Sleep Apnea Is No laughing Matter

| May 17, 2013

Snoring is one of the great clichés. In cartoons, you just know that a blissfully snoring dog, cat, or human is about to be startled by an explosion or some scaringly loud noise.

In movies or TV ads, snoring is a shorthand for peaceful rest, or a way to poke gentle fun at a character.

But the truth is that snoring is no laughing matter. Very often it's a sign of sleep apnea, a harmful disorder that has been positively linked to diabetes-both as a contributor to the disease and one of its outcomes. Health problems linked to sleep apnea include high blood sugar, hypertension and heart disease.  

What It Is and How It Harms

Officially, the condition is called "obstructive sleep apnea," where the air passage between the throat, tongue, and soft palate becomes obstructed during sleep because muscles there relax too much. That often leads to the worst manifestation of sleep apnea, when the person suffering from it stops breathing completely. 

He may go 20 or 30 seconds without drawing a breath. Then, as the oxygen-deprived nervous system automatically kicks in with a reflex gasp, the sleeper loudly draws in air through his mouth. Some are temporarily awakened by the gasp, and may toss and turn to a more comfortable position to try to aid air flow.

For most though, the gasp is unconscious and there's no attempt to move to a better breathing position. But even changing position works for only awhile. Back asleep, the apnea sufferer's relaxed throat muscles soon block off air flow again, and the pattern of stopped breathing begins anew. Then comes the reflex gasp, which can occur dozens or even hundreds of times in one night.

This vicious cycle of stopping breathing, gasping for breath, then repeating the process is hard on the heart. Repeated drops in oxygen levels brought on by stopping breathing take a long-term toll on the heart muscle. It also wrecks any attempt at restful, uninterrupted sleep. Apnea sufferers often rise in the morning tired, even exhausted, from their restless night, and spend much of the day feeling sleepy.

Who's Likely to Get OSA? 

OSA is most commonly associated with being overweight. The heavier you are, the more likely you are to develop a weight-induced obstruction of the air passage. 

How is OSA linked to diabetes? For one thing, the repetition of stopping breathing then suddenly starting it again creates stress, which the body responds to by increasing its blood sugar level-"fuel" for fighting the emergency. But the body doesn't really have a way to use that extra glucose. In overweight people who are not yet diabetic but have become increasingly insulin-resistant, sleep apnea produces a hard push toward full-blown type 2

What You Can Do to Counter It

Before seeking medical intervention for sleep apnea, there are several ways you can ease its symptoms:  

  • Lose weight. Many people who suffer from sleep apnea enjoy reduced severity and occurrences simply by shedding a few pounds, which helps open up air passages.
  • Exercise more. Increased exercise helps with weight loss and increases insulin sensitivity. The result is that you approach bedtime in a more restful physical and mental state. 
  • Switch to a diet that avoids excess carbs and processed foods. 
  • Don't consume alcohol close to bedtime. The usual recommendation is to drink your last alcoholic beverage three hours before going to bed. 

More assertive treatments include:

  • CPAP-"Continuous Positive Airway Pressure" is provided by a masklike apparatus that delivers a constant mildly pressurized stream of air through the mouth and past the throat. By gently forcing the throat passage to stay open, CPAP allows sleep apnea patients to enjoy uninterrupted breathing and relatively restful sleep. Drawbacks to the device include discomfort from possible chafing and discomfort from wearing something that covers both the mouth and nose. 
  • Surgery-This is the most radical approach to treatment and is usually considered a last resort. (Sometimes, though, it is requested by people who simply cannot comfortably use CPAP, whether for physical or psychological reasons.) Procedures range from directly altering the shape and size of uvula, tongue, larynx, or palate to implants and tonsillectomies to such indirect approaches as gastric bypass, which lowers weight and often leads to a lessening of symptoms. 
  • Drugs-Four related oral drugs used to treat sleep apnea are all prescription medicines. Provigil, Nuvigil, Modafinil, and Armodafinil treat the side effects of sleep apnea by decreasing sleepiness and increasing wakefulness in people who cannot enjoy a full night's sleep due to a sleeping disorder. 
  • OTC remedies, such mouth appliances that force the air passage to remain open. The drawback to such devices is that they mask the basic problems that typically lead to sleep apnea, such as too much weight, bad diet, or excessive alcohol consumption. 

The American Diabetes Association, Web MD, and similar websites have more information on the aspects of sleep apnea. Useful search terms include:

  • Sleep apnea definition
  • Sleep apnea symptoms
  • Sleep apnea causes
  • Sleep apnea treatments
  • CPAP
  • Sleep apnea surgical procedures
  • Sleep apnea drugs
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Posted by Anonymous on 17 May 2013

Thanks for the clear well presented article. I have what was termed as a very mild case of sleep apnea, am not over weight, have heart disease and am considering some form of help. My doctor has tested me for OSA and laidout the options which I am considering. Since mine is a mild case I rule out surgery and meds do not sound like an option with viability. So I'm still looking into it and considering my options. And I read whatever I can get my hands on. Its contribution to heart disease is my main concern. Thanks again. Bill

Posted by Anonymous on 24 May 2013

I was diagnosed with Severe Sleep Apnea and am a T2 diabetic. I use a CPAP every night and have for about 6 years. I am now at the point if, I even try to sleep without the CPAP..I just cannot sleep! Even if I do suceed to dose off..I wake up with a terrible headache which was one of my symptoms before I starting using the machine. Since I started using it my A1c has been in the 5.2 to 6.0 range, my BP is normal and I have lost ~30 lbs. It was a little challenge getting use to the mask and all but, it is well worth it! Word of Advice: If you think you have Sleep Apnea..Please Do Not Be Afraid to Get Help!!!

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