What is Sleep Disordered Breathing?

Sleep Disordered Breathing is the presence of abnormal breathing patterns during sleep with detrimental consequences. It’s not just snoring and everyone that snores does not have Sleep Disordered Breathing.

Why is Sleep Disordered Breathing important?

• Humans normally spend 30% of their time sleeping, so anything that affects sleeping affects a large part of our lives.
• Abnormal breathing patterns can lead to acute and chronic illness.
  It may be a life-threatening condition that requires treatment.
• Undiagnosed sleep apnea can cause heart attacks, strokes, impotence, irregular heartbeat, high blood pressure and heart disease.

Who has it?

• 24% of men and 9% of women between 30 and 60 years of age old have Sleep Disordered Breathing.
• Only about 1% of people with sleep disorders are being treated

Why do we have it?

It can be caused by obesity, age, posture, use of alcohol and sedatives and/or sleeping pills, deformities in the oral-pharynx, allergies, trauma. It can also be found in persons with short, fat necks, those with a family predisposition to snoring, or persons with sinus problems.

What are some of the physical findings of sleep disorders?

• Obesity, increased neck circumference
• Crowding of the upper airway, nose and sinus obstruction, abnormally recessed lower jaw
• Enlarged tonsils or tongue
• Hypertension
• Lower limb edema (abnormal venous return)
• Signs of cor pulmonale (abnormal right ventricular structure and function secondary to a primary respiratory disorder)

What about snoring?

Overall, snoring is reported to affect 20-40% of the general population and more than 50% of middle-aged men. All snorers do not necessarily have Sleep Disordered Breathing.

What is leptin?

Leptin is a weight control hormone that controls the amount of fat in the body. People suffering from sleep apnea have a higher level of leptin. This may cause an inability to control appetite and weight.
Leptin signals when the body is full. As people gain weight they become more resistant to the signals sent out by the hormone.

What is Sleep Apnea and why is it important?

Sleep Apnea involves daytime sleepiness that can result in accidents, lost productivity, and interpersonal relationship problems. The severity of the symptoms may be mild, moderate or severe.

What is Obstructive Sleep Apnea?

Apnea means "cessation of breath." Obstructive Sleep apnea involves repetitive episodes of upper airway obstruction that occur during sleep, associated with low blood oxygen.

What is Central Sleep Apnea?

Central Sleep Apnea occurs when the brain forgets to send the signal to breath. Breathing may simply stop for as long as two minutes. No "mechanical" obstruction is involved. This may be caused by circulatory problems or abnormal brain tissue. Breathing may occur at irregular intervals and exhaling may also be a problem so the muscles for breathing become confused.

What sorts of tests are done for Obstructive Sleep Disorders?

Polysomnography is a diagnostic test during which a number of physiologic variables are measured and recorded during sleep. This can be done either as a home monitoring test, or as a monitored test attended by a technologist in a sleep lab. Brain waves, muscle tension, eye movement, respiration, oxygen level in the blood, and audio monitoring (for snoring, gasping, etc.) are all monitored and observed.

How are sleep disorders treated?

Mild sleep disorders can usually be treated by behavioral changes, such as losing weight, sleeping on your side, practicing good sleep hygiene, using the bedroom for sleep only (no TV or eating), and having a sleep routine. Treatments also include avoiding alcohol, sleeping pills, and sedatives (unless directed by your health care provider). There are also mouth devices that help keep the airway open by either bringing the jaw forward, elevating the soft palate, or keeping the tongue from falling back in the airway and blocking breathing. It is important to remember that sleep apnea is a progressive condition that gets worse as you age and it should not be taken lightly.

Moderate to severe sleep disorders are sometimes treated with a C-PAP (Continuous Positive Airway Pressure) or Bi-level (Bi-PAP) machine. These machines put a constant pressure in the airways, which prevents the collapse of the breathing tubes. They do not work as well for central sleep apnea but are often effective for mixed apnea. Depending on the type of disordered breathing, there are also medications available such as Provigil, Protriptyline, Triptil, Vivactil, and Klonopin. Surgical treatments for obstructive disorders include tracheostomy (creating an opening to the breathing tube through the neck), myotomy (surgical sectioning of the cricophayngeus muscle), and uvuloplasty (reducing or removing the "bell" that hangs in the back of the throat).

Can Sleep Disordered Breathing be a sign of other problems?

Yes, more severe types of sleep disordered breathing may reveal secondary polycythemia (abnormally high red blood cell count), proteinuria (protein in the urine), respiratory failure, nocturnal cardiac arrhythmia (abnormal heart beat occuring at night), and GERD (acid reflux).

What else is associated with sleep disorders?

Some things that can be associated with sleep disorders include:

• loud snoring
• morning headaches
• un-refreshing sleep
• a dry mouth upon awakening
• chest retraction during sleep in young children (chest pulls in)
• high blood pressure
• overweight

What are the signals of Sleep Disordered Breathing?

The signals include:

• irritability, change in personality, depression
• difficulty concentrating
• excessive perspiring during sleep
• heartburn
• reduced sex drive
• insomnia
• frequent urination at night
• restless sleep
• snorting, gasping, choking during sleep (may wake self up)
• rapid weight gain
• confusion upon awakening

How can I determine if I have Sleep Disordered Breathing?

You can start by asking if you:

• stop breathing during sleep (ask your partner)
• feel tired upon wakening
• wake up with headaches
• feel sleepy during the day
• have memory lapses
• have decreased sex drive
• have high blood pressure
• have a history of high blood pressure, congestive heart failure, stroke, or TIA (transient ischemic attacks or mini stroke).

Keep in mind there are many reasons for these health conditions and sleep disorders may or may not be a part of the cause or result of the diseases. You should consult your health care provider if you have any of these conditions.

Is there a test to determine how sleepy I am?

The Epworth Sleepiness Scale measures how sleepy you are. To determine your score, answer each question using the following scale:

0 = no chance of dozing
1 = slight chance of dozing
2 = moderate chance of dozing
3 = high chance of dozing

0 1 2 3 Sitting and reading  
0 1 2 3 Lying down to rest in the afternoon when circumstances permit  
0 1 2 3 Watching TV  
0 1 2 3 Sitting, inactive in a public place (like a theater or a meeting)  
0 1 2 3 As a passenger in a car for an hour without a break  
0 1 2 3 Sitting and talking to someone  
0 1 2 3 Sitting quietly after lunch without alcohol  
0 1 2 3 In a car, while stopped for a few minutes in traffic  

Your Total Score is:  

What your score means:

1-6             Congratulations!  You are getting enough sleep.
7-8             Your score is average
9 and up    Seek the advice of a sleep specialist without delay

Where can I get more information?

You should always contact your health care provider for questions about your health.
You can look at some different types of sleep-aid devices at resmed.com or learn more from Stanford University.