FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

SLIMMING DOWN CAN OFTEN CURE ONE COMMON SLEEP PROBLEM

Question: I needed to have a hysterectomy a few months ago. One of the doctors I saw thought I could have sleep apnea and sent me to have sleep studies at another hospital. I had my surgery without any problems, but I haven't gone back to see the doctor again about the sleep apnea. Is sleep apnea important enough to require treatment?

Answer: Sleep apnea is a fancy medical term that means one stops breathing for brief periods of time during sleep. About 24 percent of men and 9 percent of women have this problem, so it is quite common.

During a sleep apnea episode, the individual attempts to breathe but is unable to move air into and out of the lungs because the upper air passages relax so dramatically that they temporarily collapse. This is very much like trying to breathe while someone pinches your nose closed.

Your nervous system controls the process of breathing by gathering information from a number of different parts of the body. Two of the most important of these "feedback loops" monitor the concentration of oxygen and carbon dioxide within the blood.

The regular muscular efforts of the diaphragm continue during sleep apnea; they are just ineffective at moving air into and out of the lungs. Consequently, the oxygen level in the blood falls and the carbon dioxide level rises. Ultimately these changes cause the individual to awaken sufficiently that muscle tone returns in the upper airway, allowing normal breathing again.

The arousal from sleep may occur 600 or 700 times each night in individuals with sleep apnea. Curiously, though, the individual usually is unaware of this. They just know they don't feel rested in the morning. The most frequent signs of sleep apnea are daytime sleepiness and irregular and loud breathing noises while asleep. Morning headaches and morning disorientation are also quite common.

Sleep apnea occurs in various levels of severity. Mild cases cause the symptoms I've described. Individuals with more severe problems develop high blood pressure, heart failure, and behavioral changes. So, the amount of symptoms you have determine the urgency of treatment for your sleep apnea.

Question: What are the treatments for sleep apnea?

Answer: About 40,000 people are treated in the United States each year for sleep apnea. Being very overweight is often the cause, but slender individuals and those who consume large amounts of alcohol are also frequently affected. In many of these cases the treatment is obvious - lose weight and stop drinking alcohol. For most people, however, additional measures are also required.

The most common treatment for sleep apnea involves wearing a tight-fitting nasal mask that supplies air under moderate pressure to the nose. This air pressure counteracts the tendency of the upper airway to collapse during sleep, thus allowing normal breathing to continue. In some individuals, medications are used to help stimulate regular respiration. In others, surgery to make the airway space in the nose and throat larger or "less collapsible" is done. Unfortunately, only about 35 percent of the patients who undergo this surgery receive the desired benefit from it. In the most severe cases, an additional opening into the windpipe is made. The windpipe in doctor lingo is called the "trachea," so this procedure is known as a "tracheotomy." While a tracheotomy always works to relieve obstructive sleep apnea, it's disfiguring and has other frequent complications. Therefore, it is reserved as the treatment of last choice.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.