You wake up tired after a full night’s sleep. Maybe you’ve become a bit forgetful, and you struggle to stay awake at work or behind the wheel. The problem might be obstructive sleep apnea, an often overlooked condition that has increased sharply in the past 20 years.
In the United States, more than 40 percent of men and 28 percent of women between the ages of 50 and 70 experience obstructed breathing while asleep, according to researchers whose work was published online in April by the American Journal of Epidemiology. About 17 percent of the men and 9 percent of the women have cases serious enough to meet the Medicare criteria for a sleep apnea diagnosis. But even milder cases can affect your health.
Obstructive sleep apnea causes the muscles and tissues in the lower throat to collapse, blocking the flow of air to the lungs during sleep.
A person with obstructive sleep apnea may stop breathing, typically for 20 to 25 seconds or for as long as two minutes. The amount of carbon dioxide in the blood rises, triggering an alarm in the brain that stirs the sleeper to resume breathing. That cycle can repeat itself dozens of times an hour throughout the night, preventing the sleeper from reaching the restorative stages of deep sleep. Upon awakening, he or she usually has no recollection of those events.
Overweight men are the most frequently affected because they tend to have a throat with bulkier soft tissue and fat deposits, but women and people of normal weight also develop sleep apnea. Loud snoring can be a warning sign, especially if you learn from a bed partner or roommate that you gasp for breath or choke while you are asleep. High blood pressure and heart-rhythm abnormalities are also red flags, especially if you take antihypertensive medication and still have trouble keeping blood pressure under control. Waking up with a headache may also signal the condition.
Proper diagnosis and treatment are vital, not only to improve sleep but also to avoid life-threatening consequences.
When breathing stops during a bout of sleep apnea, the nervous system seems to trigger a spike in blood pressure. The combination of lost sleep and repeated bouts of oxygen deprivation promote the inflammation of artery walls. High blood pressure and inflammation, which can damage blood vessels, also boost the risk of a heart attack or stroke. And that repeated stress might break down the body’s ability to regulate blood sugar, leading to Type 2 diabetes.
To find out if you have sleep apnea, you should have an overnight sleep study. Monitoring devices will record brain activity, heart rate and rhythm, breathing, and oxygen and carbon dioxide levels in the blood. For years, sleep studies required an overnight stay at a hospital or stand-alone sleep laboratory.
Now, in many cases, particularly when your physician feels you have a high likelihood of having more severe obstructive sleep apnea, home sleep testing may provide enough information to make the diagnosis. But sleep monitoring at home doesn’t always work well, and it isn’t advisable if you have diabetes, heart or vascular disease, or lung disease, or if your doctor suspects the problem might be caused by something other than obstructed breathing.
If a doctor diagnoses mild sleep apnea, you may be able to try lifestyle changes first.
If you’re overweight, shedding excess pounds has been found to help control the sleep disorder, with long-lasting results. If you smoke, quit. Sedatives, tranquilizers and alcohol also worsen apnea attacks. If you drink, stop at least three hours before bedtime. It may help to train yourself to sleep on your side by using pillows or by sewing a pocket on the back of your pajamas and inserting a tennis ball to keep you from rolling on your back.
The most effective treatment for sleep apnea is using a continuous positive airway pressure machine, or CPAP. It’s a breathing mask connected to an air pump that maintains enough pressure to prevent the airway from collapsing. Studies have found that using one significantly reduces the risk of a heart attack or stroke for people with sleep apnea compared with those who don’t use the device.
An alternative is an oral appliance that pushes the lower jaw forward or holds the tongue forward. It might not work as well as a CPAP device, which props open the airway deep into the throat, but it can be effective for people with mild or moderate sleep apnea, or for those who can’t tolerate a mask.
For further guidance, go to www.ConsumerReports.org/Health, where more detailed information, including CR’s ratings of prescription drugs, treatments, hospitals and healthy-living products, is available to subscribers.