Unrecognized Symptoms - You Could Have Sleep Apnea Without Knowing It
Unrecognized Symptoms -
You Could Have Sleep Apnea Without Knowing It
According to Sleepapnea.org, an estimated 22 million Americans suffer from sleep apnea, with 80 percent of the cases left undiagnosed. Among those living with the disorder, there are some who never recognize the symptoms for what they are. They either have no symptoms (outside of the apnea events themselves), or they have symptoms but do not notice their frequency or severity. If living single, for example, or sleeping in separate beds from a spouse or partner, individuals may not be conscious enough to recognize apnea or hypopnea events when they occur. While others may recognize symptoms, such as daytime sleepiness, but not associate them with the possibility of a sleep disorder. Any number of circumstances can lead to unrecognized sleep apnea, while the consequences can be as mild as an occasional awakening during sleep or as serious as early mortality. Sleep apnea is often related to comorbid conditions such as obesity, high blood pressure, diabetes, stroke, and cardiovascular disease, as well as mood disorders such as anxiety, depression, and substance abuse. Along with chronic, sometimes unnoticed sleep deprivation, these conditions lead to a significant number of injuries and deaths due to automobile crashes, on-the-job accidents, and associated health problems. In addition, effects on work productivity and academic performance can make these conditions costly on both a personal and national level, with an economic impact in the hundreds of billions annually. The question that arises is how best to screen for sleep apnea syndromes, and how to educate the public on a range of signs and symptoms, including those of mild or even asymptomatic cases. While sleep apnea symptoms may be subtle, especially during the day, the apnea events themselves are the most defining characteristics of the disorder. In most cases there will be some recognizable risk factor associated with the condition, whether it is snoring, weight gain, or simply not feeling fully awake or refreshed in the mornings. The best course of action is to be proactive about any changes in sleep or mood. Most insurance plans cover sleep tests and CPAP equipment for those experiencing symptoms of sleep apnea, and there are home-test options as well. But if you have no current signs of the condition, it is your call to make. Getting a negative test result is better than becoming yet another undiagnosed sleep apnea statistic among the hundreds of millions worldwide.
Most Common Signs and Symptoms of Sleep Apnea
The most common signs of sleep apnea are snoring loudly or choking in the night, as well as any other behaviors associated with breathing difficulties. Some may inhale deeply as if trying to get more air, while others may stop breathing for long periods, often followed by gasps. Outside of the apnea events themselves, excessive daytime sleepiness or fatigue is very common, or waking with a dry mouth, a headache, or sweating. During the day, people with sleep apnea may experience difficulties with concentration, memory, or mood, for example, you may become irritated more often or more easily, or feel angry or depressed. Some may turn to substances to help them sleep or get through the day. A decreased libido is very common as well, due to physical as well as mental factors that arise from the disorder (i.e. hypoxemia or low energy due to fragmented sleep). High blood pressure is one of the most common early warning signs of a sleep apnea condition, as the apnea events begin to cause fluctuations in blood oxygen.
The most effective preventive measure to take is simply getting tested regardless of signs or symptoms, but at the very least, make sure to follow the recommendations of your health provider. You can always ask about sleep apnea or other disorders during physical exams or other visits, letting your doctor know that the issue is on your mind. And if anything comes up, such as an odd awakening in the night or a complaint about snoring from a bed partner, schedule an appointment sooner than later to check if a complete sleep test is warranted. In many cases, a doctor may have you take a home test first or fill out a questionnaire to assess the possibilities of a number of different sleep disorders and other related conditions.
Sleep Apnea Types and Severity
It is also important to distinguish between the three types of sleep apnea when considering symptoms. The most prevalent type, obstructive sleep apnea (OSA) is caused by a blockage of the airway, often when the tongue collapses against the palate and blocks the airway. For this type of sleep apnea, snoring and/or choking is much more common during the night. Central sleep apnea (CSA), by contrast, occurs not by blockage of the airway but by a lapse in breathing signals from the brain. During this type of sleep apnea, it is more common to hear complete cessations of breathing for extended periods. Complex sleep apnea, the third type, is a combination of both obstructive and central sleep apneas. In each of these three types, breathing eventually resumes, but apnea events can last up to several minutes at a time. In addition to the three types, there are also differences in severity. Those with more severe sleep apnea can have many events in succession, up to 30 per hour in some cases. When this occurs, sleep can become extremely fragmented and chronic sleepiness and/or fatigue often follows. The more events a person has, the less oxygen they are receiving into the lungs and bloodstream (and as a result, the tissues and organs as well). This is one of the first signs of the disorder, known as hypoxia or hypoxemia, and prolonged untreated apneas can lead to more serious conditions such as stroke and cardiovascular disease.
Screening Protocols - An Ongoing Debate
Paralleling trends in population aging, sleep apnea prevalence has increased significantly in the past 20–30 years, and yet a large proportion of sleep apnea patients do not report common symptoms such as daytime sleepiness. This has lead to some debate among healthcare providers and policymakers on whether or not screening is merited for those without signs or symptoms. Reports such as the U.S. Institute of Medicine’s “Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem” have emphasized the cumulative effects of sleep loss and sleep disorders as an under-recognized public health problem in the U.S. and abroad, with some even referring to the issue as a public health crisis. Despite these concerns, the research literature lacks evidence on whether screening people in the general population (some of whom might have unrecognized symptoms) leads to the same benefits that patients experience when treating their symptoms. There is a plentitude of evidence supporting CPAP as a standard treatment for sleep apnea, but health providers and others seeking to establish a universal standard for such things as commercial driver screenings, health insurance requirements, or public employee contracts, continue to seek further research addressing the value of regular screenings (regardless of signs or symptoms). While some suggest that the costs of treating mild asymptomatic sleep apnea far outweigh the potential benefits, others, especially patients who have experienced those benefits first-hand, argue that the more we screen for the disorder, the more lives we can potentially save through proper diagnosis and treatment.
ACP Internist - https://acpinternist.org/archives/2010/07/thoracic-apnea.htm
Alaska Sleep Clinic - https://www.alaskasleep.com/blogb/does-insurance-cover-sleep-studies
Journal of Clinical Sleep Medicine - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2792976/
Sleepapnea.org - https://www.sleepapnea.org/learn/sleep-apnea-information-clinicians/
United States Institute of Medicine Committee on Sleep Medicine and Research: “Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem” - https://pubmed.ncbi.nlm.nih.gov/20669438/