What is Sleep Medicine?
Signs and Symptoms
The incredible explosion of information and direct application to the diagnosis and treatment of patients has lead to the establishment of the TMJ & Sleep Medicine Network, of which Dr. Langstaff is a member. At the same time developments in sleep medicine technology have allowed us to more easily and accurately study the process of sleep and apply this study to the problems that sleep medicine patients present. One of the most dangerous sleep disorder is Sleep Apnea.
Dr. William N. Langstaff
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Sleep Medicine & Sleep Apnea
Sleep apnea ia a very common disorder (up to 10% of men and up to 5% of women) of sleep in which breathing stops while a person is asleep. There are two types of sleep apnea, obstructive and central.
In obstructive sleep apnea, the upper airway becomes obstructed by the collapse of the soft palate, the tongue and the airway above the larynx. These tissues sag into the airway as the muscles relax during sleep. As a result, the flow of air is impeded (hypopnea) or stops completely (apnea). As the brain continues to drive breathing movements, the airway obstruction becomes worse. This can be compared to the collapse of a paper soda-straw when you suck too hard in drinking a thick drink.
When this happens, the brain is forced to arouse itself in order to restart breathing. During apnea and hypopnea, the blood oxygen level, measured by oxygen saturation, drops significantly. In addition to the drop in oxygen saturation, there can be other events such as irregular heart rhythms or jerking of the limbs.
Because obstructions (apneas) can be very frequent through the sleep period, sleep becomes fragmented.
Sleep is a very orderly process, normally progressing through early, more superficial stages to the deeper more restful, restorative stages. With each arousal the process must start all over again. These interruptions to the the flow of sleep deprive the patient of the more restorative stages and continuity of sleep.
Symptoms of sleep apnea can be predicted with this sleep process in mind. Snoring is the most common problem and is usually reported by spouses, bedmates, roommates, family and sometimes neighbors! Patients awaken in the morning feeling unrefreshed, as though they have not slept well or at all. Spouses may observe pauses in the breathing which represent apneas. Patients usually have some degree of of increased or excessive daytime sleepiness especially when inactive. Patients frequently get up from sleep at night to urinate and often note that they have been sweating in their sleep. There may also be morning headaches. Inability to concentrate and memory disturbance is common.
Much less frequently, the brain may simply not stimulate an effort to breathe. This is central apnea. Occasionally, this may be from unknown causes or may be the result of neurologic disorders such as stroke or other neuromuscular disorders.
The excessive daytime sleepiness causes a loss of life quality, and the apneas and snoring may cause marital distress due to the impact on the spouse's sleep. There is mounting evidence that sleep apnea is also associated with heart attack, stroke hypertension and trauma (from falling asleep at the wheel or in some other inappropriate situation in which to sleep), resulting in an increased mortality rate.
The diagnosis of sleep apnea is confirmed by doing a sleep study which demonstrates the apneas and/or hypoppneas.