Sleep apnea–yet another serious health condition tied to obesity February 4, 2010Posted by Gretchen Giannelli in Healthcare, Mental Health, Prevention.
Obesity is in the forefront these days as a serious public health problem. According to CDC, during 2007-2008 about one-third of US adults were considered obese which is defined as:
“a body mass index (BMI) of 30 or greater. BMI is calculated from a person’s weight and height and provides a reasonable indicator of body fatness and weight categories that may lead to health problems. Obesity is a major risk factor for cardiovascular disease, certain types of cancer, and type 2 diabetes.”
As if this weren’t enough, obesity is also linked to sleep apnea, a temporary cessation in breathing while sleeping, which deprives the brain of oxygen and causes disturbed sleep and may lead to daytime sleepiness, insomnia and mood disorders, enlarged heart and/or a heart attack or stroke. The quantitative definition of sleep apnea is “if you stop breathing completely or take less than 25% of a normal breath for a period that lasts 10 seconds or more”. According to the National Sleep Foundation about 18 million people have sleep apnea.
Although you don’t have to be overweight to have sleep apnea, obstructive sleep apnea is more likely in overweight individuals, who have excessive body fat around their necks. This is in contrast to central sleep apnea, a much rarer type of apnea (5%) caused not by obstruction, but by improper brain signaling to breathing muscles and not tied to overweight. Mixed apnea is rarer still and includes both types.
Know anyone who snores? This can be a sign that they have obstructive sleep apnea. The snoring sound you hear is a vibration of excess tissue in the base of the throat when the airway becomes partially obstructed by the tissue. Partial obstruction means less oxygen is being delivered to the lungs and brain. The brain picks up the signal and “alerts” the individual which causes partial waking. This is when the snoring stops momentarily followed by a deep gasp. Even though snorers may not be fully aware of this partial waking, it prevents them from going into deep REM sleep, the type of sleep that is restorative and important to good health. Although these episodes vary depending on the severity of the problem some people can have many interruptions or alerts per hour all night long.
My friend Mark (not his real name) shared details with me about his sleep apnea and how it has impacted his life. He said he suffered for over five years with not sleeping well, feeling tired during the day and actually falling asleep a lot in the afternoon. He also said he was “snoring like a train” and that his wife had to go to sleep before he did or she would not be able to even fall asleep. His snoring was worse on his back, but occurred in all positions. He was also continuing to gain weight during this period and considers himself overweight now.
Mark’s doctor sent him to a local hospital to participate in a sleep study, which involved spending the night in the sleep lab hooked up to electrodes to monitor his sleep and breathing. Results revealed that he was having 4 episodes per minute of apnea. Roughly once every 15 seconds Mark’s brain was alerting him to “get more air” and he was being partially awakened. Just thinking about it is exhausting.
Options to treat sleep apnea are limited. There are dental appliances which reposition the jaw and may prevent obstruction, and there is the surgical option which involves removal of excess tissue in the throat, but is said to be very painful and doesn’t always work. The treatment of choice is the CPAP mask (pronounced “see-pap”). CPAP stands for constant positive airway pressure and by means of a mask worn over the nose and mouth the sleep apnea patient receives a steady flow of air into their lungs. The constant pressure keeps the airway open and sleep quality improves.
Mark says the CPAP is not fun to wear as the mask is not all that comfortable and there is a tube leading from the machine next to his bed into the mask which gets in the way. Other complaints are that some people get claustrophobic with the mask on their face, the settings on the CPAP need to be calibrated every year or so which requires another overnight stay in the sleep lab and the masks wear out and need replacing every so often. Mark said a lot of people get fed up with the CPAPs and stop wearing them and that they don’t check in with their doctors as often as they should.
Although Mark complains about the CPAP, he admits the device has helped him and that his wife can sleep better, too, without his snoring. He confided that his doctor told him he could probably get rid of his sleep apnea and go off the CPAP device altogether if he returned to a normal weight. Mark said he was really trying to work on that.