Looking for Science-Backed Information about Sleep Apnea?


Hi there and welcome.

I'm Kimberly MD and I'm here to help you get a great night's sleep in today's session. I'm gonna help you understand some of the fundamentals of sleep apnea.

I recently learned how to play pickleball. It's a fun and social sport, and I was anxious to get started and I wanted to win, but I wasn't really winning until I slowed down and really started paying attention to the fundamentals.

The forehand, the backhand and the game strategy. Once I spent time on these fundamentals and practiced, I really improved. Now I'm killing it.

Like pickleball, learning the basics of sleep apnea and CPAP treatment will greatly improve your chances of success.

I'm here to help you learn the fundamentals of sleep apnea. And I hope that you will take the time to understand them so that you can be more successful on your journey to better sleep.

What you'll learn in today's lesson is one, what is sleep apnea? Two, what are the health consequences of untreated sleep apnea? And three, what the heck is an AHI? And why is it important?

Let's get started.

What is sleep AP apnea? Well, apnea means stopping breathing. So sleep apnea just means stopping breathing during sleep. And the most common form of sleep apnea is obstructive sleep apnea, which is when the back of the throat blocks your breathing while sleeping. If you think of your airway, like a balloon, the skinny part that you blow into, it's very collapsible and can close off. And so when you relax at night to sleep and your body relaxes the back of your throat also relaxes, and it can close down, then you don't get any air in that causes your oxygen levels to drop. Then that message gets back to your brain and it causes you to do one of these and wake up... sound familiar. This arousal to wake up and breathe can happen. Hundreds of times, each night, really fragmenting your sleep so that you're not able to get into and stay in some of the deeper stages of sleep that we know need in order to feel and function our best during the day. Also, each time this happens, our body goes through a stress response. We tend to panic because we're not breathing. Our blood pressure goes up. Our heart rate goes up and it puts our body under stress. So cumulatively over time, this can call has a lot of problems.

Stay tuned to later in this recording, where I'll give you a peek behind the curtain to see what this sleep apnea really looks like in your sleep test.

And let me tell you it, ain't pretty, you're probably already aware that sleep apnea makes you feel bad, but did you know that untreated sleep apnea is associated with a number of short and long term health consequences? Let's use your teeth as an example. If you decide that brushing your teeth is a waste of time, you may develop bad breath and some yellowing of your teeth in the short term, but over the long term, not brushing your teeth will lead to cavities tooth pain and probably having to have your teeth pulled. So it seems like a good idea to go ahead and brush your teeth.

Well, sleep apnea is similar. It can negatively affect you now and make you feel bad. But the cumulative effect of untreated sleep apnea over time can lead to many more serious medical issues. Let's start with the short-term effects of untreated sleep apnea.

These can be broken down into daytime and nighttime symptoms. One of the most common symptoms of sleep apnea is snoring. And your bed partner may notice pauses in your breathing. These are the apnea. Your sleep may be very restless or you feel that you wake up a lot during the night apnea can even cause you to wake up, to go to the bathroom. During the day, you may feel groggy and notice morning headaches. You may feel excessively sleepy and may even doze off during routine activities, such as in a meeting, or maybe during this video, you can also feel more irritable and have trouble concentrating.  When we don't sleep well, we just don't function well in the long term.

Untreated sleep apnea has been associated with a number of serious medical problems, and we are learning more every year. Most notably sleep apnea increases blood pressure. Every time you have an apnea at night, your body responds by increasing your heart rate and your blood pressure. When this happens many times an hour, night after night, year after year, it takes a toll on your body, which further leads to more heart attacks, strokes, and even problems with sexual function.

There are also studies showing an increased risk for weight gain, diabetes and dementia with untreated sleep apnea, pretty scary, huh?

A lot can go wrong. When our bodies are put through the stress of untreated obstructive sleep apnea, which leads me to our third and final topic of the session, the AHI or the apnea OFIA index.

The AHI is a number that tells you how severe your sleep apnea is with higher numbers indicating more severe sleep apnea. Your apnea severity is directly correlated to your health risks associated with untreated sleep apnea, as well as what treatments are available to you.

Let's go back to our teeth brushing example. If you skip brushing your teeth, occasionally say one to two times per week, it's gonna take a lot longer for your teeth to rot and fall out than it will. If you skip brushing say five times a week, or if you decide to never brush your teeth again. Well, if you have mild sleep apnea, which is stopping breathing just a few times per hour, it will take a lot longer for you to develop heart disease or dementia. For example, then it will, if you stop breathing 30 or 60 times per hour, which suggests more severe sleep apnea, and that's why AHI or the measure of severity of your sleep apnea is important. Take a look at this sleep study data. This is from a home apnea test and shows what normal breathing looks like. This person is having stable breathing.

Their oxygenation is also remaining stable and is in the normal range in the mid-nineties. Now, look at this sleep study data. These flat lines are apneas or periods when breathing stops and are marked by the red areas, then breathing starts again for several breaths, then stops again. This person is having severe sleep apnea with one apnea after another it's during this time when breathing restarts that the blood pressure and heart rate go up as their body goes through a stress response.

When we calculate your AHI or apnea hyperopia index, we're counting how many of these apnea or red-shaded areas you have over the entire night and divide it by the amount of time that you are asleep. This gives us an average, which is your AHI. Your AHI is reported on your sleep study and it's used by your healthcare team to make treatment decisions.

In reality, there are times when sleep apnea is better or worse during a single night, for example, it tends to be worse when you're sleeping on your back or when you're in dream or REM sleep.

If you dig deeper into your sleep study report, you can often find what's called a supine AHI or a REM AHI, which will give you the specific AHI for those particular sleep conditions. However, for the sake of this session, and for a general understanding the overall AHI is an average over the entire night. This gives us a uniform guide that everyone can understand.

There are other important measures in your sleep study, such as your lowest oxygen level or the time that you spent with an oxygen level below normal, which is typically 90%, but for simplicity in today's session, I am simply focusing on the AHI. Do you know what your AHI is?

If your AHI is less than five, that is generally considered within normal limits for an adult, and you would not be diagnosed with sleep apnea, at least not based on that night, an AHI between five and 15 is considered mild sleep apnea. And between 15 and 30 moderate sleep apnea, an AHI above 30 is considered severe apnea. And the numbers only go up from there.

I have had patients over the years within AHI over a hundred, which basically means they aren't having any normal breathing during their sleep at night. Having untreated severe sleep apnea is like having a mouthful of cavities and still refusing to brush your teeth. Wow.

You all have learned a lot. Thanks for sticking with me. In summary today, we talked about three topics.

Number one, what sleep apnea is, which is periods of stopping, breathing during sleep most often due to blockage at the back of your throat.

Number two, what some of the health consequences are of untreated apnea, such as feeling groggy, irritable, and having trouble concentrating in the short term and high blood pressure strokes and even dementia in the long term, just to name a few.

And lastly, number three, we talked about the apnea hypo apnea index or the AHI and how that number is the average number of breathing events you had per hour during your sleep study and how this number gives you an idea of how severe your sleep apnea truly is with higher numbers, equaling more severe sleep apnea.

Thanks for joining me. And I hope to see you again, as I continue on my journey for making a bigger difference in the lives of patients with sleep disorders.



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