Sleep Apnea and the Heart
Sleep apnea is a serious sleep disorder that occurs when a person’s breathing is interrupted during sleep. In sleep apnea your breathing passages becomes blocked, or the muscles that control your breathing stop moving. Either way, breathing stops, and then resumes with a gasp. In the worst cases, this can happen hundreds of times every night. This means the brain and the rest of the body may not get enough oxygen. And if left untreated, sleep apnea can result in a growing number of health problems, including:
- Cardiovascular problems. The more severe the sleep apnea, the greater the risk of coronary artery disease, heart failure, irregular heartbeats, heart attack, and stroke. Men with sleep apnea are especially at risk of heart failure.
- High blood pressure. Sudden drops in blood oxygen levels can increase blood pressure and strain the cardiovascular system.
- In children, sleep apnea can cause hyperactivity, poor school performance, angry or hostile behavior and a worsening of ADHA.
- Fatigue. Sleep apnea usually is a chronic condition that disrupts your sleep. When your breathing pauses or becomes shallow, you’ll often move out of deep sleep and into light sleep. As a result, the quality of your sleep is poor, which makes you tired during the day. Sleep apnea is a leading cause of excessive daytime sleepiness and can increase the risk of having work-related or driving accidents.
Symptoms of Sleep Apnea: Sleep apnea often goes undiagnosed, as doctors usually can’t detect the condition during routine office visits and there isn’t a blood test that can diagnose the condition. Most people who have sleep apnea don’t know they have it, because it only occurs during sleep. A family member or bed partner might be the first to notice signs of sleep apnea. Signs and symptoms of sleep apnea include:
- Loud or frequent snoring
- Daytime fatigue
- Morning headaches
- Memory or learning problems and not being able to concentrate
- Feeling irritable, depressed, or having mood swings or personality changes
- Waking up frequently to urinate
- Dry mouth or sore throat when you wake up
There are two types of sleep apnea:
Obstructive Sleep Apnea (OSA). The most common type of sleep apnea is Obstructive Sleep Apnea (OSA). In this condition, the soft tissue in the back of the throat collapses or becomes blocked during sleep, causing shallow breathing or breathing pauses. Oxygen levels drop when breathing slows and the body responds by releasing epinephrine (also called adrenaline), a stress hormone. When this happens over and over, adrenaline levels remain high, leading to high blood pressure. “Over time, OSA exposes the heart and circulation to harmful stimuli that may cause or contribute to the progression of most cardiovascular diseases,” explains Dr. Atul Malhotra, associate professor at Harvard Medical School and sleep specialist at Brigham and Women’s Hospital. OSA affects an estimated 15 million adult Americans and is present in a large proportion of people who have hypertension and other cardiovascular disorders, including coronary artery disease, stroke, and atrial fibrillation (irregular heartbeat).
Central Sleep Apnea (CSA): Central sleep apnea (CSA) is a less common type of sleep apnea. This disorder occurs when the area of your brain that controls your breathing doesn’t send the correct signals to your breathing muscles. CSA can be caused by a number of conditions that affect the ability of your brain-stem, the area that links your brain to your spinal cord and controls many functions such as heart rate and breathing, to control your breathing.
Who is at Risk for Sleep Apnea?
- Men are more likely than women to develop sleep apnea
- About half of the people who have sleep apnea are overweight
- The risk for sleep apnea increases after age 40
- A large neck (17 inches or greater in men and 16 inches or greater in women) has more soft tissue that can block your airway during sleep
- Large tonsils, a large tongue, or a small jaw bone can restrict airways
- Opioid users
- A family history of sleep apnea
- Gastro-esophageal reflux, or GERD
- Nasal obstruction due to a deviated septum, allergies, or sinus problems
- Heart disorders. People with irregular heartbeat (arrhythmia) or congestive heart failure are at greater risk of sleep apnea.
- Stroke, brain tumor or a structural brain-stem lesion.These brain conditions can impair the brain’s ability to regulate breathing.
- High altitude.Sleeping at an altitude higher than you’re accustomed to may increase your risk of sleep apnea. High-altitude sleep apnea is no longer a problem when you return to a lower altitude.
Treatment: Sleep apnea is a chronic condition that requires long-term management. Lifestyle changes, mouthpieces, breathing devices, and surgery can successfully treat sleep apnea in many people.
Lifestyle Changes: If you have mild sleep apnea, some changes in daily activities or habits might be all the treatment you need.
- Avoid alcohol and medicines that make you sleepy. They make it harder for your throat to stay open while you sleep.
- Lose weight if you’re overweight or obese. Even a little weight loss can improve your symptoms.
- Sleep on your side instead of your back to help keep your throat open.
- Talk with your doctor about whether nasal sprays or allergy medicines might help keep your nasal passages open at night.
- If you smoke, quit.
Mouthpieces: A mouthpiece, sometimes called an oral appliance, may help some people who have mild sleep apnea. A dentist or orthodontist can make a custom-fit plastic mouthpiece for treating sleep apnea. The mouthpiece will help keep your airways open while you sleep.
Breathing Devices: A CPAP (continuous positive airway pressure) is the most common treatment for moderate to severe sleep apnea in adults. A CPAP machine uses a mask that fits over your mouth and nose, or just over your nose. The machine gently blows air into your throat. The pressure from the air helps keep your airway open while you sleep.
Surgery: Some people who have sleep apnea might benefit from surgery. Surgery is done to widen breathing passages by shrinking, stiffening, or removing excess tissue in the mouth and throat or resetting the lower jaw.
If you, or a loved one, is having trouble breathing at night, see a doctor. Life style changes can help a person with mild sleep apnea, and in more severe cases, there are treatments that can keep the breathing passages open and normalize oxygen levels.
The American Heart Assoc. Sep. 16, 2016: http://www.heart.org/HEARTORG/Conditions/More/MyHeartandStrokeNews/Sleep-Apnea-and-Heart-Disease-Stroke_UCM_441857_Article.jsp#.WIkikVMrJ9M
Journal of the American Heart Assoc., Aug. 19, 2016: http://jaha.ahajournals.org/content/5/8/e004195.full
The Mayo Clinic, Jun 15, 2016: http://www.mayoclinic.org/diseases-conditions/obstructive-sleep-apnea/symptoms-causes/dxc-20205871
>Harvard Health Publications/Harvard Medical School , Feb 13, 2013: http://www.health.harvard.edu/heart-health/how-sleep-apnea-affects-the-heart