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Sleep apnea–yet another serious health condition tied to obesity February 4, 2010

Posted by Gretchen Giannelli in Healthcare, Mental Health, Prevention.
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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.

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Comments»

1. Sara Imershein, MD - February 5, 2010

just underscoring the incredibly wide effects of obesity which effects quality and length of life and costs more medical dollars. But it is soooo easy to gain weight and soooo hard to lose it.

2. Ashraf Faden - February 6, 2010

That’s scary. Along the line of sleep apnea causing stroke and heart attacks, it can cause hypertension. This is a link for more information: http://www.jhsph.edu/publichealthnews/press_releases/PR_2000/apnea_hypertension.html

Gretchen Giannelli - February 6, 2010

Great point, Ashraf. Hypertension can be another sign that someone has sleep apnea.

3. Joe - February 6, 2010

Snorers are the butt of many jokes, but science has proved that it is not a laughing matter; here is my story:

I was a snorer for a long time. As I got older, my snoring got more frequent and louder. Also, I was overweight, tired a lot, and liked to take naps during the day. People complained about my snoring and I did not want to sleep in the same room with others for fear of keeping them awake.

Finally, I talked with a doctor about the problem. He sent me home with a machine to check my breathing and pulse while I slept. Eek! The results really shocked me! The doc said my airway was closing off up to 70 times each hour, and that I stopped breathing for as long as one full minute at a time! I had severe apnea. He strongly recommended I start using the CPAP machine, since I was risking damage to my heart due to lack of oxygen.

I had read a little about CPAP machines and always thought I would never be able to sleep with one, since I am a little claustrophobic. Surprisingly, it only took me a few minutes to get accustomed, and I was able to start sleeping comfortably right away.

The mask part is just a small nose manifold that covers the nostrils to blow in air. That keeps the throat inflated like a balloon, preventing throat closures and snoring. One problem is with the straps over the head that keep the nose piece in place. They can be a little annoying at first, and if you change sleeping positions at night, it is possible for these straps to move, causing the nose piece to slip off.

I had been using a Dreamhelmet (a combination sleep mask sound-muffling pillow) for years, to sleep at night and for napping during the day. I always find it hard to sleep without the Dreamhelmet, and was afraid I would not be able to use it with the CPAP mask, but I was wrong.

After using the CPAP machine and mask for a short while, I tried wearing the Dreamhelmet over the CPAP mask, covering up the straps – voila, it worked like a charm! I found that the Dreamhelmet actually helps keep the straps in place when I change positions, so now I can sleep all night in comfort, not being bothered by sound, light, or changing positions. The CPAP combined with the Dreamhelmet are the perfect sleeping combo for me. Dreamhelmets are only sold online at http://www.dreamhelmet.com

As a bonus, I don’t have to eat all the time now to maintain my energy, and I’m able now to exercise and get on a diet to lose weight.

4. Gretchen Giannelli - February 6, 2010

Joe, thanks for the important information you have added here and also for the link to the dreamhelmet.

5. Creating a Rapid Weight Loss Diet Plan - February 7, 2010

[…] Sleep apnea–yet another serious health condition tied to obesity […]


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