Sleep apnea Breathing misfire at night

Tired during the day because of nocturnal breathing

19/10/2015

If you feel tired and de-energized during the day, even though you have slept for at least eight hours, you may be suffering from Obstructive Sleep Apnea (OSA). Around two percent of women and four percent of men between the ages of 30 and 60 are affected by nocturnal respiratory distress. Oxygen deficiency increases the risk of heart attack, stroke, high blood pressure and lung disease. If you suspect sleep apnea people should urgently consult a doctor.

Nocturnal respiratory arrest in sleep apnea increases the risk of cardiovascular disease
Sleep apnea is characterized by nocturnal respiratory arrest and reduced oxygenation, as well as repeated wakefulness reactions. However, the awakening reactions usually do not actually wake the person concerned, but act as an alarm function of the body, which leads to an increase in its bodily functions such as the acceleration of the pulse. Most sufferers are not aware of these waking reactions. Nevertheless, they feel badly rested the next morning and suffer from the typical extreme daytime tiredness, lack of concentration and fatigue. Frequently, the affected people snore loudly, so that the partners wake up and notice the nocturnal respiratory arrest.

As the respiratory failure causes a lack of oxygen, which increases the risk of heart attack, stroke, lung disease and high blood pressure as well as stress disorders such as tinnitus and sudden hearing loss, a doctor should be consulted to investigate the cause of sleep apnea. Ten respiratory arrests per night are recommended for treatment.

In the sleep laboratory, the doctors can perform various measurements (including ECG, EEG, oxygen content of the blood). With sleep endoscopy, the cause of sleep apnea can be reliably diagnosed. The patient is put into a twilight sleep. The doctor can then use a probe to observe closely, causing the occlusion of the airways. Often the tongue is the cause of the discomfort. But it can also play a role in overweight, a long Halszäpfchen and too large almonds.

To determine the severity of sleep apnea, use the Apnea Index (AI), which shows how many 10-second breathing pauses occur during sleep. In the optimal case, it is less than five per hour. The higher the apnea index, the more severe the sleep apnea.

Treatment options for sleep apnea
In many patients, the CPAP mask is the most effective. This is worn on the face during the night as a nose or full face mask. The patient is supplied with air by overpressure, so that obstruction of the respiratory tract is prevented. Not a few patients, however, feel disturbed by the mask and the device in their nocturnal bed rest.

In addition, it is possible to carry various other devices such as clips or rings, which should usually prevent snoring. In some cases, they also work against sleep apnea by keeping smoking open.

Orthodontics, so-called lower jaw protrusion splints made of plastic, move the lower jaw forward so that the upper respiratory tract does not close. They are used when a backward displacement of the lower jaw and the base of the tongue causes the occlusion of the respiratory tract.

In order to change the sleeping position, there are special pillows or pajamas, in which, for example, tennis balls were sewn in, so that back sleepers no longer turn on their backs. However, these aids are effective only in a mild form of sleep apnea.

Surgery only in severe cases of sleep apnea
In severe cases, surgery may be necessary. So it is possible to tighten or shorten the soft palate. Also the tongue length or the tongue base can be changed operationally.

A relatively new procedure that is currently being tested in clinical trials worldwide is the tongue pacemaker. In this case, a so-called neurostimulator is implanted under the skin slightly below the collarbone. A cable leading to the costal arch transmits the respiratory rate through the movements of the diaphragm. A second lead with electrode is placed to the hypoglossal nerve, which is responsible for the activation of the tongue muscles. When the patient inhales, the tongue pacemaker sends an impulse to the lingual nerve, leaving the tongue muscles taut and the airways free. The device is switched on in the evening by remote control and switched off again tomorrow. In Germany, the procedure is currently being tested at, among others, the Sleep Medicine Center of the Berlin Charité and the ENT Hospital Mannheim. (Ag)