INFORMATION ABOUT SLEEP APNEA

I, Karl Loren, learned about the symptoms of sleep apnea, and felt that I might well have this condition. I have started through the normal HMO process to get it tested. There may be some interest in my personal experience as I move along and I will keep this page updated.

As this research was moving along I also "ran into" a different label -- low body temperature. It was amazing to me to learn that a person who has consistently low body temperature is undoubtedly suffering from a lack of sufficient oxygen in his blood. This could be caused by improper sleep, not enough deep sleep, therefore inadequate breathing and low oxygen content. I have published vital information about this HERE.

I started, as required, by visiting my "primary care physician." He's a good guy, a bit cynical about HMOs. I described what I wanted. He agreed. He said that before I could be tested for "sleep apnea" the HMO required that I first see the "Eye, Ear, Nose & Throat" doctor. That took, of course, another three weeks for the appointment.

That doctor was quite nice, a cute assistant with him. He listened to my story, looked into my throat, and inspected a couple other simple things. Then he agreed that I could have the "sleep test." So, he writes up his report (a few days) and sends his recommendation to the HMO. They have to approve that.

This sleep test takes place in a rather converted motel room. The sleep center operates four of these rooms, 7 nights per week.

I get that before 9 PM, get some electrodes attached to my body, and simply go to sleep in the bed. There is someone "monitoring" me -- to be sure the electrodes don't get detached. Usually they will wake you up half way through and "install" the "sleep mask" that, eventually you would have to wear every night (for a good night's sleep).

Then, the test the remainder of the night while you are wearing the sleep mask.

The first opening for the sleep test was almost four months into the future. I guess that the HMO does this on purpose as a means of rationing this type of care. I asked, and was told that the sleep center charges $3,000 for the one night! That's a lot to watch me sleep.

So, I may get a call earlier if there is a cancellation, but someone time along this line I'll post more data here.

The Greek word "apnea" literally means "without breath." There are three types of apnea: obstructive, central, and mixed; of the three, obstructive is the most common. Despite the difference in the root cause of each type, in all three, people with untreated sleep apnea stop breathing repeatedly during their sleep, sometimes hundreds of times during the night and often for a minute or longer.

Obstructive sleep apnea (OSA) is caused by a blockage of the airway, usually when the soft tissue in the rear of the throat collapses and closes during sleep. In central sleep apnea, the airway is not blocked but the brain fails to signal the muscles to breathe. Mixed apnea, as the name implies, is a combination of the two. With each apnea event, the brain briefly arouses people with sleep apnea in order for them to resume breathing, but consequently sleep is extremely fragmented and of poor quality.

Sleep apnea is very common, as common as adult diabetes, and affects more than twelve million Americans, according to the National Institutes of Health. Risk factors include being male, overweight, and over the age of forty, but sleep apnea can strike anyone at any age, even children. Yet still because of the lack of awareness by the public and healthcare professionals, the vast majority remain undiagnosed and therefore untreated, despite the fact that this serious disorder can have significant consequences.

Untreated, sleep apnea can cause high blood pressure and other cardiovascular disease, memory problems, weight gain, impotency, and headaches. Moreover, untreated sleep apnea may be responsible for job impairment and motor vehicle crashes. Fortunately, sleep apnea can be diagnosed and treated. Several treatment options exist, and research into additional options continues.

If you suspect that you have sleep apnea and need to see a doctor about your symptoms, we suggest that you first check your insurance policy before making any appointments. You may be required to get a referral to a sleep specialist from your primary care physician and/or you may be required to go to a certain testing facility. In some cases, your primary care physician orders the tests and receives the results for you. Keep in mind that you may be tested in a sleep center or laboratory or in your own home. Some insurance policies require you to undergo a “split-night” study in the sleep lab. (During a split-night study, the first half of the night is the testing phase. If the study shows you have sleep apnea, during the second half of the night you begin treatment for sleep apnea.)

Doctors who work in sleep medicine may be pulmonologists (specializing in lungs), neurologists (the brain), otolaryngologists (the ears, nose, and throat), psychiatry (mental health), or primary care physicians such as internists or family practitioners. Their expertise in the field of sleep may come from having trained with other sleep specialists and/or having studied sleep medicine through a residency program, continuing medical education (CME) courses, and scientific meetings. Some are certified by the American Board of Sleep Medicine (ABSM) as well. In any case, a sleep doctor may hold one of many degrees that meet the requirements of the ABSM: an MD, DO, MB (the European equivalent of an MD), a PhD, or a PsyD in a health-related field. In addition, some dentists have studied sleep apnea and, when appropriate, treat sleep apnea patients by fitting them with an oral appliance. You should feel free to ask any doctor or dentist about his/her credentials and experience. You should also be satisfied with the explanations of what sleep apnea is and how it is diagnosed and treated in your particular case.

If you do have a choice of doctors and sleep testing facilities, you can find a referral from a few different sources. There is no one complete list of all such facilities, and as a non-profit organization, the American Sleep Apnea Association (ASAA) does not endorse or recommend any company, product, or health care provider. However, there is a list of sleep centers and laboratories accredited by the American Academy of Sleep Medicine that pay their AASM membership dues. (The AASM, formerly known as the American Sleep Disorders Association or ASDA, is the professional society in the field of sleep medicine that accredits such facilities; accreditation implies adherence to a certain set of standards.) The most up-to-date list of accredited member sleep centers and laboratories appears on the AASM's web site: www.aasmnet.org/listing.htm. You can request a list from the ASAA as well. Remember that other centers are in the process of being accredited, have chosen not to be accredited, or do not qualify for accreditation.

You can also check with local hospitals, home health care companies, and health care professionals to find a testing facility. The telephone directory for businesses can be helpful in this regard. Neighbors, friends, and family members may have further suggestions.

Some insurance policies specifically exclude the diagnosis and/or treatment of sleep disorders and some do not cover durable medical equipment (the most common form of treatment for sleep apnea is considered durable medical equipment or DME). These are points to consider when examining your policy and whenever thinking about changing your policy (such as during your employer's open season). Depending upon where you live and the provider you see, the diagnosis and treatment of sleep apnea can be a significant expense, usually at least $1000, but, even without insurance coverage, when you consider the possible consequences and costs of untreated sleep apnea, being diagnosed and treated properly is well-worth the price.

Sleep apnea also occurs in children. For more information on pediatric sleep apnea, you may want to read Having Your Child Evaluated for Obstructive Sleep Apnea.

As a non-profit organization, the ASAA does not endorse or recommend any company or products.

Hi Karl:

About sleep apnea, there are two types of breathing masks that are dispensed by the medicos. The one that you referred to is the C-Pap and it uses a positive pressure. The other is the Bi-Pap and it also has a positive pressure, but it senses when you go to exhale and stops pushing air at you. I would not waste my time on the C-Pap, but get the Bi-Pap, if you go that route.
Patrick

This full-featured unit offers an all-new icon-based display, expanded ramp capabilities and integrated humidification controls. It even offers features that make set-up easier and significantly more accurate. And its unique new session meter records the number of sessions that last more that four hours giving you insight into patients' daily usage patterns.

Sleep apnea is a serious, potentially life-threatening condition that is far more common than generally understood. First described in 1965, sleep apnea is a breathing disorder characterized by brief interruptions of breathing during sleep. It owes its name to a Greek word, apnea, meaning “want of breath.” There are two types of sleep apnea: central and obstructive. Central sleep apnea, which is less common, occurs when the brain fails to send the appropriate signals to the breathing muscles to initiate respirations. 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.

In a given night, the number of involuntary breathing pauses or “apneic events” may be as high as 20 to 60 or more per hour. These breathing pauses are almost always accompanied by snoring between apnea episodes, although not everyone who snores has this condition. Sleep apnea can also be characterized by choking sensations. The frequent interruptions of deep, restorative sleep often leads to excessive daytime sleepiness and may be associated with an early morning headache.

Sleep apnea occurs in all age groups and both sexes but is more common in men (it may be underdiagnosed in women) and possibly young African Americans. It has been estimated that as many as 18 million Americans have sleep apnea. Four percent of middle-aged men and 2 percent of middle-aged women have sleep apnea along with excessive daytime sleepiness. People most likely to have or develop sleep apnea include those who snore loudly and also are overweight, or have high blood pressure, or 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..

Certain mechanical and structural problems in the airway cause the interruptions in breathing during sleep. In some people, apnea occurs when the throat muscles and tongue relax during sleep and partially block the opening of the airway. When the muscles of the soft palate at the base of the tongue and the uvula (the small fleshy tissue hanging from the center of the back of the throat) relax and sag, the airway becomes blocked, making breathing labored and noisy and even stopping it altogether. Sleep apnea also can occur in obese people when an excess amount of tissue in the airway causes it to be narrowed. With a narrowed airway, the person continues his or her efforts to breathe, but air cannot easily flow into or out of the nose or mouth. Unknown to the person, this results in heavy snoring, periods of no breathing, and frequent arousals (causing abrupt changes from deep sleep to light sleep). Ingestion of alcohol and sleeping pills increases the frequency and duration of breathing pauses in people with sleep apnea.

During the apneic event, the person is unable to breathe in oxygen and to exhale carbon dioxide, resulting in low levels of oxygen and increased levels of carbon dioxide in the blood. The reduction in oxygen and increase in carbon dioxide alert the brain to resume breathing and cause an arousal. With each arousal, a signal is sent from the brain to the upper airway muscles to open the airway; breathing is resumed, often with a loud snort or gasp. Frequent arousals, although necessary for breathing to restart, prevent the patient from getting enough restorative, deep sleep.

For many sleep apnea patients, their bed partners or family members are the first ones to suspect that something is wrong, usually from their heavy snoring and apparent struggle to breathe. Coworkers or friends of the sleep apnea victim may notice that the individual falls asleep during the day at inappropriate times (such as while driving a car, working, or talking). The patient often does not know he or she has a problem and may not believe it when told. It is important that the person see a doctor for evaluation of the sleep problem.

In addition to the primary care physician, pulmonologists, neurologists, or other physicians with specialty training in sleep disorders may be involved in making a definitive diagnosis and initiating treatment. Diagnosis of sleep apnea is not simple because there can be many different reasons for disturbed sleep. Several tests are available for evaluating a person for sleep apnea.

The specific therapy for sleep apnea is tailored to the individual patient based on medical history, physical examination, and the results of polysomnography. Medications are generally not effective in the treatment of sleep apnea. Oxygen is sometimes used in patients with central apnea caused by heart failure. It is not used to treat obstructive sleep apnea.

Somnoplasty is a procedure that uses radiowaves to reduce the size of some airway structures such as the uvula and the back of the tongue. This technique is being investigated as a treatment for apnea.

drowsiness

By Adam Brochert, MD

Drowsiness is a state of decreased awareness or alertness associated with a desire or tendency to fall asleep.

What is going on in the body?

Almost everyone has felt drowsy before, usually due to normal tiredness from a long day or lack of sleep. There are other causes of this condition as well. Most of the causes are not serious, but some are life threatening.

What are the signs and symptoms of the condition?

When someone complains of abnormal drowsiness, the healthcare provider will ask questions, such as: · how long it has been present · whether it occurs all day every day or only on some days · whether it is getting worse, better, or staying the same · the number of hours of sleep the person gets every night and whether there is any trouble with sleeping · the amount of stress in the person's life · the amount of activity or exercise a person engages in · the person's diet · any other symptoms the person is having, such as weight loss, fever, or confusion · what medications, drugs, or herbs a person takes, if any · what other medical problems a person has, if any

What are the causes and risks of the condition?

There are many possible causes of this condition, including: · lack of sleep or sleep disorders, such as insomnia and sleep apnea. Sleep apnea is a disorder of breathing during sleep that prevents a person from getting enough rest. · infections, such as chronic bronchitis or infectious mononucleosis · a low red blood cell count, called anemia · stress · working, studying, or exercising too much · lack of exercise or poor physical conditioning · hormone imbalances, such as hypothyroidism, a condition caused by a low level of thyroid hormone · depression or other psychological disorders · autoimmune disorders, or conditions in which a person's immune system attacks his or her own body. Examples include systemic lupus erythematosus and rheumatoid arthritis. · low oxygen levels in the blood, which can occur with heart disease or chronic obstructive pulmonary disease · toxin or chemical exposure, such as carbon monoxide poisoning · medications, such as antihistamines, sedatives, and certain medications used to treat depression and high blood pressure · alcohol · systemic disorders, such as uncontrolled diabetes · a stroke, or brain attack · any severe, life-threatening illness, such as meningitis, severe pneumonia, or end-stage cancer

Other causes are also possible. Sometimes no cause can be found.

What can be done to prevent the condition?

Avoiding stress and overexertion, getting enough sleep, and eating a healthy diet can prevent many cases of drowsiness. Avoidance of alcohol and medications that cause drowsiness can avoid cases due to these causes. Maintaining a normal weight and avoiding obesity can sometimes prevent sleep apnea. Many causes cannot be prevented.

How is the condition diagnosed?

After a physical examination, the healthcare provider may order further tests. A chest x-ray may be done if lung disease is thought to be the cause. A sleep study, called polysomnography, may be done if sleep apnea is suspected. A blood test called a complete blood count (CBC) may be ordered if anemia or an infection is suspected. Other tests may also be needed in some cases.

What are the long-term effects of the condition?

Drowsiness, when persistent, can limit a person's ability to work, go to school, and drive. Severely affected people may need to rest for most of the day. Other long-term effects depend on the cause. For instance, end-stage cancer often results in death. Cases due to a stroke may cause permanent drowsiness and other limitations from brain damage.

What are the risks to others?

Drowsiness is not contagious and poses no risk to others. However, if the cause is an infection, such as meningitis, the infection may be contagious.

What are the treatments for the condition?

Specific treatment is directed at the cause. For instance, a person may need to get antibiotics for an infection or thyroid hormone pills for a low thyroid level. In other people, control of diabetes or other systemic disorders may be needed. A person with depression often needs medications to treat the condition. Those with cancer may need surgery, chemotherapy, or radiation therapy.

What are the side effects of the treatments?

All medications and surgeries have possible side effects. For instance, antibiotics may cause allergic reactions and stomach upset. Surgery carries a risk of bleeding, infection, and allergic reactions to anesthesia.

What happens after treatment for the condition?

If the drowsiness goes away, a person may or may not need further treatment. For instance, those with kidney failure need further treatment even if their drowsiness goes away. Those who were "overdoing it" or not getting enough sleep may need no further treatment once they get some rest. Those with serious diseases, such as end-stage cancer, may die if treatment is unsuccessful.

How is the condition monitored?

Any new or worsening symptoms should be reported to the healthcare provider. The cause of drowsiness may or may not need monitoring. For instance, those with anemia need repeat CBC blood tests to make sure the blood count returns to normal.

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CONTENTS
1	WHAT IS SLEEP APNEA?
2	WHO GETS SLEEP APNEA?
3	WHAT CAUSES SLEEP APNEA?
4	HOW IS NORMAL BREATHING RESTORED DURING SLEEP?
5	WHAT ARE THE EFFECTS OF SLEEP APNEA?
6	WHEN SHOULD SLEEP APNEA BE SUSPECTED?
7	HOW IS SLEEP APNEA DIAGNOSED?
8	HOW IS SLEEP APNEA TREATED?
9	SEEKING MEDICAL HELP?

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SLEEP APNEA DEFINED

What is Sleep Apnea?

Who Gets Sleep Apnea?

What Causes Sleep Apnea?

How is Normal Breathing Restored During Sleep?

What are the Effects of Sleep Apnea?

When Should Sleep Apnea be Suspected?

How is Sleep Apnea Diagnosed?

How is Sleep Apnea Treated?

Seeking Medical Help?