Sleep is a bodily function that affects every aspect of your life. But one of the most important is how you feel during the day. Improving your sleep will have a positive effect on your overall health. And your sleep affects those around you as well. You’re a better friend, partner and/or parent when you sleep better.
Kevin Smith, PhD, a clinical psychologist board certified in behavioral sleep medicine, and David Ingram, MD, a board-certified sleep medicine physician, both with the Children’s Mercy Sleep Disorders Center, discuss one of the most common sleep disorders that may be keeping you up at night, and what you can do about it—sleep apnea.
The details on sleep apnea
Dr. Smith asked Dr. Ingram a series of questions. Below is their conversation.
I bet almost everyone knows of someone with sleep apnea. Can you give us an overview?
Dr. Ingram: Sleep apnea means you have pauses in breathing during sleep. There can be different reasons for the pauses. One is if your airway is collapsing and obstructing. What happens is your airway partially collapses when you’re asleep, but you are still trying to breathe hard and get the same amount of air. That can create turbulence in your airway, which makes your airway vibrate, causing snoring. If the airway completely collapses, the person becomes silent. Maybe their chest and their belly are moving up and down, but you don’t hear anything. Your brain senses the changes in your oxygen and C02 levels and goes, “Whoa! We need to start breathing again!” So you have a little awakening, or arousal. That’s good because your airway opens up and you start to breathe again. You may see the person gasp or wake up with kind of a choking sound. The problem is if that’s happening frequently throughout the night, then you’re having these little arousals all night long. This is obstructive sleep apnea.
Is there a heredity factor with obstructive sleep apnea?
Dr. Ingram: Sleep apnea tends to run in families. That probably has to do with the fact that the things that can contribute to sleep apnea, like the structure of your airway, jaw size, tongue size—all those anatomical factors tend to be similar in families. The other thing that can run in families is being overweight or obese. As you add extra weight, your body can also add extra tissue around your neck, which can contribute to airway collapse. Sometimes that fat is also in the tongue, and having a big tongue can contribute to airway obstruction.
What are some of the more common symptoms of sleep apnea?
Dr. Ingram: The most common symptoms in adults are loud snoring and being sleepy or fatigued during the day. People also may be very restless sleepers because they are trying to reposition and open up their airway. They may have gasping or choking awakenings. And sometimes they wake up and have to go to the bathroom during the course of the night. Snoring is very frequently associated with apnea, but to really make the diagnosis, the next step would be to do a sleep study.
For adults, are there sleep study options other than going to a sleep lab overnight?
Dr. Ingram: If you have an adult who might have moderate or severe sleep apnea, and they don’t have any other major illnesses or sleep disorders that could confound the sleep study, then an at-home study works fine. It’s not as accurate, especially for mild sleep apnea, but for someone who has moderate or severe sleep apnea, it’s a reasonable option.
If you’re diagnosed with sleep apnea, what’s next?
Dr. Ingram: There’s a lot of different therapies, and what’s right for one person might not be right for another. In adults, usually the first place we start is with Continuous Positive Airway Pressure, or CPAP. It takes air from the room and blows it into your nose. It’s heated, purified, humidified air—the best you’ll ever breathe.
Dr. Smith: The plus side to CPAP therapy is that it can be effective. The downside is that it’s not easy to get used to. Thirty to 35% of adults struggle and use it less than recommended or abandon it.
Dr. Ingram: It works, but you’ve got to wear the mask every night. It takes effort on the patient’s part, and it takes pairing with an experienced sleep team.
Dr. Smith: If someone is prescribed CPAP and is really struggling, I recommend talking with the prescribing physician about engaging a psychologist or other mental health specialist. There are effective behavioral treatments to help patients get used to wearing it so they can start to feel the benefits.
Dr. Ingram: There are apps and educational materials that are also helpful. Take the time up front to try different masks. See which one is most comfortable. And, make sure you get replacement supplies.
Dr. Smith: And if your child has been prescribed CPAP, our Sleep Disorders Center published a book (edited by Dr. Ingram) entitled, “Sleep Apnea for Children: A Handbook for Families,” available on Amazon. All the proceeds go to helping defer expenses for Children’s Mercy’s families while their children are at the hospital.
So, for patients who may either have mild sleep apnea and CPAP isn’t appropriate, or have moderate/severe apnea and can’t tolerate CPAP, what are some of the other therapies?
Dr. Ingram: There are several therapies. Some involve lifestyle changes and some do not. One thing that is incredibly hard to do, but that helps, is to work on nutrition and exercise to reach an optimum weight. Another one is to look at what you are consuming, like sedatives or alcohol, that may be worsening your sleep apnea. Adults who have mild to moderate sleep apnea and can’t tolerate CPAP are having success with a dental device called a mandibular advancement device. This is a mouthguard-like device that a dentist can make for you, and you wear it at night. It pushes the lower jaw forward and brings the structures of the airway up and out, helping open up the airway and preventing airway obstruction. Surgery is an option. In kids a lot of times we’re talking about tonsils and adenoids, but in adults, the newest treatment is called a hypoglossal nerve stimulator. That is an implanted pacemaker-like device. You turn it on at night and when you are breathing, this device delivers a gentle pulse of energy to the nerve that serves your tongue. This causes your tongue to move forward instead of falling back, and that can prevent airway obstruction.
Dr. Smith: And some patients respond well to positional therapy; gravity can make snoring and sleep apnea worse when you sleep on your back. The lower tongue, lower jaw, and soft tissues of the palate and uvula can easily fall into and block your airway. Positional therapy devices help keep you on your side or stomach all night. If you’re crafty, you can even make one yourself by sewing a long pocket into the back of a t-shirt and filling it with 2-4 tennis balls.
Dr. Ingram: Yes, there are definitely options if CPAP isn’t right for you.
So the take-home message today: If you are tired despite an adequate amount of sleep and you snore, consider talking to your doctor about it—you may have sleep apnea. And if you do, there are treatments available to improve your sleep and as a result, your quality of life.
Associate Program Director, Sleep Medicine Fellowship; Associate Professor of Pediatrics, University of Missouri-Kansas City School of Medicine; Education Associate Professor of Pediatrics, University of Kansas School of Medicine