Putting sleep apnea to rest

February 14, 2000
Web posted at: 4:41 PM EST (2141 GMT)

In this story: Don't hold your breath Who's at risk? Getting help Treatment options RELATEDS

(WebMD/Healtheon) -- Andrew Altenberg of Los Angeles hasn't slept well since the Reagan administration, but his sleepless nights have nothing to do with '80s nostalgia.

For over a decade, he's been waking up several times a night for no apparent reason and spending most mornings in a cranky haze. "I'd go to work and have to remind myself to be extra nice or just keep my mouth shut for the first few hours because I'd be afraid to say something rude," Altenberg says.

Altenberg followed this routine until he entered into a serious relationship. His partner was concerned about his odd snoring pattern. Soon thereafter, Altenberg visited an ear, nose, and throat specialist and found out his crabby mornings were not an attitude problem but a case of sleep apnea.

Don't hold your breath

Sleep apnea is characterized by breathing pauses, or apneic events, caused by an obstruction in the airway, generally at the base of the soft palate (the fold at the back of the roof of the mouth) or lining of the neck. These events tend to last from 10 to 40 seconds, leaving sufferers gasping for air. Dr. Jerrod Kram, medical director of the California Center for Sleep Disorders in Oakland, California, commonly sees patients who stop breathing for up to a minute.

"The longest that I've ever seen was three minutes," Kram said. "With patients like that, you can actually see their complexion change, and they tend to briefly wake up when they eventually take a breath."

The National Sleep Foundation says high blood pressure, irritability, depression, sexual dysfunction, fatigue and impaired driving are common effects of sleep apnea, with all of these symptoms building upon each other and possibly worsening over time.

Who's at risk?

According to the National Institutes of Health, sleep apnea affects 12 million Americans, about two-thirds of whom are men. Studies have also shown that postmenopausal women are just as likely as men to have sleep apnea, suggesting a possible hormonal link.

The American Sleep Apnea Association lists the following risk factors: Being over 40, being overweight, being a back sleeper or having someone in your family with sleep apnea.

Getting help

Kram says sleep apnea can be identified by symptoms such as fatigue, frequent daytime sleeping, choking or gasping when waking up, sore throats, frequent dreams about drowning or choking. Unfortunately, sufferers often ignore symptoms until a partner decides to move out of the bedroom.

"A lot of the men at the (UCSF Sleep) Center are depressed because they are not only disconnected from their spouse, but their kids as well, because they are often too tired to participate in family activities," says Kimberley Trotter, chief polysomnographic technologist at the center.

Sleep centers recommend that prospective patients see a primary care physician first to assess and discuss treatment for possible side effects (such as high blood pressure) and to determine if a sleep specialist is needed. The specialist, if called for, observes the patient during sleep.

Treatment options

With a diagnosis of sleep apnea, there are a number of treatment options, both surgical and noninvasive.

Surgical treatment focuses on removing the excess tissue causing the obstruction, and it usually involves either cutting away tissue with a scalpel or using a laser to cauterize and shrink tissues. An approach that has come into favor in the last year is called somnoplasty. In this procedure, a needle inserted into the back of the tongue microwaves the flesh, shrinking it as it heals into scar tissue.

The most popular and effective noninvasive treatment is the CPAP (continuous positive airway pressure) device, which gently sends a continuous stream of air pressure into the throat through a mask worn by the patient. But it doesn't work for everyone.

"I tried using the CPAP in November, but the mask made me feel claustrophobic," Altenberg said.

Another option is a mandibular splint, a dental appliance to prevent the jaw and tongue from sliding back during sleep. It may be sufficient treatment for milder cases, Kram said.

He adds that those who seek nonsurgical treatments should keep in mind that they'll have to use these devices indefinitely. In Altenberg's case, he has decided to have surgery with the hope that this decade might be a little more restful than the last. He's keeping his fingers crossed.

© 2000 Healtheon/WebMD. All rights reserved.

RELATEDS AT :

Sleep Apnea
Sleep Apnea Treatments
Sleep Disorders

American Sleep Apnea Association
American Academy of Sleep Medicine
National Sleep Foundation

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