Sleep apnea is a common disorder with potentially dangerous results if left untreated. Sam Baker talked about this with Dr. David Luterman, Medical Director of the Sleep Center at Baylor Medical Center at Dallas.
Dr. Luterman: Now the airway can completely close and you will stop breathing, and that is called an apnea. Or the airway may narrow, so airflow is restricted and the amount of air you move in and out is reduced, and that is called a hypopnea. They disrupt sleep, fragment sleep, and cause a major disruption of sleep where sleep is no longer refreshing.
Sam: What causes this?
Dr. Luterman: It’s an anatomical variant. Everybody’s airway narrows when they go to sleep. However, if you start out with a small airway and then you narrow further, the airway gets so small you have a hard time breathing or it closes and you’re not breathing at all. The body doesn’t like that. So the patient awakens from sleep and he may do this five times an hour, ten times an hour, 30 times an hour, a hundred times an hour…
Sam: Sounds very dangerous.
Dr. Luterman: It can be. Because of the various different physiologic things that happen during sleep with sleep apnea, it’s associated with an increased incidence of hypertension. It’s associated with cardiac disease, including coronary artery disease that leads to angina and heart attack, heart failure, cardiac arrhythmias, of which atrial fibrillation is very common. And a higher incidence of stroke. Because people are sleepy and tired, they have an increased incidence of automobile accidents. Also, if you have a dangerous job – you’re climbing phone poles or working with heavy equipment – you could fall asleep working with that and the accident rate is increased in the workplace.
Sam: Isn’t a symptom of this, maybe, snoring?
Dr. Luterman: The vast majority of patients with sleep apnea snore, and they snore loudly. It’s not necessary that you snore. I have several patients that don’t snore and have severe sleep apnea. The next thing that you notice is sleepiness. Patients have unrefreshing sleep.
Sam: But do you undergo a sleep study or something to determine this?
Dr. Luterman: You spend a night in the lab or maybe two nights. They monitor your brain waves, your breathing, your heart rate, you oxygen. And they also look at your legs because we look at periodic leg movement that can disrupt sleep. So after you’ve had a night in the lab, they make a diagnosis. And then you may come back for a study to see if positive pressure - the CPAP mask that a lot of patients have – will improve that and what pressures you need for control.
Sam: First of all, what does CPAP stand for?
Dr. Luterman: CPAP stands for Continuous Positive Airway Pressure. And what that does is there’s an interface that either fits on your nose or over your mouth and nose that puts a pressure into your upper airway, and that works as a pneumatic splint to keep the airway open so it won’t collapse while you’re breathing. There are other treatments. If you have mild to moderate sleep apnea, and you’re not morbidly obese, often an oral airway that splints and pulls the jaw forward can open the back part of the throat and work. There are surgical procedures that help, but they’re actually major surgeries of moving things around and they’re big surgeries.
Sam: Does insurance cover the various kinds of treatment or even a sleep study to determine a diagnosis?
Dr. Luterman: It’s rare now to find insurance that doesn’t cover it?
Sam: How widespread a problem is this? How many people suffer from sleep apnea?
Dr. Luterman: We know sleep apnea is more common in men. We know it’s more common the heavier you are. It’s more common the older you are.
Sam: Why more common in men than women?
Dr. Luterman: We don’t know. Part of it probably is hormonal. After women go through menopause, they tend to catch up. Their incidences of sleep apnea rises. It never catches up to men. But the differences between men and women are less.
Sam: Is it something you could possibly live with for years before you ever know you have it?
Dr. Luterman: It’s estimated 75 percent of the patients with sleep apnea never go diagnosed. You have to be aware. You certainly want to get sleep apnea diagnosed prior to having core morbidities - hypertension, heart disease, stroke – because a lot of these things are irreversible. If you have a heart attack, whatever heart muscle you lost isn’t coming back. If you had a stroke and you’re paralyzed, that’s not going to come back once you’re treated. It’s important to make that diagnosis, not only because you’ll feel better. From a health maintenance standpoint, you’ll live longer.
Dr. David Luterman is Medical Director of the Sleep Center at Baylor Medical Center at Dallas.
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