Obstructive Sleep Apnea: An Underrecognized Medical Problem

Sleep apnea is a medical condition that occurs when there’s an interruption in your breathing that results in a sudden drop in the oxygen levels in your blood while you sleep. Periods when the breathing stops are called apnea or apneic episodes. There are 3 types of sleep apnea including central, complex, and obstructive. Of the three types of sleep apnea, obstructive sleep apnea (OSA) is one of the most common yet underrecognized and underdiagnosed. Normally, air flows smoothly from the nose and mouth into the lungs but with this medical condition, breathing stops involuntarily for short periods during sleep.

Sleep Apnea Risk Factors

Sleep apnea can happen to anyone, but it affects 20% of obese people, while it only affects 3% of people who are within a healthy weight range. Sleep apnea generally impacts men more than women, but sleep apnea rates will start to equalize later in life as women experience menopause. The reason women are more likely to experience sleep apnea after menopause is due to how excess body weight is distributed later in life. Premenopausal women will typically gain weight in the lower body but after menopause, women will start to put on weight in their belly and upper body. This shift in weight accumulation increases the weight felt on airways which increase the likelihood of sleep apnea happening. In addition to unhealthy weight, some other risk factors that impact the likelihood of sleep apnea include:

  • Narrowed airway – Enlarged tonsils or adenoids can block airways.
  • Hypertension – OSA is relatively common for people with high blood pressure.
  • Chronic nasal congestion – OSA is more common with people who have routine nasal congestion at night; this may be a result of narrowed airways.
  • Family history – If you have family members with OSA, you could be at increased risk.
  • Asthma – Studies show that people with asthma are at higher risk for OSA.
  • Sedentary lifestyle –The lack of exercise that can lead to increased weight.

What are the Signs of Sleep Apnea?

There are 3 different types of sleep apnea which are identified by where the interruption occurs. Obstructive sleep apnea (OSA) occurs when your airway doesn’t allow airflow into or out of your lungs even though your body is trying to actively breathe. Central sleep apnea occurs when your brain fails to send the subconscious signals your body needs to tell your lungs, diaphragm, muscles, and airway to work together to breathe. Complex sleep apnea is a combination of both central and obstructive sleep apneas. This type usually presents itself as OSA but does not respond to the use of a CPAP machine.

Obstructive sleep apnea is generally easier to diagnose since your body makes some noise as it tries to draw air in. The most apparent sign is heavy snoring which is usually identified by a partner. This heavy snoring can be interrupted by pauses in breathing, heavy breathing, and gasping for air as the body’s reflexes kick in and prompt the body to recover. With that said, snoring is not always an indication of sleep apnea and sleep apnea doesn’t always occur with heavy snoring.

Other signs of sleep apnea include:

  • Constantly being tired and fatigued. Since sleep apnea interrupts sleep patterns, it isn’t uncommon for those that experience sleep apnea to be tired, even after a full night of “sleep.”
  • Waking up with dry mouth. Sufferers of sleep apnea often end up breathing through their mouth to attempt to get enough oxygen. This dries out saliva which results in dry mouth.
  • Waking up with a headache that could be the result of oxygen deprivation or high carbon dioxide levels.
  • Experiencing memory problems, mood swings, or depression.

Complications That Can Result from Undiagnosed Obstructive Sleep Apnea

In worst case scenarios, there are serious complications that can arise from undiagnosed sleep apnea.

  • Hypertension can result from sleep apnea due to the body releasing stress hormones as a response to suffocation while sleeping.
  • Increased risk of serious cardiovascular problems like heart attack or stroke due to the heart working overtime to supply sufficient oxygen to major organs.
  • Eye degeneration caused by lack of blood flow and oxygen to the optic nerve.
  • Diabetes can be a direct result of long term exposure to regular periods of hypoxia.
  • Brain degenerative disorders like dementia and Alzheimer’s and OSA have a long suspected connection caused by chronic sleep interruption.

Sleep Apnea’s Impact on Hypertension

A strong association has been created between obstructive sleep apnea and hypertension. While hypertension is a known risk factor for sleep apnea due to an individual who suffers from both likely being overweight, it is also a serious complication that can arise from OSA. The American Heart Association has determined that sleep apnea causes extreme stress on the body which results in an increase in hormones like cortisol. These hormones increase blood pressure which cause the heart to beat faster and harder while constricting blood vessels. When this happens for an extended period, normal periods of high blood pressure become chronic hypertension. Hypertension is a leading factor in other serious cardiovascular problems including heart failure, heart attack, stroke, kidney damage, aneurysm, artery disease, and erectile dysfunction in men.

Sleep Apnea’s Impact on Cardiovascular Risk

Sleep apnea is often connected to other problems like cardiovascular disease. This is because obesity plays a significant role in both heart problems and an individual’s likelihood that they will suffer from sleep apnea. Sleep apnea obstructs regular breathing which deprives the body of the oxygen it needs to continue normal operation. This causes the heart to work harder than it needs to in order to pump enough oxygen to critical organs like the brain. This overexertion combined with other problems like plaque buildup in arteries increase the likelihood of heart failure, heart attack, or stroke.

Weight loss is a critical element of effectively treating against sleep apnea and cardiovascular disease. Individuals who are able to reduce the fat buildup in the neck and upper belly can reduce the strain put on airways and reduce the severity of their sleep apnea.

Sleep Apnea’s Impact on Eyesight

Another organ that suffers from oxygen deprivation during OSA is the eyes. By suffocating the blood flow to the brain and optic nerve, the following ocular comorbidities may exist:

  • Nonarteritic Anterior Ischemic Optic Neuropathy (NAION): The lack of oxygen to the optic nerve can cause temporary blindness which typically occurs in the morning and then fades as oxygen levels are balanced after waking up from an apneic episode.
  • Glaucoma: This results in the eyes experiencing increased pressure and swelling which can lead to permanent vision reduction or loss. Studies have indicated that those that experience sleep apnea are 10x more likely to suffer from glaucoma.
  • Papilledema: The recurrent disruption of normal breathing patterns leads to hypoxia which results in intercranial pressure that can cause the deterioration of eyesight over time.
  • Floppy Eye Syndrome: FES is characterized by loose eyelids that easily flip over when sleeping which results in irritation of the eyes upon waking. Studies have indicated that there is a strong association between OSA and FES with one study showing 90% of participants experienced both comorbidities.

Sleep Apnea’s Impact on Diabetes

The oxygen deprivation that sleep apnea can cause has a direct impact on a body’s ability to regulate glucose levels. This is a result of increased carbon dioxide levels causing the body to have a higher resistance level for insulin which leads to higher levels of glucose in the blood stream. When this happens for an extended period, it increases the likelihood of type 2 diabetes developing. Studies have indicated that OSA can increase both the risk and severity of type 2 diabetes independent of obesity.

Sleep Apnea’s Impact on Neurodegeneration

There is growing support that shows that brain degenerative disorders like dementia and Alzheimer’s are connected to OSA due to chronic sleep interruption. This connection has been suggested because brain degenerative disorders have been associated with the accumulation of beta amyloid proteins in the brain which are typically cleared during stages of N3 sleep. During N3 sleep, your brain and body are in a regenerative period where critical healing occurs. When this level of sleep is not reached or constantly interrupted, these proteins will build up leading to the increased likelihood of neurodegeneration over time. Studies indicate that individuals that suffer from OSA are diagnosed with cognitive impairment on average 10 years younger than people without.

Getting Sleep Apnea Diagnosed

The leading diagnosis for OSA is polysomnography, a comprehensive sleep study used to diagnose sleep disorders. However, a medical specialist can review a patient’s detailed medical history and conduct a physical examination that may help reveal previously undiagnosed cases.

Diagnosing sleep apnea is important because left undetected, OSA can lead to additional serious medical issues such as heart disease, depression, hypertension, and even death. If an individual is suffering from any of the existing complications known to be associated with OSA, it may be time to get diagnosed by a qualified professional.

Treating for Undiagnosed OSA Can Possibly Prevent Many of These Complications

Upon diagnosis, your doctor may present treatment options including:

  • Treating the underlying medical condition that is causing sleep apnea
  • Breathing devices or apparatus like CPAP
  • Dental devices
  • Implants
  • Surgery

Medication can also be used to treat sleep apnea. Regardless of the treatment method, it’s best to seek medical advice as soon as you think you may suffer from OSA.

Contact Headache TMJ – Los Angeles Pain Clinic Today

Recognizing signs of OSA is important so you can get seek treatment as soon as possible. If you are experiencing any signs of this medical problem, contact our clinic so we can provide you with a diagnosis and treatment options. Headache TMJ is the top orofacial pain clinic in Los Angeles, California. We provide the best treatment services for patients suffering from complex head, face, mouth, temporomandibular joint, neck pain, snoring, or other related symptoms of obstructive sleep apnea. Our clinic serves patients in Los Angeles and Santa Monica. Contact us today to schedule your appointment.

Undiagnosed Sleep Apnea FAQs

What happens with undiagnosed sleep apnea?

Undiagnosed sleep apnea can result in a number of related health problems like hypertension, heart failure, diabetes, stroke, arrhythmias, cardiomyopathy, and headaches.

Can you have obstructive sleep apnea and not know it?

Yes, since obstructive sleep apnea occurs while an individual is sleeping, they often go unaware of their disease for some time. It is often a partner that realizes that someone may suffer from sleep apnea. Other times, an individual may realize that they are experiencing a problem after being fatigued and suffering from headaches, memory problems, and depression.

What does untreated sleep apnea feel like?

If sleep apnea is left untreated, it can lead to serious cardiovascular problems, diabetes, depression, mood swings, and memory problems. Many of these symptoms are largely related to oxygen deprivation and obesity.

About the Author

Dr. Katayoun Omrani

Dr. Katayoun Omrani

Dr. Katayoun Omrani is a Diplomate of the American Board of Orofacial Pain. She is the former co-director of Orofacial Pain mini-residency at UCLA. Her research focus is in headache and neuropathic pain and has lectured extensively on these topics. As a lecturer and clinical professor at UCLA in the Department of Oral Medicine and Orofacial Pain, she is responsible for training residents. She is also a board certified attending doctor at Cedars-Sinai and an active member in several organizations in her field of practice including:

• The American Academy of Orofacial Pain
• American Board of Orofacial Pain
• American Academy of Dental Sleep Medicine
• Headache Cooperative of the Pacific
• American Headache Society

At the Headache TMJ – Los Angeles Pain Clinic, Dr. Katayoun Omrani has a unique and conservative approach to patient care that consists of a comprehensive examination and an individualized treatment program. Dr. Katayoun Omrani is committed to medical excellence and provides state-of-art diagnosis and treatment for chronic painful conditions in the head, face, neck and temporomandibular joint with an evidence-based approach and the use of current scientific knowledge and information supported by appropriate studies and research.

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