Apnea means a "pause" or interuption in breathing and "sleep apnea", rather
obviously, refers to an interruption in breathing that occurs during sleep. Sleep
apnea itself is generally divided into two types; "central sleep apnea" which is
caused by a problem with the brain, and "obstructive sleep apnea" which is caused
by closing-off of the airway during sleep.
Obesity is a strong risk factor for obstructive sleep apnea although not all patients
with sleep apnea are obese and not all obese people develop sleep apnea. In
obesity, fatty tissue can accumulate in the throat and grow to a thickness that it
causes the airway to become very narrow (see diagram below). While this
narrowing may not present a breathing problem during the day, during sleep, the
muscles that support the opening of the throat relax enough that the fatty bulge
closes down the airway as the patient is a drawing a breath in.
This causes breathing to stop, sometimes for as much as ten to twenty seconds
until the patient gasps and either rises up or rolls over into a different position in
order to breathe. This can happen many times during the night.
While we might expect people to remember waking up and gasping during the
night, they usually do not. Often, patients with obstructive sleep apnea believe
that they are sleeping soundly through the night. In fact, they will often tell their
doctor that they sleep "too well"; that they can fall asleep anytime and
anywhere. Indeed the primary symptom of obstructive sleep apnea is chronic
The actual effect of sleep apnea is usually as follows: Patients go to bed feeling
very tired and often fall rapidly to sleep. Most people with sleep apnea begin to
snore---snoring is caused by the same narrowing and vibration of the airways
that can cause sleep apnea. As a patient falls deeper into sleep, an observer
would notice their snoring often (but not always) becomes louder and louder until
there is a "pause" lasting several to perhaps twenty seconds. Immediately
following the pause in snoring, the patients chokes or gasps suddenly, usually
shifts position and then the whole cycle starts again. In severe cases, people
can stop breathing like this hundreds of times during each night. The effect of
this is that people never get restful sleep. They fall into the first stage of sleep
called "alpha sleep", but as they drift into deep (delta) sleep, the apnea occurs
and causes them not to fully awaken (at least not usually) but to rise back into
alpha-sleep. Because these patients rarely awaken fully, they cannot remember
Diagnosis of sleep apnea usually requires a "sleep study" wherein a patient sleeps
for an evening in a medical facility while their breathing, brain waves, heart rate
and oxygen levels are continuously monitored. Even before such a study is
performed, there are a few classic symptoms of obstructive apnea that people
should know. These symptoms are:
-Chronic fatigue lasting months or years
-Snoring as reported by a spouse or even people in the next room.
-Snoring with gasping
Once a patient is diagnosed with sleep apnea, there are several ways to help
them. The most immediate relief is usually through a machine-assisted breathing
technique called C-PAP (continuous positive airway pressure). A patient wears a
tight-fitting mask over the nose only or over the nose and mouth at bedtime.
The mask is connected to a C-PAP machine that pushes a pre-determined
amount of humidified and pressurized air (or even pure oxygen) into the mask.
When the patient begins to inhale the airway stays open because the the air
pressure from the machine literally inflates it. Itsead of chocking and gasping all
night, patients on CPAP sleep well, often for the first time in years, and awaken
refreshed. Unfortunately, some patients find the mask and the noise from the
machine to be intolerable and will often just stop using C-PAP.
Weight loss can often vastly improve obstructive sleep apnea and many patients
who were dependent upon C-PAP when heavy can stop using it and still sleep
well once thinner. Unfortunately, weight loss is not always effective and of
course, even when it is, weight regain will cause the apnea to re-appear.
Surgery can be a last resort for patients with severe sleep apnea who cannot or
will not use cpap or lose weight.
Obstructive sleep apnea is strongly linked to obesity and improved by weight
loss. It is a debilitating and often hidden ilness but should be suspected in
overweight and chronically fatigued snorers.
Sleep Apnea and Weight
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