Sleep Apnea

Sleep apnea is defined by episodes during which a sleeper’s breathing stops. Sleep apnea episodes can last 10–20 seconds or longer and often are associated with brief periods of arousal. While individuals suffering from sleep apnea may not be aware of these repeated disruptions in sleep, they do experience increased levels of fatigue. Many individuals diagnosed with sleep apnea first seek treatment because their sleeping partners indicate that they snore loudly and/or stop breathing for extended periods of time while sleeping (Henry & Rosenthal, 2013).

Sleep apnea is much more common in people who are overweight and it may exacerbate cardiovascular disease (Sánchez-de-la-Torre, Campos-Rodriguez, & Barbé, 2012). While sleep apnea is less common in people who are thin, anyone, regardless of their weight, who snores loudly or gasps for air while sleeping, should be checked for sleep apnea.

While people are often unaware of their sleep apnea, they are keenly aware of some of the adverse consequences of insufficient sleep. One person explained that the sleep apnea affected his daily life saying, “I’m in a job where there’s a premium on being mentally alert. I was really sleepy . . . and having trouble concentrating. . . . It was getting to the point where it was kind of scary” (Henry & Rosenthal, 2013, p. 52).

There are two main types of sleep apnea: obstructive sleep apnea, listed as obstructive sleep apnea hypopnea (OSAH) in the DSM-5, and central sleep apnea. Obstructive sleep apnea occurs when an individual’s airway becomes blocked during sleep and air is prevented from entering the lungs. It is diagnosed if a person has at least five obstructive apneas per hour of sleep combined with breathing disturbances such as snoring and daytime sleepiness or at least fifteen obstructive apneas per hour of sleep without other symptoms. The apnea is characterized by at least ten-second disturbances in breathing. In central sleep apnea (CSA), disruption in signals sent from the brain that regulate breathing cause periods of interrupted breathing (White, 2005). Central sleep apnea is less common than obstructive sleep apnea hypopnea (OSAH) and is more commonly associated with illnesses.

Approximately 2%-9% of adults in the United States have obstructive sleep apnea and about 0.9% of adults over the age of 40 are diagnosed with central sleep apnea, but many cases are estimated to be undiagnosed. Both are more common in men than women. There are multiple factors that contribute to being at risk for sleep apnea, including obesity, hormonal imbalances, smoking cigarettes, family history, and the size and positioning of the jaw, throat, and tongue.^[1]

Treatment

One of the most common treatments for sleep apnea involves the use of a special device during sleep. A continuous positive airway pressure (CPAP) device includes a mask that fits over the sleeper’s nose and mouth, which is connected to a pump that pumps air into the person’s airways, forcing them to remain open, as shown in Figure 1. Some newer continuous positive airway pressure (CPAP) masks are smaller and cover only the nose. This treatment option has proven to be effective for people suffering from mild to severe cases of sleep apnea (McDaid et al., 2009). However, alternative treatment options are being explored because consistent compliance by users of continuous positive airway pressure (CPAP) devices is a problem. EPAP (excitatory positive air pressure) device has shown promise in double-blind trials as one such alternative (Berry, Kryger, & Massie, 2011). Treatment of sleep apnea also involves treading comorbid medical conditions, sometimes through surgery or medications.

Figure 1. (a) A typical CPAP device used in the treatment of sleep apnea is (b) affixed to the head with straps and a mask that covers the nose and mouth.

Key Takeaways: Sleep Apnea

SIDS

Figure 2. The Safe to Sleep campaign educates the public about how to minimize risk factors associated with SIDS. This campaign is sponsored in part by the National Institute of Child Health and Human Development.

In sudden infant death syndrome (SIDS), an infant stops breathing during sleep and dies. Infants younger than 12 months appear to be at the highest risk for SIDS, and boys have a greater risk than girls. A number of risk factors have been associated with SIDS, including premature birth, smoking within the home, and hyperthermia. There may also be differences in both brain structure and function in infants that die from SIDS (Berkowitz, 2012; Mage & Donner, 2006; Thach, 2005).

The substantial amount of research on SIDS has led to a number of recommendations to parents to protect their children (Figure 2). For one, research suggests that infants should be placed on their backs when put down to sleep, and their cribs should not contain any items that pose suffocation threats, such as blankets, pillows, or padded crib bumpers (cushions that cover the bars of a crib). Infants should not have caps placed on their heads when put down to sleep in order to prevent overheating, and people in the child’s household should abstain from smoking in the home. Recommendations like these have helped to decrease the number of infant deaths from SIDS in recent years (Mitchell, 2009; Task Force on Sudden Infant Death Syndrome, 2011).