What are Sleep Disorders?

Sleep disorders encompass difficulties with sleep & with staying awake, and include behaviors that cause difficulties with sleep in all age groups from neonatal to the elderly. Types of sleep disorders are:

SLEEP HYGIENE: is defined as the conditions and practices that promote continuous and effective sleep. These include regularity of bedtime and arise time; conformity of time spent in bed to the time necessary for sustained and individually adequate sleep (i.e., the total sleep time sufficient to avoid sleepiness when awake); restriction of alcohol and caffeine beverages before bedtime; and employment of exercise, nutrition, and environment factors so that they enhance, not disturb, restful sleep.

RESTLESS LEGS SYNDROME
ADVANCED SLEEP PHASE SYNDROME (ASPS)
DELAYED SLEEP PHASE SYNDROME (DSPS)

  • Sleep apnea in adults
  • Symptoms
  • Causes
  • How is it diagnosed?
  • Treatment options
  • Sleep apnea self-test

Approximately 4% of middle-aged men and 2% of middle-aged women suffer from sleep apnea. The condition affects an estimated 12 -18 million Americans, which makes it almost as common as diabetes and asthma. Yet the majority of adults with sleep apnea remain undiagnosed. OSA in adults is associated with irritability, excessive daytime sleepiness, an inability to concentrate, and decreased job performance. Untreated sleep apnea also can increase an individual’s risk of heart attack, high blood pressure, diabetes, stroke and automobile accidents. If you suspect you or your loved one may have sleep apnea, it is important to seek medical attention.

Sleep apnea can occur in males and females of all ages, weights, and ethnicities. Yet certain risk factors are associated with a higher incidence of sleep apnea, such as:

  • Excess weight or obesity (body mass index, or BMI, >25)
  • Family history of sleep apnea
  • Male gender
  • Large neck (greater than 17″ in men, greater than 16″ in women)
  • Recessed chin
  • Physical abnormality in the nose, throat, or upper airway structure
  • Age
  • Smoking
  • Use of alcohol or sleeping pills
  • Ethnicity (African-Americans, Pacific Islanders and Hispanics seem to be at an increased risk)
  • Snoring
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What are the symptoms of sleep apnea in adults?

Symptoms of sleep apnea in adults can include:

  • Excessive daytime sleepiness and not feeling rested
  • Loud snoring and “snorting awake” (though some sleep apnea sufferers do not snore)
  • Irritability
  • Difficulty concentrating
  • Memory loss
  • Depression
  • Morning headaches
  • Falling asleep inappropriately, such as while working, talking on the phone, or even driving
  • History of automobile accidents
  • High blood pressure (hypertension)
  • Cardiovascular problems

The majority of adults with sleep apnea remain undiagnosed. OSA in adults is associated with irritability, excessive daytime sleepiness, an inability to concentrate, and decreased job performance. Untreated sleep apnea also can increase an individual’s risk of heart attack, high blood pressure, diabetes, stroke and automobile accidents. If you or your loved one exhibits symptoms of sleep apnea, it is important to seek medical attention.

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What causes sleep apnea in adults?

A variety of factors can cause obstruction of the airway or airway collapse, such as:

  • Certain physical abnormalities in the nose, throat, or upper airway structures
  • Extra tissue in the back of the throat, such as a large uvula or overly large tonsils
  • Some physical facial characteristics, such as a recessed chin
  • Excess weight or a large neck

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How is sleep apnea diagnosed in adults?

Often, a sleep partner or family member will first notice the sleep apnea sufferer’s symptoms and suspect that something may be wrong. Since there are a variety of factors that can disturb sleep, a diagnosis of sleep apnea is not always a simple task. A full medical history and physical examination is usually conducted, but the primary method of diagnosis is a polysomnography (sleep study).

A sleep study is an important method for diagnosing sleep apnea and its severity in a particular patient. Typically this test is conducted in a sleep center and measures the patient’s heart rate, respiration, brain activity, eye movement, and blood oxygen level.

Clinically, an apnea event is defined as a cessation of breathing for at least 10 seconds, yet it can last up to a minute or longer. Sleep fragmentation and the negative effects from it can also arise from what is called a hypopnea event. Hypopnea derives from the Greek and means “less than normal breath.” If you experience a hypopnea event during sleep, your breathing does not stop completely as in an apnea event, but there is a measurably reduced airflow that can lower the level of oxygen in the bloodstream.

The apnea-hypopnea index (AHI) and the respiratory disturbance index (RDI) are important measurements obtained during a sleep study that can indicate the severity of the patient’s condition. The AHI or the RDI refers to the total number of apnea and hypopnea events divided by the patient’s total amount of sleep during the study. Adults with sleep apnea generally need an RDI of 15 to be considered candidates for surgery.

Another test that can be used to help diagnose sleep apnea is the Multiple Sleep Latency Test (MSLT). This test measures how quickly the patient falls asleep when given several opportunities to fall asleep during the course of a day when the patient would normally be awake. If an individual falls asleep in less than five minutes during this test, he or she is likely to need treatment for some type of sleep disorder. The MSLT can help determine the degree of daytime sleepiness, a frequent symptom of sleep apnea, and rule out the possibility of other sleep disorders.

Widely used by sleep researches around the world, the Epworth Sleepiness Scale (ESS) measures a patient’s level of sleep deprivation and sleepiness. In this test, patients will answer six questions regarding how likely they are to fall asleep in a particular situation, in contrast to just being tired. Each answer is assigned a numerical value, and the numbers for each answer are added to produce a total score. A total score that is greater than 10 is considered indicative of possible sleep apnea, whereas a total score less than 10 is considered normal. Click here for a graphic of the Epworth Sleepiness Scale.

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Treatment options for adults

  • Behavioral treatments
  • Mechanical treatments
  • Surgical treatments

Treatment for adult OSA must depend on the individual patient’s current physical condition, medical history, and pertinent test results. Behavioral, mechanical and surgical methods are the most common forms of treatment for sleep apnea in adults. Medical treatments for OSA are generally not effective and not used.

Behavioral treatments
Typically, patients diagnosed with sleep apnea are advised to avoid tobacco, alcohol, sedatives, and medications that relax the airway and/or reduce respiratory function. In addition, regular exercise and weight reduction can help some patients with mild or moderate sleep apnea minimize their symptoms. Sleep apnea sufferers are also advised to avoid sleeping on their back, if possible.

Mechanical treatments
A common mechanical treatment for adult sleep apnea sufferers is the use of a continuous positive airway pressure device, or CPAP. The patient wears a CPAP device while sleeping, and the device works to keep the airway open by continuously blowing air through the nasal passages at a pressure high enough to prevent the airway from collapsing.

In addition, some dental appliances may help treat some patients with mild or moderate sleep apnea. When worn, these devices reposition the tongue or lower jaw so that the airway remains open while the patient sleeps, thus preventing the apnea or hypopnea events.

Surgical treatments

There are a variety of surgical treatments available to treat adult sleep apnea, with varying results. Some of the surgical treatments are listed below.

Surgery involving the nose

Septoplasty and /or inferior turbinate reduction
The inferior turbinates are a part of your nose whose primary function is to disrupt airflow and moisten the air before it goes into your lungs. Sometimes the inferior turbinates are too large and interfere with proper breathing. For patients with mild sleep apnea, it may be helpful to surgically reduce the size of the inferior turbinates. This is usually done with an oscillating blade or a radiofrequency probe. In addition, straightening a deviated septum may also improve airflow and help relieve mild sleep apnea.

Surgery involving the throat (pharynx)

Uvulopalatopharyngoplasty (UPPP, also known as “UP3”)
In some patients with sleep apnea, the airway obstruction may be caused by excess tissue in the uvula or soft palate. UPPP is performed to open up the airway at the level of the soft palate. Some of the soft palate, the uvula, and some of the tissue on the side of the mouth are removed, which usually includes the tonsils, as well.

Laser-assisted uvulopalatopharyngoplasty (LAUP)
LAUP is very similar to UPPP, but it is performed with a laser instead of an oscillating blade.

Tonsillectomy
Tonsils can contribute significantly to airway obstruction and sleep apnea. They may be removed as a separate operation or in conjunction with a UPPP or LAUP.

Advancement of the soft palate may be accomplished by either resecting part of the soft and/or hard palate and advancing it forward to open up the airway or by using fixation devices on the upper jaw bone (maxilla)

Surgery involving the tongue

Radiofrequency ablation of the tongue
Sometimes an overly large tongue can be the cause of airway obstruction and sleep apnea. Over the course of five treatments, a radiofrequency probe may be applied to the back part of the tongue to generate heat and progressively shrink the volume of the tongue.

Suture suspension of the tongue
To keep a large tongue from blocking the airway, a surgeon can place a suture (stitch) through the back of the tongue that is fixed to the inside front part of the jawbone (mandible). This forms a sling to keep the tongue from falling back into the throat and blocking the airflow.

Mandibular advancement
This is another way to reposition the tongue and keep it from obstructing the airway. In mandibular advancement, the jawbone is broken, moved forward and fixed temporarily to move the chin and tongue away from the back of the throat.

Surgery involving the neck

Hyoid advancement
The hyoid bone, a bone in the neck may be advanced forward to open the airway in the neck.

Tracheostomy
This procedure is usually used as a last resort. The entire upper airway is bypassed with a tracheotomy tube that is placed in the neck and provides an alternate breathing site that through the nose or mouth.

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Sleep apnea self-evaluation

Widely used by sleep researchers around the world, the Epworth Sleepiness Scale (ESS) is a self-test that measures your level of sleep deprivation and sleepiness. In this test, you will answer six questions regarding how likely you are to fall asleep in a particular situation, in contrast to just being tired. Each answer is assigned a numerical value, and the numbers for each answer are added to produce a total score. A total score that is greater than 10 is considered indicative of possible sleep apnea, whereas a total score less than 10 is considered normal.