Friday, August 1, 2008

Study finds sleep apnea erodes health

In Friday's edition of Journal Sleep, a study reported that people with the severe form of apnea -- the kind that disrupts sleep -- are significantly more likely to die from any cause than those without the disorder. According to the article, the findings in the 18-year study "underscore the need for heightened clinical recognition and treatment of sleep-disordered breathing."

Fauquier residents are fortunate to have a sleep diagnostic center close at hand.

Dr. Richard Swift practices critical care and pulmonary medicine, and is the director of the Fauquier Health Sleep Center. He says that people who experience sleep deprivation are four to 13 times more at risk for car accidents. They can also become grouchy, exhibit memory problems and have trouble at work.

Cardiovascular difficulties can also develop, including high blood pressure, heart rhythm problems and even heart failure or stroke.

What’s the problem?

Dr. Swift said that when a person has obstructive sleep apnea, the muscles of the throat become too relaxed, causing the airway to collapse. This startles the patient awake and causes a brief adrenaline rush. If this disruption happens five times an hour, it’s in the normal range. But if it happens 20 or 40 or 80 times an hour, the patient is exhausted during the day. Two to four percent of the population has sleep apnea, Dr. Swift said.

Risk factors include obesity, hypertension and having a large neck. Men are more likely to suffer than women, although spouses also lose sleep because of the snoring of sleep apnea patients.
Dr. Swift described a typical case: “He was miserable, tired all the time. He said he thought it was part of the aging process. The treatments we used made a huge difference in the quality of his life.”

There are three questions a doctor asks when trying to determine whether or not a person might have sleep apnea. 1) Does the person snore? 2) Has someone witnessed the person’s breathing stop while they are sleeping? 3) Is the person experiencing daytime sleepiness?

If sleep apnea is suspected, that’s where the Sleep Center comes in.

Studying sleep

The patient will spend a night at the Sleep Center while technicians monitor 16-20 biological and neurological functions as they slumber. Electrodes attached to the patient’s head, chin, throat and nose will measure brain waves, oxygen level and air flow. A microphone listens for snoring, and belts around the patient’s chest and stomach measure how much effort the patient is using to breathe. Comparisons will be made to see how much air the person is getting for that effort.

The technician will be able to see what stage of sleep the patient is in at any given time and how many interruptions he or she experiences during the night. When a person is resting soundly, the brain wave needle is relatively quiet, but with each interruption, the needle jumps up and down rapidly, indicating the patient has been startled awake. For someone with sleep apnea, the report of the night’s sleep shows a mass of black lines, one grouping after another.

Because so many factors are monitored — from brain waves to eye movements — the technicians and the doctors are able to distinguish dream sleep from abrupt awakenings.
The technicians stay up all night as the patient sleeps, monitoring the equipment and watching for seizures or heart rhythm problems.

The Fauquier Health Sleep Center recently expanded from two beds to four. The rooms are comfortable and welcoming.

“Some patients wonder, ‘How am I ever going to fall asleep here, attached to electrodes, with someone monitoring me?’ Within five minutes, they’re out,” Dr. Swift said.

Treatments

After the sleep study is complete, the Sleep Center sends the results, along with recommendations, to the patient’s doctor for review and follow-up. Dr. Swift said that there are several treatments that are viable. Which one is used depends on the severity of the sleep apnea and the individual circumstances of each patient.

CPAP therapy (continuous positive airway pressure) has been the most successful treatment, according to Dr. Swift. The patient wears a mask over his or her nose and mouth while sleeping. Air is pumped through the mask and keeps the airway open. The CPAP machine is about the size of a bedside radio and makes a barely audible hum. There are many different types and sizes of masks available.

Once CPAP therapy is selected, another sleep study can be conducted to see whether the air pressure is effective and to adjust pressure levels.

Surgery is also an option. Tonsils, adenoids and uvula are removed to keep the airway open. “Surgery doesn’t always work,” Dr. Swift said. “We can’t tell who it will work on, and you can’t go back.”

Fauquier Health Sleep Center

Accreditation: Accredited by the American Academy of Sleep Center Medicine (AASM)
Director: Dr. Richard Swift, board-certified in sleep medicine.
Administrator: Robert Rodriguez
Location: Warrenton Professional Building, Suite 317A, 493 Blackwell Road, Warrenton
Phone: 540.316.2660

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