1.  Do you wake up choking or gasping, or is more like a feeling of worry or panic?

It’s important to be clear about your symptoms. Stress (caused by work or home problems, for example) might be the reason why you have trouble sleeping. These worries can make you feel like you have many things left undone, and so you wake up, wanting to do more. Waking up gasping for breath is something else. It suggests that airflow stops for some time as you sleep. When your brain senses lack of oxygen and increase in carbon dioxide, it triggers arousal from sleep (choking and gasping) so that you can consciously breathe again.

2.  Has anyone seen you stop breathing while you sleep?

Have a significant other or a family member like your sister watch you for a few hours while you sleep. Cessation of breathing for 10 seconds or more is cause for concern. Patients with a severe disorder stop breathing for as long as three minutes. Observed in a clinic, patients can have from 30 to 500 episodes each night. You report only one episode, around the time that you fall asleep, but it’s possible that this happens several times each night but you are too sleepy or tired to remember. Patients with sleep apnea are often unaware of the awakenings.

3.  Are you overweight?

Fat deposits in the neck can reduce airway size. When you sleep, fat deposits compress the airways more (compared to when you are in an upright position), and that might account for intermittent stoppage of airflow.

4.  Do you snore?

By itself, and in the absence of other symptoms, snoring is not associated with long-term health risks. However, for a person with sleeping problems, snoring might signal narrowing or blockage of the upper airways. Soft tissues in the throat and neck might be “floppy” and collapse backwards as you sleep. It might be caused by anatomical abnormalities like a large tongue or swollen tonsils.

5.  Are you always sleepy in the daytime?

It’s absolutely okay to have a mid-afternoon nap plus shorter night-time sleep. At workplaces, it’s not unusual for employees to doze off during the lunch hour. At home, an afternoon nap with the kids is a great way to re-energize. However, a disorder that causes fragmented sleep leads to excessive sleepiness in the day. You notice it first as dozing while watching TV or reading a book, but as it gets worse, you might see memory loss, inability to concentrate, irritability, or slow thinking. You might be caught sleeping inappropriately, such as during important meetings. Watch out for sleepiness while driving or operating machinery. Persons with sleep disturbances are more likely to have motor vehicle accidents compared to other drivers.

Frequent episodes of low oxygen and high carbon dioxide adversely affect the heart and lungs.  Obstructive sleep apnea (OSA) is associated with hypertension and heart problems, including irregular heartbeats.

There is another kind of sleep apnea, where the cause is not obstruction of the airway but rather the inability of the brain to tell the body to breathe. This is called central sleep apnea (CSA). The main difference between CSA and OSA is that there is no respiratory effort in CSA, while in OSA, the body makes breathing motions against a blocked airway.

When the brain detects high levels of carbon dioxide, it tells the respiratory system to breathe so that this waste product is removed. While awake,some patients with CSA tend to hyperventilate (shallow and fast breathing), usually because of underlying heart or lung disease, but sometimes for no identifiable reason at all.

Should you worry?

The answer is yes.  This should be checked. But before going to a doctor, make sure you get a handle on your symptoms. Record your nocturnal waking times and episodes of sleepiness during the day. Ask another person to observe you while you sleep. Remember that unlike other ailments, you’re not conscious when the worst symptoms occur. Perhaps all you remember is a few awakenings, a morning headache, and tiredness during the day.

What kind of doctor should you see?

This largely depends on the nature of your symptoms. A primary care physician can do an overall evaluation and help you with associated problems like obesity and hypertension. Heart and lung problems are best seen by internists (cardiologists and pulmonologists). If snoring is a prominent symptom, consult an otorhinolaryngologist (ENT specialist). If problems like headache, behavior change, and loss of cognitive ability are prominent, then a neurologist is the best person to see.

A trained physician can observe certain parameters as you sleep, such as oxygen, carbon dioxide, heart rate, brain activity, eye and chin movement, and ventilation. This usually means overnight hospital confinement. Monitors are clipped or taped onto the body so that there is no pain.

Is it preventable?

OSA tends to happen less when sleeping on your side, compared to sleeping on your back, but that is no guarantee. If you are obese, you now have another compelling reason to lose weight. Unfortunately, there are no preventive measures for CSA, but it helps to avoid alcohol before bedtime and to stop smoking. Do not self-medicate with sedatives. If you are already diagnosed with a heart, lung, or neurologic disease, make sure your condition is re-evaluated considering your new symptoms.

Don’t be afraid to seek help. Sleep disturbances are one of the most common causes of medical consults. Studies show that more than half of adults complain of sleep problems at least once in their lifetime, and up to one in five have chronic sleep disturbances. Researchers believe that sleep apnea is as common as adult diabetes. It is not diagnosed in 80 to 90 percent of affected individuals.

So sleep apnea is more common than you think. If this is what you have, it should not remain undiagnosed and untreated. There are many treatment options, depending on the nature and degree of the disorder. Treatment means better performance at work, avoidance of accidents, and overall improvement of quality of life.

Filed under: Fitness

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