Sleep Apnea

What is sleep apnea?

Sleep apnea is a common medical illness affecting millions of Americans. Sleep Apnea can be central (e.g., due to a neurological condition such as a stroke) and due to a lack of respiratory effort, obstructive (due to a closed airway in spite of normal respiratory effort), or the combination of both.

Obstructive Sleep Apnea/Hypopnea Syndrome (OSAHS) is the most common cause of sleep apnea and is caused by the repetitive closing of a person’s airway (e.g., trachea or “windpipe”) while they are asleep. When a person goes to sleep, all of the body’s muscles which are under voluntary control begin to relax. In a person with OSAHS, the relaxation of these muscles closes off their airway, making it impossible to breath.

Apneas are the moments when breathing is stopped due to the obstructed movement of air (lasting more than 10 seconds) and hypopneas are moments of abnormal and decreased breathing due to obstruction. Snoring is common for many people with OSAHS. This is the sound that occurs with partial blockage of the airway during sleep. OSAHS causes poor sleep, excessive daytime sleepiness, and a number of other medical and psychiatric issues that comprise the syndrome.

How is it diagnosed?

OSAHS is frequently diagnosed by a doctor who recognizes the combination of symptoms that are seen in people who have this syndrome. This is called a “clinical diagnosis.” Specifically, many people with OSAHS may:

  1. Experience poor sleep, (e.g., waking up multiple times overnight)
  2. Report excessive daytime sleepiness (e.g., the need to nap, falling asleep while driving, difficulty focusing)
  3. Be aware of nighttime snoring (often times he or she is notified of this from a family member or a significant other)
  4. Have other symptoms such as unexplained high blood pressure, daytime headaches, or incontinence while sleeping (nocturia)

A definitive diagnosis of OSAHS is made using a test called a “sleep study” or a polysomnogram that measures for apnea and hypopnea events that are present when a person sleeps overnight in a hospital or another medical setting.

Who is at risk?

Men are at greater risk of developing OSAHS than women and younger people are less likely to develop OSAHS than older individuals. People who are overweight are also significantly more likely to be diagnosed with OSAHS. The relationship between smoking and OSAHS is still being studied, but it cannot hurt to stop smoking!

What are some of the complications of OSAHS?

People with OSAHS are more likely to develop high blood pressure and diabetes which increases the risk of heart disease and heart attacks. People with OSAHS are also at increased risk when undergoing surgeries or other procedures that require general anesthesia.

OSAHS and Mental Illness

Getting a good night’s sleep is very important for all people, but even more so for people with depression, anxiety, bipolar disorder and other mental illnesses. Many mental illnesses can disrupt sleep when untreated, but sometimes it is the other way around: poor sleep worsens mental illness and makes it harder to treat the symptoms of mental illness.

The poor sleep that is caused by OSAHS has been shown to significantly worsen the symptoms of depression in scientific studies. Furthermore, severe OSAHS can decrease the efficacy of certain treatments in depression. Older people with OSAHS may also more likely to develop cognitive impairment, a major symptom of dementia. Treatment of OSAHS has also been studied in relationship to schizophrenia, ADHD and other mental illnesses. All of the scientific data shows the connection between medical and mental illnesses: good treatment for OSAHS is necessary for recovery—or prevention—in both types of conditions.

What is the treatment for OSAHS?

After a diagnosis is made, sitting down and talking with a physician is the first step in the treatment of OSAHS. A person’s doctor will likely counsel them on smoking and alcohol use: both of these substances may worsen OSAHS. People can also expect to be counseled to lose weight as this will decrease the severity of symptoms associated with this condition. Some people who are taking medications that increase sleepiness (such as the benzodiazepines: diazepam, alprazolam, clonazepam and lorazepam) may also be advised to stop these medications.

There are not medications that can be prescribed to “cure” OSAHS. Some people may seek treatment with stimulant medications (such as methylphenidate or detroamphetamine) or non-stimulant medications (such as modafinil and armodafinil) but these are not efficacious in treating the underlying cause of OSAHS. These medications are only useful in decrease daytime sleepiness.

Continuous Positive Airway Pressure (CPAP) is a treatment of choice in OSAHS. This consists of a mask that people wear on their face while sleeping in bed. This mask is attached to a machine that blows air into a person’s nose and mouth and helps to keep the airway open. The most common complaint that people have with CPAP treatment is that “it feels weird.” For many people, this feeling goes away after a few nights and the improvement in sleep quality is “well worth it.” Most people find that this treatment is very effective.

Some people might also seek surgery to cure their OSAHS. It is not generally recommended for most people with OSAHS for multiple reasons:

  1. Surgical treatments of OSAHS (such as uvulopalatopharyngoplasty) do not have consistent scientific data supporting its use in the treatment of OSAHS for most people
  2. People with OSAHS are frequently at increased risk of serious medical complications when undergoing surgery
  3. Non-surgical treatment of OSAHS has good scientific data supporting its use for most people

Another treatment used by some people is a Mandibular Repositioning Splint (MRS). This is often called a “mouth guard” or an “oral device” and is an object that people place inside of their mouth that can help to open the airway and decrease apnea and hypopnea events. This is thought to be less effective that CPAP.

Reviewed by Ken Duckworth, M.D. and Jacob Freedman M.D., July 2012