When sleep threatens health

Registered Polysomnographic Technologist Lisa Almy, with the Oregon Sleep Specialists Clinic of La Grande, demonstrates how to put on a continuous positive airway pressure (CPAP) machine. The CPAP is designed to provide air pressure at a customized regularly adjusted level to keep the airway open for those suffering from sleep apnea. CHRIS BAXTER/The Observer

by TRISH YERGES / Observer correspondent 

Obstructive sleep apnea can lead to serious health problems including stroke, heart attacks and high blood pressure 

Sleep can be restful and healthy unless you are the one in five people who have some sort of sleep-related disorder.   

In that case, you are among 40 million people whose health is at risk because they don’t get enough sleep or the quality of sleep they need. 

Of those with sleep disorders, 18 million suffer from sleep apnea, which literally means “sleep without breath.”

There are two principal types of sleep apnea. One is central sleep apnea, when the brain doesn’t send proper signals to the muscles that control breathing. The most prevalent form of sleep apnea, though, is called obstructive sleep apnea, or OSA.

“Obstructive sleep apnea is a serious and potentially life-threatening medical disorder. It is characterized by repetitive collapse of the upper airway during sleep with consequent cessation of breathing,” states a brochure from the clinic office of the Oregon Sleep Specialists in La Grande.  

A sleeping patient is usually not aware that he is exhibiting breathing pauses unless someone witnesses it and tells him. However, the sleeper may get a clue if he is suddenly awakened by his own loud or disruptive snoring, snorting, choking or gasping. 

Still, it is usually at the insistence of a caring spouse or doctor that a person will finally get examined and tested for OSA.

“Any snoring at all is a sign of problems, and if any of these symptoms occur five or more times per hour during sleep, it is a sleep disorder,” said Lisa Almy, a registered polysomnographic technologist for Dr. Mark Gabr of the Oregon Sleep Specialists at 700 Sunset Drive, Suite B in La Grande.  

While statistics published in the New England Journal of Medicine state that the prevalence of OSA among men and women between the ages of 30 and 60 is 24 percent in men and 9 percent in women, Almy said the OSS clinic has not noted this gender difference among their patients.   

“We receive patients of all ages with OSA, and the prevalence of OSA cases in men and women are about 50-50 percent,” Almy said. 

Predictably, a high percentage of patients go undiagnosed.

“This can lead to serious health problems like depression, weight gain, high blood pressure, Diabetes-2, stroke and heart attacks,” Almy said.  “It’s better to be tested. If you fix the sleep apnea, those other problems will be improved greatly. We’ve found that OSA is often the root cause of these other conditions.”

Risk factors vary and even seem co-related, but Almy said that one prominent factor seems to underscore them all.     

“It’s all about the size and shape of someone’s airway, and that’s why it can affect someone of any age, gender or weight,” she said. 

A patient’s anatomy changes with age, and sometimes there is also a genetic predisposition for OSA, but regardless, the following risk factors are red-flag symptoms that an examination is in order.

Risk factors

• Age — When a patient ages, the muscles in his throat often lose their tone and may sag toward the back of the throat when laying down to sleep. These sagging muscles may narrow or even close off the airway. 

“It started out that doctors could pinpoint easily those people who had OSA, and those people got treated first.  But as the years have gone on and doctors have become more informed on OSA, we’re seeing more and more patients of all ages with OSA, because again, it is all about the size and shape of the airway,” Almy said.

 • Gender — According to some patient population studies, the number of middle-aged men with OSA are almost three times as great as the number of middle-aged women. This gender difference seems to diminish when women become postmenopausal and gain weight. This gender difference is not observed in all patient populations. For the OSS clinic in
La Grande, gender has not been a distinguishing risk factor for OSA. 

 • Obesity — Some studies show that males with fat distribution around the abdomen, torso and neck are at higher risk for OSA.

The same appears to be true for postmenopausal women whose fat is distributed in the lower thighs and buttocks. Reducing the body mass index to below 30 is recommended for diagnosed OSA patients.

“Weight loss does help, but it’s not a cure for it,” Almy said.

Of course, even nonobese people and pediatric patients can have OSA if there is a family history of it or the patient suffers from allergies that cause nasal congestion and difficulty breathing through the nose. 

• Neck Circumference — This is also related to obesity. A large neck girth has been found to link to OSA in men and women. “Any woman with a neck circumference over 16 inches or a male with a neck circumference over 17 inches is at risk for OSA,” Almy said.

• Upper Airway Anatomy — Several anatomical structures in the throat can cause OSA, including enlarged adenoids, uvula, tongue, tonsils, soft tissue volume or fat pads in the throat. Mouth breathing could also be an indicator of some anatomical condition that needs to be examined by an ear-nose-and-throat specialist.

“In addition to that, our scaling (vertical) muscles in our neck that normally keep our airway open when we’re awake, will relax in sleep, and then those tissues could sag into the airway,” Almy said.

Some patients have these tissues surgically reduced or removed to open up the airway. 

• Alcohol and medications — Any substance that relaxes the scaling muscles of the throat may cause the tissue to collapse and block the airway while sleeping.

• Smoking — This behavior can do a lot of injury to the soft tissue of the throat, including causing inflammation and water retention in the upper airway, which affects how much airflow occurs. When a patient quits smoking, the risk drops.

“A common test for OSA is an overnight sleep study, which can be done in the lab or in a patient’s home,” Almy said. “The in-home study is an unattended study, and the in-lab study is an attended study where a medical professional is present with you.” 

Gabr, a board certified sleep specialist and neurologist, is the medical director at the Oregon Sleep Specialists clinic where in-home sleep studies are arranged. Almy equips OSA patients with a Continuous Positive Airway Pressure machine or CPAP. 

“It’s continuous because air is constantly blowing,” Almy said. “Whether a person is inhaling or exhaling, the pressure is still blowing the same. It’s acting as an air splint to keep the airway open.”

Most OSS patients seem to tolerate the CPAP therapy. Almy said that’s due, in part, to the new equipment and the humidifiers. The CPAPs that the OSS clinic uses are manufactured by Philips Respironics and ResMed.

The OSS clinic fits their patients with a CPAP machine and teaches them how to use it. 

“A person doesn’t have to be referred by a physician to set up an appointment at the OSS La Grande clinic,” Almy said. “Just contact the Oregon Sleep Specialist clinic at 866-285-4245 to be seen at the La Grande office.”

Patients without health or medical insurance can work out a monthly payment plan with the Oregon Sleep Specialist clinic’s administration.

For 10 tips on how to avoid common problems with CPAP machines, see the Mayo Clinic website at http://www.mayoclinic.com/health/cpap/SL00017