Sleep Apnea

Sleep apnea is a sleep disorder characterized by hypopnea, pauses in the normal breathing cycle during sleep. Apnea comes from a Greek word, literally meaning "without breath." The pauses last anywhere from ten seconds to a minute, causing the individual to miss one or more breaths. Sleep apnea sufferers often repeat this process several hundred times a night yet rarely remember these episodes upon waking.

According to the National Sleep Foundation, 18 million Americans suffer from sleep apnea. This number may be inaccurate because sleep apnea is often ignored or misdiagnosed. Acknowledgement and treatment of the disorder is a relatively recent phenomenon. The first reports of what is now called obstructive sleep apnea were made in 1965. William Osler, a 20th century physician, called sleep apnea "Pickwickian Syndrome" after Joe, the "fat boy" from Charles Dickens’s first novel, The Pickwick Papers. Joe was known to consume large amounts of food and frequently fall asleep throughout the day. Initially, a tracheostomy was the only recommended treatment for sleep apnea. The procedure often helped but there were many associated side effects and problems.

Sleep apnea is found in individuals of any age, race or sex; yet, there are several risk factors associated with the disorder. Several of these risk factors are genetic or began at birth and cannot be changed. A family history of sleep apnea is a big red flag. Individuals 30 years of age or older have a higher risk of developing sleep apnea; that risk increases even further after the age of 65. Males are two to three times more likely to suffer from sleep apnea than females; yet, once women have passed through menopause they are at the same risk level as men.

Ethnicity also plays a role – African Americans, Hispanics and Pacific Islanders are at an increased risk for sleep apnea. Some surmise that due to ethnic structural differences, these individuals have narrower throat and nasal passageways, heightening the risk for sleep apnea. Spine deformities, such as scoliosis, can make breathing more difficult and thus increase the chance of suffering from sleep apnea. Craniofacial conditions, those that cause abnormalities of the head and face, make individuals more susceptible to sleep apnea. These craniofacial conditions include Marfan’s syndrome and Down syndrome.

Individuals can make lifestyle changes to help eradicate or lessen the effect of several sleep apnea risk factors. Being overweight or obese is the number one risk factor for sleep apnea. 70 percent of apnea cases are overweight individuals. Considering the rapid expansion of people in the United States alone, this is a major cause of concern. According to the Centers for Disease Control, 65 percent of adults are overweight, 30.5 percent are obese and five percent are severely obese. Children are not exempt from this gathering girth; 13 percent of six to 11 year olds and 14 percent of 12 to 19 year old are overweight, according to the U.S. Surgeon General. A sleep apnea risk factor that often correlates to obesity is neck circumference – 17 inches around for men and 16 for women. It can signal the existence of excessive throat tissue.

Simply having a natural excess of nose, mouth or throat tissues can also place one at a greater risk for sleep apnea. Individuals with craniofacial bone deformities, especially those with small, receding jaws have been known to suffer from sleep apnea more often. Endocrine system disorders, hypothyroidism or acromegaly, can also increase sleep apnea risk. Chemical use or abuse can heighten the risk of sleep apnea. Chemicals that are known to be risky include: alcohol, sleeping pills, narcotics, barbiturates, sedatives and cigarettes. These substances all relax the muscles that work to keep airways open. Using too many pillows, sleeping in the supine position or engaging in poor sleeping habits – going to sleep at various times in different locations – can lead to sleep apnea symptoms, as well.

The preceding risk factors are for obstructive sleep apnea, one of three sleep apnea types. Central sleep apnea, although it exhibits similar symptoms, is a very different disorder associated with different risk factors. Disorders of the heart, such as atrial fibrillation or congestive heart failure, can lead to central sleep apnea. A stroke or brain tumor can impair the brain’s ability to regulate breathing if the problems occur in a certain area of the brain. Neuromuscular disorders – amyotrophic lateral sclerosis (Lou Gehrig’s disease), spinal cord injuries and muscular dystrophy – can affect the breathing function of the central nervous system. Sleeping at a higher altitude than one is used to may also lead to central sleep apnea.