Sleep Apnea

Obstructive sleep apnea syndrome (OSAS) is a disruption of breathing during sleep which can seriously threaten health and well-being. OSAS and snoring are related. Very simply, OSAS is snoring in its most dangerous form. Snoring happens when the muscles in the throat over-relax during sleep to the point that they fail to hold the airway fully open. The airway narrows and its tissues vibrate with each breath. The tissue vibration causes the snoring sound. 

Snoring can be harmless even if it’s very loud. Snoring containing periods of silence, followed by choking or snorting sounds, might be a sign of OSAS. The silences happen when the vibrating airway collapses or obstructs. As breath can’t pass through the obstructed airway, the tissue vibration and the snoring stop. Apnea, or absence of breathing, is the result. 

The apnea can last from a few seconds to a few minutes. During this time the body’s oxygen levels may fall. The apnea period ends only when the sleeper’s brain forces partial wakefulness in order to regain control of the airway muscles. The airway is then opened, usually with loud gasping or snorting sounds. Breathing is restored just long enough to bring oxygen levels back up toward normal levels, but in a few seconds or minutes the cycle of obstruction, apnea and partial awakening reoccurs. This cycle may repeat dozens to hundreds of times each night with the sleeper remaining unaware of the breathing fluctuations.
 

Sometimes people who have OSAS don’t recognize their symptoms simply because the symptoms have slowly worsened over months or years rather than appearing suddenly. The symptoms can be divided into two groups, sleep and waking:

Sleep symptoms:

Snoring in OSAS is sometimes loud and usually has a distinctive pattern. It contains periods of silence as apneas occur. The silences end with noisy gulps of air.

Choking or gasping for air during sleep is sometimes noticed by an alarmed bed partner who may try to wake up the sleeper. In some cases, choking spells are severe enough to awaken the sleeper who may or may not remember the spells in the morning.
 

Frequent arousals to “lighter” levels of sleep occur even while the person may be unaware or only faintly aware of any sleep disruption. The arousals seldom result in full awakenings, but repeated arousal from deep sleep can lead to daytime sleepiness.

Restless sleep is a common problem in people who have OSAS. This restlessness may range from occasional jerking leg movements to near continuous thrashing and changing of body position.

Heavy sweating at night is often noticed. This is caused by the restlessness and distressed breathing of repeated airway obstruction.

 

Awake symptoms:

Daytime sleepiness is caused by OSAS’s repeated disruption of nighttime sleep and ranges in severity. Some people with OSAS don’t note feeling sleepy. Others can’t stay awake at work or school, or while reading, watching television or even driving.

Personality changes such as irritability, anxiety, depression or aggression, can result from sleep deprivation and daytime sleepiness. Memory, judgment or concentration ability can also be affected. These changes can sometimes lead to relationship and work performance issues.

Morning headache is a common problem of OSAS sufferers. It’s caused by the unstable oxygen levels and other body disturbances that occur with repeated apneas.

Untreated OSAS can cause a range of problems from lifestyle interference to potentially life-threatening conditions. Low oxygen levels and sleep deprivation can lead to:

  • High blood pressure
  • Daytime sleepiness
  • Heart attack
  • Accidental death
  • Heart disease
  • Reduced quality of life
  • Stroke
  • Anxiety
  • Sexual dysfunction
  • Depression

Daytime sleepiness is a serious issue. Affected people who operate heavy or delicate equipment, or even just drive a vehicle, can suddenly fall asleep and cause serious accidents. Sober drivers who fall asleep behind the wheel cause road accidents every day in Ontario. Many of those drivers who survive are found to be sleep-deprived due to untreated OSAS.

Treatment for OSAS is highly successful in reducing sleepiness and risk of accidents. It’s extremely important to recognize the signs of sleepiness and seek help before an accident occurs.

High blood pressure can develop and worsen due to OSAS’s nightly disruptions of oxygen levels and other body functions. High blood pressure is related to increased risk of stroke, heart attack and other serious medical problems. Heart function can be affected by OSAS as oxygen-poor blood is pumped through the heart and the rest of the body. The combination of untreated OSAS and heart disease is a serious medical risk.

Talk with your healthcare provider if you suspect you have OSAS. You may want to take your bed partner with you to provide more information about your sleep pattern. Answer any questions your healthcare provider might have about your lifestyle, medications, and health and family history. All of these factors can relate to sleep apnea and may be important clues to your individual case.

Your healthcare provider may refer you to a specialist in sleep disorders for a polysomnogram (PSG) - an overnight test also referred to as a sleep study. Typically, a sleep study for OSAS is done during the night at a clinic. Before you go to sleep in the clinic’s private room, a technician applies several sensors to your body. The sensors don’t interfere with your movements in bed.

While you sleep these sensors send signals about your sleep levels, breathing, oxygen levels and other body systems to the technician’s station located in a separate room. The technician monitors the signals and records them for the specialist to review. The specialist determines if you have OSAS by examining the recorded signals and prepares a prescription if necessary.

In some cases, options may depend on the cause of the OSAS. Several options are currently available to treat OSAS. All are intended to improve sleep quality and daytime function, as well as reduce the risk or severity of related health problems. Talk with your healthcare provider about choosing the right treatment for you. Some people might choose one option as a short-term measure to control their OSAS while they pursue other measures for lifelong control. Treatments include:

CPAP Therapy:

CPAP ("See-pap") is the acronym for continuous positive airway pressure. CPAP is the most common and effective form of OSAS treatment. Hundreds of thousands of Canadians use it every time they sleep. CPAP consists of a gentle stream of air directed through the airway during sleep. The pressure of the air stream holds the airway open and prevents apnea. Oxygen levels, blood pressure, heart function and sleep patterns are stabilized, resulting in a more restful sleep.

Lifestyle changes:

Being overweight, smoking, drinking alcohol or using muscle relaxants or sleeping pills may contribute to your OSAS. All of these factors can affect the airway or the brain’s control of the airway muscles during sleep. Eliminating these lifestyle factors may be the only treatment needed in some mild cases of OSAS. Even people who require additional OSAS treatment can improve by developing good sleeping habits. 

Oral appliances:

If you have mild to moderate OSAS you may improve with a custom-made device which is worn in the mouth during sleep. These devices are designed to adjust the tongue or lower jaw position to keep the airway open. Their effectiveness in OSAS varies and their cost may not be covered by public or private health insurance plans. Your healthcare provider will help you decide whether this option is appropriate for you.

Airway surgery:

surgical procedures, such as laser surgery, may be used to treat OSAS. Various success rates are reported post-surgery. Generally, the success rates are higher for snoring than for OSAS itself. It’s difficult for healthcare providers to predict which OSAS sufferers may improve after airway surgery and to what extent. More than one procedure may be required. Consult your healthcare provider to learn more about surgical options.  

The trend in industrialized nations suggests people are increasingly sleep deprived. In today’s busy world, sleep is as important as diet and exercise. To charge through your day, you need to recharge at night.

Why is sleep important? 
Sleep is a building, healing, and rejuvenating period essential for the normal, healthy functioning of the human body. It affects our physical and mental health and our immune system's ability to fight disease and endure sickness. Poor sleep quality is also related to many health conditions such as obesity, diabetes, and high blood pressure. 
Sleep enhances alertness, energy, mood, memory, reaction time, productivity, performance, communication skills, safety, and longevity. Most adults need eight hours of “good” uninterrupted sleep every night. Children, even teens, should get nine or more hours a night. 

Why can't I sleep?
There are many factors that affect your quality of sleep regardless of your efforts to get to bed on time and fall asleep. Conditions such as asthma or allergies, chronic pain, stress, anxiety, or depression can prevent a good sleep.
Blood pressure and other medications such as antidepressants, antihistamines, decongestants and muscle relaxants can affect sleep. Consult your regulated health professional before stopping or starting any medication in attempt to improve your sleep.

Your lifestyle
Nicotine, caffeine, and alcohol can make falling asleep difficult. Changes occurring in your life such as a new baby or moving are disruptive, but often temporary. If you work shifts or travel frequently your body could be having trouble adjusting. A routine bedtime can help set your body clock and keep you on track. 

Avoiding certain lifestyle habits and accommodating for others in a balance will help regulate your sleep schedule. 
Your sleeping environment

For some people it’s all about where they sleep. Quick fixes could include purchasing a new bed, installing blackout window coverings, or ensuring your room is calm, cool, and quiet. Even listening to soothing music or background noise such as the ocean or white noise can help you relax and drift off.

Sleep disorders
There are over 70 sleep disorders. Some of the more common ones include insomnia, narcolepsy, parasomnia, and obstructive sleep apnea syndrome.

Good Sleep Habits

  • Keep a regular sleep schedule. Go to sleep and get up at about the same time each day. Wake up time is particularly important – keep it the same, even on weekends;
  • Sleep only as much as you need to feel refreshed during the day;
  • Go to bed only when you’re feeling sleepy. Do not try to fall asleep - this only makes things worse. If you’re unable to sleep within 20 minutes, get up, leave the bedroom, and do something else (i.e., listen to quiet music, drink herbal tea) but avoid stimulating activities (i.e., smoking, watching TV, working). Return to bed when you’re sleepy. Repeat as necessary; and,
  • Avoid taking daytime naps as they can be very disruptive to your nighttime sleep.

Important Lifestyle Tips

  • Exercise regularly-ideally in the morning or afternoon, or at least four to six hours before bedtime;
  • Don’t eat/drink anything containing caffeine (i.e., chocolate, tea, coffee, and cola) within six hours of bedtime;
  • Don’t smoke or drink alcohol within three to four hours before bedtime; and,
  • Try to set aside problem solving or worry time early in the evening (i.e., make lists of problems and whether there is anything you can do to solve them).
  • Avoid worrying in bed.

Bedroom Habits

  • Limit the bedroom to sleep and sexual activity (the bedroom shouldn’t be an activity area - i.e., do not watch TV, eat, read in bed, or look at your phone or computer). Train your body to associate the bedroom with sleep;
  • Keep your room comfortable, secure, quiet, dark, and cool (too hot or too cold will disturb sleep);
  • Sleep alone if your bed partner is disturbing your sleep or if you worry about disturbing your partner; and,
  • Keep pets out of the bedroom if they are disturbing your sleep.

Before bed rituals

  • Avoid brain-stimulating activities such as playing video games or watching TV. Schedule relaxing activities before bedtime;
  • Have a light snack before going to bed if you feel hungry; and,
  • Have a warm bath for at least 30 minutes, two to four hours before bedtime.

If you continue to feel sleep deprived or have concerns about the quality of your sleep, talk to your physician or nurse practitioner; you may need a referral to a sleep specialist.

Manufactures

Fisher & Paykel Healthcare - www.fphcare.ca
Philips Respironics - www.respironics.com
ResMed - www.resmed.com

Respiratory Health Links

Assistive Devices Program (ADP) - www.ontario.ca/page/assistive-devices-program
Respiratory products covered under ADP -
www.ontario.ca/page/respiratory-equipment-and-supplies

Associations, Organizations & Societies

American Association for Respiratory Care - www.aarc.org
American College of Chest Physicians - www.chestnet.org
Lung Health Foundation - www.lunghealth.ca
Canadian Medical Association - www.cma.ca
Canadian Society of Respiratory Therapists - www.csrt.com
Home Care Ontario - www.homecareontario.ca/
Respiratory Therapy Society of Ontario - www.rtso.ca