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Sleep Disorders

Obstructive Sleep Apnea

08/07/2009

Question:

I took part in a sleep study and was told that I had sleep apnea. I use oxygen at night using a oxygen tube that connects to my nose (not a mask). I am also taking Trazadone at night. Isn`t this dangerous and should I be using the oxygen mask? I have a lot of trouble staying awake during the day. I fight to keep my eyes open and take several naps during the day. Please help!

Answer:

When Sleep Specialists speak of sleep apnea or sleep disordered breathing, they are generally referring to obstructive sleep apnea (OSA), though central sleep apnea (CSA) can also occur with or without OSA. Both types of sleep apnea are conditions where individuals have problems with breathing in their sleep - usually due to intermittent episodes of not breathing or reduced breathing effort. It’s not clear to me which type of sleep apnea you have, though your symptoms suggest you likely have OSA, which is much more common than CSA, and thus will be discussed first.

OSA is a common condition, affecting roughly 5% of middle aged adults in America. OSA is a condition where the airway partially or completely collapses during sleep. This results in fragmentation of sleep and, in some individuals, low oxygen level during sleep. The consequences of this condition can be serious and range from a poor quality of life (morning headaches, disabling sleepiness, poor concentration, irritability, etc) to increasing problems with blood pressure control, heart disease and strokes.

The primary treatment for OSA is the use of continuous positive airway pressure, or CPAP, which is very effective at keeping the airway open during sleep. It does this by “pressurizing” the airway to prevent it from collapsing. In a large number of well-done studies, CPAP therapy has been shown to be very effective at improving a number of measures of quality of life, including daytime alertness, improved concentration and improved mood. Individuals with OSA who can successfully use CPAP generally feel better! In addition, growing data suggest that CPAP may reduce some of the medical consequences associated with sleep apnea. The main problem with CPAP is that many individuals, such as you, have trouble sleeping with this type of device and, as such, alternative therapies must be considered. These alternative therapies generally include surgery or an oral appliance. Oxygen is not considered a primary treatment for OSA as it does not prevent the airway from collapsing; it only helps keep the oxygen level normal during sleep. It’s no surprise that your symptoms would continue despite the use of oxygen.

CSA is much less common than OSA. As opposed to the airway collapsing as in OSA, in CSA, there is generally a lack of effort to breath during sleep. The brain fails to send the signal to breath and individuals will experience a lack of breathing for several seconds at a time before resuming normal respirations. This condition may be seen in individuals who have had strokes or who have advanced heart failure, though no cause is identified in some individuals. Unlike OSA, those with CSA often complain of trouble sleeping and insomnia. They may feel tired and fatigued as a result. In some individuals, it is being recognized more and more that CSA can occur along with OSA and thus there may be considerable overlap. A number of treatment options are available for CSA as well and will depend upon the associated conditions and other clinical factors. Oxygen can be used in some individuals with CSA as a primary treatment, though CPAP or other advanced positive pressure therapies are usually considered as first line treatment.

It sounds as though your sleep apnea is significant and causing you a lot of trouble. You should discuss your sleep study results with your sleep specialist to make sure you are on the correct therapy. It is more than likely that you will need CPAP therapy.

To learn more about sleep apnea, sleepiness, or other sleep disorders, please visit the American Academy of Sleep Medicine website. In addition to information, the website contains a list of Sleep Centers across the country so that you may locate one near you. The website Sleep Education.com also contains plenty of consumer friendly information about sleep and sleep apnea.

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Response by:

Meena S Khan, MD Meena S Khan, MD
Clinical Assistant Professor of Pulmonary, Allergy, Critical Care & Sleep
Clinical Assistant Professor of Neurology
College of Medicine
The Ohio State University