Sleep apnea is a serious sleep disruption that stops people from breathing at night and thus prevents a restful night of sleep. It is a condition much more serious than chronic fatigue and daytime sleepiness -- sleep apnea can actually kill. In sleep apnea, the sleeper's tongue slackens and blocks the air passage, which prevents a sufficient amount of oxygen to get to the brain and interrupts the normal function of the heart.
"It has been described like choking," says Dr. Engelberg at Altima Healthcare's Sleep Well Centre in downtown Toronto, "The person develops an overwhelming desire to breathe until their muscles overcome the obstruction. If the person is weak and frail (i.e. an elderly person), they may not be able to overcome the obstruction. This is how people can die in their sleep."
Sadly, it isn't only old people who "die in their sleep." A friend's cousin in his early 50s recently died of sleep apnea, leaving behind a small son and a very shocked and saddened family.
Stress and Sleep Apnea
Health issues, stress, weight, and age are factors in sleep apnea. I spoke to a patient of Dr. Engelberg's (who asked not to be named), a gent over 60 who experiences snoring, sleep apnea, arrhythmia (irregular heartbeat), and tooth grinding. The link between sleep apnea and heart disease is well known, but teeth grinding, or excessive clenching of the jaw, known as bruxism, is regarded by doctors as a stress manifestation. In the case of Dr. Engelberg's patient, his stress, grinding, and sleep disturbances increased when his wife became ill with cancer.
Nursing his ailing wife and working full time, the patient felt age-related weakness and his condition intensified. Along the way, he learned that his arrhythmia is related to his level of hydration, so he makes sure that he takes enough liquids, and with the help of an oral sleeping appliance, his arrhythmia and sleep apnea occurs much less frequently and with much less intensity, but his snoring continues. He believes this is strongly related to sleeping on his back.
Positional Sleep Apnea
When people sleep in the supine position (on their back), there is a greater and more severe tendency for obstructive respiratory events. In some patients, apneic episodes are twice as likely to occur in the supine position than when one sleeps on their side or stomach, according to a 2012 study published in Sleep Medicine Review.
"The supine position and laxity of the tissues in the neck cause the tongue to fall back against the oropharynx (throat)," Dr. Engelberg says. "This problem increases with age and weight gain. Sleep apnea is a progressive disease that worsens as the patient gets older."
Body mass is a key factor in sleep apnea because when one sleeps in the supine position, this can increase the risk of the airway collapsing under the weight of the chest. Ironically, sleep apnea can cause weight gain because sleep deprivation causes leptin, the "appetite control" hormone to fall, and so overeating begins and the risk cycle worsens.
At the suggestion of his heart doctor, Dr. Engelberg's patient wears a harness type of garment to bed which prevents him from rolling onto his back and this keeps him snoozing on his side with an open air passage. Another simple and cost-effective method to avoid the supine position is the "tennis-ball technique": a tennis ball is rolled in a t-shirt or a cloth belt and tied around the sleeper's torso so the ball is against the back; when the sleeper attempts to roll onto their back, the tennis ball provides just enough discomfort to keep them on their side. Propping a pillow against the back could be another easy way to prevent rolling onto the back.
It is possible that sleeping on the right mattress and pillow could also make a difference in sleep disturbances. According to Zen Abode, a medium firm memory foam mattress is the best for sleep apnea sufferers because the mattress offers correct spinal alignment. "By having the best possible alignment, you give yourself the best chance of having a clear airway," the eco home site says. "It also reduces pressure points and allows you to sleep on your side, giving you the opportunity to take advantage of side sleep pillows."
Sleeping on one's side is the advisable position for those who suffer sleep apnea because it reduces the weight on the chest and keeps the airway open. Zen Abode says to sleep with a high, firm pillow to keep the neck and head aligned with the shoulder.
Dr. Engelberg's patient says he has not changed his bedding, but maybe after reading this article, he'll invest in a good pillow or mattress to keep him more comfortable and breathing easier, or at least, snoring less.
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