Obstructive sleep apnea syndrome

Obstructive sleep apnea syndrome.

One in five people after 30 years of constantly snoring in his sleep.

According to popular opinion, snoring — it is unpleasant but harmless sound phenomenon. However, few people know that the so-called "mighty" snoring is a precursor and one of the main manifestations of severe illness — Obstructive sleep apnea (OSA) or disease stops breathing during sleep. The first witnesses of this terrible disease are awake loved ones who anxiously watch as suddenly breaks off and there is a scary snore stop breathing … and then sleep loud snort, sometimes tossing and turning, move his arms or legs and begins to breathe again. Sometimes it can be observed up to300-400 pauses in breathing per night up to a total3-4 hours.

Disordered breathing of a sleeping person lead to a sharp deterioration in the quality of sleep. Headaches, constant drowsiness, irritability, decreased attention and memory, reduced potency — is only part of the symptoms that may be experiencing chronic nevysypayuschiysya people. Especially dangerous attacks of acute sleepiness while driving, when you want agonizingly close your eyes and go to sleep even for a few minutes. Statistics show that the likelihood of automobile accidents in patients with obstructive sleep apnea syndrome is ten times higher than average accident rate.

What's going on?

Why develop the disease? Patency of upper airway depends on the inner diameter of pharyngeal muscle tone value and the negative pressure during inspiration. During sleep, when there is a significant reduction in muscle tone of the throat, the conditions for the full wears off airways. It is usually on the breath, when negative pressure is formed and there is a force that promotes convergence of the airway wall.

When a person goes to sleep, there is a gradual relaxation of the muscles of the pharynx. One of the immediate results in full breaths spadenie airways and respiratory arrest. To restore the airway requires activation of the brain, which should send a pulse to the pharyngeal muscles and open the airways. After the resumption of breathing in the body is restored normal levels of oxygen, the brain calms down and falls asleep again … the cycle repeats again.

Frequent long pauses in breathing cause a sharp decrease in blood oxygen saturation. Thus, primarily affected organs consume large amounts of oxygen: the brain and heart. Persistent morning headaches are a manifestation of a night of brain hypoxia. In the case of coronary heart disease, disorders of blood oxygen saturation can trigger the development of dangerous arrhythmias and myocardial infarction. Besides, hypoxia interferes with the action of insulin, which may exacerbate diabetes mellitus.

Each stop breathing — it is stressful for the body, accompanied by a short-term increase in blood pressure to200-250 mm Hg. Art. Persistent nocturnal episodes increasing pressure leads to chronic hypertension often has during krizovoe. This may explain the increase in the likelihood of stroke in these patients. Moreover, in such cases, the blood pressure is poorly treated by conventional antihypertensive drugs.

Hypoxia and the lack of deep sleep stages cause a decrease in production of growth hormone, responsible for the exchange of body fat adult. As is well known, partly eaten food processed into energy, partly deposited in the reserve in the form of fat. With a lack of food fat is converted into energy and is consumed by the body. HGH provides transition fat into energy. What happens in case of violation of secretion of the hormone? Fat can not turn into energy despite its deficiency in the body. Thus, people almost always have to consume food to replenish energy expenditure. In this case, all generated surpluses fall "dead weight" that can not be claimed. The person begins to gain weight quickly, and any effort or diet medications aimed at weight loss, are inconclusive.

Moreover, body fat at the neck lead to further narrowing of the airways and disease progression stops breathing during sleep, which in turn exacerbates growth hormone deficiency. Thus, a vicious circle which break without treatment impossible. In severe forms of the disease and there is a decrease in testosterone production, which leads to a decrease in libido and impotence in men.

Diagnostics

As you can suspect the disease stops breathing during sleep? Patients with this disease usually have a very distinctive appearance, as described by Charles Dickens has the character Joe in the "Pickwick Papers": "It was a fat man with a short neck and a red face, who always fell asleep and began to snore in the most uncomfortable situations … "

There are quite simple scheme by which the disease can be suspected and to appoint additional testing.

When there are three or more of the above characteristics (the first or only indication) to depth study:

  • Indications of sleep apnea.
  • Loud or intermittent (with the snores) night snoring
  • More frequent night urination
  • A long night of sleep disturbance (> 6 months)
  • Increased daytime sleepiness
  • Obesity
  • Hypertension (especially night and morning)

To detect pauses in breathing during sleep easier just to watch the sleeping man. Usually right after the person has sleep snoring. Soon, the patient suddenly stopped breathing. At this time no hear breath sounds, snoring stops. However, the patient struggles to breathe, which is evident by the movements of the chest and abdominal wall. After about 15-30 seconds a person makes a loud snort and a few deep breaths. Usually the patient is very restless sleep: he turns in bed, moving his arms and legs, sometimes something says.

The frequency and duration of pauses in breathing depends on the severity of the disease. In severe illness cyclic respiratory arrest occur almost immediately after falling asleep in any position of the body. In less severe forms, it occurs only in the deeper stages of sleep, or when the patient is sleeping on her back. Respiratory disorders are often associated with alcohol. Sometimes snoring and pauses in breathing occur only after a considerable dose of alcohol, adopted shortly before bedtime.

Recommendations

The following are generic guidelines that can be applied without the intervention of a physician:

  1. Only sleep on your side. Respiratory greatly exacerbated in the supine position because of the tongue. There is a simple and effective way to get people to not sleep on your back. At night pajamas or a special vest pocket is sewn between the shoulder blades, which is placed in a shaded ball. In this case, every time you try to lie on his back the person wakes up. As practice shows, through 3-4 week produced persistent reflex not to sleep on your back.
  2. Ensure the raised position of the head. It also prevents the tongue and increase snoring. You can tilt the entire bed, setting the thickness of the bars 10-15 cm under the feet of the head, or put under the mattress with a sheet of plywood in the pelvis level (similar to the functional medical bed). It is advisable to use a special contoured cushions that provide the most optimal position of the head relative to the torso. These techniques help not only with snoring, but belching gastric contents, is often noted in obese people snore.
  3. Avoid taking sedatives / hypnotics. Sedatives and sleeping pills typically reduce muscle tone and promote relaxation of pharyngeal muscle, which in turn can provoke airway spadenie. These drugs are absolutely contraindicated in patients with moderate and severe forms of the disease. In mild cases, the question of their appointment must be decided individually.
  4. Do not drink alcohol the night. Alcohol also relaxes the pharyngeal muscles and trigg
    ers snoring and the disease stops breathing during sleep. Human liver processes 10 ml of pure alcohol per hour, so you may find what dose and for how long before bedtime can drink without consequences for health. For example, in 100 ml of vodka contained 40 ml of absolute alcohol, respectively, negative effect of this dose will continue for about 4 hours.
  5. Slim. Statistically proved that the decrease of body weight by 10% from the original parameters can improve breathing during sleep by 50%.
  6. Quit Smoking. Smoking often causes chronic inflammation of the pharynx and trachea, accompanied by swelling of their walls. This in turn can lead to a narrowing of the airways and increased risk of stops breathing during sleep.
  7. To provide maximum free nasal breathing. Difficulty in nasal breathing can significantly enhance and induce snoring sleep apnea. If this is a temporary phenomenon, try to use any of the vasoconstrictor agents of the common cold (glazolin, Otrivin, etc.). In chronic nasal obstruction (polyps, deviated septum, hypertrophy of the mucous membrane) should consult an ENT doctor and a solution to the issue of surgical treatment.
  8. Use intraoral devices for snoring. There is plenty of witty domestic invention, the so-called "dummy" from snoring. In addition, you can use the simulated intraoral devices. In some cases, they do have a positive effect, though, of course, are not a panacea and can be used only in mild forms of snoring.

Treatment

Currently, the following treatment of snoring and obstructive sleep apnea syndrome:

  • Laser staphyloplasty
  • Увулопалатофарингопластика. In this long term lists the names of the tissues of the pharynx, which are removed in order to increase the airways at the level of the throat (tonsils, the palatine arches, uvula). The operation is used to treat the disease stops breathing during sleep. The intervention provides only about 50% of positive results and very painful. Besides, through 5-7 years at the throat tissue can grow again and lead to relapse. The last time this operation is rarely used.
  • Creating a Continuous Positive Airway Pressure (CPAP). Currently, it is the most common method of treatment for severe forms of the disease stops breathing during sleep.

MD RV Buzunov, Clinical sanatorium "Barvikha"

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