In the course of a day at the clinic, we encounter a wide range of human frailties. Particularly when we do Department of Transportation (DOT) exams, the topic of sleep and rest arises. Specifically, we are dealing with obstructive sleep apnea (OSA).
There are so many issues like this that make me wonder whether a condition has worsened in recent years or whether there is merely more awareness of it today. The former is possible because some of the causative factors may be more in play. The latter is likely because information is ubiquitous today on the internet and 24/7 news cycles.
So what is OSA? In some folks, during sleep there is a partial or complete obstruction of the airway. This leads to low oxygen, which your brain bitterly resents. It reacts by driving blood pressure and heart rate up, and this acceleration of vital signs stimulates the waking centers of the brain. Thus, sleep is interrupted.
The person who experiences this usually snores loudly. Spouses, bed partners, and possibly the neighbors and pets are all suffering sleep loss. Snoring is not just the subject of numerous complaints. It might be a sign of a serious health issue.
How serious? OSA interrupts sleep cycles, so it affects circadian rhythms in a way that alters hormone secretion that maintains and repairs your body. The consequences may include metabolic syndrome, creating weight gain and eventual obesity. Recall from our previous discussions that obesity is the #3 cause of cancer. It leads to heart disease, type II diabetes, and hypertension. OSA can also interrupt cardiac rhythm, causing sudden death.
The person with OSA may have unexplained daytime sleepiness, and the exhaustion brings anxiety, irritability, forgetfulness, and depression. Morning headaches are common. Sleep loss is compounded also by nighttime urination, gastroesophageal reflux disease (GERD), or significant night sweats related to all the work you are doing instead of resting. Decreased sex drive is possible due to the hormonal issues or overall health decline.
I get involved with OSA doing DOT exams because the DOT is very concerned about it as a safety issue. Several studies have been done to assess whether people with OSA are more likely to have traffic accidents. A recent study suggested that drivers with OSA are 2.5 times more likely to have motor vehicle accidents, and that the risk is reduced by 70% when the condition is properly treated. The AAA Foundation says there are 328,000 MVAs and 6,400 fatalities on American roads annually.
Risk factors for OSA are still being studied. It was thought from early studies that obesity was causative, but with closer investigation, the relationship of OSA to obesity is very unsettled. Many obese people have no OSA problem at all, so that issue is still debated.
Neuromuscular laxity in the upper airway may be a result of neurological disease or other factors such as alcohol or drug use. Still others appear to have structural/anatomical issues that may enable closure of the airway during sleep.
So if you snore, and you want to find out whether you have OSA, what’s next? One option is to spend thousands of dollars for a night in a hospital or a sleep center. You will be wired to a monitor system while strangers watch you sleep. It’s a little creepy, and a lot expensive.
The other option is to come visit with me. If you appear to be at risk, we can program a headset for you to take home to your own bed and sleep with it. Next day, you return the headset and we upload the data from the recording chip to a neurologist. We get the official report the next day, and I’ll call you and we’ll chat about it. Cost for this option is $250, and you get to sleep in your own bed. I promise I will not come over to watch you sleep. I need sleep myself, plus it would be creepy, but still less expensive.
The sleep study will show if you are having episodes of apnea (when you stop breathing). It will show your heart rate, ventilation rate, and oxygen saturation as well. The system will know if you are awake or asleep. If you sleep like a baby, your study will be negative, and you can rest easy. If you have a positive study, we will need to talk about treatment options.
Many people associate OSA with the “mask,” the continuous positive airway pressure (CPAP) device. Additional options are available, including a mouthpiece that advances the jaw. Exercise, with or without weight loss, helps with OSA. I have spoken with an anesthesiologist who is inventing a pillow that will help position the head to keep the airway open. I like this last possibility because it is less expensive, and it may be vastly superior for claustrophobic or post-traumatic stress disorder patients.
So whether you are the one who’s “losing snooze,” or whether you are the spouse/partner/neighbor/pet, you can see there may be an issue that needs assessment. If you have it, you need to consider your options before you get in trouble.
I hope I’ve given you something to consider here. Sleep on it, and let me know if I can help you.
