Believe it. You will not be the first to know if you have sleep apnea. It might be your spouse, your roommate, or your night-time attendant who first notices it. If you have sleep apnea, not only do you keep your loved ones awake, your sleep is interrupted, too. If you have it, you’re not alone. In fact, people with spinal cord injuries have a 9%-15% higher chance of having sleep apnea than similar people without spinal cord injuries.
So what is apnea?
Apnea is when you involuntarily stop breathing for one or more breaths or 10 seconds and longer. These episodes occur repeatedly throughout the night. Apnea is not the same as snoring although if you have apnea, you probably also snore.
There are three types of sleep apnea:
- The first, central apnea is the most serious and uncommon cause. The airway is not blocked but your brain forgets to tell your body to breathe.
- The second and most common form of sleep apnea is obstructive apnea. This is caused when your breathing passages become blocked enough to temporarily stop the flow of air. This usually occurs when the soft tissue in the back of the throat collapses and closes during sleep, or the tongue relaxes and falls backward in the mouth blocking the top of the airway.
- The third, mixed apnea is a combination of the first two.
What happens during sleep apnea?
So what happens when you actually have an episode of apnea? Well, if you aren’t breathing, you aren’t getting enough oxygen. You may be asleep and not realize it, but your brain will figure it out soon enough. You may awake suddenly with a sense of panic, surprise, or even nighttime choking, gasping or snorting spells. It may not be nightmares; it might be apnea. Loud snoring may also occur. You might only wake up a little bit but if you spend the night frequently waking up you’re going to be tired the next day. This can lead to fatigue and daytime sleepiness. During each apnea, the stress on the body leads to an increase or irregularity of the heart rate and increased blood pressure which can lead to chronic heart disease and high blood pressure disease.
- Are you overweight? Do you have a large neck (more than 17 inches for men, 16 inches for women)? Your muscles may have to work harder for you to breathe and if your neck is large, there may be less space inside for your airway. A combination of relatively weaker muscles having much more work to do to move air, and less space to do it in, greatly increases your risk.
- Sometimes a person’s natural anatomy or family history puts them at a higher risk.
- SCI: Because of your injury, you may be able to use only some of the breathing muscles. At particular risk are people with quadriplegia or high paraplegia. For those folks, their injuries affect some or even all of the muscles used for breathing. That leaves less strength to get past the minor blockage. Also, your spinal cord injury might confuse the symptoms or be part of the problem. Your medications, especially for spasms or pain, may make you sleepy. Some studies have suggested that medications which can have a sedating effect, like anti-spasm meds, mildly to moderately increase the risk of apnea in people with spinal cord injury.
- TBI: Sometimes the brains ability to control breathing during sleep becomes altered after a TBI, resulting in periods of central sleep apnea.
Testing and Diagnosis:
Sleep apnea is diagnosed based on patient symptoms, physical examination, CT scan of the head, and sleep study testing. Since you aren’t actually awake to notice that you aren’t breathing, you may not even know that you have sleep apnea. Ask someone who is occasionally awake when you are asleep. Ask whether you are sometimes perfectly quiet for a few seconds and then make a gasping, snorting, or choking sound. Once you’ve spotted the warning signs, your doctor may do a few tests. The most common test involves monitoring your breathing overnight. That could either be wearing an instrument pack overnight at home or in the hospital or spending the night in a sleep lab.
Treatments: Once you’re diagnosed, a few things can be done. Interventions range from behavioral changes, medical equipment, oral devices, or even surgery.
- Behavioral Changes: (While behavioral changes are relatively straightforward, they often work only for the minor cases). You could lose weight. Interestingly, one study suggests that apnea may cause some weight gain. In another study, a person with spinal cord injury actually lost weight after dealing with his apnea. Even a little weight loss could improve your symptoms.
- Avoid alcohol and smoking.
- Avoid medications that make you sleepy. These substances make it harder for your throat to stay open while you sleep.
- Try to sleep on your side or your stomach instead of your back as it may help keep your throat open.
- Continuous Positive Airway Pressure – CPAP: Among the most common pieces of medical equipment used for sleep apnea is a machine that performs continuous positive airway pressure (CPAP). A CPAP machine increases the air pressure in your throat so that your airway does not collapse.
- Bilevel Positive Airway Pressure – BiPAP: Bipap is a more advanced mode of treatment. Not only does it provide pressure to keep the throat open, it also provides an additional pressure to open the lungs as you take a breath in. And, in cases of central sleep apnea, a BiPAP can be set to breathe for you if the brain forgets to take a breath on its own.
There are many varieties of CPAP or BIPAP, but most involve wearing some sort of mask over your nose and/or mouth or prongs that fit in your nose. It may take time for you to become comfortable with using the device. Gradual initiation of CPAP therapy can help with adjustment to the therapy.
Mist can be added to assist with humidity and comfort. Working with your sleep machine specialist and adjustments to CPAP settings can help minimize side effects. Patients generally feel much better once they begin CPAP treatment.
- Dental Appliances: For some people, all that’s needed for apnea is the use of a dental appliance at night. This insert, something like a retainer, can help keep open the part of the airway nearest your mouth.
- Surgery: Surgery is most useful if the cause of your apnea is some sort of anatomic abnormality.