Are you Waking up Tired and Unrefreshed. Do you have Obstructive Sleep Apnea ?

Updated: Nov 3, 2020

We have already discussed that the hours you sleep are important in a previous post on the effects of Sleep Deprivation.


So what if you are getting the right amount of sleep, but you are tired and sleepy throughout the day. What if you are waking up unrefreshed and snoring all night ? Everyone wakes up unrefreshed at some point in their life. But for many people, they wake up like this all the time.


The most common cause for this is Obstructive Sleep Apnea or Sleep Disordered Breathing.

So what is OSA ?

The way I explain this to patients is to discuss the anatomy of your Oropharynx and Sleep architecture and what happens to your body during various phases of sleep.


The Oropharynx is part of a passageway transporting air to your lungs. Unfortunately various structures can make this airway smaller in certain people. Doctors look at the airway and its characteristics to help predict if you are at Risk for Obstructive Sleep Apnea using a Mallampati Classification System.


Sleep Architecture

Ok so now lets talk about Sleep Architecture. First we have Awake and Sleep. Good start. Now in Sleep, we break this into 2 phases again. NREM and REM Sleep. Each has different characteristics we can discuss later, but today we Discuss REM sleep. When you go into REM sleep, you dream . REM means Rapid Eye Movement which occurs in this phase of sleep. When the body is dreaming , we dont want to be moving around the bed, as we do in our dreams, so the body relaxes the muscles when you are in REM sleep. This is an important characteristic we will come back to.


In the Hypnogram below we can see Sleep, Cycling thru several stages from NREM (1,2,3,4) to REM and back again. This is what happens in Normal sleep.

Returning to the image of the Oropharynx, you can see there are numerous structures which contain muscle and the tongue is the largest of these. So when we go into REM sleep and relax these muscles, you can Obstruct this Airway. The airway can either block off entirely which we call an Apnea or result in a decreased rate of breathing, a Hyponea. Both of these are known as Obstructive events which we see in Obstructive Sleep Apnea.


When these Obstructive events occur , various warning systems in the body alert the brain to this impending issue. As a result the brain receives disruption or what we call Arousals to the sleep pattern. So whilst you may not wake up, we can see these arousals on a Sleep Study and of course constant arousals to your sleep will make you tired and sleepy when you should be alert and awake.


This is the Sleep disorder, Obstructive Sleep Apnea.


If you have symptoms of....


  • waking unrefreshed

  • sleepy or excessive tiredness throughout the day

  • snoring badly

  • waking with headache

  • teeth grinding during sleep, painful jaw / teeth in the morning

  • stop breathing whilst you sleep, or waking up gasping

  • sore, dry throat in the morning

  • falling asleep easily during the day, after meals or whilst driving

  • unexplained high BP

  • unexplained drop in concentration or memory

.......you should see your Dor for a review and organise a Sleep Study to rule out OSA.


How Does OSA affect my Health?


"Increasingly, Obstructive sleep apnea is also being recognized as an independent risk factor for several clinical consequences, including hypertension, cardiovascular disease, stroke, and abnormal glucose metabolism..............Factors that increase vulnerability for the disorder include age, male sex, obesity, family history, menopause, craniofacial abnormalities, and certain health behaviors such as cigarette smoking and alcohol use. Despite the numerous advancements in our understanding of the pathogenesis and clinical consequences of the disorder, a majority of those affected remain undiagnosed." [1]


OSA is estimated to affect 20% of the population, however, its likely that the condition is under diagnosed and this number higher. Thankfully, there are good treatments available and people have amazing results with treatment. I've seen many patients turn their lives around, beginning with treatment of their Obstructive Sleep Apnea.[12]


As we have discussed, Sleep is linked to many mechanisms in the body. Poor Sleep can affect your ability to exercise , concentration , mood, diet and weight. So, if you want to make a start and lose weight or improve your performance, its probably best to fix your sleep problem first.


References

[1]Punjabi NM. The epidemiology of adult obstructive sleep apnea. Proc Am Thorac Soc. 2008;5(2):136-143.

[2]. Peppard PE, . Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med 2000;342:1378–1384.

[3]. Peker Y. Increased incidence of coronary artery disease in sleep apnoea: a long-term follow-up. Eur Respir J 2006;28:596–602. [PubMed] [Google Scholar]

[4]. Punjabi NM, . Disorders of glucose metabolism in sleep apnea. J Appl Physiol 2005;99:1998–2007.

[5]. Marin JM. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 2005;365:1046–1053.

[6]. Lavie P. Restless nights: understanding snoring and sleep apnea. New Haven, CT: Yale University Press; 2003.

[7]. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep 1999;22:667–689.

[8]. Bixler EO. Effects of age on sleep apnea in men: I. Prevalence and severity. Am J Respir Crit Care Med 1998;157:144–148.

[9.] Bixler EO. Prevalence of sleep-disordered breathing in women: effects of gender. Am J Respir Crit Care Med 2001;163:608–613.

[10]. Young T. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 1993;328:1230–1235.

[11]Peppard PE. Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA. 2000 Dec 20;284(23):3015-21.

[12] Tishler PV,. Incidence of sleep-disordered breathing in an urban adult population: the relative importance of risk factors in the development of sleep-disordered breathing. JAMA. 2003 May 7;289(17):2230-7