Thursday, January 12, 2012

Causes of Insomnia Part 6 Obstructive Sleep Apnea OSA

Keeping up with today’s schedules, workloads and family life there seems to be little time to relax and take care of the most important person in your life…YOU. We tend to stay up too late at night to get all of our to-dos done before the next day. We lay in bed tossing and turning each night wondering if we haven’t forgotten anything we have to do. As time ticks by we get less and less sleep and many of us resort to some kind of sleep aid in an effort to avoid insomnia. Causes of insomnia can vary from the mild to the extreme, but there is one cause that gets overlooked and that is obstructive sleep apnea (OSA). Why, because we tend to ignore the symptoms of OSA such as snoring and excessive daytime sleepiness because we don’t realize the connection between the two and/or the impact OSA has on one’s health. Also, OSA has joined type 2 diabetes as a condition largely associated with the national epidemic of obesity.

It is important to distinguish the difference between snoring and OSA. Many people snore. Approximately 30% to 50% of the US population snore at one time or another, but unlike simple snoring OSA is a potentially life-threatening condition that requires medical attention. The risks of undiagnosed OSA include heart disease, stroke, fast irregular heartbeat, high blood pressure, heart attack and decreased libido. OSA causes afternoon sleepiness that can result in a car or work related accidents, loss in job performance due to lack of concentration and relationship problems. These symptoms like the symptoms of insomnia can range from mild to severe.

When a person snores because of sleep apnea their pharynx or windpipe collapses during sleep and they stop breathing for at least 10 seconds. This may happen frequently, even hundreds of times during the night. The person may be totally unaware that their breathing has stopped and usually it is their bed partner that notices and becomes alarmed. OSA is very common and it is estimated that one out of every five adults have at least a mild case of OSA and one in 15 have a moderate case. The greatest reason for OSA is being overweight and as many as 40% of obese people have sleep apnea. Obese children have four to five times the risk of developing OSA verses non-obese children.

How does their air flow get blocked? The pharynx is located behind the tongue and soft palate. Muscles are relied upon to keep the airway open because the upper portion from the lungs has little support from bones or cartilage. With OSA the throat relaxes allowing the windpipe to collapse. In adults this occurs from loss of muscle tone from aging or fat buildup in the throat.

In children the cause is often enlarged tonsils and adenoids. When breathing is cut off the blood vessels constrict and blood oxygen levels begin to fall. Low oxygen levels signal the brain to wake the person up enough to cause the throat muscles to tighten, which stiffens and opens up the airway passage for air to come in. Snoring occurs when the person inhales and is a sign that air is getting into their lungs. Other signs of OSA may be gasping for breath or snorting.

People of any age may develop OSA, but those more likely to be at risk are those that are obese, middle aged (40-60), smokers, those with enlarged tonsils and/or adenoids, men (especially men with a neck circumference of 17” or more), women with a neck circumference of 16” or more and those that use alcohol, sedatives and tranquilizers before bedtime.

Not only is obesity a cause of OSA, OSA can worsen obesity. Sleep apnea causes insomnia which causes an imbalance the two hormones that are associated with hunger and satiety; leptin and ghrelin. Leptin levels decrease when we do not get enough sleep so we feel we haven’t eaten enough and Ghrelin levels increase which simulates our appetite.

For those that have OSA and are not overweight usually have a chronic nasal condition, a larger than normal uvula, enlarged tonsils or a small receding jaw. Not treating this condition can be deadly as those afflicted are three times more like of dying from OSA risks compared to those that don’t have the disorder. One of the more likely risks is heart disease caused by high blood pressure. 50 to 60% of people with OSA have hypertension which is the result of over stimulating the sympathetic nervous system due to a constant responds to the threat of low oxygen levels. Normal blood oxygen saturation values are 97-99% while those with OSA may have levels around 60% or lower. The sympathetic nervous system reacts to these low levels by increasing the heart rate. Their blood pressure can rise as high as 250/110 mm Hg during a sleep apnea episode. Worse still this stimulation can continue during awake hours continually constricting blood vessels which can lead to hardening of the arteries or atherosclerosis. These problems cause heart attack and stroke, pulmonary vascular disease, congestive heart failure and heart arrhythmias.

Other problems can stem from OSA, such as fatigue, headaches, afternoon sleepiness, lack of focus, decreased desire to interact socially, men may suffer from erectile dysfunction, little regard to take care of one’s self and depression. OSA can raise insulin and blood sugar levels that impair the body’s ability to process glucose. Those with moderate to severe cases of sleep apnea may be twice as likely to develop diabetes.

If the OSA is mild to moderate some lifestyle changes can effectively cure this condition. Number one is weight loss! Even 10% of a person’s body fat can help relieve sleep apnea, while a larger weight loss can cure the condition completely. Purchase a pillow wedge to prevent them from sleeping on their back which will limit the tongue and soft palate to rest on the back of their throat blocking the airway. NO alcohol or sleep aides, they relax the muscles in the back of the throat. Quit smoking.

Moderate to severe cases may need a CPAP machine to keep the airway open by a continuous flow of air that pushes the throat open while they sleep. The amount of air flow delivered by the CPAP machine is individualized. To determine the best adjustment, it's necessary to sleep overnight in the sleep lab wearing the CPAP mask while the sleep technician monitors your sleep.

Oral appliances, or dental devices, are generally less effective than CPAP, but some people find them easier to use. They are usually plastic devices that are designed to prevent soft tissues from collapsing and pressing on the airway. There are many different kinds, and it's necessary to go to a dentist to have one custom-fitted for individual needs. If you or someone you know may have OSA seek professional help. The severity of OSA is usually diagnosed by a polysomnography which will monitor their breathing, heart rate, brain activity, blood pressure and other functions while they sleep overnight.

Scientists are still exploring why we need to sleep and why the lack of it causes so much damage. Animals when deprived of sleep lose immune function and die in a matter of weeks. Losing one night of sleep can cause us to lose concentration, impair our memory and reduce our physical performance the very next day. Continued lack of sleep or insomnia can lead to irritability, hallucinations and depression. If the cause of their insomnia is due to chronic snoring and/or gasping for breath continually during the night, it’s time to find out if obstructive sleep apnea is the reason.

The content provided in Causes of Insomnia Part 6 Obstructive Sleep Apnea (OSA) is for information purposes only, intended to raise the awareness of different solutions for you or your families sleep problems and should not be considered medical advice. For medical diagnosis and treatment, please see your qualified health-care professional.

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