SLEEP APNEA

“Sleep is the most important ‘repair’ mechanism our body has, and getting enough of it will ensure you’re feeling fit and energized the next day”- Janson Smith

Well…we all know, a good quality sleep helps in better memory, productivity, physical performance, immunity, metabolism and heart health. It also prevents depression, reduces pain and inflammation and improves overall psychological well- being. So sleep can be termed as a biological necessity for life and overall health! These are just the scenarios of one side of the coin. The other side of the coin is really different. One such issue is ‘Sleep apnea.’ If at all you have addressed constant tiredness even after having normal sleeping hours every night, or constant undisturbed sleeping pattern, then it’s time to know more about sleep apnea. 

So, What is sleep apnea? Sleep apnea is one of the most common sleep disorders and the most undiagnosed. It is a condition, which is potentially serious in which breathing repeatedly stops and starts. The occasional cessation of breath during sleep causes one to snore loudly or create choking noises while trying to breathe. The body slowly becomes deprived of oxygen and makes the patient wake up abruptly. When the airway repeatedly becomes blocked, the quantity of air that reaches the lungs becomes limited. This can be further categorized into 3 forms: Central sleep apnea(CSA) – here, the pauses of breath are due to the brain failing to signal the respiratory system to breathe Obstructive sleep apnea (OSA)- here, the breath is paused by the physical obstruction/ blockage in the upper airways. It is mostly caused by the tongue falling back or collapsing into the airway or by soft issues of the throat. Studies have shown that Obstructive sleep apnea (OSA) affects 17% of women and 34% of men.

● Loud snoring 
Don’t consider snoring as a natural part of aging. Snoring is commonly associated with sleep disorder mainly, obstructive sleep apnea. Sleep apnea should be considered if snoring accompanied with any of the following symptoms are present. 

● Frequent morning headaches

They are a clear sign of improper quality of sleep. These kinds of headaches are caused by the reduced oxygen level due to the intermittent cessation of breathing during night. This causes widening of blood vessels that initiate vascular headaches.


● Frequent daytime tiredness and sleepiness 
Excessive daytime sleepiness and fatigue is the most common and frequent overlooked symptom of sleep apnea. 
All the interruptions and pauses of sleep reduce the quality and quantity of a good night’s sleep, which eventually leads to daytime tiredness. 


● Frequent awakenings and night time urination 
Studies have shown that if the patient wakes up frequently, they will sense the pressure as the need to urinate.

 
● Mood swings 
A person’s mood and quality of sleep are interconnected. Lack of quality sleep can lead to irritability; short temper, anxiety and can eventually trigger depression. 


● Obesity

Obese people are more likely to have sleep apnea due to too much of fat build up around the circumference of the throat. The excess tissues can fall back into the airways during sleep, which can cause airway obstruction leading to apnea events. 

● Increase in blood pressure 
● Stroke 
● Heart diseases 
● Depression 
● Metabolic diseases like diabetes

Pulmonologist, neurologist and otolaryngologist can diagnose sleep apnea. Diagnosis is either by in-lab sleep study or home sleep apnea test. 

Solutions for sleep apnea 

CPAP therapy 

It is the most frequently prescribed and frontline treatment for sleep apnea, which maintains a continuous positive airway pressure. It generally involves a mask that’s fitted over the nose and/or mouth and worn during sleep. A machine delivers air through the mask to keep the airway open and assist breathing.  CPAP therapy is usually given for moderate to severe sleep apnea cases. 

Oral appliances 

Dentists help to intervene with mild to moderate obstructive sleep apnea with oral appliances, which cannot be tolerated or haven't been helped with CPAP.  Generally, Mandibular Advancement Device (MAD) is given which is worn at night. This prevents the tongue falling back or blocking the throat. Mandibular Advancement Device (MAD) is generally catogerised as
⦁ Fixed advancement MAD
⦁ Adjustable advancement MAD
The principle mechanism of MAD is that they carry out anterior and inferior movement of jaw. This generates anatomical variations in the upper airway and thereby enables an increase in the pharyngeal area. This movement eventually stabilizes and fixes the jaw and hyoid bone. Thus prevents the posterorotation of these structures during decubitus and thus prevents airway blockage.

Surgery 

Surgery for sleep apnea involves physically widening the throat’s airway to eliminate obstruction. It is generally the most extreme and least frequent solution for sleep apnea.  Surgery is mainly decided based on the severity of your sleep apnea, but may not eliminate symptoms entirely. Hence, it's generally considered as a last resort treatment. 

Weight loss 

High prevalence of obstructive sleep apnea (OSA) is seen in increased prevalence of obesity. Hence, losing weight is the most effective means of fighting back against sleep apnea.

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