You may have Obstructive Sleep Apnea (OSA)

by Dr. James Howenstine, MD

Sleep apnea afflicts between 12 and 18 million Americans. This condition is more frequent in males who are obese and over the age of 40. Patients with sleep apnea often have unusually loud snoring, daytime sleepiness, increased incidence of hypertension, nocturnal headaches, memory problems, and an increased frequency of accidents.

A 2003 study in JAMA reported that one in 5 adults has some degree of sleep apnea and OSA is moderately severe in one person out of 15. This may make OSA the most under-diagnosed condition in the US

Patients with OSA have periods of absent breathing during the night (apnea). This is caused by partial or complete blockage of the airway during sleep when the tissues in the back of the throat block air flow. Oxygen levels drop to dangerous values and carbon dioxide values immediately rise.

The continuous waking up prevents patients with this condition from getting to the most beneficial level of sleep REM. The deepest, most rejuvenating and most important level of sleep is REM (rapid eye movement). Persons with OSA never get the benefits of REM sleep and this leaves them constantly sleepy. Sleepy drivers cause more than 70,000 automobile accidents annually. The lack of REM sleep plus periods of sleep where low oxygen levels are found in the blood leads to high blood pressure, nocturnal headaches, narrowed heart arteries, strokes, cardiac arrhythmias, heart failure, erectile dysfunction, immune abnormalities, memory loss and difficulty with concentration.

Patients with sleep apnea have a greatly increased risk of hypertension. A New England Journal of Medicine study of 709 patients revealed that persons with moderate episodes of apnea had three times the risk of hypertension as those with no nocturnal apnea.

A study at a sleep lab in Gothenberg, Sweden followed 182 men for 7 years. Of these 182 men only 60 had OSA. At the end of the study 22 of the 60 OSA patients had developed some form of heart disease either a stroke, hypertension, or heart failure. In the larger group without OSA only 8 developed heart disease. This strongly suggests that men with OSA are 5 times more vulnerable to developing heart disease than males without OSA. Considering that the arteries of these men with OSA were exposed to dangerously low values of oxygen during portions of each night it is easy to understand why they have an increase in hypertension, stroke and heart failure.

In individuals with sleep apnea blood tests often reveal clear evidence of increased oxidation (undesirable). There is also an increase in CRP values and signs of excessive clotting both of which are associated with an increased risk of heart attacks.

Patients with OSA have higher levels of blood sugar and insulin along with insulin resistance. Severe sleep apnea confers a five-fold increased risk of diabetes.

Traditionally the diagnosis of OSA is established by monitoring of sleep overnight in a sleep laboratory (polysomnogram). This study confirms multiple periods of no breathing lasting up to a minute or longer (apnea) along with anoxia (low oxygen in the blood). The failure to reach deep levels of sleep produces severe continuous sleepiness.

A simpler and less expensive way of proving the diagnosis involves measuring pulse rates and blood oxygen levels (pulse oximetry) during the night using a sensor attached to a finger. This simple testing technique is nearly as reliable as the $2000 to $3000 polysomnogram performed in a sleep laboratory. Pulse oximetry can be ordered by lay persons by contacting American Sleep Systems at 866-364-7378 who mail the sensor to the subject. This costs $120. Test results and an explanation are mailed back promptly.

Therapy Of Obstructive Sleep Apnea

Therapy with continuous positive airway pressure (CPAP machines) using a mask keeps the soft tissues at the back of the throat from collapsing and occluding the air passages. This therapy was used for most cases of OSA in the past. A few patients find the mask uncomfortable to wear. This equipment now exists in a model that automatically adjusts the positive pressure needed so regulation by sleep specialists is no longer necessary. The CPAP machines cost from $1500 to $2500 but used models can be obtained on e-Bay for much less.

Some cases have been successfully managed using continuous nasal oxygen during the night. A patient of Dr. Julian Whitaker treated in this way had her blood pressure return to normal in 2 weeks. She lost her need for daily naps and no longer takes blood pressure drugs.

Some rarer cases of sleep apnea are due to failure of the brain to properly signal the respiratory muscles (Central Sleep Apnea CSA). These cases are harder to treat and are usually handled by sleep specialists.

Dr. Farrand Robson, a Tacoma, Washington dentist, achieves remarkable results (100 % success) in treating OSA with mouth splints. His program also helps some patients with fibromyalgia, chronic fatigue syndrome, multiple sclerosis, heart disease, autism, cervical osteoarthritis with neuritis and ADD (Attention Deficit Disorder). Proper splint placement greatly increases oxygenation of the body. Contact Dr. Robson at 253-272-8651 to find a dentist trained in this technique near you.

What Are The Clues A Person May Have Obstructive Sleep Apnea?

Some of the symptoms and findings in OSA include:

Loud Snoring
Snorting, gasping for air and periods of no breathing during sleep
Jumping movements, jerking and twitching when asleep
Daytime drowsiness with frequent sleeping during reading, meetings and TV watching

Establishing the diagnosis and effectively treating OSA will improve longevity for many patients as their hypertension and arteriosclerosis cease being a health problem. Additionally untold work place and auto accidents will be prevented.