Sep - Oct 2014

Your Sleeping Habit Can Wreak Havoc on Your Health

By Christy Powers, FNP, CBN


What is obstructive sleep apnea (OSA)? OSA occurs when the muscles of the throat and tongue relax during sleep, blocking good air movement with breathing. Snoring is a usual symptom; or you may choke or gasp for breath. Falling asleep easily during the daytime is another sign of sleep apnea, along with irritability, headaches, and trouble concentrating.


With sleep apnea you stop breathing (apnea) for 10 seconds or longer and/or you breathe 50% less deeply than normal (hypopnea). This shallow breathing, or periods of no breathing, repeats itself many times during the night. The lack of normal breathing decreases the body’s oxygen level activating the “fight or flight” response of the sympathetic nervous system. Then the heart rate, blood pressure and respiratory effort increases. Blood glucose and mental activity also increases. By the end of the night you feel exhausted both physically and mentally. Over time, the repeated episodes place a strain on the cardiovascular system. Untreated OSA can lead to hypertension, heart dysrhythmias such as atrial fibrillation, heart failure, myocardial infarction, stroke, and pulmonary hypertension.


Filling out a sleep questionnaire such as the Epworth Sleepiness Scale, seeing a sleep specialist physician and having an overnight sleep study performed can confirm OSA. Treatment usually involves increasing positive airway pressure (PAP) or using a dental device to advance the lower jaw to prevent airway collapse during sleep. Continuous positive airway pressure (CPAP), bilevel positive airway pressure (BiPAP) with specific airway pressure with inhalation (usually higher) and another airway pressure (usually lower) with exhalation or auto set positive airway pressure which adjusts with a range of pressure settings to the body’s need during sleep are prescribed for a diagnosis of sleep apnea.


Several factors can physically predispose a person to OSA including: higher body mass index, neck circumference larger than 17 inches in men and 16 inches in women, crowded posterior throat with increased soft tissue, large tonsils, and elongated uvula. A study by O’Keefe and Patterson in 2004 showed that approximately 80% of patients presenting for bariatric surgery had evidence of sleep apnea. Anesthesia, pain medications, sedatives, and alcohol can increase the symptoms of OSA.


It is very important to have follow-up visits with your sleep specialist after losing weight to adjust positive airway pressure. If weight loss is sufficient, OSA can be improved or even cured. A study published in Annals of Surgery (2011), showed 28,616 patients from one hundred nine U.S. hospitals with OSA at baseline resolved at one year. Of those patients with resolved OSA, 62% had sleeve gastrectomy, 66% gastric bypass, and 38% gastric band.