According to the American Sleep Apnea Association, it is estimated that 22 million Americans suffer from obstructive sleep apnea. Most cases of sleep apnea go undiagnosed because most people who have it don’t even know it’s happening. Research shows that individuals with sleep apnea have an increased mortality rate due to a higher risk of a stroke or heart attack.
Mattress Advisor set out to understand what causes sleep apnea, what happens if it goes untreated, and how you can determine if you or a loved one has a true disorder.
To help answer these questions, we called on the expertise of Dr. Jennifer Le, Diplomate of Dental Sleep Medicine (ABDSM) and practitioner of Wake Dental Sleep in Raleigh, NC.
Understanding the Basics: Obstructive Sleep Apnea
What is Sleep Apnea?
“Obstructive sleep apnea is a serious disorder in which breathing pauses repeatedly for 10 seconds or longer during sleep,” Dr. Le tells us. “It’s caused by the collapse and or blockage of the airway.”
Obstructuve sleep apnea is a serious disorder in which breathing pauses repeatedly for 10 seconds or longer during sleep.
Patients who suffer from sleep apnea are constantly jerked out of reparative sleep. Not only is sleep disrupted, but so is oxygen flow. Sometimes oxygen flow can be interrupted greater than 10 times in one hour — which is enough times to tell your body you are in crisis mode.
What Causes sleep apnea?
Sleep apnea can be caused by a few different things:
- First and foremost, it can be caused by an anatomic issue. For example, jaw position, the structure of the soft palate, excessive tissue narrowing the airway, or enlarged tonsils to name a few.
- Another more common cause is being overweight or obese. “When someone is overweight, the extra weight carried in the neck can compress and obstruct the airway,” Dr. Le explains.
- Finally, sleep apnea can also be caused by inflammation of the soft palate from being sick or eating inflammatory foods.
How do I know I have sleep apnea?
Dr. Le shared with us the most common symptoms of sleep apnea. These include:
- Loud snoring*
- Restless sleep
- Periods of not breathing during sleep
- Irritability or personality change
- Difficulty concentrating and poor memory
- Drowsy driving
*A quick note on snoring
Snoring is known to be something that people poke fun at. “Our society has made snoring something to chuckle about, but it’s not normal,” Dr. Le explains.
What people fail to realize is that snoring is actually a sleep disorder in itself.
“Snoring occurs when there is a partial obstruction to the flow of air through the nose and mouth. The sound occurs when loose structures in the throat, like the uvula and soft palate, vibrate as air passes over them. Snoring can get worse when the muscles in the back of the throat are too relaxed either from drugs that induce sleep or alcohol consumption.”
Snoring is an interruption of you and your partner’s quality of sleep. When sleep is interrupted, you can’t complete your sleep stages, which has various repercussions that we’ll discuss later on.
Snoring is the precursor to sleep apnea and has similar causes. Dr. Le recommends that if you snore every night, you should go to your primary physician and have an open conversation about it. That way, you can work together to rule out other disorders.
Long-term Implications if Sleep Apnea Goes Untreated
Did you know people who suffer from sleep apnea can’t dream? That’s because restorative sleep is interrupted so frequently, they can’t make it far enough into the sleep cycle to the stage where dreaming occurs.
Dr. Le explains that the body uses sleeping hours to repair itself and process what it learned that day. The brain’s ability to compartmentalize information during sleep assists in memory recall. That’s why patients who suffer from sleep apnea have difficulty concentrating or remembering information.
Additionally, lack of sleep causes all sorts of hormones to be out of whack — including cortisol, insulin, leptin and ghrelin to name a few.
- Cortisol: At night, cortisol levels should decrease. However, if you have lost sleep, these levels may stay elevated. This promotes insulin resistance, which is a risk factor for obesity and diabetes.
- Leptin: This hormone signals satiety to the brain, meaning it suppresses appetite. Lack of sleep causes a decrease in leptin. In other words, your brain is telling you that you’re still hungry, even when you’re full.
- Ghrelin: Related to leptin, ghrelin stimulates appetite. It’s been proven lack of sleep increases levels of ghrelin. Meaning, if you aren’t getting enough sleep, you might be taking in more calories than you need, especially carbohydrates.
Learn more about how sleep affects hormones here.
The ramifications of poor sleep are cyclical. Take an overweight individual that suffers from sleep apnea for example. This individual may have sleep apnea due to excess weight that obstructs the airway. Because of their sleep apnea, they suffer from sleep deprivation. Sleep deprivation throws their levels of leptin and ghrelin out of whack, which increases their appetite. The excess calories from unnecessary snacking cause them to put on more weight that may worsen their sleep apnea.
Other health risks
There are many other health risks associated with sleep apnea other than the consequences that come with lack of restful sleep.
Risk of stroke, heart failure, diabetes, depression, high blood pressure and mental impairment go way up in people with sleep apnea. Wondering why? Dr. Le explained it like this:
“If the main highway in your city is shut down that creates detours. Meaning traffic is going to be redirected to roads that were never built to accommodate the amount of traffic a highway can accommodate. As a result, these roads start to break down from potholes, pavement deterioration, etc. A similar thing happens if your main airway is obstructed. The body overcompensates for the problem by compromising other systems: blood vessels, organs, etc.”
The goal of any type of sleep apnea treatment is to keep the airway open. With that being said, patients need to know they have options.
One of the most important things Dr. Le stressed to us about treatment options for sleep apnea is that they should be modified to best suit a patient’s needs. For this to happen, patients must see a trained doctor that addresses the issue from a holistic point of view. That includes managing your sleep hygiene*, monitoring weight gain and finding the mode of treatment that works best for you.
*By managing sleep hygiene we mean monitoring your sleep habits. Dr. Le suggests limiting the amount of TV you watch at night, reducing the amount of alcohol consumed before bed and finding the proper mattress to name a few. Basically, create an environment that is conducive to getting the best sleep possible.
Here are some potential treatment options that may be available to you.
Continuous positive airway pressure (CPAP) is considered the standard of care for sleep apnea. However, forced oxygen is of no use if you don’t wear the CPAP.
Oral Appliance Therapy
An alternative to CPAP therapy for those who do not wear or cannot wear CPAP is oral appliance therapy. There are a variety of oral appliances available. The choice of which is best for you is based on many factors, including the severity of the sleep apnea, jaw structure and personal preference. Visit Dr. Le’s website to learn more about oral appliance therapy.
How to relieve symptoms
On top of oral appliance therapy, here are a few tips Dr. Le recommends to help relieve the symptoms of sleep apnea:
- Try avoiding alcohol and sedatives before you go to bed. These substances can make symptoms worse because they can cause relaxation of the airway.
- Try not to sleep on your back. Sleeping on your back can cause your tongue and soft palate to collapse to the back wall of your throat which obstructs the airway and promotes snoring.
- Weight loss reduces the amount of weight that compresses the airway; thus, decreasing the number of times breathing stops.
Advice From Dr. Le
“The sooner you identify sleep apnea the better,” Dr. Le tells us. If sleep apnea runs in the family, keep an awareness that your likelihood to develop it increases.
If you have experienced any of the symptoms listed above and believe you may have sleep apnea, Dr. Le recommends seeing your physician to discuss your sleep health. You may also use an app to record your snoring to help identify whether you have reason for concern. Check out this list of apps that record snoring published by the American Sleep Association to start.
Dr. Le leaves us with this: “Remember that sleep management is a team effort. If your sleeping partner suffers from snoring or sleep apnea, that affects your quality of sleep too.” Don’t be afraid to start a conversation with your bed partner about how your sleeping affects them too. Work together to get the help you need.
Dr. Jennifer Le, DMD, D- ABDSM, CPCC, ACC received her dental degree from the University of Pittsburgh in 2001. She now practices at Wake Dental Sleep in Raleigh, NC. Dr. Le is the Director of the American Board of Dental Sleep Medicine (ABDSM), an independent board of examiners that was established in 2004 for duly licensed dentists who treat sleep-related breathing disorders with oral appliance therapy, an effective alternative treatment to commonly used CPAP machines. Additionally, Dr. Le is Chair of Accreditation for the American Academy of Dental Sleep Medicine (AADSM). We chose to speak to Dr. Le for this campaign given her prestige in the field of Dental Sleep Medicine.