Sleep Apnea
Sleep Apnea :
Steven O'Brien
Sleep, why do people sleep at all? Why can't we just stay awake? Some biologists suggest that sleep provides the opportunity to conduct self-repair and purge the body of its waste that has built up during the day's activity. Nevertheless, the body is capable of repairing itself and disposing of wastes during waking hours, so sleep in a way really isn't necessary for routine maintenance (e.g., urinating, etc.).
Dr. Quentin Regestein, lead sleep and sleep disorders researcher at Harvard Medical School also believed that sleep kept our distant ancestors out of harm’s way during the night when they could not see as well as their night roaming predators. Sleep is regulated by a connected series of structures in the deep midline areas, and along other way stations that extend through the central axis of the brain, these structures relay information about things that affect sleep. In Dr. Regestein notes, he spoke of experiments that were performed by researchers. The researchers he spoke of would destroy specific brain structures of a lab animal and then note how the animal slept. For instances, in one lab animal the researcher cut through the axis of the brain at one level, which would prevented the animal from awakening; showing that brain structures below the level of the cut were responsible for awakening the lab animal.
The American Sleep Disorders Association (ASDA), Association for the Psychophysiological Study of Sleep (APSS), Association of Sleep Disorder Centers (ASDC) and the American Psychiatric Association (APA) has studied sleep and sleep disorders since the early 1970's. Out of all the sleep disorders currently being studied, sleep apnea has gain worldwide attention, affecting over 15 million people. Apnea, derived from the Greek word want to breath. Sleep Apnea (cessation of air flow at the mouth for greater than 10 seconds) can reflect
1. loss of central nervous system drive to maintain ventilation
2. mechanical upper airway obstruction, or combinations of both.
The second edition of Anesthesia and Co-Existing Disease states "Conversely, obstructive forms of sleep apnea are due to an abnormal relaxation of the posterior pharyngeal muscles" - there is persistence of respiratory movements, but airflow is absent due to upper airway obstruction. Study shows awakening occur when the arterial partial pressure of carbon dioxide rise or oxygen falls. Severe apnea, which affects about 1 percent of the general adult population, often results in 400-500 awakenings a night. Moreover, depending on the severity and the number of episodes of sleep apnea, the patient's daily life and survival can be greatly endangered. According to the Wisconsin Sleep Cohort Study, over an eight-year period, a 37 percent death rate has been reported among persons with apnea (20 episodes or more per hour). The Wisconsin Sleep Cohort Study also reported sleep apnea is more likely to occur in men than women, for the male hormone, testosterone is believed to be related to sleep apnea. Admittedly, researchers believe a female hormone, progesterone stimulates respiration and therefore may help prevent breathing problems. In the Wisconsin Sleep Cohort Study, the researchers noted a strong link between smoking and sleep apnea. Smokers that smoked 40 or more cigarettes a day had the greatest risk of developing sleep apnea then patients who had never smoked.
The medical community has yet to fully understand the intra play of factors producing the sleep apnea syndrome. Sleep affects psychological well-being. Because sleep apnea deprives patients of sleep, numerous of studies have consistently shown that sleep loss affects daytime performance, sleepiness and mood. One of the first capacities that Dr. Arthur J. Speilman of the Department of Psychology in New York spoke of, is the ability to produce creative solutions to problems., and how being deprive of sleep can impair a patients functional capacity. Dr. Paul Glovinsky, Dr. Spielman's research colleague noted "the focus of psychology is behavior, which at first glance might be thought to cease during sleep". Dr. Glovinsky also noted "neither the mind nor the body truly cease activity during sleep. Far from turning off, the brain in sleep generates a variety of states , accompanied by predictable physiological changes and typical forms of mentation." By studying Drs. Speilman and Glovinsky works one can conclude, the sleeplessness of sleep apnea or the prolonged wakefulness of creative output, the timing of physiological rhythms can be affected by psychological states.
In 1988 a congressional commission determined that sleep related problems cost American Society 50 billion dollars a year and that 95% of individuals with sleep disorders were going undiagnosed. According to the American Academy of Family Physician (AAFP), The standard method for diagnosing sleep apnea is nocturnal polysomnography. In order for this test to be performed often requires the patient to stay overnight in a sleep laboratory, which can be quite costly. There are also less costly methods of diagnosing sleep apnea. Dr. Tivinnereim of the AAFP developed the use of a five portable pressure transducer catheters connected to a data logger that can be clipped to the patients garment. The transducers are used to measure the intrathoracic pressure fluctuations.
Case study: Ten patients with obstructive sleep apnea were recruited from a sleep clinic to undergo simultaneous evaluation with the portable transducer catheter. Pressure signals were synchronized with the polysomnography tracings to compare the classification of 200 events of apnea. The portable transducer catheter detected all 200 events recorded during the nocturnal polysomnography procedure.
Because of in-depth research of sleep apnea and sleep disorders, the ASDA can now safely treat sleep apnea. One method that is widely used is C-PAP (Continuous - Positive Airway. C-PAP is a mask that covers the patient’s face that provides a slightly increased air pressure for easier breathing. As a result from using the C-PAP machine, muscles lining the airway and structures such as the soft palate are no longer sucked into the airstream. Another method of treating sleep apnea (a fairly new surgical procedure) called uvulopalatopharyngoplasty.
This procedure involves revision of the uvula (the tissue that hangs from the midline of the throat) and tightening up the throat's lining. Study has shown surgery to be the best route for sleep apnea patients. Case study: A 38-year-old production supervisor was interviewed four months postoperative and reported that the surgery had changed his life. He was no longer weary, and he had astonished his employers by coming up with some new business innovations. He also added that he felt so energetic that he had taken on a second job. Some patients that were seen postoperative reported comparable improvements.
The biochemistry of sleep is only partially understood; yet the knowledge of sleep apnea and how it occurs intra plays a great role in treatment. In short, being deprived up sleep because of a sleep disorder like sleep apnea can eventually lead to interruption of daily task and human survival is greatly reduced. Many people choose to prognosis themselves as to why they are having trouble sleeping. Researchers urge patients with a unbalanced sleep pattern to seek professional help.
"Five billion people go through the cycle of sleep and wakefulness every day, and relatively few of them know the joy of being fully rested and fully alert all day long." - William Dement
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