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Sleep Apnea: Killing You While You Sleep

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Twenty-eight million Americans have sleep apnea, a sleep disorder in which breathing repeatedly stops and starts. More than 80% of these people don’t know they have it. And every year, an estimated 38,000 Americans die in their sleep because sleep apnea has exacerbated a circulatory problem, causing a fatal heart attack or stroke.

Bottom line: Diagnosing and treating sleep apnea can save your life. And now there’s an exciting new treatment that’s available. What you need to know…

THE DANGER

For people with sleep apnea, nighttime levels of blood oxygen can plummet from an optimal saturation of 100% to below 65%. This oxygen-robbing disorder can contribute to extreme daytime sleepiness, as well as high blood pressure, heart attack, stroke, congestive heart failure, type 2 diabetes, Alzheimer’s disease, erectile dysfunction, depression, anxiety and gastroesophageal reflux disease (GERD). In fact, if you have sleep apnea, you have a nearly five times higher risk of dying overall.

What happens: During sleep, the muscles at the back of the throat relax, which relaxes the soft palate and the uvula, a small, triangular piece of tissue hanging from the soft palate.

When you have obstructive sleep apnea, the most common kind, this tissue doesn’t just relax, it sags, plugging the airway—and breathing stops. You may snort, grunt, gasp or cough as the body rouses itself—and breathing restarts. Then you fall back to sleep, never remembering that you woke up.

This mini-suffocation and awakening can occur over and over—from as few as five times an hour (the criteria for being diagnosed with “mild” sleep apnea) to dozens of times each hour.

Risk factors for obstructive sleep apnea include snoring (a sign of a thickened soft palate), being male, being 65 or older (for women, risk rises after menopause) and obesity. But some people with sleep apnea have none of those risk factors.

DO YOU HAVE IT?

Several daytime symptoms are possible signs of sleep apnea. You might wake up with a headache and a dry mouth. You could be intensely tired during the day—even falling asleep at a red light. You might be irritable and depressed and find it hard to think clearly.

If your doctor suspects sleep apnea, he may recommend a “sleep study” conducted in a sleep disorder center. This overnight test—polysomnography—monitors and measures breathing patterns, blood oxygen levels, arm and leg movement, and heart, lung and brain activity. But there are several downsides to a study in a sleep center…

It’s expensive, costing $1,500 to $2,500—which could be out-of-pocket if your insurance has a high deductible.

It’s inconvenient. You’re spending the night in a strange place with a video camera focused on you and personnel walking in and out.

Instead, I often recommend a sleep study at home. Using a portable device, it provides the same information as a study at a center—for a fraction of the cost ($450 to $650). It is becoming the preferred method of testing for many doctors and often is covered by insurance. I prefer the home test by SleepQuest. For more information: 800-813-8358, www.SleepQuest.com.

EXCITING NEW TREATMENT

Up until now, the standard treatment for sleep apnea has been a continuous positive airway pressure (CPAP) machine. This device uses tubing and a mask worn over the nose…over the nose and mouth…or directly in the nose (via what is called a nasal pillow). The mask continuously pumps air into the airway, preventing the soft palate from sagging. But the mask often is uncomfortable. In one study, nearly half of people prescribed a CPAP device stopped using it within one to three weeks.

fs_proventThe exciting news is that there’s a convenient treatment for sleep apnea called Provent. A small, disposable patch fits over each nostril (see right). The treatment uses your own breathing to create expiratory positive airway pressure (EPAP)—just enough to keep the throat open.

Recent scientific evidence: In a three-month study involving 250 people with sleep apnea, 127 used Provent and 123 used a fake, look-alike device. The people using Provent had a 43% decrease in nighttime apnea events, compared with a 10% decrease for those in the fake group. Over three months, there was also a significant decrease in daytime sleepiness among Provent users.

A 30-day supply of the patches costs $65 to $80. They are prescription-only and currently are not covered by insurance or Medicare.

My perspective: Provent is an excellent new option for many people with obstructive sleep apnea, but it is not for mouth breathers, people with nasal allergies or those with severe apnea. Information: 888-757-9355, http://Provent.ActiveHealthCare.com.

CUSTOMIZED MOUTH GUARD

If the nasal patch is not an option for you, a customized oral appliance may be best. It moves the lower jaw forward, opening the throat. It usually is covered by insurance, either partially or totally.

I was diagnosed with severe obstructive sleep apnea six years ago—and I’ve had very good results with a customized oral appliance. In a recent sleep test, I used CPAP half the night and my oral appliance the other half—my blood oxygen levels were higher while using the appliance.

Red flag: Over-the-counter oral appliances for snoring are available, but for optimal results, you need an oral appliance created for your mouth and jaw by a dentist trained to make such a device.

Important: No matter which device you use, you need to get tested first and then retested after you start using the device to make sure that you are getting the oxygen you need.

LIFESTYLE CHANGES

Self-care strategies…

Sleep on your side. This helps keep airways open.

Lose weight, because extra pounds mean extra tissue in the throat. Just a 10% weight loss can decrease apnea events by 26%. However, thin people and children can have apnea, too.

Don’t drink alcohol within three hours of going to bed. It relaxes the airway.

Sing some vowels. In a study by UK researchers, three months of singing lessons helped decrease snoring, which could in turn decrease apnea. What to do: Sing the long vowel sounds a-a-a-e-e-e, taking two or three seconds to sing each vowel. Do this once or twice every day for five minutes a session.

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Source: Chris Meletis, ND, former chief medical officer for the National College of Naturopathic Medicine and currently the executive director of the Institute for Healthy Aging and a physician on the staff of Beaverton Naturopathic Medicine in Oregon. He is author of 18 books on health and healing, including most recently The Hyaluronic Acid Miracle (Freedom Press). www.DrMeletis.com

Date: June 15, 2012 Publication: Bottom Line Personal
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