As we discussed in our last blog, patients with Obstructive Sleep Apnea need to be aware of their condition and possibly take extra precaution during a pandemic, as well as the upcoming Flu Season. The current CDC recommendations should be reviewed carefully and implemented in your daily routine and in your efforts to improve your sleep hygiene.
Obstructive sleep apnea is a potentially serious sleep disorder. OSA occurs when your throat muscles intermittently relax and block your airway during sleep, which causes breathing to repeatedly stop and start during sleep.
How prevalent is undiagnosed OSA?
According to Science Direct, “Obstructive sleep apnea (OSA) affects approximately 20% of US adults, of whom about 90% are undiagnosed.”
“More than 25 million adults in the United States are believed to have moderate to severe OSA, which is comparable to the prevalence of diabetes and even higher than asthma, she said. However, about 75% of severe cases are undiagnosed.”– Jeanne Wallace, MD, MPH, health sciences professor of medicine at the David Geffen School of Medicine at the University of California, Los Angeles
Why are there so many cases of undiagnosed OSA?
With nearly 80-90% of cases suspected to be undiagnosed, it causes one to question why are there so many people out there suffering with this disorder and not getting the treatment that would greatly improve their quality of sleep? Often with any diagnosis, the lack of education is first and foremost. If patients are not aware of the condition or the symptoms of the condition, they may not know the meaning of the correlation of their symptoms or that they can find relief. In regard to the medical community, only two weeks are spent on sleep apnea in medical school for primary care physicians, which does not give medical students ample time to understand and be able to recognize OSA in their patients.
Another possible reason is that recognizing symptoms is not a clear-cut situation. Symptoms of OSA vary by patient, can be intermittent, or common or vague which can often lead to misdiagnosis of other syndromes. For example, fatigue and inability to concentrate can be symptoms of a host of conditions so that alone may not be enough data for your physician to go on.
A third reason is lack of adequate or consistent medical attention by a primary care doctor. According to the JAMA Internal Medicine journal, 25% of Americans do not have a primary care provider as of 2015, and some feel that number has grown to 30% in 2020. And in a recent study, nearly 25% of Americans visited their Primary Care Physician less than once per year or never. Women are more likely to visit their PCP during the year at 78%. In contrast, one study at the Cleveland Clinic revealed 60% of men do not see a doctor regularly and only 40% see a doctor only when they fear they have a serious medical condition.
A fourth reason is that many patients may suspect OSA as a possible cause for their symptoms but they are reluctant to seek medical attention as they fear or are hesitant to utilize CPAP therapy. They may be embarrassed to wear a CPAP mask in front of their partner or family, or feel the CPAP equipment is cumbersome, uncomfortable, or difficult to clean and maintain.
Also, there are many misconceptions about what a good night’s sleep looks like. Many equate snoring with good sleep, which is far from the truth. Snoring actually indicates a partial closing of the upper respiratory tract or a temporary obstruction of your airway. Snoring is actually a strong indication of OSA and can cause a drop in oxygen level during the night.
“Normal oxygen levels are in the range of 98-94%, but snoring for 30 seconds or more can lead it to drop to 80% or less.”– Resmed
While all the above reasons may be why so many cases of OSA are undiagnosed, the reasons do not justify the health benefits of CPAP therapy. Undiagnosed OSA can lead to serious health effects and long-term and detrimental conditions.
What are the Potential Risks of Undiagnosed Obstructive Sleep Apnea?
Recognizing the symptoms and treating OSA is absolutely critical, because if left untreated interrupted sleep patterns can induce a host of risks and complications. Poor sleep caused by obstructed airways can lead to a host of symptoms and cognitive impairments in adults and children.
Undiagnosed OSA in Adults can cause:
- Drop in Oxygen Levels during your sleep
- High blood pressure or Metabolic syndrome
- Heart Disease
- Accidents including automobile accidents, work-related accidents and
- Abnormal heartbeats, such as atrial fibrillation
- Type 2 Diabetes
- Increased Blood Sugar Levels
- Decreased quality of life
- Mental Health concerns including anxiety, depression, mood swings, and irritability
- Adult asthma
- Acid reflux
- Liver problems
- Sleep-deprived partners
- Complications with medications and surgery
- Lack of Job Performance which can result in loss of revenue for their companies.
“Research shows that work performance can be decreased by 30 percent due to sleep fragmentation and repetitive hypoxia, which are characteristics of OSA. Large corporations could save millions of dollars in lost productivity by screening and treating high-risk employees for obstructive sleep apnea.”– AASM.org
Undiagnosed OSA in Children can cause:
- Decreased Oxygen levels
- Learning disorders including ADHD with either hyperactivity or inattentive types.
- Social Issues including anxiety and depression
- Sleepwalking and night terrors
- Daytime sleepiness and behavioral problems
- Difficulty waking in the morning
Your school-aged child’s teacher can be an advocate to leading to an accurate diagnosis, if they communicate to the child’s parent or guardian of their schooltime behavior, attentiveness and energy levels. If your child’s teacher sees that your child is often falling asleep in class, easily distracted, having social issues or is often irritable or combative during the school day, do not dismiss these symptoms as a passing phase or just a child acting out. Make note of the school’s observations and address these with your child’s pediatrician.
What are the Causes & Symptoms of OSA?
“Sleep apnea occurs in about 3 percent of normal weight individuals but affects over 20 percent of obese people.”– Hopkinsville Medicine
For those who are overweight or obese can increase their risk factor of OSA including those who accumulate fat in the neck, tongue and upper body. Premenopausal and post-menopausal women are also at risk as their metabolism changes and weight tends to accumulate in their mid-section and hips. While weight may be one common risk factor that leads to OSA, there are quite a few others:
Potential causes of OSA:
- Being Male: Men are 2 to 3 times more likely to have sleep apnea.
- Neck circumference: Those with thicker necks may have narrower airways
- Enlarged tonsils and adenoids
- Older adults: The prevalence of OSA still increases also after the age of 60 years
- Family History
- Regular use of Use of alcohol, sedatives or tranquilizers. These chemicals can relax the muscles in your throat and thus increase symptoms.
- Smoking. Smokers are 3 times more likely to suffer with obstructive sleep apnea.
- Nasal congestions, whether from an anatomical condition or allergies.
- Pre-existing medical conditions such as congestive heart failure, high blood pressure, type 2 diabetes, Parkinson’s disease, Polycystic ovary syndrome, hormonal disorders, stroke patients, lung disease can all increase your risk of OSA.
Common Symptoms of OSA:
- Loud persistent snoring
- Witnessed pauses in breathing
- Choking or gasping for air
- Restless sleep
- Awakening with a dry mouth
- Frequent visits to the bathroom
- Early morning headaches
- Daytime sleepiness
- Poor concentration
- Falling asleep during routine activities
Prevention is worth a Pound of Cure
Finding a cure or effective treatment of your symptoms can only be accomplished through a professional diagnosis. Before your Primary Care Physician can address the symptoms, the patient will have to be cognizant of and able to communicate their symptoms, their risk factors and how they relate to one another. It may be a good idea first to review the symptoms and risk factors in this article to see which ones are applicable to you or your child. Then begin recording your sleep and sleep-related activities in a sleep diary. You can also utilize an activity tracker or smartwatch like FitBit or Apple Watch to monitor sleep patterns and/or oxygen levels.
After a few weeks or few months of self-monitoring, bring your diary and tracking data with you to your sleep physician or primary care doctor. Communicate with the doctor the resulting symptoms you are experiencing, any medications you are taking, as well as which sleep tips you’ve tried and for how long. Write down questions for the doctor and be sure to relay any pre-existing conditions that may increase your risk.
“Rest comes not from the Quantity but from the Quality of Sleep”– George Gurdjieff
Our next article will discuss the following:
Why is quality sleep so essential to your health? What are the four stages of sleep and how do they contribute to your mental and physical wellbeing?