WHAT HAPPens when you stop breathing temporarily during sleep?

Sleep apnea is a potentially serious sleep disorder in which breathing repeatedly stops and starts involuntarily. It is a common condition, as common as type 2 diabetes; however, there are still many people who have never heard of it, and many don’t even know they temporarily stop breathing in their sleep. It is estimated that 22 million Americans suffer from sleep apnea, but 90% have no idea they have it. Because of this lack of awareness by the public, the majority of sleep apnea patients remain undiagnosed. This is a cause for concern, since when left untreated, sleep apnea can cause a variety of health problems in the long run, such as high blood pressure, heart disease and abnormal cholesterol levels. So why is this condition somewhat under-recognised compared to many other common conditions? 

Dr. Joseph Krainin, a sleep medicine specialist based in the United States, believes that there are two main reasons why many people live their lives without knowing that they have sleep apnea. The first being that the number of physicians trained in sleep medicine is still relatively small and the second being that the public don’t realise how serious sleep disorders can be. Frequent, loud snoring is one of the main indicators of sleep apnea – many people see this as an irritating habit, an annoyance, with very little people concluding that underneath the snoring, there may be an underlying medical condition. With that being said, not all snorers have sleep apnea and some can even have it without its most well-known symptom. In addition to the snores, other symptoms can include excessive daytime sleepiness (hypersomnia), difficulty staying asleep (insomnia), gasping for air during sleep and morning headaches. However, the symptoms present depends on a variety of factors, including the severity of the condition.  

There are several types of sleep apnea, but the most common is obstructive sleep apnea (OSA). This type occurs when the throat muscles relax intermittently and block the airway during sleep. During this period, breathing may be inadequate, the oxygen level in the blood may drop and cause a buildup of carbon dioxide, lasting for ten seconds or longer before the brain senses this impaired breathing and briefly rouses the person from sleep, reopening the airway. The awakening is usually brief, so many people end up not remembering it, and this pattern can repeat itself five to thirty times or more each hour, all night. These disruptions may decrease the ability to reach the desired, restful phases of sleep. For example, it may be harder for sleep apnea patients to reach a period of deep sleep (Stage 3).  

Figure 1 – diagrams comparing normal and closed airways

Image source: https://www.sleepdr.com/the-sleep-blog/so-what-if-i-snore-the-link-between-snoring-and-sleep-apnea/

Anyone can develop obstructive sleep apnea (OSA), but there are various factors that can put people at increased risk. One risk factor is excess weight – being overweight can cause fat to deposit and accumulate in the upper airway, obstructing breathing. The prevalence of OSA has risen substantially since the 1990s, parallel with the worsening obesity epidemic. That said, not all patients with OSA are overweight. Some people may have naturally narrow airways, or they may have enlarged tonsils which block the airway. Another interesting risk factor is sex. According to Mayo Clinic, men are twice as likely as premenopausal women to have OSA. This is due to the levels of oestrogen and progesterone in women’s bodies. These hormones act as stimulants and play a role in keeping airways open by maintaining muscle tone in the throat. Furthermore, there are multiple treatments and therapies for OSA, depending on the severity. For example, patients with mild OSA are usually recommended lifestyle changes, whereas patients with moderate to severe cases are usually recommended devices to keep the airway open, the most common being CPAP (continuous positive airway pressure).  

We have all heard about the importance of sleep, and many of us have experienced tiredness and unproductivity when only get a couple of hours of it. We know that using electronics and exposure to artificial light at night can affect the quality of sleep, and that we should try and eliminate these sources of light at night. If we all know the importance of sleep, shouldn’t sleep disorders like sleep apnea be addressed more? 

Bibliography:

Mayo Clinic. (2020). Sleep Apnea - Symptoms and Causes. [online]. Available at: www.mayoclinic.org/diseases-conditions/sleep-apnea/ [Accessed Sept. 2020].

Mayo Clinic. (2018). Obstructive Sleep Apnea - Symptoms and Causes. [online]. Available at: www.mayoclinic.org/diseases-conditions/obstructive-sleep-apnea/symptoms-causes/syc-20352090. [Accessed Sept. 2020].

American Sleep Apnea Association. (2019). Sleep Apnea Information for Individuals. [online]. Available at: www.sleepapnea.org/learn/sleep-apnea/. [Accessed Sept. 2020].

Nowak, C. (2017). 90 Percent of People Don’t Know They Have This Disorder—Do You? [online]. Available at: www.thehealthy.com/sleep/sleep-apnea/sleep-apnea-hard-to-detect/. [Accessed Sept. 2020].

Health Essentials from Cleveland Clinic (2018). Could You Have Sleep Apnea — Without Knowing It? [online]. Available at: health.clevelandclinic.org/sleep-apnea-its-waaaay-more-common-than-you-think/. [Accessed Sept. 2020].

sleepfoundation.org. (2018). Menopause and Obstructive Sleep Apnea. [online]. Available at: www.sleepfoundation.org/articles/how-handle-obstructive-sleep-apnea-during-menopause. [Accessed Sept. 2020].

sleepfoundation.org. (2020). How Weight Affects Sleep Apnea. [online]. Available at: www.sleepfoundation.org/sleep-apnea/weight-loss-and-sleep-apnea#:~:text=Having%20sleep%20apnea%20can%20also. [Accessed Sept. 2020]

 

Natabhorn (Plume Plume) Kashemsri Na Ayudhaya

(Year 12 Student at Bangkok Patana School)