely obese persons, most of whom attempt to sleep flat on their back. Men are more affected than women are. Obesity, coupled with the particular partial obstructions, leads to upper airway narrowing, glottic obstruction and pulmonary failure. Eventually, a combination of low oxygen (hypoxemia) and high carbon dioxide (hypercarbic hypercapnia) in the blood stimulates the breathing center or can paradoxically induce cessation of breathing (central apnea).
  • Central sleep apnea is most often seen in infants born prematurely.
  • Mixed apnea starts as unobstructed apnea quickly followed by thoracoabdominal movement with upper airway obstruction. Mixed apnea occurs more often than central but less often than the obstructive type.

Sleep apnea tends to occur at the transition from nonrapid eye movement (NREM) to rapid eye movement (REM) or dream sleep. Adult sleep apnea is roughly defined as more than five breathing interruptions for at least ten seconds each per hour of sleep.

Heavy snoring is considered a type of sleep apnea and it is also common in obese persons.

How is it diagnosed?

Sleep Apnea signs and symptoms

  • Long periods of not breathing while asleep. Sleep apnea must be observed by others. It is most reliably recorded in a sleep laboratory.
  • Choking while asleep caused by obstruction in the back of the throat from the uvula and other loose tissue. This causes cycles of sleep, choking, startled awakening, drowsiness and sleep. The cycles often continue throughout the day because poor sleep causes chronic sleepiness.
  • Chronic severe fatigue.

History: Complaints include disturbances in sleep, with possible cardiac arrhythmias, daytime sleepiness, morning headache, and slowed mental activity. Changes in an individual's sleep pattern may produce noticeable physical symptoms which include yawning, dozing during the day, decreased attention span, drooping eyelids, and slight hand tremor.

Physical exam: Complications from this condition include cardiac abnormalities (sinus arrhythmia, extreme bradycardia, atrial flutter and ventricular tachycardia), excessive daytime sleeping, morning headache and slowed mental activity. Individuals require a thorough examination of the mouth throat, neck, and palate.

Tests to determine the extent of the condition include sleep electroencephalogram (EEG) (the stages of sleep can be recorded), blood gases, cognitive skills testing, pulmonary and systemic hypertension evaluation.

How is Sleep Apnea treated?

Weight reduction is thought to reduce episodes of sleep. Medications to promote breathing have not been effective. Administering oxygen at night has had limited success.

Medications

Ambien (Zolpidem)

What might complicate it?

Conditions that may complicate this condition include obesity, polio, stress, and allergies. Prescribed medications, drug, and alcohol use interfere with REM sleep, which is the stage that provides the greatest amount of mental recuperation.

Predicted outcome

This condition is manageable. Relief of obstruction can usually correct the related pulmonary and systemic hypertension, cardiac arrhythmias, and cognitive difficulties.

Alternatives

Primary brainstem medullary failure, neurologic medullary depression, tumors of the posterior fossa, polio, stress, or thyroid disease are other possibilities.

Appropriate specialists

Neurologist.

Seek Medical Attention

  • You suspect you have sleep apnea.
  • You observe signs of sleep apnea in another family member.
  • Sleep apnea continues or worsens after treatment is initiated.

Last updated 22 June 2011


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