By Matt T. Bianchi, MD, PhD
Chief, Division of Sleep Medicine
In an era when advanced technologies, imaging, genetics, and personalized medicine is making heroic steps towards improving healthcare it may come as a surprise that a common and serious disorder with multiple available treatments remains largely undiagnosed. Yet such is the case for sleep apnea, which affects about 10% of adults but is diagnosed in fewer than half of these. Sleep apnea is defined as repeated obstructions in breathing during sleep, each lasting typically 20-30 seconds. These events can range from complete obstruction (apnea) to partial obstruction (hypopnea) and are often accompanied by drops in oxygen.
Sleep apnea is more common in people with diabetes, especially if other risks like obesity are present. Undiagnosed sleep apnea can increase risk of heart attack and stroke – which are already increased in those with diabetes. Sleep disturbances such as sleep apnea can also make it harder to keep blood sugars under control. Other risk factors include male sex, older age, smoking, and alcohol use. Those who have already had a heart attack or stroke, or who have poorly controlled blood pressure, are also at increased risk.
Diagnostic testing, performed in the laboratory or sometimes even at home, involves monitoring breathing and oxygen levels. Pauses in breathing (obstructions) occurring at 5 or more times per hour indicate sleep apnea is present. Increased pause rate means increased severity of the problem (15-30 is moderate; >30 is severe). This disorder often comes with snoring, sleepiness and being overweight – but not in every case.
There are many treatment options for those with sleep apnea. Wearing a mask known as continuous positive airway pressure (CPAP) while sleeping is the standard treatment. Although some initially find the prospect of this treatment daunting, there are dozens of different kinds of masks to help accommodate each person’s needs and comfort. Alternatives come in two categories: surgical and non-surgical. Surgeries include soft palate surgery and jaw advancement surgery, as well as a new stimulator device that acts like a pacemaker to prevent obstructions in sleep. Dental appliances can be made that pull the bottom jaw forward in sleep – these are made by specially trained dentists.
For some people, the sleep apnea is present mainly when they sleep on their back. In these cases avoiding that position can be helpful. This can be accomplished with a shirt/vest that has a bumper on the back that makes back-sleeping uncomfortable. (The challenge is that some people end up sleeping on their back for some or all their sleep regardless.) Finally, weight loss can be helpful for those patients who are overweight. Whichever treatment pathways are chosen, alone or in combination, it is best to speak with your doctor about your choices and how to monitor your progress.