What is sleep apnea? It is an extremely common condition that should be understood by everyone. Sleep apnea is a temporary blockage or obstruction of our breathing while we sleep. A person with sleep apnea experiences repeated blockages of their air passage during sleep. The condition of obstructive sleep apnea is diagnosed when the blockages occur repeatedly.
When we sleep, our muscles relax. This can result in significant narrowing and often closure of the air passage between the lungs and the mouth and nose. The obstruction occurs between the voice box (larynx) and the nasal passage and mouth. This relaxation results in a critical narrowing. At some degree of relaxation, as the passage narrows, air has difficulty passing in and out of our lungs. A partial obstruction is called ‘hypopnea’ while a complete obstruction is an ‘apnea’. Both hypopneas and apneas have the same effects. Each is a significant obstructive event.
Figure 1
Side view of anatomy of upper airway. Top figure shows normal open airway. The bottom figure shows area of obstruction during a obstructive apnea event. The obstruction demonstrated is at the base of the tongue
Obstruction of the airway leads to physiological changes. The level of oxygen in the blood drops and the level of carbon dioxide increases. These changes occur within a few seconds. The brain, through its mechanisms to control breathing, senses these changes and immediately increases our breathing efforts. The increased breathing effort results in the opening of the air passage and the return to normal of the blood oxygen and carbon dioxide levels. This increased effort often produces a loud noise, snore or snort as airway open. The blockage will last for 15 to 20 seconds on average. An individual can wake with the choking sensation when this occurs, however, that is very unusual. Most people sleep through the entire choking episode.
Figure 2
A three minute graphic recording of a person’s normal breathing. The items recorded are chest wall movements, air movement at nose and mouth, oxygen level, snoring and sleep level.
Figure 3
A three minute recording of a person having obstructive apnea events. Note the increase in chest wall movement, the absent of airflow, dropping oxygen levels, and snoring that is occurring.
The condition of obstructive sleep apnea is diagnosed when these events occur regularly and frequently. Current knowledge suggests that these have to occur at a certain frequency to create symptoms and/or medical problems. Medical professionals, insurance payers, and government bureaucrats established that five events or more per hour indicates the presence of the condition of obstructive sleep apnea.
Many, if not most people, come to doctors, sleep doctors or clinics because of symptoms or at the request of a family member. Symptoms can be almost any issue with sleep and its quality, but nonrestorative sleep with daytime tiredness is the most common. More on that at another time. Family members often become concerned because of a person’s snoring or the interrupted breathing of a family member – a Bear in the Bedroom.
A bear you might not want in your bedroom
Snoring is extremely common with estimates running greater than 50% of some populations reviewed. Snoring is common in Obstructive Sleep Apnea and snoring is a sign of possible apnea. But, not all those individuals with Obstructive Sleep Apnea snore and not all snorers have the condition.
Well, what about a bear in the room? To be honest, I don’t even know if bears snore. The phrase, ‘snores like a bear,’ is frequently used to describe loud snorers. Loud is hard to define. One person’s loud is another person’s soft. However, if we define loud as being able to hear someone outside of their sleeping room and down the hall or up or down stairs, those folks almost always have apnea and it is usually significant apnea.
Hear Someone Snoring From Outside Their Room? They All Most Always Have Apnea!
Do you hear you mother, father, sister, brother, friend, roommate, spouse or significant other snoring from the other side of the house? They should be considered to have Obstructive Sleep Apnea until testing proves that is not the case. Loud snoring is almost always Obstructive Sleep Apnea. We’ll talk more about snoring in a future issue.
The Intermittent Bear in the Bedroom
You can hear the person sleeping. They are snoring, first softly and then more loudly. The snores develop a rhythmic pattern. They start to come and go. The pattern of noise gets your attention and keeps you from sleeping.
There is a loud, gasping, rough sounding snore or several in a row. Following these grating, rattling noises, a slow, steady, almost melodious series of snores rhythmically lull you back toward your own sleep. The snores fade and stop. You listen and hear nothing. Then, after this quiet period, the grating, gasping suddenly returns and jars you awake.
Does the above experience sound familiar? They are the sounds of obstructive apnea. The quiet period is the apnea. The person is breathing and the diaphragms are working to move air into the lungs, but the airway is closed and no air is moving. The person takes a forceful breath and the airway opens with a loud gasp.
If you have been observed to have these events, you are extremely likely to have obstructive apnea. If you have seen these events in others, they are also likely to have apnea.
Hear Someone Having Breathing Problems While Asleep? They Almost Always Have Apnea!
If you sleep in a room or home with a bear, you are sleeping with someone who probably has significant Obstructive Sleep Apnea.
What Have We Reviewed
Loud snoring is almost always a sign of Obstructive Sleep Apnea.
Not everyone with Obstructive Sleep Apnea snores.
Hearing and Observing someone with breathing problems while he is asleep is almost always a sign that he has Obstructive Sleep Apnea.
Mr. Oso. The only type of bear you want in your bedroom. (Best Friend of SPH).
Previously
Obstructive Apnea is a very common problem for humans.
Symptoms and signs are often non-specific
When sleep symptoms are present, Obstructive Apnea is often the cause.
What to Expect in Future Installments
What is Obstructive Apnea?
Why are individuals with Obstructive Apnea tired and sleepy?
Do you know what your apnea number was when you were diagnosed?
Welcome to The Sleep Center blog. I know, just what you need, another email, another electronic interruption to your life. But, with a little bit of luck you will find some pearl, some nugget, some small fact that will make you sleep better, your days clearer and life more rewarding.
Let’s start with a brief note about Obstructive Sleep Apnea. Why are doctors so concerned? Why will so much of what we talk about on these pages be related to Obstructive Apnea. I hope you know. But, if not, it is because apnea can lead to many long-term medical problems and early death. Successful treatment has been shown to reduce the apnea symptoms and reduce the long-term problems that people experience. Patients with apnea who successfully control their apnea live longer better lives.hy does your doctor focus on whether you have Obstructive Apnea? Of course it causes those nasty conditions – hypertension, diabetes, vascular disease resulting in heart problems (atrial fibrillation, heart attacks, heart failure), strokes, memory problems, and accidents – along with the possibility of dying earlier than you might want. While that is reason enough, it is far from the only reason
The reason is….
Apnea is Very, Very Common
Obstructive Apnea is estimated to occur in greater than 25% of the adult population. It is more common as we grow older. It occurs in all age groups.
Furthermore
Sleep Symptoms are often non-specific
Many symptoms can result from apnea. Similar symptoms can result from other disorders of sleep. As a result, testing is almost always required to exclude Obstructive Apnea as a cause of a person’s symptoms.
A problem with your sleep may result from more than one problem. It is not uncommon for a person to have sleep problems and be found to have Obstructive Apnea on sleep testing. After being treated, usually with positive airway pressure, the doctor says the treatment is working well. The apnea is corrected. But the individual feels no better. Apnea is so common that it is frequently discovered and diagnosed when other sleep problems are also present and those problems are causing the symptoms. Treating the apnea is still important for the majority of these individuals because of the significant long-term complications of Obstructive Apnea.
The reasons the doctor is worried about obstructive sleep apnea are
Obstructive Apnea is a very common problem for humans.
Symptoms and signs are often non-specific
Obstructive Apnea causes many long term medical problems
