Definition:- Sleep apnea is a sleep disorder characterized by pauses in breathing during sleep. Each episode, called apneas (Greek: ?p???a (ápnoia), from a- (a-), privative, p??e?? (pnéein), to breathe), lasts long enough so that one or more breaths are missed, and occurs repeatedly throughout sleep. The standard definition of any apneic event includes a minimum 10 second interval between breaths, with either a neurological arousal (a 3-second or greater shift in EEG frequency, measured at C3, C4, O1, or O2), a blood oxygen desaturation of 3-4% or greater, or both arousal and desaturation. Sleepapnea is diagnosed with an overnight sleep test called apolysomnogram.
Clinically significant levels of sleep apnea are defined as five or more episodes per hour of any type of apnea (from the polysomnogram). There are three distinct forms of sleep apnea: central, obstructive, and complex (complex is a combination of central and obstructive) making up 0.4%, 84% and 15% of cases respectively. Breathing is interrupted by the lack of effort in central sleep apnea; in obstructive sleep apnea, breathing is interrupted by a physical block to airflow despite effort. In mixed sleep apnea, there is a transition from central to obstructive features during the events themselves.
Regardless of type, the individual with sleep apnea is rarely aware of having difficulty breathing, even upon awakening. Sleep apnea is recognized as a problem by others witnessing the individual during episodes or is suspected because of its effects on the body (sequelae). Symptoms may be present for years, even decades without identification, during which time the sufferer may become conditioned to the daytime sleepiness and fatigue associated with significant levels of sleep disturbance.
Sleep apnea is disturbed or interrupted breathing during sleep. For those affected by sleep apnea, there can be many temporary interruptions in breathing, each usually lasting about 10 seconds, throughout the sleep period. These interruptions in breathing can occur as often as 20 to 30 times per hour.
Because some of the symptoms of sleep apnea occur during sleep, they may be recognized first by people with whom one shares living quarters.
* Heavy snoring, although not everyone who snores has sleep apnea
* Struggling to breathe during sleep
* Interruption in breathing during sleep followed by a snort when breathing begins again
* Being excessively sleepy during the day
* Falling asleep during activities that require attention and concentration, such as driving, working or talking
If you are experiencing these symptoms, see a doctor; you may have sleep apnea or some other condition that needs medical attention.
Causes of Sleep Apnea:-
* Obstructive— Partial or complete obstruction of the airway, which can be caused by relaxation of the muscles of the throat, soft palate, and tongue during sleep * Central— Problems with signals from the brain that control breathing
For mild cases of sleep-disordered breathing one can
* Sleep on one’s side instead of back
* Avoid drinking alcohol before sleeping
* Avoid using sleeping pills
* Avoid smoking or using other tobacco products
* Lose weight, if overweight
The most common medical treatment for sleep apnea is continuous positive airway pressure (CPAP), which is a therapy that uses pressure from an air blower to circulate air through the nasal passages and upper airway. The patient wears a mask over the nose that is connected to the air pressure hose, and the air pressure is adjusted to keep the airway open during sleep. Other therapies include dental appliances that change the position of the jaw and tongue, and various surgeries to keep the airway open during sleep.
Special situation: surgery and anesthesia in patients with sleep apnea syndrome
Many drugs and agents used during surgery to relieve pain and to depress consciousness remain in the body at low amounts for hours or even days afterwards. In an individual with either central, obstructive or mixed sleep apnea, these low doses may be enough to cause life-threatening irregularities in breathing.
Use of analgesics and sedatives in these patients postoperatively should therefore be minimized or avoided.
Surgery on the mouth and throat, as well as dental surgery and procedures, can result in postoperative swelling of the lining of the mouth and other areas that affect the airway. Even when the surgical procedure is designed to improve the airway, such as tonsillectomy and adenoidectomy or tongue reduction – swelling may negate some of the effects in the immediate postoperative period.
Individuals with sleep apnea generally require more intensive monitoring after surgery for these reasons.
Definition : Sleep disorders involve any difficulties related to sleeping, including difficulty falling or staying asleep, falling asleep at inappropriate times, excessive total sleep time, or abnormal behaviors associated with sleep.
Sleep disorders are a group of conditions characterized by disturbance in the amount, quality, or timing of a person’s sleep. They also include emotional and other problems that may be related to sleep. There are about seventy different sleep disorders. Short-term, temporary changes in a person’s sleep pattern are not included in sleep disorders.
Sleep disorders are divided into two major categories. One category consists of disorders in which a person has trouble falling asleep or staying asleep. This category also includes disorders in which a person may fall asleep at inappropriate times. Conditions of these kinds are called dyssomnias. A second category of sleep disorders includes those in which people experience physical events while they are sleeping. Nightmares and sleepwalking are examples of these disorders. Conditions of this type are called parasomnias.
The following are some examples of each type of sleep disorder:
Insomnia. Insomnia (see insomnia entry) is perhaps the most common of all sleep disorders. About 35 percent of all adults in the United States experience insomnia during any given year. People with insomnia have trouble falling asleep. Often people with this disorder worry or become anxious about not being able to sleep, which can make the problem even worse. Insomnia may begin at any time in a person’s life. It tends to be most common in young adulthood and middle age.
Hypersomnia. Hypersomnia is a condition in which a person is excessively sleepy during normal waking hours. The person may often fall asleep for lengthy periods during the day, even if he or she has had a good night’s sleep. In some cases, patients have difficulty waking up in the morning. They may seem confused or angry when they awaken. About 5 to 10 percent of people who seek help for sleep disorders have hypersomnia. The condition is most common in young adults between the ages of fifteen to thirty.
Narcolepsy. Narcolepsy is characterized by sleep attacks over which patients have no control. They may fall asleep suddenly with no warning. The sleep attack may last a few minutes or a few hours. The number of attacks patients experience can vary. People with narcolepsy usually feel refreshed after awakening from a sleep attack but they may become sleepy again a few hours later and experience another attack.
Three other conditions are often associated with narcolepsy: cataplexy, hallucinations, and sleep paralysis. Cataplexy is the sudden collapse of a person’s muscles. The person may become completely limp and fall to the ground. A person may also experience hallucinations. Hallucinations are sounds and sights that a person experiences that do not exist in the real world. Sleep paralysis occurs when a person is just falling asleep or just waking up. The person may want to move, but is unable to do so for a few moments.
Sleep apnea. Sleep apnea (pronounced AP-nee-uh) is a condition in which a person actually stops breathing for ten seconds or more. The most common symptom of sleep apnea is very loud snoring. Patients with this condition alternate between periods of snoring or gasping and periods of silence.
Circadian rhythm sleep disorders. The term circadian (pronounced sir-CAYD-ee-uhn) rhythm refers to the usual cycle of activities, such as waking and sleeping that is common to any form of life. Most people are accustomed to falling asleep after it gets dark out and waking up when it gets light. In certain conditions, this pattern can be disrupted. A person may fall asleep as the sun comes up and wake up as the sun goes down. An example of a circadian sleep disorder is jet lag. People who fly suddenly across many time zones may have their sleep patterns disrupted. It may take a few days before those patterns return to normal.
Also called sleepwalking, it refers to a range of activities a patient performs while sleeping, from walking to carrying on a conversation.
Nightmare disorder. Nightmare disorder is a condition in which a person is awakened from sleep by frightening dreams. Upon awakening, the person is usually fully awake. About 10 to 50 percent of children between the ages of three and five have nightmares. The condition is most likely to occur in children and adults who are under severe stress.
Sleep terror disorder. Sleep terror disorder occurs when a patient awakens suddenly crying or screaming. The patient may display other symptoms, such as sweating and shaking. Upon awakening, the patient may be confused or disoriented for several minutes. He or she may not remember the dream that caused the event. Sleep may return in a matter of minutes. Sleep terror disorder is common in children four to twelve years of age. The condition tends to disappear as one grows older. Less than one percent of adults have the disorder.
Sleepwalking disorder. Sleepwalking disorder is also called somnambulism (pronounced suhm-NAHM-byoo-LIHZ-uhm). The condition is characterized by a variety of behaviors, of which walking is only one. Sleepwalkers may also eat, use the bathroom, unlock doors, and carry on conversations. If awakened, sleepwalkers may be disoriented. They may have no memory of their sleepwalking experience. About 10 to 30 percent of children have at least one sleepwalking experience. The occurrence among adults is much lower, amounting to about 1 to 5 percent of all adults.
A few sleep disorders are related to some physical or mental disorder. The three conditions that fall into his category include:
Sleep disorders related to mental disorders. Many types of mental illness can cause sleep disorders. People who have severe mental illness, for example, may develop chronic (long-lasting) insomnia.
Sleep disorders due to physical conditions. Physical illnesses such as Parkinson’s disease (see Parkinson’s disease entry), encephalitis (see encephalitis entry), brain disease, and hyperthyroidism may cause sleep disorders.
Substance-induced sleep disorders. The use of certain types of drugs can lead to sleep disorders. The most common of these drugs are alcohol and caffeine. Certain types of medications can also cause sleep disorders. Antihistamines, steroids, and medicines used to treat asthma are examples.
More than 100 different disorders of sleeping and waking have been identified. They can be grouped in four main categories:
Problems with falling and staying asleep
Problems with staying awake
Problems with adhering to a regular sleep schedule
In many cases, the cause of a sleep disorder is not known. In other cases, researchers know at least part of the reason the disorder occurs. Some examples include:
Insomnia. Insomnia may be caused by emotional experiences or concerns such as marital problems, problems at work, feelings of guilt, or concerns about health. A person may become so distraught that sleep is impossible. Insomnia often becomes worse when patients worry about the condition. In such cases, the worry itself becomes another cause for the disorder.
Hypersomnia. One possible cause of hypersomnia is restless legs syndrome. Restless legs syndrome is the name given to cramps and twitches a person may experience in the calves of the legs during sleep. These sensations may keep a person awake and lead to sleep episodes during the day.
Narcolepsy. The cause of narcolepsy is currently not known.
Sleep apnea. The most common cause of sleep apnea is blockage of the airways. The condition occurs most commonly in people who are over-weight. The snoring and gasping that are typical of apnea are caused by the person’s trying to catch his or her breath. Less commonly, sleep apnea is caused by damage to the brainstem.
Circadian rhythm sleep disorders. Circadian rhythm sleep disorders are caused when people are forced to adjust to new dark/light patterns. An example is a worker whose assignment is changed from the day shift to the night shift. The worker must learn how to sleep when it’s light out and to work when it’s dark out.
The causes of most parasomnias are not well understood. In some cases, severe stress may be responsible for the condition. In other cases, it is not clear what the cause for the disorder is.
The symptoms of most sleep disorders are obvious from the descriptions above. A person with insomnia, for example, tends to be very tired during the day. A person with nightmare disorder displays the disturbed behavior typical of a person who has been awakened from sleep by a bad dream.
Loss of memory (or complaints of decreased memory)
Lower leg movements during sleep
The symptoms may vary with the particular disorder. Diagnosis:
A beginning point in diagnosing sleep disorders is an interview with the patient and his or her family. From this interview may come a list of symptoms that suggests one or another form of sleep disorder. For example, very loud snoring may be an indication that the patient has sleep apnea. Sleepwalking is, itself, enough of a symptom to permit diagnosis of the condition.
Doctors use a number of other tools to diagnose the exact type of sleep disorder a patient has experienced. Some of these tools include:
*Sleep logs. Patients are asked to record everything about their sleep experiences they can remember. The log might include symptoms, time of appearance, severity, and frequency. Events in the person’s life may also be recorded as possible clues to the cause of the disorder.
*Psychological testing. Some sleep disorders are caused by emotional problems in a person’s life. Those problems may be identified by means of certain tests. Examples of these tests are the Minnesota Multiphasic Personality Inventory (MMPI), the Beck Depression Inventory, and the Zung Depression Scale.
*Laboratory tests. Techniques have now been developed to observe and record a patient’s behavior during sleep. The most common device used is called a polysomnograph. this device measures a person’s breathing, heart rate, brain waves, and other physical functions during sleep. Various types of sleep disorder can be identified based on these measurements. Exams and Tests :
*Polysomnography (recording brain activity, muscle activity and breathing during sleep)
The most common device to use to test for sleeping disorders is called a polysomnograph. This device measures a person’s breathing, heart rate, brain waves, and other physical functions during sleep. (Photograph by Russell D. Curtis. Reproduced by permission of the National Audubon Society Collection/Photo Researchers, Inc.)
The choice of treatment for a sleep disorder depends on the cause of the disorder, if it is known. For example, some people develop insomnia because they have become depressed. The solution to this problem is not to treat the insomnia, but to treat the depression (see depression entry). The patient may be given antidepressants or counseling to improve his or her emotional outlook. If this treatment is successful, the insomnia usually disappears on its own.
In many cases, however, the sleep disorder itself may be treated directly. The five forms of treatment that can be used are medications, psychotherapy, sleep education, lifestyle changes, and surgery.
One might expect that insomnia should be treated with a sedative (a substance that helps a person relax and fall asleep). But sedatives provide only temporary relief from insomnia. They do not cure the underlying cause for the disorder. In addition, some sedatives may be habit-forming or may interact with other drugs to cause serious medical problems.
Stimulants (substances that cause a person to feel more energetic or awake) are often effective in treating narcolepsy. The drug known as clonazepam is used to treat restless legs syndrome. Benzodiazepines are used for children with sleep terror disorder or sleepwalking because they help the child sleep more soundly.
Psychotherapy is used when sleep disorders are caused by emotional problems. Patients are helped to understand the nature of their problems and to find ways to solve or to live with those problems. To the extent this treatment is successful, the patient’s sleep disorders may be relieved.
Researchers now know a great deal about the sleep process. By learning about that process, and changing their behavior patterns, patients may overcome some forms of sleep disorder. Some general guidelines that can help people sleep better include the following:
Wait until you are sleepy before going to bed.
Avoid using the bedroom for work, reading, or watching television.
Get up at the same time every morning, no matter how much or how little you have slept.
Get at least some physical exercise every day.
Avoid smoking and avoid drinking liquids that contain caffeine.
Limit fluid intake after dinner.
Learn to meditate or practice relaxation techniques.
Do not stay in bed if you can’t fall asleep. Get up and listen to relaxing music or read.
Some types of sleep disorders can be relieved by changing one’s lifestyle. For example, people with sleep apnea should stop smoking if they smoke, avoid alcohol and drugs, and lose weight to improve the function of their airways. People who experience circadian rhythm sleep disorders should try to adjust their travel or work patterns to allow time to adjust to new day/night patterns. Children with nightmare disorder should not watch frightening movies or television programs.
Surgery is the treatment of last resort for sleep apnea, perhaps the only type of sleep disorder that is life-threatening. Combined with other factors, such as obesity, it can cause death. In such cases, surgery may be required to open up the patient’s airways and make breathing easier.
Stress may be responsible for a number of forms of sleep disorder. Alternative treatments that teach people how to reduce stress in their lives can be very helpful. These treatments may include acupuncture, meditation, breathing exercises, yoga, and hypnotherapy. Homeopathic practitioners recommend a variety of substances to treat insomnia caused by various factors. They suggest Nux vomica for insomnia caused by alcohol or drugs, Ignatia for insomnia caused by grief, Arsenicum for insomnia caused by fear or anxiety, and Passiflora for insomnia related to mental stress.
Practitioners of Chinese medicine also have a range of herbs for the treatment of sleep disorder. The substance recommended depends on the particular type of disorder. For example, the magnetic mineral known as magnetite is recommended for insomnia caused by fear or anxiety.
Dietary changes may also help relieve some sleep disorders. Patients should avoid any food that contains caffeine or other stimulants. Such foods include coffee, tea, cola drinks, and chocolate. Some botanical remedies that may help a person relax and get a good night’s sleep include valerian, passionflower, and skullcap.
Prognosis depends on the specific type of sleep disorder. In most cases, children outgrow sleep disorders such as nightmares and sleep terror disorder. Other conditions tend to be chronic. Narcolepsy, for example, is a life-long condition. Relatively few forms of sleep disorder represent life-threatening medical conditions. Sleep apnea is one of the few examples.
A complication is dependence upon sedatives or other medications prescribed for sleep disorders.
Maintaining regular sleep habits and a quiet sleep environment may prevent some sleep disorders.
Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.
Snoring is a noise produced when an individual breathes (usually produced when breathing in) during sleep which in turn causes vibration of the soft palate and uvula (that thing that hangs down in the back of the throat). The word “apnea” means the abscence of breathing.
All snorers have incomplete obstruction ( a block) of the upper airway. Many habitual snorers have complete episodes of upper airway obstruction where the airway is completly blocked for a period of time, usually 10 seconds or longer. This silence is usually followed by snorts and gasps as the individual fights to take a breath. When an individual snores so loudly that it disturbs others, obstructive sleep apnea is almost certain to be present.
There is snoring that is an indicator of obstructive sleep apnea and there is also primary snoring.
Primary Snoring, also known as simple snoring, snoring without sleep apnea, noisy breathing during sleep, benign snoring, rhythmical snoring and continous snoring is characterized by loud upper airway breathing sounds in sleep without episodes of apnea (cessation of breath).
How Does Primary Snoring Differ from Snoring that Indicates Obstructive Sleep Apnea?
A complaint of snoring by an observer
No evidence of insomnia or excessive sleepiness due to the snoring
Dryness of the mouth upon awakening
A polysomnogram (sleep study) that shows:
Snoring and other sounds often occurring for long episodes during the sleep period
No associated abrupt arousals, arterial oxygen desaturation (lowered amount of oxygen in the blood) or cardiac disturbances
Normal sleep patterns
Normal respiratory patterns during sleep
No signs of other sleep disorders
What can be done about primary snoring?
First of all, it is absolutely necessary to rule out obstructive sleep apnea or other sleep disorders. Be wary of any doctor who says it is not necessary. Behavioral and lifestyle changes may be suggested. Losing weight, sleeping on your side, refraining from alcohol and sedatives are often recommended.
The Causes Of Snoring:
Modern research reveals snoring to often have more than one cause. These include the many factors that lead to nasal blockage such as nasal allergy or deformities of the nasal septum (the cartilage partition between the two sides of the nose) and other internal nasal structures. This nasal blockage can contribute to poor nasal airflow into the lungs and can in turn set the soft tissues of the palate (roof of the mouth) and throat vibrating. These vibrations cause the loud fluttering noise of snoring.
Other factors which can influence the snoring condition are obesity; lack of fitness or aging and associated loss of general muscle tone, congestion of the throat due to the reflux of stomach acid (heartburn); and the effects of alcohol or smoking.
Congestion of the throat tissues leads to swelling of fluids within the tissues. This causes loss of muscle tone and generally makes the lining tissues of the airways flop. Where nasal congestion causes faulty or turbulent airflow through the airway, then the resonance of these floppy tissues contributes to the noise known as snoring.
Correction of snoring may not only require surgical intervention, but will probably also need cessation of smoking, minimised alcohol consumption, control of gastric acid reflux where neccessary and weight control.
The Anatomy of the Upper Airway Passages.
CURE & TREATMENT: Pillar Procedure
The Pillar Procedure is a new snoring treatment. It is an operation carried out under local anaesthetic in most cases. Three tiny implants, made from woven polyester, are injected into the tissues of the soft palate. Floppiness of the soft palate, that part of the roof of the mouth which extends from the bony hard palate to the uvula (or central, dangling portion of the soft palate), is a frequent contributor to snoring. Stiffening the soft palate has been well known to quieten snoring in selected cases. However, palatal stiffening is suitable for patients who have been carefully evaluated by an ear, nose and throat surgeon with an interest in snoring problems. It does not assist every patient. Other factors may be contributing to snoring in these patients.
Now, what are Pillar implants?
The Pillar implants, made from polyester material, were developed in Europe and now have FDA US Government authority approval for surgical use. This material has been frequently used in medical products and can be safely inserted within the body. The implant creates a fibrous capsule around the implant which is the mechanism of the stiffening.
How do they work?
During the Pillar Procedure, three tiny woven inserts are placed in the soft palate to help reduce both the vibration that causes snoring and the ability of the soft palate to obstruct the airway. The Pillar inserts add structural support to the soft palate over time and prevents palatal fluttering (snoring).
The complex anatomical structure of the upper airway passages is due to the close association of the air, food and fluid passages. We not only breathe through our mouth and nose, but we also eat and drink through our mouth. The food passages of the mouth, throat and oesophagus leading to the stomach are separated from the airway by the soft palate and epiglottis and associated structures of the larynx or voicebox. This normally prevents food or fluid passing into the air passages and lungs. Occasional strong coughing fits are reminders that this is not always the case!
The nasal air passages serve to moisten the air intake and also provide the olfactory, or smell sense. Alternating congestion of the nasal passages helps channel the air intake between the two lungs.
There are mouth/oral devices (that help keep the airway open) on the market that may help to reduce snoring in three different ways.
bring the jaw forward or
elevate the soft palate or
retain the tongue (from falling back in the airway and thus decreasing snoring).
There is also surgery. Snoring is Not Funny, Not Hopeless. There is uvulopalatopharyngoplasty (UPPP) or Laser-Assisted Uvulopalatoplasty (LAUP), that involves removing excess tissue from the throat.
The newest surgery, approved by the FDA in July 1997 for treating snoring is called somnoplasty and uses radio frequency waves to remove excess tissue.
Regular Yoga Exercises like Meditation, Breathing Exercise etc. are also a permanent cure for snoring and sleep apnea.
Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.