Question:
I have been ignoring my long-time habit of waking up several times per
night. I have enough energy to put in a good days work but generally
am not worth much energy wise by the time I get home. This has been a
problem for me since I was in my early 20s (I'm 43 now). Prior to my
wife and I having children I would simply take a one to two hour nap
right after getting home if I had anything planned for the evening.
However, with loud and active children (5 and 6 y/o) I can't use the
nap technique anymore. I plan on seeing a doctor soon.
For those of you who have had good success in treatment is weight loss
the norm? I love the idea of getting rid of some (all?) of my middle
age spread simply by sleeping better. The flip side of this question
is how much improvement in sleep can be expected with weight loss? I
have been on a regular exercise program for the past few months (after
laying off regular exercise for years) and have lost a few inches
around my middle. While I still wake up as often as before I feel
like the quality of my sleep is better (less tossing and turning as
shown by less chaos in my bed sheets). Can a significant weight loss
fix breathing problems associated with bad sleep? I am fairly certain
my problem is breathing related as my wife tells me I stop breathing
at night.
Answer:
If you research the weight OSA connection you will find that there is a
conneciton but it is a chicken/egg thing going on. I personally believe that
osa caused me to gain weight. I had huge weight gains and that caused my osa
to worsen.
Since my surgery in December (I had a tracheostomy) I have lost 45 + lbs. I
have not dieted I am just getting good sleep.
First of all, Tony, welcome! I think you'll find lots of folks, who try to
help here. But onto your question ...
It's common, but not necessarily the norm, and certainly not guaranteed.
This can be due to many reasons. For example, if you eat late at night to
avoid sleep, then you will have to unlearn that habit.
However, what often occurs is the amount of activity and exercise increases.
So, even if weight loss does not start right away, an increase in heathy
'tone' does start as soon as the therapy is effective.
Depends. If you had this problem PRIOR to the weight gain, don't expect it
to go away just because you loose weight. That's the case with me. During
my teen years my sister complained that I snored loudly and would stop
breathing at night. Sounds like I've had this most of my life. But it took
too much stress, not enough exercise, attendant weight gain, and probably
increased age before it became extremely serious.
Many changes that case (or increase) obstructive sleep apnea occur as a
result of aging. No amount of weight gain will change that.
Usually spouses know what's going on... they WORRY when we stop breathing.
And they have WAY too many times they get to listen and worry. So, PLEASE
do follow through and see a doctor. You will need to see a sleep
specialist.
Please understand that I'm not discouraging you from exercise (and wight
gain) as a way to control your obstructive sleep apnea (OSA). For some
people that's all they really require. You might fit that category. But do
NOT try to play doctor and self diagnose. Let a doctor and a sleep study
determine what's going on.
LOL! Like anything else, there's a common vocabulary here ... which we
often shrink to a set of abbreviations. We just love those TLAs and ETLAs
(three letter acronymns and extended TLAs). I'll try with no guarantees of
complete accuracy or spelling (or is that speeling ?? ;-):
And remember ... you asked for it! ;^)
OSA - Obstructive Sleep Apnea. This type of sleep apnea occurs when the
airway to the lungs is obstructed (such as with the soft palate or tongue).
To be cleared, the individual arouses enough to tighten the muscles ...
Though not fully awake, such obstructions keep the individual from deeper
sleep (and often REM sleep). As a result, the individual suffers sleep
deprivation.
Hypopneas - Sometimes the airway does not completely obstruct. However, a
severely decreased airflow (only 50% of normal) can also cause an arousal
from deeper sleep. This decreased airflow is called a hypopnea.
UARS - Upper Airway Resistence Syndrome - Sleep researchers are beginning to
understand that the airway resistence does not necessarily come from an
obstruction in the throat. This can occur ABOVE the soft palate. Hence the
UA part of the name.
RDI - Respiratory Disturbance Index is the number of apneas (obstuctive +
central mixed) AND the number of hypopneas. As a rule of thumb we should
not have more than 5 per hour. Note that SOME apneas are normal. This is
actually a mechanism our body uses to keep our lungs properly filled and
cleaned ... it's why we occassionally take a deep breath during the day.
RDIs above 5 are considered abnormal. I've forgotten the exact range, but
basically the scale is used to determine the effectiveness of therapy. And
might might not ACCURATELY reflect the effectiveness of sleep. Since it
does not include the SAO2 (saturated O2) levels.
PSG stands for Polysomnogram (the sleep study ... means many sleep
measurements). And of course when someone takes those many sleep
measurements we call it polysomnography. These (should) occur at certified
sleep labs, where they monitor movement during the night (via videotape ...
usually using a red light), they also have several EEG type electrodes to
monitor your brain wave patterns, and measure the muscle tone of the jaw,
the REM activity, the breathing through the nose and mouth, two EKG patches,
two 'belts' to measure respiratory activity, one or more electrodes to
measure leg movements (for PLMD), and a pulse oxymeter to measure the
saturated O2 levels (which implies the CO2 levels, since that is MUCH harder
to measure). THAT is why it's called a POLY-somnogram.
During a sleep apnea, the body stops breathing. The result is decreased
blood oxygen levels. Anything less than 90% is considered abnormal. It
often drops downto and below 70% for minutes at a time. This is dangerous,
and leads to permanent damage if untreated for too long. Of course the body
tries to avoid this, so rouses to lower levels of sleep where the
obstruction can be cleared. (If it's due to an obstruction).
The most common therapy for OSA is CPAP (Continuous Positive Airway
Pressure). This device is essentially a blower attached to a nasal mask to
apply pressure to deliver a precise and continuous pressure to help splint
open the airway. The pressure is not very high and is measured in cm H2O
pressure.
But sometimes problems with the Continuous pressure causes other systems to
be used. For example, if breathing against the pressure causes problems,
then a BiPAP (Bi-level PAP) unit can be used. This provides a decreased
exhalation pressure. And it costs MUCH more. And sometimes individuals
have wildly varying pressure needs. The DPAP (or VPAP) unit provides
Demand-based (or Variable) PAP to help splint open the airway.
Whew! That's one sleep disorder ... more to come ...
CSA - Central Sleep Apnea occurs when the breathing reflex fails to fire.
Thus the Central Nervous System is the underlying problem. (Often for
simplicity, I'll say "the brain forgets to breathe" ... though it's MUCH
more complex). This can occur for many reasons. Often someone with years
of OSA problems may also see CSA events (even after CPAP), since the body
starts to expect an increased CO2 level. So, the breathing reflex is not
triggered until that CO2 level is approached. Sometimes this dissappears
after CPAP therapy is started. But it can be due to an underlying problem
with the central nervous system.
The PSG determines the difference between CSA and OSA events. In this case,
NO respiratory effort is made. My wife notes that sometimes I inhale,
exhale, and fail to even try to breathe in again. She will often just lay
her hand on me, which is enough to kick in the ol' motor, and I start to
inhale. This is a central sleep apnea.
Obstructive events are often associated with a mild gulping or snorting
sound, when the obstruction is finally cleared. It can be a REALLY loud
snore ... I did it so loudly before treatment that I would wake myself and
the kids up -- terrified and screaming (the kids were screaming ... I just
wanted to! ;-).
Treatment for central sleep apnea usually consists of medication to help
improve the breathing reflex. If this fails, a MUCH more expensive BiPAP
unit can be used which has a back-up rate ... a minimum number of breathes
per minute ... that it monitors. If you fall below that amount, it switches
from exhalation to inhalation pressure to attempt to jog the breathing
reflex.
That's two sleep disorders ... often intertwined, as you can seel.
Mixed Apnea - This is fairly simple to explain. Essentially this is an
apnea event that starts as a central sleep apnea (the breathing reflex
fails), the body rouses enough to trigger the breath, but an obstruction
also exists. Again the body must rouse enough to clear the obstruction.
Makes for a very bad night of attempted sleep.
If this exists, therapy will include both xPAP and medication.
xPAP stands for any type of PAP applied to splint open the airway.
Sometimes you will also see nCPAP, which stands for Nasal CPAP.
PLMD - Periodic Limb Movement Disorder occurs when the body sends stray
signals that cause the body to 'jerk' during sleep. This arouses the body
enough to keep the individual from getting deep sleep. And sometimes it's a
learned reflex the body uses to avoid deep sleep. For example, if
obstructions occur during deeper sleep. If this is associated with OSA,
many doctors will treat that first, and see if the PLMD clears. If not,
medication will be used to help control the movements that distrub sleep.
Stages of sleep - The body should pass through several stages of sleep. The
lightest level is Stage 1 sleep, the deepest level is Stage 4 sleep. Often
Stage 3 and 4 are lumped together as 'deep sleep'. From stage 4, the next
level is REM (Rapid Eye Movement) sleep. This cycle usually lasts about 90
to 120 minutes. That often explains the common frequency that we develop to
when we awaken.
Alpha-wave intrusion occurs when deep sleep is distrubed by the presence of
alpha-waves (that occur during wakefulness and the first stage of sleep).
This is often a sign of another physical problem, such as fibromyalgia.
RLS is Restless Leg Syndrome, which results from a constant restless feeling
in the legs. Unfortunately for someone that suffers from this, it continues
during sleep (as PLMD) and distrubs sleep causing sleep deprivation. Again,
medication is the normal path for therapy.
REM Behavior Disorder occurs during REM sleep. Normally during REM sleep
all our voluntary muscle activity is dampened. No matter how much we flail
our arms and legs in our dreams, they ...
