Sleep Apnea Treatment in Ocala

By Dr. Adam Alpers, D.O.


Sleep apnea is a sleeping disorder characterized by episodes of breathing stoppage ("pauses") during sleep. The word apnea ("Greek") means no breathing. It is a common disorder in men, women and children. It is clinically defined as an interval of no breathing, lasting for more than 10 seconds between normal breaths. In children, the interval is measured as 2.5 missed breaths. It is usually undiagnosed, but at the same time it may lead to serious consequences and complications. The American Sleep Apnea Association ASAA estimates that at least 10 million Americans suffer from this disorder, without any knowledge that they have such a thing. It may be associated with hypopnea, which means shallow breathing or reduced airflow by 50% for more than 10 seconds.


There are 3 types of sleep apnea. Obstructive apnea is the most common type, in which the smooth muscles in the throat relax, leading to collapse of the upper airway wall and obstruction of the air passage.


The second type is called central apnea, in which the respiratory center in the brain is impaired, leading to abnormal breathing. A normally functioning respiratory center reacts to increased Carbon dioxide (CO2) levels in the blood, by stimulating breathing to wash out CO2 and re-oxygenate the blood. In this type of sleep apnea, the function is impaired and CO2 levels rise without stimulation of the respiratory center. Its common causes are sedative hypnotic drugs, heart diseases and some Central Nervous System (CNS) diseases.


The third type is a combined apnea, a mixed central and obstructive type. A sleep apnea occurring in episodes with a rate more than 5 times per hour is a clinically significant sleep apnea. Patients may not be aware, that they are waking up during an episode. Actually most patients doesn’t remember being awakened. Sleep apnea may remain undiagnosed for many years. The people witnessing the sleeping patient are the first to notice the sleeping disorder; otherwise, sleep apnea may be diagnosed according to its sequela or effects on the patient’s health.


There are several factors increasing the risk of sleep apnea, two of the most common include:

  1. The male factor; being male increases the incidence 3 times more than being female.

  2. Excess weight also increases the risk, because the fat deposits around the upper air way can cause obstructed breathing. It can be revealed by the neck circumference, whether you have a high risk for sleep apnea, or not. Tonsillar, or adenoid hypertrophy, causes narrowing of the throat leading to obstructive apnea, as well.


It is not uncommon for a Hypertensive patient to suffer from sleep apnea. Smoking, alcohol, sedative drugs and CNS depressants are major risk factors. In fact, a family history of sleep apnea disorder in other members means high risk for the patient to suffer from the same disorder. Also, patients with heart disease, brain tumors or stroke are known to develop central sleep apnea. A patient should suspect having sleep apnea if he suffers from insomnia with daytime fatigue, headache and sleepiness (hypersomnia), loud snoring (more in obstructive type), observation of recurrent episodes of cessation of breathing, repeated awakening with shortened breath (more in central type) and dry mouth and throat. If you have these symptoms, you should see your health care provider for medical advice.


Physicians require some diagnostic tests, upon suggesting the disorder. Nocturnal polysomnography is a good overnight sleep test which records the breathing pauses lasting more than 10 seconds. The pauses are observed by cessation of the rib cage movement and airflow through the nose and mouth, and associated with drop of oxygen saturation and physical attempts to breathe or awakenings at night.


The apnea-hypopnea index is the measure showing the number of apneas and hypopneas per hour of sleep. There are other tests, such as oximetry and portable cardio respiratory testing (a tool for home testing) that may be used to assess changes in oxygen saturation and cardio respiratory rates, rhythms and functions.


It is good to diagnose sleep apnea disorder before it advances to complications. Upon discovery, a sleep apnea patient should be properly treated, avoiding complications such as daytime fatigue and cardiovascular complications, such as hypertension and heart failure. On some occasions, the patient may suffer a stroke, due to body hypoxia (low oxygen levels).


Sleep apnea treatment depends on its type. In obstructive sleep apnea in moderate to severe cases, a continuous positive airway pressure CPAP is used. This therapy is one that uses a machine that delivers air pressure through masks while the patient sleeps. This pressure is enough to keep the airway patent. A humidifier may be added, in order too avoid dry mouth. Another method is called the adjustable airway pressure devices. It is more comfortable and less problematic to the patient, as the pressure changes during sleep. For example, a lower pressure during exhalation and more pressure during inhalation are much better than a steady, maintained pressure. This is called bi-level positive airway pressure treatment (BiPAP). Alternatively, you can use an oral appliance designed to keep the throat opened, thus maintaining a patent airway. Additionally, the airway can be kept patent by surgery to remove excess soft tissue narrowing the lumen by UPPP or Uvulopalatopharyngeoplasty, Maxillomandibular advancement or, in very severe cases, Tracheotomy. Cases of central sleep apnea should be treated by proper diagnosis and treatment of the cause, with the use of supportive treatment in the form of oxygen supplies, CPAP and BiPAP.


Along with these treatments, the patient should make some lifestyle modifications, as well. Obese patients should start reducing excess weight. Patients should stop smoking, consuming alcohol and using sedatives and tranquilizers. Patients are also advised to sleep on their side or abdomen, instead of lying on their back. Certain nasal medications may assist in helping to keep the nasal passage patent. The treatment, lifestyle modifications and period of therapy need to be decided by the health care provider.


Consumption Assumption

No one enjoys tossing and turning into the wee hours of the morning, willing yourself to sleep so you don’t look like someone auditioning for Return of the Living Dead Part 2. Next time you have one of these fitful nights try to recall what you consumed in the 3- 4 hours before hitting the sack. What you consume before bed can drastically affect how well you sleep, it is essential to choose foods that promote rest and relaxation rather than those that stimulate you. While it may seem like common sense, is dessert not usually the last meal Americans consume before bedtime?


What foods are natural sleep aids?

I’ll bet that at some time or another someone, probably your grandmother, has told you to drink a glass of warm milk with honey for insomnia, why is this?


Milk – Milk contains tryptophan, the amino acid that the body uses to make serotonin, which promotes better sleep.


Honey - Consuming too much sugar before bedtime can make it difficult to fall asleep. However, a small amount of glucose before bedtime causes the brain to stop producing orexin, a neurotransmitter that keeps people alert.


Whole grains - Whole wheat, brown rice, and oats have a calming and soothing effect on the nervous system and the mind. Carbohydrates also boost serotonin, which promotes better sleep.


Bananas - Bananas balance melatonin and serotonin levels, which are the neurotransmitters necessary for deep sleep. They also contain magnesium, which is a muscle relaxant.