Always tired? You may have sleep apnea
Effects can be serious -- but there is treatment available
Saturday, December 15, 2012
Your spouse says your snoring is driving her nuts.
You wake up feeling unrested and irritable.
You nod off at the computer -- or worse, at the wheel.
These are common signs that you may have obstructive sleep apnea (OSA), a sleep disorder that -- left untreated -- can take its toll on the body and mind.
Untreated OSA has been linked to high blood pressure, heart attacks, strokes, car accidents, work-related accidents and depression. According to the American Sleep Association, OSA affects more than 12 million Americans.
The Food and Drug Administration (FDA) regulates the safety and effectiveness of devices, including the device most often used to treat OSA -- the Continuous Positive Airway Pressure machine, commonly known as CPAP.
What is sleep apnea?
The Greek word "apnea" literally means "without breath." With sleep apnea, your breathing pauses multiple times during sleep. The pauses can last from a few seconds to minutes and can occur 30 times or more an hour. Sometimes when you start breathing again, you make a loud snort or choking sound.
Obstructive sleep apnea, the most common type, is caused by a blockage of the airway, usually when the soft tissue in the back of the throat collapses. The less common form, central sleep apnea, happens if the area of your brain that controls breathing doesn't send the correct signals to your breathing muscles.
According to Eric Mann, M.D., Ph.D., deputy director of FDA's Division of Ophthalmic, Neurological, and Ear, Nose and Throat Devices, you may be unaware of these events since they happen while you're sleeping.
Because you partially wake up when your breathing pauses, your sleep is interrupted, and you often feel tired and irritable the next day.
Maria Jison, M.D., a medical officer in FDA's Anesthesiology and Respiratory Devices branch, says, "Sleep apnea is often under-recognized by patients, who may attribute their chronic tiredness to various other factors in their busy lives. They don't even think to mention day-to-day fatigue when they see a physician."
Sleep apnea is almost twice as common in men as it is in women. Other risk factors include:
- being overweight, as extra fat tissue around the neck makes it harder to keep the airway open,
- being over age 40,
- having a family history of sleep apnea, and
- having a nasal obstruction due to a deviated septum, allergies or sinus problem.
Children also get sleep apnea, most commonly between ages 3 and 6. The most common cause is enlarged tonsils and adenoids in the upper airway.
"You should certainly tell your physician if you think you are experiencing symptoms of sleep apnea," Mann says. "But the diagnosis of sleep disorders such as obstructive sleep apnea requires a formal sleep study."
Polysomnogram (PSG) is the most common sleep study for sleep apnea and often takes place in a sleep center or lab. You sleep with sensors on your scalp, face, chest, limbs and fingers that record brain activity, eye movement, blood pressure and the amount of air that moves in and out of your lungs.
The first line of defense can be behavioral. Weight loss may go a long way toward improving OSA. It may also help to stop using alcohol or medicines that make you sleepy, because they can make it harder for you to breathe. Some people with mild OSA find it helpful to sleep on their sides instead of their backs, Jison says.
The second and most common treatment is a CPAP machine.
CPAPs use mild air pressure to keep your airways open. They have three main parts:
- A mask that fits over your nose or nose and mouth, with straps to hold it in place.
- A tube that connects the mask to the machine's motor.
- A motor that blows air into the tube.
Mary Weick-Brady, M.S., R.N., senior policy analyst at FDA's Center for Devices and Radiological Health (CDRH), says manufacturers are improving and refining CPAPs to make them easier and more comfortable to use. "They're getting smaller, more portable, and quieter," she says. The hoses are easier to extend and retract and less intrusive to the person using the device. But, Brady adds, CPAPs are only effective if you use them properly every night. That means making sure you have a correct fit, keeping the equipment clean, and working with your physician or respiratory therapist to make sure the air flow settings are correct.
CPAP devices can have unpleasant side effects, such as a dry or stuffy nose, irritated skin from the mask and straps, and headaches. "It takes patience, perseverance and a willingness to work with your physician or respiratory therapist," Brady says.
There are no drugs that are approved by the FDA to treat sleep apnea.
Ronald Farkas, M.D., Ph.D., at FDA's Center for Drug Evaluation, says doctors sometimes prescribe drugs that promote wakefulness such as Provigil and Nuvigil for patients suffering from the daytime sleepiness caused by sleep apnea -- but that these drugs do not treat the nighttime breathing problem.
Moreover, Farkas recommends that if you've been diagnosed with sleep apnea and are taking other medications, you should let your doctor know what those medications are. "A number of drugs can actually make sleep apnea worse, including many for insomnia, anxiety or severe pain," he says.
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