Sleep Apnea - A Dangerous Sleeping Disorder

There are 3 types of sleep apnea:

1. Central Apnea - caused by a failure of the brain to activate the muscles of breathing during sleep.
2. Obstructive Sleep Apnea (OSA) - caused by a collapse of the airway during sleep.
3. Mixed Apnea- a combination of central and OSA.

If interruptions in breathing (apnea) occur 15 or more times per hour the individual has significant sleep apnea. A normal Apnea Hypo Apnea Index (AHI) is < 5. A AHI of 5-15 is mild OSA, 15 to 30 is moderate OSA and > 30 apneic episode per hour is severe OSA.
Risk Factors for OSA include:
Increasing age (common among adults, rare in children)
More common in men than in pre-menopausal women, but the prevalence in post-menopausal women is about the same as men of same age.
Central/truncal obesity
Large neck size (> 17 inches in men and > 16 inches in women)
A large tongue that obstructs the airway
Smoking
Use of alcohol or other Central Nervous System (CNS) depressant drugs, sedatives and muscle relaxants.
Short-term OSA
Short-term OSA may be the result of upper airway infections, nasal congestion, swelling of the throat as in Infectious Mononucleosis and also in individuals with large tonsils. Here the apnea resolves once the underlying condition is treated.
Warning signs of OSA include:
Loud snoring
Excessive daytime sleepiness (fatigue), sleepy while driving
Apneic episodes witnessed by another person
Choking and gasping for air during sleep
Memory problems, irritability, anxiety and increasing depression.
Difficulty performing duties at work/home/school
Accidents on the job and /or Motor Vehicle Accidents (MVA).
Waking up due to acid reflux from the stomach- Gastro Esophageal Reflux Disease (GERD)
Morning headaches
Complications of OSA:
High Blood Pressure (hypertension)
Ischemic Heart Disease leading to heart attacks and stroke
Arrhythmias (irregular heartbeats)
Type 2 Diabetes Mellitus
Pulmonary Hypertension (elevated pressure in the blood vessels of the lungs) and Death.
Diagnosis of OSA:
Diagnosis is made by a careful history from patient and individual(s) who observe apneic episodes in the patient during sleep, and a careful physical examination. The gold standard test used to diagnose sleep apnea is an overnight polysomnogram(PSG) "sleep study". The polysomnogram can be performed either in a sleep laboratory or by Home Diagnostic Titration Testing (HDTT).
Treatment of OSA:
For mild to moderate cases of OSA, oral appliances may work; these can be made by a Dentist or Orthodontist. Upper airway surgery (on the soft palate) or nasal surgery (correction of nasal septum/rhinoplasty) may be recommended.
For Severe OSA the most common treatment is the use of CPAP therapy (Constant Positive Airway Pressure). The CPAP device is a small portable machine with a generator which delivers room air to the lungs at a positive pressure through a tubing via a full face mask worn every night during sleep.
For patients who find it difficult to sleep with a mask, a nasal pillow device can be substituted to increase compliance. If the CPAP pressure appears to be excessive bi-level therapy which uses a lower level of pressure can substituted.
RECOMMENDATIONS:
Behavior modification is the key to symptom improvement. Individuals should lose weight, engage in regular exercise, stop smoking, avoid sleeping on the back, avoid alcohol and sedating medications, treat any allergic/upper respiratory symptoms.

Summary:
Even if symptoms improve with behavior therapy, individuals should not discontinue their CPAP therapy without consulting with their Health Care Provider. The only accurate and safe way to determine if an individual no longer has sleep apnea is to perform a repeat polysomnogram.

By Beverly P Russell 

How Do Sleeping Pills Work?

Author: Eric Cho
Sleeping pills are sedatives that depress the central nervous system of the human body. This results in tranquility, relaxation, less anxiety, sleepiness, slowed breathing, slurred speaking, staggering gait, poor judgment and slow, uncertain reflexes. They are also called downers, tranquillizers, depressants, anxiolytics, soporifics or sedative hypnotics.

Most sleeping pills are usually prescribed for patients with anxiety problems. However, those described as sedatives are also used to help people sleep. Long term use of sleeping pills is discouraged as they are addictive and could be dangerous to the health of the patient.

The human body has two basic drives which is the waking drive and the sleeping drive. During the day, the waking drive is strong and the brain remains active. As the day wears on, the waking drive becomes weaker and the sleeping drive strengthens. As evening approaches, the sleeping drive builds up and by the time night approaches, the body is ready to go to sleep. What a sleeping pill does is that it strengthens the sleeping drive in the human body. A person with insomnia has imbalanced sleeping and waking drives.

In normal people, the onset of darkness induces the pineal gland in the brain to secrete a hormone called melatonin which prompts the body to go into the sleep drive. The melatonin makes the body less alert, it slows down the body mechanisms and the person begins to feel the need to sleep. The action of sleeping pills is similar. It sends signals to the brain that approximate to the symptoms produced by the hormone melatonin. The central nervous system is dampened and its ability to function is diminished. This makes the person sleepy. Sleeping pills work less effectively when the patient has had long term insomnia or has had trouble staying asleep for a long time.

Most sleeping pills are Benzodiazepines. Benzodiazepines are minor tranquilizers that belong to a class of drugs that are used to induce sleep. There are several drugs such as Nitrazepam, Loprazolam and Flurazepam that are categorized under Benzodiazepines. However, benzodiazepines are also used to tackle problems relating to anxiety, epileptic seizure and amnesia and it is important to choose the right benzodiazepine as a sleeping pill. Some of the trade names of benzodiazepines drugs are Mogadon, Remnos and Somnite. The natural herb Mandrake is also a common ingredient in these drugs. Mandrake is traditionally known as a drug that helps people sleep.

However, there are possibilities of side effects when taking sleeping pills. Most benzodiazepines have the same side effects- headaches, drowsiness, light-headedness, unsteadiness, confusion, forgetfulness, dependence, withdrawal, increase in aggression and muscle weakness. There are many drugs that one might be consuming that may interfere with the effectiveness of sleeping pills. These drugs themselves may be sleep inducing and taking sleeping pills in addition to such drugs will result in the effect of these pills lasting longer. People with respiratory problem, muscle problems, a history of drug or alcohol abuse or personality disorder, who are consuming sleeping pills, are advised to use it with caution and to consult their physician before taking any sleeping pill.

Moreover, some sleeping pills are known to cause amnesia. Patients have been known to perform several physical activities-even going on a binge on food-while completely asleep under the effects of the sleeping pill. Patients must, therefore, ensure that the instructions are followed meticulously and go to bed immediately after taking the sleeping pill.


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