Sleeping next to a snorer can be irritating. If you don’t fall asleep first, you could be lying there for an extended time before being able to fall asleep yourself. You toss and turn. You nudge your partner hoping the change in position will stop the annoyance.
It’s not just the annoyance that can be a problem. Snorers can be putting their health at risk. There are approximately 88 sleeping disorders. Sleep apnea is the primary condition, along with insomnia. The disorders can increase the risk for high blood pressure, heart disease, heart attack, stroke, or driving- or work-related accidents. Diabetics left untreated for sleep apnea can record higher sugar levels in the morning. Treated, the sugar levels may be in normal range. In children, sleep apnea can cause hyperactivity and affect development. As a rule, children should not snore.
Obstructive sleep apnea (OSA) afflicts about 20 million adult men and women in the U.S. Only about 10 to 15 percent have actually been treated. The result is repeated breathing cessation during sleep because the airway collapses. This may be due to anatomical factors like a large tongue, extra tissue in the airway, or decreased muscle tone holding the airway open. Weight can be another cause.
“Weight does have an impact,” says Francis Connelly of the Cedar Valley Sleep Center, a partner of Cedar Valley Medical Specialists (CVMS). “Gravity pushes down on the airway if you have a lot of tissue. But I have seen significant sleep apnea in people that are quite slim. Each person’s anatomy is different, especially in the throat and with the tongue. Some people may have big tonsils that can cause snoring.”
The Sleep Center and CVMS have been in partnership since 2014. Connelly is a registered EEG technologist and registered polysomnographic technologist. Electroencephalography is a monitoring method to record electrical activity of the brain. Connelly worked at Mercy Medical Center-North Iowa in Mason City for 24 years. It was one of the few hospitals in the state that performed sleep testing in 1986, when the specialty was in its infancy.
“I got involved with it really early,” Connelly says. “I took a liking to it because it changes peoples’ lives, sometimes almost immediately.
“I’ve done tests on people who have bad sleep apnea, put them on a CPAP (continuous positive airway pressure) machine and they wake up the next morning and say, ‘oh, my gosh, I haven’t slept this good in 20 years.’ They didn’t realize how tired they were, how disruptive this can be to their daily lives.”
Sleep disorders are broken down into disorders of excessive somnolence (sleepiness) and disorders initiating and maintaining sleep. Parasomnias are the bizarre sleep or unusual sleep disorders, such as REM behavior disorders, sleep terrors, sleepwalking and sleep eating.
“Some people get up in the middle of the night, eat food and not even know they are doing it,” Connelly explains. “They’ll eat dog food or cigarettes.”
When a person dreams, the body paralyzes itself, a preventative mechanism so the dream is not acted out, like jumping out of a window, running into walls or striking your bed partner if the dream is about being chased or held. If the person has REM behavior disorder, this mechanism isn’t working for some reason, whether because of a previous stroke, medications or a brain tumor. Connelly says this condition is not very common and generally affects males in their 60s.
When adolescents and adults have an apnea event there is a protective mechanism in the brain to arouse the person so they take another breath. It is believed babies who have SIDs may not have that preventative mechanism in place. When they stop breathing, they don’t recover.
If a person is suspected of having a sleep disorder, they are referred to a sleep lab such as the Cedar Valley Sleep Center. The center is located at 2413 W. Ridgeway Ave. in Waterloo. The patient is hooked up to various monitors and allowed to go to sleep. The patient is made as comfortable as possible in a home-type atmosphere. The monitoring provides answers as to what kind of sleep disorder or disorders the person suffers from.
“If the condition is severe enough, we try to fix the problem in one night,” Connelly says.
The “fix” most often includes the fitting of a mask and initiating a CPAP machine that the person wears each night when they go to bed. The mask provides a continuous stream of air pressure to keep the airway open. A bilevel PAP machine may be prescribed for certain situations and gives two levels of pressure, while an auto-PAP machine adjusts the pressure while the person sleeps according to the person’s needs. A Servo-Ventilation machine is similar to a ventilator but is non-invasive. Each time the machine senses the person is not breathing, it kicks on automatically and breathes for the patient until they begin breathing on their own.
Extreme cases may require surgery such as a tracheotomy. Other corrective measures include changing sleeping positions, or fitting the person with an oral device to help keep the airway open.
As a result of more awareness on the parts of physicians and sufferers, sleep testing is becoming more accepted. Cardiology is one of the specialties that refers patients for sleep testing.
“Sleep apnea creates a stress, and if you have heart problems, the stress becomes more serious,” Connelly explains. “Cardiologists believe the sleep problem should be addressed quickly before they start treating other conditions. For example, hypertension medications may be reduced or possibly eliminated due to the correction of the sleep apnea.”
Concerns regarding sleep apnea have arisen in other areas as well. The U.S. is the last developed country to implement sleep testing for truck drivers. A large number of accidents annually have been attributed to sleep apnea or driving drowsy behind the wheel.
The Sleep Center can perform four to six studies per night. It currently performs 60 to 80 studies per month. The monitoring technicians are respiratory therapists or are registered in sleep therapy. In 2017, everyone performing sleep tests in Iowa must be a registered sleep technologist and be licensed.
The Cedar Valley Sleep Center is an independent diagnostic testing facility, meaning it treats patients in an outpatient environment. “This is a true advantage for our patients,” Connelly says. “Hospital-based sleep testing can be quite expensive. We’re the only independent facility in the local area.”
Connelly says the CPAP therapies will continue to improve because of the technological advances. More dentists will become involved because of the improvements and advancements of oral appliances. More sleep testing will be home-based because of technological advances. Sleep labs still will be needed, however. The number of patients being tested will increase because of better awareness of the problem by both patients and physicians. Testing will become less expensive because there will be more facilities like the Cedar Valley Sleep Center.
“Sleep apnea is a treatable condition,” Connelly says. “Losing weight may improve or correct the problem, but again it depends upon the anatomy, how large the airway or how thick your tongue is. ENT (ear, nose and throat) specialists can perform laser procedures to shrink the palate or remove tissue to open a small airway.
“The older you become, the better chance you have of developing sleep apnea. Males tend to have more sleep apnea issues, but women have equally as much sleep apnea after menopause. The first step is to get diagnosed, then the right treatment plan can be explored for you.”