Sleep Breathing Disorders: How to Recognize, Diagnose, and Treat Apnea
Kyiv • UNN
Ukraine celebrates Apnea Awareness Day. A somnologist spoke about the symptoms, diagnosis and modern methods of treating apnea, which can lead to serious consequences.
Almost 1 billion people worldwide suffer from apnea. Almost half of them (425 million) have a moderate or severe degree of the syndrome. Today, April 5, is Apnea Awareness Day – a condition in which the breathing process is blocked during sleep. At this time, the level of oxygen in the blood decreases, which can lead to more serious health problems and even death. UNN spoke with somnologist Daria Pylypenko to find out how to recognize the symptoms of apnea and treat this syndrome.
According to the expert, sleep disorders include more than 80 classifications, but the "top three" usually include restless legs syndrome, insomnia and apnea. The latter is central and obstructive.
Obstructive apnea
This most common type of apnea is characterized by breathing stops and breathing disorders due to its stops. They occur when the airways narrow and fall at the level of the larynx, which in turn leads to a decrease in air flow and blood oxygen saturation.
That is, the supply of oxygen stops during the night. There are several types of apnea severity: mild, moderate and severe. If we talk about the severe form, for example, a person may not breathe normally for five hours out of eight hours, for example. This is a very dangerous disease
Symptoms of apnea
These may include snoring, waking up with a feeling of lack of oxygen, dry mouth, headaches, and daytime sleepiness. All of them, individually and in combination, may indicate the presence of apnea.
It is important to highlight the symptoms here, whether a person gets up broken, whether he has frequent urination at night, that is, frequent trips to the toilet, whether he has dry mouth, headache, whether his partner complains of snoring
The danger of the syndrome
Breathing stops can vary in time. According to Pylypenko, a person normally holds their breath for up to 10 seconds. If they last longer, the supply of oxygen to the human body decreases by more than 30%. This may indicate a mild form of apnea.
Here, of course, it is necessary to conduct diagnostics. Because if it (apnea - ed.) is not treated, it can lead to stroke, heart attack, ischemic heart disease, because it is a stressful situation for the cardiovascular system
The thing is that in case of lack of oxygen, cortisol hormones are released into the blood, blood pressure rises, all this wears out the cardiovascular system, in particular the endothelial vessels, which increases the risk of cardiovascular diseases, especially in people with hypertension. Also, people with psychological disorders and diabetes are at risk.
"If, for example, a person has diabetes or increased sugar. Cardiovascular diseases. And if a person, for example, has already been diagnosed with mental illnesses, well, for example, depressive disorder. These are exactly three risk zone categories," - notes Pylypenko.
Diagnosis of apnea
Pylypenko says that the first thing to do is to consult a specialist who works with the patient's diagnoses, against the background of which he developed apnea.
Depending on what bothers the person: cardiovascular diseases, endocrinological diseases, perhaps a deviated septum or hyperplasia of the soft palate (soft tissues grow in it and block the airways), obstruction. A person may come with obesity, and he developed apnea against the background of obesity. Then first - to an endocrinologist
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Next, this specialist, to whom the person turned with complaints about poor sleep, needs to conduct a differential diagnosis.
For this, it is necessary to determine how a person sleeps and how many times he wakes up at night, whether he has increased sweating during sleep. If a person has turned to a somnologist with complaints about sleep immediately, he has the Berlin questionnaire at his disposal, which allows to detect hidden pathology and further conduct a more complete diagnosis, as well as prescribe appropriate treatment. And the Epworth daytime sleepiness scale, which will help the specialist understand how well the person is sleeping. At the same time, these questionnaires are validated and can be used in general medical practice.
"Very often people wake up, they have a wet pillow and hair. Frequent urination and a wet pillow. That's all. This is already a screening. Give more questionnaires, for example, the Berlin questionnaire or the Epffert scale for daytime sleepiness and it will immediately become clear where to direct further: either to go to a sleep laboratory, or to a clinic where there is a home test like polysomnography for home use," - says the expert.
Next, the specialist sends the patient for polysomnography: either a full night or a home one, in order to confirm or exclude the diagnosis of apnea and determine its severity.
Full polysomnography involves the patient spending the night in the clinic. This technique allows to accurately confirm the presence of apnea in the patient. The home test has less efficiency, but, according to the expert, in Ukraine it can be obtained for use in many clinics in Kyiv, where there is an ENT department. This is a device that is worn on the sternum or on the arm and has special tubes that are inserted into the nose.
Apnea treatment
But after confirmation of this syndrome, patients in Ukraine, according to the expert, "expect a real quest." The somnologist explains that the treatment should be comprehensive in order for the therapy to be effective. The most common treatment method available in Ukraine is CPAP therapy. It is used to treat patients with both mild and severe apnea.
"CPAP therapy is the gold standard for treating apnea worldwide. This is a compressor that delivers oxygen through a mask and expands the airways under pressure. Blood is saturated with oxygen, a person can breathe, but you have to sleep in a mask. However, not everyone wants to, not everyone can. There are anatomical and psychological features. Conditionally, a person has a panic disorder, he has panic attacks, then such a method becomes at risk," - informs the somnologist.
Also, according to Pylypenko, there are various oral and mandibular appliances. They are various caps that are inserted into the mouth and push the lower jaw forward to restore breathing. However, they are mostly used to treat mild apnea.
There is also a treatment method that involves stimulating the muscles of the tongue.
"This is such an implantation, a small surgery that stimulates the muscles of the tongue. And the space of the airways also opens. It has already appeared in Ukraine, but it is not yet widely available, because it is quite expensive," - says the expert.
However, Soviet treatment methods have also been preserved, which can even scare some people, because they include current stimulation.
I know from patients and doctors who still have such Soviet methods. Conditionally, a metal clothespin with a current conductor is inserted into the jaw, the main thing is not to touch the tongue, and a metal holder is given into the hand and such electrostimulation takes place. A very unpleasant procedure
However, in the rest of the world, there are many non-invasive methods approved by the FDA that do not cause any discomfort. For example, a device in the shape of an egg that reacts to the sound of snoring and signals that a person needs to change position. Or devices in the form of springs that are inserted into the mouth and pull out the jaw, allowing you to inhale.
And there is also the first device for people with apnea for daytime sleep, which provides a small pleuromuscular stimulation, reminding you to change position when snoring.
The somnologist also said that there is a device in the form of an Air Sleep belt, which is worn on the neck and creates a pleasant slight pressure that helps open the airways.
"Unfortunately, in principle, if we sum it up, there are many non-invasive cool methods in the world, but we only have oral devices and CPAP therapy - this is what is available and widespread," - Pylypenko summed up.
She also added that a big problem is the lack of training for relevant specialists, because even with most devices, you still need to be aware of how to work with them and what nuances may be. Currently, these devices can be ordered from abroad, but remember that they require knowledge about their use.
If a person at least knows that snoring is not normal and knows that there are symptoms of apnea and consults specialists about this, then the problem is easier to solve in the future. First of all, it is important that a person at least knows that he has such a problem. And then - he who seeks will find, I still believe
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Sleeping pills are contraindicated in apnea
Most people, noticing sleep disorders, turn to a family doctor. However, according to the somnologist, some medical specialists do not differentiate these complaints and prescribe sleeping pills to patients, which are highly not recommended and even dangerous in the case of apnea. The expert stressed that sleeping pills are not a treatment for the cause, they are a treatment for the symptoms, which can even lead to death. A person may not wake up because the body will not react to a decrease in the level of oxygen in the blood and may even die.
"If a person has moderate or severe apnea, he has breathing stops, what do sleeping pills do? They relax, not only the muscles, but also turn off some controls in the brain centers. Arousal centers are triggered, just if a person is suffocating. And if a person has apnea, especially in severe form, then in general it is not recommended to use sleeping pills in the protocols, a person may die. She just doesn't get excited. And we have a lot of deaths in our sleep. Especially from heart attacks, in the morning," - explains Pylypenko.
Sleep trackers
When asked whether sleep trackers or smartwatches can be used to diagnose apnea on their own, the expert noted that this method is more harmful than useful, because noticing unsatisfactory indicators, a person may only start to worry more, which may provoke even more insomnia in himself.
"From appeals to me, I can say that these trackers led to insomnia and anxiety. That is, they are lying, a person begins to worry that he is not sleeping properly, that he does not have the same sleep phase, that he does not have deep sleep and he simply falls into anxiety," - says Pylypenko.
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However, the sleep specialist noted that not all trackers are the same and there are those that can be useful, but they are less common in Ukraine.
"There are trackers in the world, there are no patented such trackers in Ukraine that can measure the level of oxygen, first of all, a low level of oxygen can indicate apnea," - explained Pylypenko.
Other tracker options are available in Ukraine in the form of a ring, which has sensors that measure several indicators at once: frequency, change of position, movement during sleep, heart rate, blood oxygen saturation, which in total can become a conditional hint to consult a specialist.
"If you find the right tracker, as an option, but only if the person did not diagnose himself, but still turned to a doctor and underwent a differential diagnosis," - explained the expert.
Psychotherapy in the treatment of apnea
According to Pylypenko, in the case of a severe form of apnea, when a person has not only physiological sleep disorders due to lack of oxygen in the blood, but also acquired psychological problems because of this, for example, is afraid to fall asleep, because he knows that he may suffocate, you can also connect work with a psychologist. This will help make the treatment more qualitative. However, if a person has exclusively physiological aspects of the disease, psychotherapy is powerless.
When a person is afraid to go to sleep, because he knows that he will lie down and suffocate and may die, in such cases it is better to use everything in the complex. Psychotherapy plus CPAP therapy, for example. This is just perfect
Consequences of insomnia
Prolonged insomnia can be dangerous for a person and even his environment. Due to insufficient sleep, attention and concentration decrease, irritability is added, which significantly worsens the quality of life. In addition, if a person is driving during the day or working with large mechanisms, for example in a factory, a decrease in concentration and attention can be decisive in matters of safety and even life.
"According to American statistics, when the clock is turned forward to daylight saving time on Sunday, the largest number of surgical errors is recorded on Monday. Because he didn't get enough sleep and the concentration decreases," - notes Pylypenko.
And these are the consequences of only one hour that a person "did not get enough sleep." In chronic sleep deprivation, for any reason, the situation may look even more dramatic. The expert also added that those who have apnea, according to statistics, get into accidents more often than other people, because their concentration decreases due to lack of sleep.
"Those who work with dangerous chemicals, those who work on heavy machinery, for example, in workshops, surgeons, all this, of course, can lead to industrial injuries or even fatal cases," - adds the somnologist.
