Sleep related problems affect many Americans. The most commonly known disorder, obstructive sleep apnea, affects at least 40 million people in the United States. It is characterized by snoring, breath-holding during sleep and cessation of airflow into the lungs for greater than 10 seconds. Most people experience daytime fatigue, falling asleep while driving or watching television, and morning headaches. One never feels truly rested.
Why is it dangerous if it goes undiagnosed and treated? There is a 5-fold increase in automobile accidents in those affected with the condition. Add to that the myriad of other sleep related problems that occur with obesity and you have a recipe for disaster. Just remember that when you are driving along side an 18-wheeler is driven by a sedentary truck driver who is 50 pounds overweight, and has poor sleeping habits.
Why is sleep apnea detrimental to our health? A recent study from Finland identifies that men between 40 and 60 years old with sleep apnea have an increased incidence of cardiac problems such as irregular heartbeats, hypertension or high blood pressure, and stroke. The irregular heartbeat can contribute to sudden death especially during sleep or in the early morning hours.
The field of sleep medicine is still in its infancy. It has only been in the last 30 years that physicians have even studied disorders related to sleep and it is clear that we have an awful lot to learn. We are beginning to understand the complexities of neurochemistry and how our brain regulates our sleep. When sleep is disrupted for whatever reason, and especially in those with sleep apnea, our brain chemistry becomes unbalanced leading to a vicious cycle of ever-increasing poor sleep.
We are experiencing an epidemic of obesity in this country. The primary risk factor for obstructive sleep apnea is obesity. Much less common are deformities of the facial bones, tongue, soft palate and tonsils which contribute to the condition. We are just beginning to understand the linkage of poor sleep patterns, disturbances in brain chemistry, and resulting obesity. This terrible cycle makes it almost impossible to lose weight which is one of the first-line therapies for sleep apnea.
To make the definitive diagnosis, we put people through an overnight sleep test which quantifies the number of obstructive events that occur per hour. The severity of the apneas correlates with an increased risk of those medical complications such as hypertension.
In addition to weight loss, there are a number of treatment options which include CPAP, which is a mask that is placed over the nose during sleep. Think of it as a reverse vacuum cleaner. The mask and machine pumps air through the nose opening up the tissues of the nose, palate and tongue, thus overcoming the apnea and obstruction.
Additional treatment options are available for those that cannot tolerate CPAP. These include oral appliances, which thrust the tongue forward during sleep, and upper airway corrective surgery. An interesting finding in the Finland study mentioned earlier is that even partially surgically treated patients have a reduced risk of cardiac complications over those people who received no treatment at all.
Overall, we are just beginning to understand the complexities of sleep. This includes the brain chemistry changes that occur during our sleep cycles and the relationship between obesity and obstructive sleep apnea.
Marc M. Kerner, MD, FACS
Assistant Clinical Professor of Surgery
UCLA School of Medicine
Chief of Surgery,
Northridge Hospital Medical Center