Sleep apnea – Causes, effects and treatment (Part 2)

By NAN BROWN
As published May 16, 2007

In my previous column I wrote about my recent illness and hospitalization and the shocking diagnosis I was given of heart failure due to sleep apnea.

As I mentioned earlier, sleep apnea is far more common than realized. In fact, 90% of people who have sleep apnea don’t know they have it.

Awareness is imperative as sleep apnea not only results in sleep deprivation but, as I found out, can be a life-threatening condition as well. It is a progressive sleep disorder that worsens with age. Treatment is necessary, with the good news being it is usually successful.

There are various risk factors for sleep apnea which include: obesity or excessive fat in the neck and throat (however, it is important to note that almost half of the people with sleep apnea are not obese), male gender (although women also have it), age, anatomical abnormalities that narrow the airway (i.e., a deviated septum, a receding chin, or an enlarged tongue), snoring; enlarged tonsils or adenoids (especially in children), use of alcohol and sedatives before bedtime, smoking or exposure to secondhand smoke, and a family history of sleep apnea.

Warning signs and symptoms of sleep apnea include: frequent episodes where breathing stops (apnea) during sleep, loud snoring, choking or gasping during sleep, sudden awakenings, waking up in a sweat during the night, feeling unrefreshed in the morning after a night’s sleep, daytime sleepiness (including falling asleep at inappropriate times such as at work or while driving), lethargy, headaches, dry mouth or sore throat upon awakening, rapid weight gain, memory loss and learning difficulties, poor judgment, short attention span, depression, and personality changes.

Drastic problems that can result from sleep apnea include heart disease, heart failure or heart abnormalities, stroke, high blood pressure and other cardiovascular system problems, Type II diabetes, insomnia and restless sleep, and cognitive impairment (i.e., learning difficulties and memory problems), just to name a few.

Sleep apnea involves a cessation of breathing during sleep resulting in an upset of the balance of oxygen and carbon dioxide in the blood. This imbalance stimulates the brain to restart breathing which in turn signals waking episodes so the muscles of the tongue and throat can increase the size of the airway, allowing carbon dioxide to escape and oxygen to enter the airway.

In my case, carbon dioxide gases in my blood became too high, and I could not stay awake and was, in fact, almost incoherent. Thankfully this occurred in the hospital one day while Jack was with me. He brought it to the immediate attention of the medical staff and I was hooked up to a machine designed to filter the harmful carbon dioxide gases from my blood.

My diagnosis of sleep apnea resulted from a sleep test called polysomnography that I was given in the hospital’s sleep clinic. The testing involved hooking sensors and wires to the top of my head, nose and throat, various places on my chest and on my legs.

It is a standard test for sleep apnea that records certain data during sleep such as electrical activity of the brain, muscle movement, eye movement, respiratory effort, heart rate, air flow, and blood oxygen levels.

In the six hours I was monitored while sleeping I had 101 episodes during which I quit breathing. The resultant diagnosis I was given was Obstructive Sleep Apnea (OSA), the most common type of sleep apnea which is caused by a breathing obstruction that stops the air flow in the nose and mouth.

The method of treatment prescribed for my sleep apnea involves the use of a CPAP machine which is a commonly used long-term treatment for severe sleep apnea. CPAP stands for Continuous Positive Airway Pressure. It is a machine that sits at my bedside and blows pressurized air through plastic tubing and then into a device I place in my nose.

I was so relieved to learn that my CPAP home machine is much smaller and quieter than the one used in the hospital. Thankfully also there was a variety of masks from which to select, as the device that fits in my nose is much more comfortable than the hard plastic mask that covered my nose and mouth in the hospital.

I’m adapting to my CPAP machine and the lifestyle changes required in association with heart failure, including the use of a low sodium diet. The low sodium diet has been another real eye-opener. I never realized there is so much sodium in food; but most of all, Jack and I are so thankful for my improving health.

If you or your spouse suspect you may be suffering from sleep apnea, please seek testing and treatment. Your life may depend on it.

Sleep Apnea – Do You Know the Warning Signs? (Part 1)

By NAN BROWN
As published May 2, 2007

I’ve been away from the Messenger for a while, but it is oh so good to be back. I am sorry to say I was quite ill and was hospitalized for twelve days recently, seven of which were in the ICU. Jack and I were both shocked when I was given the diagnosis of heart failure.

I am not even sure when this severe downhill slide of my health began. In hindsight Jack and I realize at the very least it was many months in the making.

I started putting on weight for no apparent reason last fall, and in January of this year I made an appointment and saw the nurse practitioner at our family doctor’s office. I told her of the unexplained significant weight gain, but her only response was “Watch what you eat and try to get more exercise.”

Several weeks and many additional pounds later, I had an appointment with the nurse practitioner at my endocrinologist’s office (which is the specialist I work with in managing my diabetes) for my regular three month appointment. They had just started using a nurse practitioner, and under their new system, I would alternate between seeing her and the doctor every other appointment.

Again I expressed my concerns about my unexplained weight gain, and I got the same answer as before about diet and exercise.

It wasn’t until March 21 when I saw a specialist for a totally unrelated problem when he expressed concern about my extremely bloated condition and said I should see a cardiologist right away. Two days later I was in the cardiologist’s office, and he took one look at me and sent me straight to the hospital.

I was admitted and was immediately placed on intravenous diuretics which resulted in the necessity of the use of a catheter as well. I cannot and will not even attempt to explain everything that transpired otherwise during those twelve days, but the end result was absolutely mind blowing.

While I was in the hospital they took 94 pounds of fluid off my body. No, that is not a typo – I did indeed say 94 pounds!

Now here at home I continue on hefty amounts of prescription oral diuretics to help me continue to lose fluid and keep it off. As of this writing I have lost an additional 30 pounds since leaving the hospital, resulting in a total weight loss of 124 pounds in the space of just over a month.

As it turns out the cause of the severe fluid retention and resultant bloating was due to the fact I have heart failure on the right side of my heart.

Now here’s another shocker – it was determined that the cause of my heart failure is sleep apnea. I had heard of that ailment before but never imagined I would be diagnosed with it or that it is such a serious, potentially life-threatening condition that’s far more common than realized.

Simply defined, if you stop breathing periodically during sleep, you have sleep apnea. You probably remember nothing about these episodes – but in most instances your sleep partner (how politically correct is that?), i.e. your spouse (at least in my old-fashioned way of thinking) will remember a great deal about the awakenings. After all, such instances usually involve heavy snoring and an apparent struggle to breathe.

We didn’t realize it at the time, but these were indeed my symptoms as Jack mentioned several times that he heard me snore loudly at times during the night, sound as though I were gasping, and then resume normal breathing.

In my particular case, the lack of sufficient oxygen at night has caused a strain on my heart, making it weaker and less capable of pumping adequately to meet my body’s needs, ultimately resulting in the severe fluid retention and resultant significant weight gain.

People with sleep apnea often feel very sleepy during the day and their concentration and daytime performance suffer as a result of the serious disturbances in their normal sleep patterns. I am no exception because I have experienced these changes, only I wasn’t aware of the cause like so many others who are undiagnosed sleep apnea sufferers.

I hesitated at first to be so blunt here about how sleep apnea has affected me and worried that some of it might fall into the TMI (Too Much Information) category, but if what I write can help even one person recognize the signs and symptoms of sleep apnea in him or herself or a loved one and seek help, it’s all worth it.

I will continue with more information in my next column about sleep apnea, its characteristics, symptoms and the method of treatment that has been prescribed for me.