The Sleep Apnea You Probably Don’t Know
Sleep Apnea is one of the most poorly understood, common medical conditions. Most people are under the assumption that you have to be old or overweight or snore or wake up gasping for air to have sleep apnea. You don’t! You don’t have to be or do any of those things to have apnea. All of those things do make it more likely that you will have sleep apnea, but they are a very specific picture of sleep apnea. In fact, unless you are talking with a physician who has apnea themselves or a special interest in it, most will think of this classic “textbook presentation” when they think of sleep apnea because that was the way it was presented in the short bit of coverage it got in medical school. The truth is after almost a decade working in this very specific area of medicine, I can tell you that sleep apnea presents in a lot of different ways. Some people don’t have many symptoms at all and end up having severe apnea while others can barely function and only have mild apnea. In other words, the severity of the symptoms does not always correlate with the severity of the apnea.
What is Apnea?
Sleep Apnea is a sleep disorder that occurs when there are episodes of apnea (not breathing) that occur for too long and/or too frequently during sleep. There are three primary types of sleep apnea: Obstructive (which is the common one you hear about), Central, and Mixed. Obstructive sleep apnea is when there is a partial or complete blockage of the upper airway during sleep leading to not enough oxygen getting through. Central sleep apnea is when the brain stops sending the message to breathe and mixed is a combination of the two.
Obstructive sleep apnea can be caused by anatomical features of the upper airway (a narrow airway, large tongue, small jaw, enlarged tonsils), excess body weight in the neck area (fat or muscle), age (loss of muscle tone), genetics, frequent alcohol use, and nasal congestion that results in mouth breathing. Central sleep apnea is seen most commonly in those who have had head trauma, brainstem lesions or tumors or who take medications that suppress the central nervous system like opioids (oxycodone, morphine) or sedatives.
Why Does It Matter?
Apnea is important because when left untreated, it puts you at risk for heart attack, heart disease (congestive heart failure, atrial fibrillation, etc), stroke and dementia in a big way!
The symptoms of apnea aren’t too great either. It can cause insomnia, restless sleeping, nightmares, waking frequently in the night, night sweats and waking up earlier than intended, and waking up feeling unrested and unrefreshed. It can also make it hard to concentrate; it can make your short-term memory worse; it can make restless legs worse; it can make any muscle, joint or bone pain worse; it can make you gain weight; and it can make it very hard to lose weight. It can cause hypertension, acid reflux, erectile dysfunction, low testosterone, and low libido. It can make anxiety worse and it can make depression worse. It can cause headaches and make migraines worse. And it can just make you feel tired all the time. One of the worse parts though is that so many of these symptoms can be falsely attributed to other things such as age, genetics, or other medical conditions - further preventing a proper or more timely diagnosis.
What Does This Mean for You?
If you struggle with any of the symptoms listed above, discuss your symptoms with your primary care provider and ask if you can have a sleep study. These can be done in sleep labs (the most thorough kind) and through home sleep tests. Although sleep apnea is not technically curable, when adequately treated either with weight loss (if appropriate), continuous positive airway pressure (CPAP), dental appliances for apnea or nerve stimulator devices, the extra risk it imposes for heart attacks, heart disease, stroke and dementia goes away and the symptoms of untreated sleep apnea will either resolve or dramatically improve. Honestly, in my opinion, because the risk is so high when it is left undiscovered and untreated, a sleep study is something everyone should do at some point in their life. When however, should be determined by the quality of your sleep, how you feel throughout each day, your personal medical history and a conversation with your primary care provider on when the right time might be.