What Happens During Sleep Apnea and Why You Should Care

One Week to Better Sleep Common Questions and Novel Treatments
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In this module, I want to discuss what actually happens during sleep apnea. You might be saying, so what, why should I care but I promise you, if you stick around to the end, I'm going to tell you something that has the potential to dramatically impact your health, your life, and hopefully even maybe prolong it. There are two types of sleep apnea, the common obstructive kind that we all know about the snoring, gurgling, flailing around type. And then there's Central, which I'll get into in a moment. And there's actually a mixed type, which there's features of both of these. And this has some pretty important implications on how we approach dressing it with C pap machine and oxygen therapy and other things.

Basically, what happens during sleep apnea is a cascade of physiologic responses take place, which is detrimental to your body, your heart, your brain, your liver, your kidneys, and I'll share with you in a moment what sleep apnea does to all those organs. obstructive sleep apnea as well known this is basically somewhat caused by the anatomy how big a person's job is whether they have some dental defects that may preclude blocking the airway. Do they have severe TMJ, large tonsils up though that punching bag that hangs down the back of the throat sometimes that's swollen and that can be more common in smokers or mouth breathers and also the base of the tongue all those structures contribute to airflow through the upper airway into the lungs, and depending on the size of those, they certainly have the potential to narrow the airway which leads to snoring and turbulent airflow, which increases the work of breathing which puts strain on the heart and completely closes off the airway, which leads to those pauses and breathing which we call apnea.

Central is based on some structures in the brain and the carotid arteries, those blood vessels on the side of the neck. There are sensors which can detect oxygen and carbon dioxide levels, and that's how the brain sort of tells the body to breathe and this is involuntary for the most part. What happens during central apnea is these sensors, they're just they're dysregulated, they don't really respond rapidly enough, or the response that the brain puts out is really inadequate, and the body is forced to try to compensate in some fashion. What we typically see in clinical practice in a sleep lab is a person is falling asleep, and then they stop breathing. There's long pauses without any breath, APNIC periods for precise medical definition. And then this is followed by periods of a short rapid breaths, basically what's happening is the body is trying to compensate.

They're trying to increase the oxygen content back to normal quickly. And during these APNIC events, carbon dioxide levels are rising. So by breathing rapidly, it can blow off some of the co2 and this period persists throughout the night. The causes are fairly serious stroke, traumatic brain injury or concussion, heart failure, CNS depressant drugs, and sometimes we just don't know what causes it. Mixed is actually a combination of features of both of these. And the sleep expert who's monitoring the test and interpreting the results will be able to tell based on some of the parameters whether or not a person is purely obstructive, central or mixed.

As oxygen drops, and co2 rises. The brain which is connected to all our organs, communicates by nerve pathways and hormones and other mechanisms causes the adrenal gland to dump out adrenaline is basically fight or flight while you're sleeping. And so the whole point of this is the body is trying to stimulate the brain enough to open the airway to overcome the resistance from the tongue or the tonsils of the soft palate, blocking the airway and breathe in. So think about where if you've ever been frightened out of your wits, or you know, preparing for an athletic event, you know, your heart rates up, you're a little bit anxious, you're sweaty. All these things Things happen as adrenaline surges through the body. Unfortunately, these repeated surges disrupt the normal hormonal hormonal balance, as I talked about in the men's health course, it's really a balance, homeostasis setpoint.

And it leads to a condition called adrenal fatigue, which, unfortunately, is the cornerstone of a variety of health consequences from pre diabetes to diabetes to hormone imbalance, testosterone in men, estrogen and women, and progesterone as well. And this has a huge implication on health in terms of brain function, heart health, and even bone strength. What I want to drive home in this module is that apnea really affects the entire body. It's just not it's not just being tired. It has effects on the liver, the heart, the brain, in the kidneys, and we'll get into those here next. The heart needs oxygen to function.

There's no way about it and when the oxygen is low, heart's got to work much harder, it's trying to increase blood flow to get more of the oxygen it needs to do its work. Over time. This leads to an enlarged heart, elevated blood pressure reading, and can even lead to abnormal heart rhythms. More commonly seen as atrial fibrillation or flutter. And what happens in this condition is the top chambers of the heart beat much more rapidly than the bottom chambers, the atria sometimes can beat up to 300 beats a minute. And this causes blood to pool and stagnate which increases the risk for forming clots in these chambers.

And when these clots shoot out of a heart, they can either go into the lungs, causing a pulmonary embolus, which can be fatal, or can shoot up the carotid arteries into the brain in cause stroke, which is catastrophic. Sleep Apnea increases risk for heart attacks and stroke whether or not a person has a fib or not, is a bad actor. during sleep apnea, the liver is going to dump out sugar it converts some substrates and building blocks into sugar with the whole purpose of waking up the brain, the brain functions, primarily using sugar and ketones as an energy source and by dumping out sugar, the brain can become a little bit more awake with the whole goal of trying to stimulate and restore normal breathing. Unfortunately, for people who are diabetic or pre diabetic, this really messes up glucose control. And it's not uncommon at all to see people who are pre diabetic, become diabetic as their sleep apnea continues on treated.

Diabetics note that they have more difficulty controlling their sugars or a onesies may be higher. And it's just a chronic problem that cannot be ignored. I talked about already that the brain the whole point is to try to heighten the alertness with a whole goal of protecting and opening the airway. The other thing that happens is people who experience sleep apnea have a heck of a time getting into the deeper stages of sleep, and this leads to sleep fragmentation. And what is felt and seen by the patients and their family members is that they're tired All the time they're crabby, they're moody. They eat more than typical.

They have problems with a satiety and tend to gain weight and have more issues blood pressure, and they're tired all the time. Have you ever been in a family function you look over and you see uncle Tommy passed out after a meal, or yourself you sit down to read something after supper and your unconscious, people can fall asleep at a stoplight, they fall asleep in meetings, they are taking morning naps at 1030 in the morning. These are all signs of sleep apnea and should not be ignored. The kidneys are finely tuned to interpret various fluctuations in the body and they're linked to the brain and the kidneys know that hey, if the brain is awake and doing some work, I should be doing some work. And what happens is the kidneys will continue to pump out about a half cc per kilogram per hour. So doesn't sound like much but over several hours.

That's enough to stretch the bladder to cause a person to wake up and go to the bathroom. That's term nocturia What c pap machines do in terms of treating sleep apnea is they help a person get into deeper sleep. And then the body can produce ADH hormone anti diuretic hormone. You can think of it this way it's ADH is the anti pee hormone. Once the kidneys realize that the brain is sleeping, they respond to this hormone they dramatically decreased urine output and just close to it literally a trickle. The whole take home point of this module is that you know if you have these signs and symptoms if you're tired, gaining weight, your blood sugar's hard to control, you're diabetic or becoming diabetic.

Fatigued and taking naps and mental fog persists throughout the day. grinding your teeth at night kicking your legs at night your sleep partner is complaining about it's your job function and performance is falling off. These are all signs of sleep apnea and you should not ignore them. To ignore it is really just to put your health and your life in jeopardy.

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