- In 1910, American’s slept 9 hours a night.
- It’s important to get 8 to 8.5 hours of sleep. 7 hours should be the minimum hours at rest.
- 20-30% of Americans sleep less than 6 hours per night.
- 40% of adults in the U.S. snore.
- 90 million American’s snore and 37 million each night.
- 22 million Americans suffer from sleep apnea yet 80% of moderate and severe obstructive sleep apnea go undiagnosed.
What is Sleep Apnea?
Sleep apnea is a sleep disorder that happens during the night when muscles in upper throat fail to keep the airway open causing breathing to start and stop as the airway opens and closes repeatedly disrupting necessary sleep cycles and normal breathing patterns.
Apnea literally means ‘breathless’ or ‘without breath’ deriving it’s use in medicine from the Greek word ‘apnoia.’ Many sufferers from sleep apnea will stop breathing repeatedly several hundreds of times during the night and often for a minute or longer.
As breathing starts and stops during sleep, the repetitive drop blood oxygen levels and small breaks during the light, deep, and REM sleep cycles impacts the body’s natural healing and dreaming patterns.
Long term sleep apnea is a serious condition leading to life impacting conditions like high blood pressure, heath issues, sexual dysfunction, diabetes, and many more due to the continuous drop in blood oxygen levels.
Untreated sleep apnea can cause damage to the brain due to the suppression of oxygen enter the airway. Treating sleep apnea is important because the brain is just 2% of body weight but uses 20% of the body’s oxygen supply.
Technically speaking, no damage will occur when depriving the brain of oxygen for less than a minute, but continuously being deprived of oxygen throughout the night disrupts the natural processes of the body in the most critical part of life – sleep.
There are three types of sleep apnea: obstructive, central, and mixed.
Obstructive sleep apnea (OSA) is the most common but all three are tough to self-diagnosis because OSA does not trigger full awakening during the night. OSA is more a ‘mechanical’ problem when the tongue falls back against the soft palate applying pressure on the uvula pressing against the back of the throat, effectively closing the airway.
Central and mixed sleep apnea occur when the brain does not communicate with your throat and lung muscles to keep airways flowing properly. These two are generally associated with more serious illness affecting your lower brain stem. Central is common among those that suffer from heart or kidney conditions, opioid users, or those who are in high altitudes temporarily. In rare cases 5-15% of people who have OSA develop CSA.
What is a typical sleep pattern?
A normal sleep cycle follows several phases through the night:
Light non-REM sleep, deep non-REM sleep, light REM sleep as an example. The first REM cycle occurs 90 minutes falling asleep and lasts 15 minutes.
Lots of bodily functions critical for general health happens during REM. The REM cycle initiates dreaming and the body goes limp paralyzing legs and arms. The REM cycle alternates between light and deep phases where blood pressure drops and heart rate slows down allowing the body to cool down. Reaching the deep phases of REM is considered to be the most refreshing and healing cycle of sleep.
Most adults have 5 phases where three-fifths of a night’s sleep is light non-REM, one-fifth is deep non-REM sleep, and one-fifth is REM sleep. Sleep Apnea can start during any phase, but is usually its worst during deep REM cycle due to the natural drop in blood pressure and relaxed muscles.
According to the National Sleep Foundation, over 47 million adults do not get a full restorative night of sleep.
Sleep deprivation is linked to sleep apnea can result in injuries at work and decrease productivity.
- It’s estimated that lack of sleep causes US companies $18 billion dollars each year.
- Some studies show that sleep deprivation causes 1.2 million car crashes each year.
While sleep apnea is not always the cause for sleep deprivation it is certainly a factor and clear indicator for the condition.
His studies lead to an understanding around why sleep apnea in women has an impact on normal hormonal menstrual cycle leading to changes to menopause. Specifically, insomnia induced by sleep apnea will impact hormonal levels in women and men.
Insomnia induced by sleep apnea also leads to Restless Leg syndrome (RLS), also called Willis-Ekbom Disease, which causes legs to spontaneously move and shake. RLS is associated with certain vitamin deficiencies, which are not fully understood by researcher but a hypothesis believes there is an association between lack of sleep and the disruption in the body’s natural restoration of organs during sleep.
What causes Sleep Apnea?
- Weight: Excess body weight and obesity is a primary cause for sleep apnea.
- Body type and Physical features: Certain features like small upper airway; large tongue, tonsils or uvula; small jaw, overbite, receding chin and larger neck raise the risk for OSA.
- Lifestyle: Using alcohol or sedatives relax the upper airway breathing muscles.
- Genetics: data shows that OSA is passed on from parents that suffer from OSA.
- Gender and age: Sleep Apnea is more common among men and post-menopausal women. The condition is more prevalent among people are over 40 years old.
- Race / ethnicity: According to research, OSA is more prevalent among African-Americans, Pacific-Islanders, and Hispanics.
What are the warning signs of sleep apnea?
- Snoring is the most telling sign that you may have sleep apnea. Snoring usually becomes more serious as people get older.
- Daytime sleepiness
- Episodes of stopped breathing during sleep (observed by someone else usually)
- Waking up gasping or choking during rest
- Dry mouth or sore throat through the night
- Morning headache
- Difficulty concentrating and attentiveness
- High blood pressure
- Nighttime sweating
- Decreased libido
- Sleep apnea can cause mood swings, irritability, and even lead to depression.
- Waking up in the morning not feeling rested
- Unexplained weight gain
- Awaking at night feeling confused
What are treatment options for Sleep Apnea?
Mild snoring and insomnia can be easily treated with simple changes to lifestyle or correcting bad habits to get back to a state of health and restfulness. Managing things like your weight, exercising and eating healthy are proven methods to eliminate snoring. Sleeping on your side or elevating your head at night can help eliminate snoring and lead to more quality sleep.
Obstructive sleep apnea is broken into three categories depending on your frequency of sleep interruptions in breathing:
- Mild OSA– experiences 5-14 episodes of interruptions in breathing in an hour.
- Moderate OSA- experiences 15-30 episodes of interruptions in breathing in an hour.
- Severe OSA- experiences 30 or more interruptions in breathing in an hour.
Can I cure sleep apnea with over-the-counter supplements?
While Melatonin cannot fix sleep apnea, it is considered the “go-to” sleep aid can help promote healthier sleep.
Melatonin is a hormone secreted during sleep from the pineal gland. It’s main job in the body is to regulate night and day cycles or sleep-wakefulness. Over 3 million Americans use Melatonin to help them get to sleep quicker and find deeper sleep during the night. People have success using Melatonin to stop insomnia and improving sleep when traveling abroad (jet lag) or adjusting to sleep-wake cycles in people whose work schedule change frequently.
Do you scroll through social media before bed?
Going to bed should be a non-stimulated and peaceful process. “Checking your phone stimulates the brain so we are more active and awake,” says Dr. Walia of the Cleveland Clinic. “Even just a quick check can engage your brain and prolong sleep.”
Looking at your phone screen while lying in bed can affect your internal body clock and throwing off your sleep. Sleep doctors recommend 1 hour without looking screen time before bed. Even 30 minutes before bed can be beneficial.
Continuous positive airway pressure therapy uses a machine to help a person who has obstructive sleep apnea (OSA) which is the most common form of sleep apnea. A CPAP machine increases air pressure in your throat as you’re sleeping so that your airway doesn’t collapse when you breathe in. Approximately 50% of people that are diagnosed with sleep apnea and prescribed a CPAP to correct their OSA.
Involves removing and repositioning excess tissue in the throat to increase the width of the airway. Uvulopalatopharyngoplasty, or UPPP is a surgery to open the upper airways by taking out extra tissue in the throat and other soft palate procedures.
It is the go-to type of surgery for sleep apnea.
Oral Appliance Therapy
These are convenient and portable, and not only do they treat sleep apnea, they are effective to stop snoring. Mandibular Advancement Devices (MAD) are sleep apnea mouthpieces that are custom-crafted using a plastic-like mold that forms to the shape of the patient’s teeth and mouth.
There are several self-check tests to help understand if you may be experiencing a sleep disorder and are in need of further care.
Are you struggling to Breathe when you are sleeping?
Even if you don’t THINK you have a problem, take this quick self-check:
- Do you SNORE?
- Are you TIRED during the day?
- Has anyone seen you CHOKING or GASPING when you sleep?
- Have you been told you have HIGH BLOOD PRESSURE?
- Do you have ACID REFLUX?
- Do you have DIABETES?
What is the Epworth Sleepiness Scale?
The Epworth Sleepiness Scale is used across in the field of sleep medicine to help diagnosis sleep disorders like sleep apnea.
The test is a list of eight situations in which you rate your tendency to become sleepy on a scale of 0, no chance of dozing, to 3, high chance of dozing. When you finish the test, add up the values of your responses. Your total score is based on a scale of 0 to 24. The scale estimates whether you are experiencing excessive sleepiness that possibly requires medical attention.
How likely are you to doze off or fall asleep in the following situations?
You should rate your chances of dozing off, not just feeling tired. Even if you have not done some of these things recently try to determine how they would have affected you. For each situation, decide whether or not you would have:
- No chance of dozing =0
- Slight chance of dozing =1
- Moderate chance of dozing =2
- High chance of dozing =3
- Sitting and reading
- Watching TV
- Sitting inactive in a public place (e.g a theater or a meeting)
- As a passenger in a car for an hour without a break
- Lying down to rest in the afternoon when circumstances permit
- Sitting and talking to someone
- Sitting quietly after a lunch without alcohol
- In a car, while stopped for a few minutes in traffic
Your total score can range from 0 to 24. A higher score is associated with increased sleepiness. A score of 11 or higher is an indicator that you may need medical attention.
- 0 to 10 = normal range of sleepiness in healthy adults
- 11 to 14 = mild sleepiness
- 15 to 17 = moderate sleepiness
- 18 to 24 = severe sleepiness
Another tool to help screen for OSA is called the STOP BANG questionnaire. The STOP-BANG screens for obstructive sleep apnea (OSA) only.
- Do you snore? Loud enough to be heard through closed doors or loud enough to disturb your partner
- Do you often feel tired, fatigued or sleepy during the daytime?
- Has anyone observed you stop breathing, choking or gasping while you were sleeping?
- Are you being treated for high blood pressure?
- What is your Body Mass Index (BMI)?
- Are you older than 50?
- Is your neck size larger than 43cm if male or 41cm if female?
- Are you male?
If you answer YES at least 3 of the above, we recommend speaking with one of our network providers.
How do you test for sleep apnea at home?
After filling out your online questions about your symptoms, you will setup a video consult with one of our Board-Certified providers to review your medical history, sleep quality, and lifestyle. If Appropriate, the provider will prescribe an at-home sleep study to be mailed to you.
Diagnosing sleep apnea is an overnight process that requires you to do an overnight sleep study in the comfort of your own home.
The at-home sleep study is an alternative to an in-clinic sleep study and the most popular method for patients. The home sleep study will measure your airflow, pulse oximetry, heart rate, and respiration effort in the comfort of your own bed.
The at-home sleep study tracks your breathing, oxygen levels, and breathing effort giving our providers and sleep specialists an apnea index. The sleep study comes in a kit with a few different sensors, each measuring different things. Typically, you will get:
- A small oxygen sensor probe
- A chest belt measuring breaths and sometimes sleep position
- A nasal cannula to measure airflow