Obstructive Sleep Apnea is a very common malady. It is familiar to many and is frequently a subject of both social and medical conversations. Individuals not engaged in frequent work with Apnea conditions may be confused by its usage and rightly so. Discussions and writings about the subject can use the term with different meanings. When used by professionals, it can also be used in various ways. It has a physiologic technical meaning; it is used as a proper name of medical conditions; and, it has a common usage that is less specific.
The word – apnea – comes from the Latin and Greek languages. The Latin ‘a + pnea’ means without breath and the Greek ‘apnoia’ means without pain. The Webster dictionary defines apnea as ”Transient cessation of respiration”. Webster’s definition fits well with the current technical use of the word, but fails to show the scope of the word’s use that has increased over the past half-century with the recognition of the associated clinical conditions.
Webster’s definition fits well with the current technical use of the word, but fails to show the scope of the word’s use…
The word is used technically to label a cessation of breathing. Sleep testing, in facilities or at home, and physiologic monitoring of hospital patients can identify periods when no air is going in or out of the nose or mouth. No breaths can be measured. These events are called Apneas.
The word is used technically to label a cessation of breathing.
The addition of chest movement measurements during these apnea events further defines these periods of apnea. If the breathing efforts are persistent during an apnea episode, the event is labeled an Obstructive Apnea. If no breathing efforts are being made by the chest, the pump that moves air in and out, the apnea is caused by the lack of chest effort and is called a Central Apnea. It is called central because breathing effort by the chest is controlled, started and adjusted, by the Central Nervous System. If the breathing problem is associated with both partially reduced chest movement and total cessation of movement, it is labeled a Mixed Apnea. As we can see, the technical apnea breathing events are further defined as obstructive, central or mixed.
‘Apnea’ is used as part of the proper name of medical conditions
‘Apnea’ is used as part of the proper name of medical conditions. These conditions were described and first recognized approximately a half-century ago, but probably have been affecting mankind for our entire history. Obstructive Sleep Apnea is the first of these. When breathing is blocked or partially blocked for 10 seconds at least five times per hour, a diagnosis of the clinical syndrome of Obstructive Sleep Apnea is established.
Central Sleep Apnea is the clinical condition where the primary form of apneas measured is central. It is established when a certain percentage of the physiologic apneas recorded on testing are the central type. Central Sleep Apnea can be the result of multiple medical issues that range from cardiovascular problems to neurologic conditions. It can be rarely seen on its own and not associated with other medical problems.
A third commonly accepted diagnostic term is Complex Sleep Apnea. This diagnostic group represents individuals with obstructive sleep apnea treated with CPAP whose breathing events do not resolve when they are treated. Their Apnea Hypopnea Index remains high. However, on repeated testing with CPAP, the breathing events are now predominantly Central Apneas. The CPAP treatment caused a change from Obstructive Apnea events to Central Apnea events. This type of medical condition is called Complex Sleep Apnea.
The term Apnea Hypopnea Index (AHI) may be new to some, but it is very important that it is understood. The ‘Apnea’ referred to is the physiologic measured Apneas. ‘Hypopnea’ is a partial obstructive breathing event measured on testing. They have the same secondary effects as apnea events but without the total cessation of airflow. The AHI is a calculated number representing the total events (Apnea and Hypopneas) per hour.
The AHI is the measurement on a diagnostic sleep test that determines if an apnea condition of some type is present. With a patient on therapy, it is the number that is followed by the physician to determine how well the therapy is working. It is measured on most CPAP machines and can be reviewed by the patient on a day-by-day basis. The AHI on a diagnostic test is and has been the measurement to determine the severity of sleep apnea conditions for many years. The AHI is an example of the technical use of the word apnea.
…the common use of the term Apnea is far less specific…
Finally, the common use of the term Apnea is far less specific than the uses we have reviewed. Often, the word is used to encompass a broad range of the field. In writings and conversations, it will be used by an author as a single word to cover all, or one, of the apnea medical conditions – obstructive sleep apnea, central sleep apnea and complex sleep apnea. When discussing Obstructive Sleep Apnea conversationally, most will speak about apnea, meaning obstructive sleep apnea. The most simple descriptive of its common use is as a substitute for the clinical conditions associated with breathing problems during sleep.
What we have covered.
1. Apnea is technically an absence of breaths (no airflow at the nose and mouth).
2. Apnea, used technically, during sleep is further defined by its features to be obstructive, central or mixed.
*Obstructive apnea
*Central apnea
*Mixed apnea
3. Apnea is used in the formal name of medical conditions including:
*Obstructive Sleep Apnea
*Central Sleep Apnea
*Complex Sleep Apnea
4. Apnea, used in its technical manner, is a component of the Apnea Hypopnea Index measurement used to judge the severity of the problem.
5. Apnea’s common use is as a general term covering one or all of the clinical conditions
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
