Sleep Apnea an Insidious Angel of Death?

23 07 2010

I first heard of sleep apnea about 10 years back, but never gave it a second thought until 2 years ago when an in-law and now a sibling had been diagnosed and treated for this condition.  I was also told within the last 6 months from a good friend of mine while on a walk a childhood buddy of ours had died in his sleep from this disorder.  It is my understanding his early and unnecessary death occurred for lack of following medical treatment protocols.   I refer to this disorder as an insidious angel of death, why?    Because this is a serious health condition and if ignored can kill without warning!  Our childhood friend was around 47 years of age and left his loved ones before his time.  Since this disorder has such a high risk potential for fatality and emotional pain to family and friends, I felt it was high time to write on this topic.

     First let’s understand the definition of apnea.  It is the temporary suspension of respiration, or without breathing.  Sleep apnea when diagnosed is commonly referred to as OSA (Obstructive Sleep Apnea), or complex apnea.  OSA is the anatomical obstruction that is the cause of airway blockage, where complex can be with obstruction and/or central nervous system problems.  Regardless of sleep disorders cause, it increases the risk of heart failure by way of coronary heart disease for lack of oxygen when breathing is interrupted.  As oxygen levels decrease in the blood, carbon dioxide levels increase.  This condition creates a jumpy nervous system and blood pressure spikes that stresses the heart walls and disturbs heart rhythm.  Over time, this reoccurring condition puts you at risk of a heart attack.  This is not only bad for your heart, but nearly every organ and tissues of the human body creating high risk for many other types of illness and disease. 

     Okay, let’s break this down a little bit more so we can really understand the mechanics of how obstruction occurs.  As the soft palate at the back of the throat collapses during sleep those that suffer from sleep apnea begin to snore and apparently struggle to breath. The obstructive collapse for instance in the neck area while relaxed and during sleep is not able to keep a clear airway passage.  Obstructive soft tissue problems typically occur at the base of the tongue, tonsils and nasal cavity areas.  There is also sleep apnea caused by the central nervous system where the brain is not registering the lungs to breath with regular consistency.  When diagnosed with sleep apnea where obstruction is not the cause, it is understood the problem stems from the central nervous system.  The central system cause of sleep apnea is “not” well understood by researchers why the brain begins to inconsistently regulate breathing during sleep.

     Regardless of whether sleep apnea is caused from an obstructive or neurological problem, lack of oxygen during sleep causes internal disease in the following ways.  When one is awakened abruptly from sleep to catch their breath, adrenaline increases blood pressure which is also believed to contribute to vascular problems.  And with blood pressure surges, one than can also become more at risk for blood clots, stroke, arrhythmias, diabetes hypertension and memory loss.  Sleep apnea may also trigger seizures in the absence of epilepsy, or trigger seizures that were treated well in the past by medications.  In the long run the primary damage caused by this sleep disorder is due to unstable blood pressure regulation and adequate oxygen to the heart and brain.  Sleep apnea has the same risk factors on health as risks associated with heavy smoking.

     Sleep Study Tests Show the Following Results:  While asleep, those with sleep apnea unknowingly experience episodes where they stop breathing.  This can occur 5-50 times per hour and up to 300 times during regular sleep.  But if the “non breathing” episodes only last seconds or less, this does not appear to have a significant health risk to the body.  But if one is sleeping and averages 30 “non breathing” episodes per hourly average where breathing stops up to 10 second intervals minimum between breaths, this is where serious health risk increases and incremental/accumulative damage to the heart occurs.  While loved one(s) and friends assume you simply have a bad, loud obnoxious snore, this could in fact be an indicator of something far worse than irritating those around you.  And also be aware, just because you snore does not mean you have sleep apnea.  Only a sleep study test can prove this for sure.

     High Risk Indicators:  Those that are obese tend to have a lot of fatty tissue and low muscle tone around neck area.  Obesity creates the anatomical characteristics of obstruction potential for impingement, pressing down, or blockage of the airway while lying down.  Also males between 40-70 years of age and diagnosed with sleep apnea have a 68% higher risk of “coronary heart disease” than those without it.  And men that have been diagnosed with OSA have a 58 percent greater risk of “cardiac failure” than those without.  Women don’t appear to suffer from this condition, but science agrees more studies on women are recommended.   The common times of sudden death appear to occur mostly between the hours of midnight to 6am.

   What to look for:  Listen for loud snoring and/or those that fall into the obese category. If both breathing and snoring stops while the chest and body attempt to breath, this is classic of obstructive sleep apnea syndrome.  When breathing starts you’ll note a gasp for air and snoring begins again.  

 Other Recommendations and Medical Treatment

  1. Diagnostic tests: Oximetry or polysomnography – If you have insomnia consider asking your doctor to be referred to a Level 3 sleep study where your breathing, oxygen flow, heart rate and chest/abdomen expansion are monitored overnight.
  2.  CPAP (Continuous Positive Airway Pressure) This is mask worn while sleeping that injects air into the respiratory system without interruption of obstructing air flow to the body.  How it works: The device blows positive pressure into the nose to keep the airway from collapsing.
  3. Sleep at 30 degree elevated level helps to keep gravity pulling down on weakened tissues around the neck area from obstructing airway. 
  4. Decrease weight, stop smoking, chewing tobacco.
  5. If you are diabetic your odds of OSA increase 3-fold. Seek treatment and follow your doctor’s advice for diabetes.
  6. Avoid alcohol, muscle relaxants, chronic opiate use.  The presence of sleep apnea without an obstructive component appears to be a common symptom for those that abuse opiates.
  7. For those with OSA and are candidates for surgery to alter the airway may be your solution to getting away from CPAP dependency.  I.e., Throat, base of tongue and facial skeleton surgery can correct the anatomical obstruction cause.
  8. Check on medications and other treatment for complex sleep apnea that include unknown central nervous system cause, e.g., Acetazolamide to lower blood pressure and encourage respiration.

 References

  1. http://www.medindia.net/news/Risk-of-Heart-Disease-Increases-With-Obstructive-Sleep-Apnea-71310-1.htm
  2. http://www.vancouversun.com/health/Treating+sleep+deprivation+begins+with+proper+diagnosis/3295105/story.html
  3.   http://www.webmd.com/sleep-disorders/sleep-apnea/news/20050323/sleep-apnea-makes-wee-hours-sudden-death-time
  4.   http://en.wikipedia.org/wiki/Sleep_apnea

 Author:  Marc T. Woodard, MBA, BS Exercise Science, USA Medical Services Officer, CPT, RET2010 Copyright.  All rights reserved, Mirror Athlete Publishing @: http://www.mirrorathlete.com,  Sign up for your Free eNewsletter.





Sleep Apnea an Insidious Angel of Death

23 07 2010

I definitely won't fall asleep on this thing.

I first heard of sleep apnea about 10 years back, but never gave it a second thought until 2 years ago when an in-law and now a sibling had been diagnosed and treated for this condition.  I was also told within the last 6 months from a good friend of mine while on a walk a childhood buddy of ours had died in his sleep from this disorder.  It is my understanding his early and unnecessary death occurred for lack of following medical treatment protocols.   I refer to this disorder as an insidious angel of death, why?    Because this is a serious health condition and if ignored can kill without warning!  Our childhood friend was around 47 years of age and left his loved ones before his time.  Since this disorder has such a high risk potential for fatality and emotional pain to family and friends, I felt it was high time to write on this topic.

     First let’s understand the definition of apnea.  It is the temporary suspension of respiration, or without breathing.  Sleep apnea when diagnosed is commonly referred to as OSA (Obstructive Sleep Apnea), or complex apnea.  OSA is the anatomical obstruction that is the cause of airway blockage, where complex can be with obstruction and/or central nervous system problems.  Regardless of sleep disorders cause, it increases the risk of heart failure by way of coronary heart disease for lack of oxygen when breathing is interrupted.  As oxygen levels decrease in the blood, carbon dioxide levels increase.  This condition creates a jumpy nervous system and blood pressure spikes that stresses the heart walls and disturbs heart rhythm.  Over time, this reoccurring condition puts you at risk of a heart attack.  This is not only bad for your heart, but nearly every organ and tissues of the human body creating high risk for many other types of illness and disease. 

     Okay, let’s break this down a little bit more so we can really understand the mechanics of how obstruction occurs.  As the soft palate at the back of the throat collapses during sleep those that suffer from sleep apnea begin to snore and apparently struggle to breath. The obstructive collapse for instance in the neck area while relaxed and during sleep is not able to keep a clear airway passage.  Obstructive soft tissue problems typically occur at the base of the tongue, tonsils and nasal cavity areas.  There is also sleep apnea caused by the central nervous system where the brain is not registering the lungs to breath with regular consistency.  When diagnosed with sleep apnea where obstruction is not the cause, it is understood the problem stems from the central nervous system.  The central system cause of sleep apnea is “not” well understood by researchers why the brain begins to inconsistently regulate breathing during sleep.

     Regardless of whether sleep apnea is caused from an obstructive or neurological problem, lack of oxygen during sleep causes internal disease in the following ways.  When one is awakened abruptly from sleep to catch their breath, adrenaline increases blood pressure which is also believed to contribute to vascular problems.  And with blood pressure surges, one than can also become more at risk for blood clots, stroke, arrhythmias, diabetes hypertension and memory loss.  Sleep apnea may also trigger seizures in the absence of epilepsy, or trigger seizures that were treated well in the past by medications.  In the long run the primary damage caused by this sleep disorder is due to unstable blood pressure regulation and adequate oxygen to the heart and brain.  Sleep apnea has the same risk factors on health as risks associated with heavy smoking.

     Sleep Study Tests Show the Following Results:  While asleep, those with sleep apnea unknowingly experience episodes where they stop breathing.  This can occur 5-50 times per hour and up to 300 times during regular sleep.  But if the “non breathing” episodes only last seconds or less, this does not appear to have a significant health risk to the body.  But if one is sleeping and averages 30 “non breathing” episodes per hourly average where breathing stops up to 10 second intervals minimum between breaths, this is where serious health risk increases and incremental/accumulative damage to the heart occurs.  While loved one(s) and friends assume you simply have a bad, loud obnoxious snore, this could in fact be an indicator of something far worse than irritating those around you.  And also be aware, just because you snore does not mean you have sleep apnea.  Only a sleep study test can prove this for sure.

     High Risk Indicators:  Those that are obese tend to have a lot of fatty tissue and low muscle tone around neck area.  Obesity creates the anatomical characteristics of obstruction potential for impingement, pressing down, or blockage of the airway while lying down.  Also males between 40-70 years of age and diagnosed with sleep apnea have a 68% higher risk of “coronary heart disease” than those without it.  And men that have been diagnosed with OSA have a 58 percent greater risk of “cardiac failure” than those without.  Women don’t appear to suffer from this condition, but science agrees more studies on women are recommended.   The common times of sudden death appear to occur mostly between the hours of midnight to 6am.

   What to look for:  Listen for loud snoring and/or those that fall into the obese category. If both breathing and snoring stops while the chest and body attempt to breath, this is classic of obstructive sleep apnea syndrome.  When breathing starts you’ll note a gasp for air and snoring begins again.  

 Other Recommendations and Medical Treatment

  1. Diagnostic tests: Oximetry or polysomnography – If you have insomnia consider asking your doctor to be referred to a Level 3 sleep study where your breathing, oxygen flow, heart rate and chest/abdomen expansion are monitored overnight.
  2.  CPAP (Continuous Positive Airway Pressure) This is mask worn while sleeping that injects air into the respiratory system without interruption of obstructing air flow to the body.  How it works: The device blows positive pressure into the nose to keep the airway from collapsing.
  3. Sleep at 30 degree elevated level helps to keep gravity pulling down on weakened tissues around the neck area from obstructing airway. 
  4. Decrease weight, stop smoking, chewing tobacco.
  5. If you are diabetic your odds of OSA increase 3-fold. Seek treatment and follow your doctor’s advice for diabetes.
  6. Avoid alcohol, muscle relaxants, chronic opiate use.  The presence of sleep apnea without an obstructive component appears to be a common symptom for those that abuse opiates.
  7. For those with OSA and are candidates for surgery to alter the airway may be your solution to getting away from CPAP dependency.  I.e., Throat, base of tongue and facial skeleton surgery can correct the anatomical obstruction cause.
  8. Check on medications and other treatment for complex sleep apnea that include unknown central nervous system cause, e.g., Acetazolamide to lower blood pressure and encourage respiration.

 References

  1. http://www.medindia.net/news/Risk-of-Heart-Disease-Increases-With-Obstructive-Sleep-Apnea-71310-1.htm
  2. http://www.vancouversun.com/health/Treating+sleep+deprivation+begins+with+proper+diagnosis/3295105/story.html
  3.   http://www.webmd.com/sleep-disorders/sleep-apnea/news/20050323/sleep-apnea-makes-wee-hours-sudden-death-time
  4.   http://en.wikipedia.org/wiki/Sleep_apnea

 Author:  Marc T. Woodard, MBA, BS Exercise Science, USA Medical Services Officer, CPT, RET2010 Copyright.  All rights reserved, Mirror Athlete Publishing @: http://www.mirrorathlete.com,  Sign up for your Free eNewsletter.





Why Should You be Concerned about Triglycerides?

25 10 2008

Q.   What are Triglycerides, should I be concerned?   I received my blood test last week and my triglyceride count was 184.  I was told this is average for my age.  I also had another friend of mine tell me this is high.  I’m not sure I understand what this means to my health.  Can you help provide a little insight?

A.    In a world where everyone is pinched for time; meal preparations within most family units now rely heavily on processed foods for convenience.  Our country has an obesity epidemic in mass proportions occurring especially seen within our children.  It is my opinion triglycerides should be as concerning to an individual that watches their cholesterol intake.  If you are concerned about your cholesterol also take stock of your triglyceride count.   Before I answer your question directly, let me provide a brief outline of what triglycerides represent to our health and why we should care about them.

Triglycerides are a type of fat in your blood much like cholesterol.   Neither one of these fats can dissolve in the blood.  Both fats use lipoproteins to circulate these fats throughout the body to be used by the metabolism.  Cholesterol function is to build cells and various hormones.  Triglyceride function is to provide the body with energy.   However, too much (high levels) of either of these blood fats for long periods of time create health risk and disease.  High triglycerides like cholesterol is thought to cause, or contribute to hardening of the arteries, or increasing the artery wall thickness (atherosclerosis).  Most of us know these conditions can lead to stroke, heart attack and heart disease.  High triglycerides also may trigger diabetes,  or create disease in the thyroid, liver and kidney.  Suspect you may have high triglyceride levels in your blood if you have too much fat around the waist.  “More often than not,” obesity and disease have a direct correlation with high triglycerides, high cholesterol, High blood sugar (glucose) and high blood pressure.  Check your “health risk” to potential disease by entering your weight/height into our fitness calculator at our healthblog page tab (click on the Fitness Calculator Link).

Without a blood test to indicate your level of triglycerides, one may suspect an elevation of the two blood fats if you typically over consume without regard to food intake.  This is not to say one consumes more, or less fatty, or cholesterol type foods.  Blood counts could be inverted.  In other words, you may watch your cholesterol, but because of other food choices, or hormone inefficiencies, consumption of triglycerides in your foods, or hormones don’t store blood fats adequately which can create a constant elevation of  triglycerides above normal levels (hypertriglyceridemia).

Although I believe your triglyceride levels appear decent opposed to many other counts I have seen, the normal level within the medical community sees a normal triglyceride level to be less than 150mg/dl.   Your count of 184 is considered “Borderline High 150 to 199 mg/dl.  High 200 to 499mg/dl, Very High 500mg/dl or above. Note:  Prescriptions can elevate your triglyceride levels, such as birth control pills, diuretics, steroids and breast cancer drug Tamoxifen, etc. 

 RECOMMENDATIONS:

 1.  Maintain “Ideal Body Weight,” Use our Fitness Calculator at home site to determine your IBW.

2.  Reduce excess calorie consumption, especially baked goods, processed foods, sugar, white flour. 

3.  Reduce trans fats found in many baked goods, cooking, crackers, chips, snack cakes etc.  Note – Just because a product states low trans fat there is still trans fat in most of these types of foods!  Even low level trans fat consumption could increase risk of disease.

4.  Avoid Alcohol.

5.  Exercise aerobically at least 30 minutes daily.

Author:  Marc T. Woodard, MBA, BS Exercise Science, USA Medical Services Officer, CPT, RET.  2008 Copyright.  All rights reserved, Mirror Athlete Publishing, http://www.mirrorathlete.com,  Sign up for your Free eNewsletter.