When Being Sleepy is a Problem

You’re exhausted, even though you turned in early. Your partner complains that you’ve been snoring. Should you call your doctor?

While anything that interferes with a good night’s sleep is a problem to discuss with your doctor, it’s especially important to find out if you have sleep apnea, said Vivian Asare, MD, a sleep medicine specialist at Yale New Haven Hospital and associate medical director, Yale Centers for Sleep Medicine.

What is sleep apnea?

Obstructive sleep apnea is a respiratory condition where airways narrow during sleep, causing short periods where you are not breathing. Whenever a person stops breathing, even for a moment, the brain wakes up. These repeated interruptions prevent the brain from dropping into the deepest, most restful sleep. As a result, people with sleep apnea get much lower quality sleep. They often wake up feeling very tired, even though the clock says they had a full night’s rest.

“Untreated sleep apnea can increase your risk of serious complications, including high blood pressure, type 2 diabetes, stroke and heart attack,” Dr. Asare said. “There’s a high association between sleep apnea and atrial fibrillation (known as AFib). It is a complicated process, but low oxygen levels and other physiologic changes during sleep caused by sleep apnea, can cause structural changes in heart muscles and eventually lead to abnormal heart rhythms.”

What are the symptoms of sleep apnea?

“The most common symptom that we see in patients with sleep apnea is being very sleepy," Dr. Asare said. She notes that it is important to distinguish fatigue (which is a lack of energy) from sleepiness (which is an inability to stay awake). People with sleep apnea may also snore or make wheezing, choking or gasping sounds during sleep, which can be frightening for parents, caregivers or bed partners. In some cases, people with sleep apnea may wake up with headaches or a dry mouth or throat.

What are the risk factors?

While medical experts see sleep apnea in all age groups, from infants to the elderly, the causes of the disorder may differ. Though obstructive sleep apnea affects men and women, men are at a much higher risk than women-- although the risks for women increase after menopause, according to Dr. Asare.

Being overweight is one of most common causes of obstructive sleep apnea in adults. Smoking also increases the risk of sleep apnea as it causes inflammation close to the airway. Other risk factors for developing sleep apnea may include age, use of narcotics, heart disease and/or a history of stroke.

Treatments for sleep apnea

If you have been diagnosed with sleep apnea, your doctor may recommend lifestyle changes such as losing weight, quitting smoking and avoiding alcohol and heavy meals in the hours before you go to bed. Sleeping on your side instead of your back allows the airway to remain open, and elevating the head of your bed may also provide relief.

Your doctor may also recommend use of the CPAP (continuous positive airway pressure) appliance, the “gold standard” for treating sleep apnea. This device consists of a blower that delivers a small amount of air pressure through a mask that fits over your nose to keep your airway open while you sleep. Despite its effectiveness, patients may struggle to get comfortable with wearing the mask for a variety of reasons and stop using a CPAP.

“It takes time and effort to get used to using a CPAP,” said Dr. Asare, who facilitates a CPAP support group at Yale Sleep Center that is held via Zoom on the first Friday of every month at 3 pm. “Our support group meetings offer participants the opportunity to ask questions, trade helpful tips and share experiences that help people better understand and manage their sleep-related concerns.” To attend the virtual group, call 203-432-9666 at the scheduled time and enter the meeting ID number (921 4861 3236) and passcode (463881) when prompted, or log into Zoom directly.

Other nonsurgical treatment options include custom-fit dental appliances that move the lower jaw forward so that the tissues of the back of the throat relax and prevent the tongue from collapsing and blocking the airway.

For patients who cannot tolerate CPAP or who have trouble with other treatments like oral appliances or weight loss, surgical treatment options now include the Inspire upper airway stimulation device. Inspire is a small, electrical device, and like a pacemaker, it is implanted in the patient’s chest. The device is connected wirelessly to a remote that, when activated, stimulates the airway muscles so they remain open during sleep.

“Inspire is different than CPAP because it keeps airways open from inside the body,” Dr. Asare said. “It’s not appropriate for all sleep apnea sufferers, so you should talk to your doctor about whether it is right for you.”

If you notice any of the signs of sleep apnea, it’s important to mention it to your doctor. “So many people don’t know what normal, refreshing sleep feels like,” she said. “Treating your sleep apnea truly can change your life for the better.”