Sleep Medicine Guide

Symptoms and Signs

The amazing explosion of information, as well as the direct application to both the treatment and diagnosis of patients, has resulted in the TMK & Sleep Medicine Network being established. At the same time sleep medicine technology developments have enabled us to more accurately and easily study the sleep process and apply the study to problems that are faced by sleep medicine patients. Sleep Apnea is among the most dangerous of all sleep disorders.

Dr. William N. LangstaffDr. William N. Langstaff
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Sleep Apnea and Sleep Medicine

Sleep apnea is quite a common sleep disorder (up to 5% of women and up to 10% of men) that involves breathing stopping while the individual is sleeping. There are two kinds of sleep apnea, central and obstructive.

With obstructive sleep apnea, the airway over the larynx, the tongue and the soft palate collapse which results in the upper airway becoming obstructed. During sleep, as the muscles relax, the tissues sag in the airway. This results in air flow being impeded (hypopnea) or it completely stops (apnea). As breathing movements continue to be driven by the brain, the airway obstruction worsens. It may be compared to a paper soda straw collapsing when you suck too hard while drinking a drink that is very thick.

Whenever that occurs, in order to get breathing restarted again, the brain has to arouse itself. During hypopnea and apnea, the blood oxygen level, which is measured by oxygen saturation, experiences a significant drop. In addition to the decrease in oxygen saturation, other events may also occur like jerking of limbs or irregular heart rhythms.

Given that obstructions (apneas) may be quite frequent throughout the sleeping period, it results in sleep becoming fragmented. Usually sleep is quite an orderly process, usually progressing through more superficial, early stages into more restful, deeper, restorative stages. Every arousal results in the process needing to start over again. The interruption to sleep flow ends up depriving the patient of continuity of sleep and the more restorative sleep stages.

Sleep apnea symptoms can be predicted by bearing in mind this sleep process. The most common problem is snoring, and usually, spouses, family, roommates, bedmates, or even neighbors at times, report it. When patients wake up in the morning they do not feel refreshed, and instead feel like they have not slept at all or not slept well. Spouses might notice pauses in breathing which is an apnea. Patients have some degree of excessive or increased daytime sleepiness, particularly when they are inactive. Frequently patients will get up at night from sleep to urinate and quite often notice they have been sweating while they sleep. They might also have morning headaches. Memory disturbances and inability to concentrate are common as well.

The brain might, less frequently, not simulate the effort to breathe. That is central apnea. This might occasionally come from an unknown cause or it might be due to a neurologic disorder like a stroke or other kind of neuromuscular disorder.

This excessive daytime sleepiness results in loss of quality of life, and the snoring and apneas might cause marital problems from impacting the spouse's sleep as well. There is increasing evidence of sleep apnea being associated with hypertension, strokes, heart attack and trauma (due to falling asleep while driving or another inappropriate situation for sleeping), which results in a higher mortality rate.

A sleep apnea diagnosis is confirmed through conducting a sleep study that demonstrates hypopneas and/or apneas.