Apnea
Apnea is involved with the respiratory and
central nervous systems. The
respiratory system allows a person to breathe in
oxygen and excrete carbon
dioxide (Deepak 116). After entering the mouth or
the nose, oxygen travels into
the pharynx, the larynx, and then the trachea.
The trachea splits into two
branches which then split into smaller tubes
called bronchioles. Hair-like
projections called cilia cover the bronchioles
and protect them from foreign
particles. From the bronchioles, air enters
tiny air sacs called alveoli, each
of which is surrounded by capillaries
containing the blood that gathers oxygen
to be transported throughout the
body and releases carbon dioxide so that it can
be exhaled. Contractions of
the diaphragm cause the lungs to be inflated and
deflated. According to Janet
Fricker, sleep apnea is "the periodic reduction
or cessation of breathing
caused by temporary oropharyngeal collapse during
sleep"; in other words, it
occurs when a person literally stops breathing
while asleep (Fricker 122).
There are two main processes that produce sleep
apnea. The first, known as
central sleep apnea, involves the level of brain
activity during sleep. The
nighttime failure of the part of the brain that
controls breathing, located
in the brain stem, results in unmonitored oxygen
Sumner 2 levels during
sleep. When oxygen levels become too low and carbon
dioxide levels become too
high, stimulation becomes strong enough to temporarily
awaken the brain to do
its job. The brain triggers a snorting or sucking of air
in order to restore
the balance of oxygen and carbon dioxide in the body. The
episodes recur as
the brain returns to its sleep state (Coren 147-48). The
second form of sleep
apnea, known as obstructive sleep apnea, is characterized
by a severe
relaxation of the tongue, throat, and pharynx.(Deepak 116). The
severe
relaxation of the tongue causes it to cover the opening to the
trachea,
stopping the flow of oxygen into the lungs. After ten to ninety
seconds of an
apnea respiratory centers alert the brain of its
oxygen-deprived state, causing
the repeated sleep/wake cycle of the sufferer
(Fricker 122). Sleep Apnea affects
about 4 percent of middle-aged men and 2
percent of middle-aged women (Walling
851). Symptoms of sleep apnea
include loud snoring, gasping, and choking. It
causes breathing problems that
cause a person to cough and gasp as many as
several hundred times a night
(Pressman 65). Because a build up of fatty tissues
in the mouth tends to flow
over the opening of the trachea, it is most common in
middle aged, overweight
males (Coren 148). About sixty percent of sufferers are
overweight. However,
it is not actual poundage but the thickness of the neck
that affects
breathing. Men often develop thicker throat tissues and gather more
fat in
their abdomen, neck, and shoulders than women. Men with a neck
circumference
of seventeen inches or more and women with that of sixteen inches
or more are
most likely to have sleep apnea, as well as Sumner 3 those with a
double chin
or a lot of excess fat around the waist. Sleep apnea will worsen
with age as
throat tissues become looser and people gain weight.(Barone 81).
Many
side affects can occur due to sleep apnea. Sufferers can awaken to
headaches,
irritability, difficulty in remembering, and problems with
concentration
(Barone 81). More serious problems can occur, such as drowsiness
in the
daytime, oxygen scarcity, and respiratory arrest while struggling to
breathe
during sleep. Because there is less oxygen going to the heart, it has to
work
harder; adrenaline is released and blood pressure rises rapidly.
Repeated
bursts of nighttime blood pressure may cause hypertension during the
day,
leading to increased risk of heart attack, stroke, and heart rhythm
disturbances
(Barone 82). Diagnosing sleep apnea has become common only in
recent years,
since the disorder was not officially defined until 1965.
Snoring, daytime
fatigue, and a short attention span can be clues for
diagnosis. If these
symptoms persist for a prolonged period of time it may
become necessary to be
placed under the care of a pulmonary specialist, or an
ear, nose, and throat
doctor. Diagnosis is made possible by examinations of
the nose, throat, and jaw.
It is also helpful for a sufferer’s mate to
answer questions about snoring and
sleep habits. The best way to make an
accurate diagnosis and determine the
severity of the disorder is a
polysomnography exam, usually involving an
overnight stay in a sleep clinic.
There specialists are able to monitor blood
oxygen levels, heart rate, body
temperature, brain waves, and the number of
times breathing stops. The sleep
apnea rate, or the number of apneatic episodes
per hour of sleep, determines
the severity of the disorder. Rates of fifteen or
fewer indicate only mild
sleep apnea, Sumner 4 may not even be considered
clinically significant.
Rates of fifteen to thirty indicates moderate sleep
apnea, and rates of
thirty or more disturbances per hour indicate severe sleep
apnea (Pressman
204). While effective for determining treatment, polysomnography
can cost
approximately two thousand dollars, but is usually covered by
insurance. A
second option is a home monitoring device, costing about half as
much as lab
observations but not usually covered by insurance (Barone 84).
Continuous
positive airways pressure (CPAP) is the most commonly recommended
treatment
for sleep apnea. It was first described in 1981 by University of
Sydney,
Australia researcher Colin Sullivan (Fricker 122). CPAP stops snoring
and
allows the sufferer to breathe without colapsation of the throat
(Stradling
201). It consists of an airflow generator, tubing, and a mask
that goes over the
nose. Air is supplied at slightly above atmospheric
pressure, holding the
airways open (Fricker 122). Many patients find CPAP
masks to be uncomfortable,
but without them would relapse into their
pretreatment state within only
twenty-four hours (Stradling 201). Studies
indicate reductions in daytime
drowsiness and general health improvements as
a result of CPAP, but have not
shown improvements in morbidity, mortality, or
quality of life (Walling 851).
Along with CPAP treatment, personal health
measures can be taken in order to
help reduce the symptoms and risk of sleep
apnea. Dr. Richard Millman of the
Sleep Disorders Center at Rhode Island
Hospital suggests avoiding alcohol and
sleeping pills near bedtime because
they slow breathing , laying on one side
while sleeping, and using Sumner 5
nasal strips while suffering from congestion
(Barone 84). Smoking is also a
major contributor to sleep apnea because it can
swell the throat tissues and
worsen the already low oxygen levels that accompany
it. Since being
overweight is a leading cause of sleep apnea as well as many
other health
problems, it is a good idea to be as physically fit as possible.
Even a
ten percent weight loss can affect the number of apneatic episodes that
occur
each night (Barone 84). Though CPAP is the most commonly recommended
and
utilized treatment of sleep apnea, there are other options. Oral devices
similar
to a retainer can be used to reposition the tongue and jaw. These are
effective
because moving the jaw forward also pulls the tongue forward,
reducing
obstruction of the trachea. However, these devices can be expensive
and may not
be covered by insurance. Surgery is a last resort
option.
Uvulopalatopharyngoplasty, or UPPP (UP3 ) widens the airway by
reducing the size
of the uvula, the soft palate, or both. UP3 has only a
fifty percent success
rate, is very expensive, and involves a painful
recovery. Laser-assisted
uvulopalatoplasty, or LAUP, utilizes lasers to
remove excess throat tissue. It
is less expensive and painful than UP3, but
it may require several treatments (Barone
84). Sleep apnea does not have
to control a sufferer’s life. It is important
to realize that the affects of
sleep apnea on a person’s respiratory system
can be devastating. Being able
to identify the causes, health effects, and
treatment of sleep apnea can help
to prevent problems before they arise. The
constant drowsiness, headaches,
and incessantly loud snoring affect work habits,
overall health, and even
cause problems between married Sumner 6 couples who
cannot sleep in the same
bed together due to snoring. Because some people may
not even realize that
they are suffering from obstructive sleep apnea, it is
important to be aware
of the symptoms and steps necessary to confront the
problem. Avoiding
smoking, alcohol, and excessive weight gain are valuable
factors for
prevention, as well as basic principles of good health.
Psychologists
study sleep disorders such as sleep apnea in order to understand
their effect
on sleep as a state of consciousness. Consciousness is defined as a
state of
awareness. Going to sleep does not mean that a awareness ceases;
instead,
sleep changes the type of consciousness that is experienced. Sleep is
also
necessary to maintain a balance of the body’s functions and to allow the
body
to rest and restore itself. Prolonged periods of sleep deprivation for
any
reason result in fatigue, irritability, and inefficiency throughout the
day.
Being able to identify and treat sleep apnea and other sleep
disorders provides
more restful and fulfilling sleep, allowing for a
productive and
satisfying
lifestyle.