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SECRETS OF SLEEP APNEA

by Alexander Golbin, MD, PHD

 

Sleep is our healer

Whether we want to believe it or not as much as one third of our lives are spent asleep. It is known that sleep is a time for regaining strength and health. Good health means sound sleep and high alertness.

About 60 years ago it was discovered that after an hour of tranquil sleep when muscles, breathing and heart are slowed down, suddenly all body functions became turbulent; eyes started to move vigorously and rapidly (that is why this stage of sleep is called REM –Rapid Eye Movements). Not only do eyes movements became rapid, but heart rate, breathing, metabolism, and brain activity do as well; the whole body is getting into a stormy stage and we see emotional dreams reflecting this turbulence.  After about 10-15 minutes this storm calms down and another 3-4 minutes of slow – fast cycles of activity follow. Why this is important to know, because most of our hormones are attached to the sleep –wake cycles during the night.  If these cycles of sleep (called sleep architecture) are running smoothly, sleep is good and we are healthy, our memory, attention, school and job performances are great.  All our “software” programs for metabolisms and mental clearances are running well. But if sleep cycles are chronically disrupted then the metabolic “programs” start to dis-balance which eventually may turn into a disease.

Sleep is our killer

About 82 disorders start in sleep long before they appear during the day. A few of them are chronic fatigue, fibromyalgia and depression, bad habits and addiction to drugs; anxiety and impulse control problems including anger, road rage and violence. Among the most dangerous sleep problem is episodes of stops breathing during sleep which is called sleep apnea. Associated symptoms include loud interrupted snoring, awakenings with chest discomfort, bad dreams, non-restful sleep, increasing daytime fatigue. Sleep apnea causes increased blood pressure, heart problems, heart attacks and stroke, diabetes, depression, and a lot of other problems.

There are a few types of sleep apneas. In one type the brain simply “forgets” to send a signal to breathe, so breathing stops at any moment of the cycle: during inhale, exhale or in between. To compensate, heart rhythm increases and became dangerously irregular, leg spams appear and “kicking” person to awake and gasp for air. This type of apnea called “central” to emphasize the brain cause of the problem.  The other type of stop breathing is related to obstruction of the upper airways by glands, adenoids, enlarged tongue, swollen tissue, extra fat, teeth and jaw orthodontic problems.  This type of apnea is called “obstructive”, and it is the most common and dangerous apneas because they are caused acute drop oxygen supplies to the brain, heart and all other organs, causing many disorders.

TREATMENT of SLEEP APNEA

The biggest issue is that sleep apnea is a hidden disorder: we are not aware about it until it became malignant. When we sleep we don’t hear our snoring, our leg kicking, body jerks and do not remember bad dreams. Morning fatigue we conveniently explain by sleep deficiency stress and age. Only our spouses first notice the problem that disturbed them. They turn over the partner and, later, force him/her to see a doctor, actually saving the partner’s life.  This is the first and the oldest “treatment”. Sure enough, this “kick back” remedy is not very successful. The scientific treatment is to supplement by forceful continuing blow of air through the mask by a computerized fan (called CPAP – abbreviation from Continuing Airway Pressure). For a long time CPAP therapy was the only standard of treatment of obstructive apneas. This is very good even now for advance cases and this treatment has a lot of positive features. The problem, however, is that CPAP treatment is using  a very cumbersome equipment, a mask covering face causing claustrophobic reaction, and cable limiting the patient’s movements in bed. The compliance with the CPAP therapy is about 50%.

Recently, advances in dental industry allow using different dental devices that increase opening of the airways by gently moving the low jaw and tongue forward. Advantages of the dental devices have been proven in scientifically design studies and accepted by FDA. Now many dentists are trained in sleep medicine because it is important to differentiate central from obstructive apneas (because the central –brain-apnea should be treated differently). In severe cases of Obstructive Sleep Apnea (OSA) many dentists collaborate with sleep centers and help the patient to use CPAP and a dental device together or alternatively. Recently, many insurances accepted dental devices as a recognized treatment and partially cover their cost.

The good news is that the treatment for the potentially life threatening disorder is available. If you suspect sleep apnea in yourself, your spouses, relatives, or hear about snoring, stop breathing episodes in your friends, neighbors or coworkers - recommend them sleep and dental evaluation.

Sleep apnea is a dangerous problem.  Ask for help. Don’t sleep on it.

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