Obinna is a 45-year-old Igbo male who presents for a routine annual check. Obinna’s waist circumference is 54 inches and was recently diagnosed with high cholesterol. His doctor had previously advised him to eat better and exercise to lose weight to improve his cholesterol levels. Although Obinna has been making better nutritional choices, he still hasn’t lost any meaningful weight. His wife, Nkechi, accompanies him to his appointment. She has been increasingly concerned with Obinna’s sleeping pattern. She decides to discuss her concerns with the physician during the routine exam.
Nkechi tells the doctor that Obinna snores very loudly, wakes up throughout the night, sometimes very abruptly, with choking sounds. Sometimes it appears as if he is holding his breath or even not breathing. When she wakes him, he is usually startled. She also complained that he sleeps off while they are having a conversation during the day, and he sometimes appears to fall asleep while driving, so they were forced to employ a driver.
The doctor questions Obinna as to how he feels in the morning when he wakes up. Obinna responds that he usually feels like a truck ran over him and tired with a lot of day time sleepiness. The doctor then takes a full medical history, carries out some examination and makes a diagnosis of sleep apnea.
What is sleep apnea?
Sleep apnea is a sleeping disorder that is often characterized by shallow breath or pauses in breathing whilst an individual is asleep. It is usually associated with loud snoring, and accompanied by daytime fatigue. Sometimes while in traffic you find some car drivers sleeping, and you have to honk for them to move. This sometimes startle them, they step on their accelerator and if not careful, usually run into the ca in front of them. It is really important that we sleep well.
Risks factors and cause
There are no established causes of sleep apnea, but risk factors include but not limited to:
- being overweight
- having an unusual structure in the neck, such as an narrow airway, large tonsils, adenoids or tongue, or a small lower jaw
- nasal congestion
- taking medicines that have a sedative effect, such as sleeping tablets
- smoking or drinking alcohol, particularly before going to sleep
- being male, above 50 years,
- family history
- having a neck thicker than 40 cm
When breathing is paused, this can lead to a build-up of carbon dioxide in the bloodstream. The human brain is then programmed to wake the person up from sleep in order to breathe in air. This is as a result of the chemoreceptors in the blood stream detecting the extreme levels of carbon dioxide. Diagnosing sleep apnea is usually done through a number of tests while the patient sleeps overnight; these tests are called ‘polysomnograms’.
Signs and Symptoms of Sleep apnea
There are certain symptoms that are common with individuals facing this condition. Patients of sleep apnea often have issues with excessive daytime sleepiness (EDS) and reduced alertness. Other symptoms include daytime fatigue, impaired vision and slower reaction time Risks also exist in the form of driving accidents. If not treated, it could lead to cases of diabetes, and in extreme cases; death. Another problem that may occur with sleep apnea is the case of sleep paralysis.
This implies the individual has an inability to move for a few seconds after waking up. Fear of experiencing this sleep paralysis can also lead to cases of insomnia.
We all know that drinking and driving is a big no-no…but did you know that driving sleepy is just as dangerous as driving drunk? People with sleep apnea are 5 times more likely than healthy individuals to be involved in a motor accident. Sleep apnea if not treated can lead to other serious health problems such as:
- day time fatigue which could lead to drowsy driving and greatly increased risks of car accidents and possible death
- pre-diabetes or type 2 diabetes
- high blood pressure, heart disease or stroke
- weight gain over time.
- sleep deprived partner
Treatment and Management
Sleep apnea can be managed with behavioral therapy. Individuals experiencing this disorder are advised to lose weight, refrain from alcohol, smoking and sleeping pills, as these relax the muscles in the throat leading to the collapse of the airway while asleep. It is also advised that people with this condition elevate their head while sleeping and sleep on their sides, as sleeping on the back can affect breathing patterns.
Throat exercises may reduce the severity of sleep apnea by strengthening the muscles in the airway, making them less likely to collapse. Try these exercises: Press your tongue flat against the floor of your mouth and brush top and sides with a toothbrush.
Using a continuous positive airway pressure (CPAP) device – these devices prevent your airway closing while you sleep by delivering a continuous supply of compressed air through a mask
Wearing a mandibular advancement device (MAD) – this gum shield-like device fits around your teeth, holding your jaw and tongue forward to increase the space at the back of your throat while you sleep
Surgery can relieve some cases of sleep apnea caused by abnormal neck structures, enlarged adenoids or salivary glands. For most people surgery is not appropriate and may only be considered as a last resort if other treatments have not helped.
There is limited information on medication for sleep apnea but acetazolamide may be recommended for treating cases of central sleep apnea. Individuals experiencing cases of sleep apnea are faced with great discomfort during sleep. Whilst there is no certain cause of sleep apnea, healthy lifestyle choices are recommended to prevent the disorder.