Sleep Conditions

Contents
  1. Behavioral Sleep Medicine Clinic at Johns Hopkins
  2. Our Patients
  3. Services Offered
  4. Fees and Insurances
  5. How to Schedule an Appointment
  6. Location
  7. Before Your First Visit
  8. What to Expect During Our First Visit
  9. Sleep Tests and Treatments
  10. Polysomnogram
  11. Home Sleep Apnea Test 
  12. Continuous Positive Airway Pressure (CPAP) 
  13. Titration 
  14. Multiple Sleep Latency Test 
  15. Maintenance of Wakefulness Test 
  16. Cognitive-Behavioral Therapy 
  17. Light Therapy 
  18. Insomnia
  19. What are the symptoms of insomnia?
  20. How is insomnia diagnosed?
  21. How is insomnia treated?
  22. What are the complications of insomnia?
  23. Key points
  24. Next steps
  25. Conditions and Disorders
  26. Obstructive Sleep Apnea (OSA)
  27. How is OSA Diagnosed?
  28. Insomnia
  29. Circadian Rhythm Disorders
  30. Narcolepsy
  31. Parasomnias
  32. Restless Leg Syndrome (RLS)
  33. Sleep Deprivation
  34. What causes sleep deprivation?
  35. What are the symptoms of sleep deprivation?
  36. How is sleep deprivation diagnosed?
  37. How is sleep deprivation treated?
  38. Can sleep deprivation be prevented?
  39. How to manage sleep deprivation
  40. Key points about sleep deprivation
  41. Obstructive Sleep Apnea
  42. Who is at risk for obstructive sleep apnea?
  43. What are the symptoms of obstructive sleep apnea?
  44. How is obstructive sleep apnea diagnosed?
  45. How is obstructive sleep apnea treated?
  46. What are the complications of obstructive sleep apnea?
  47. Can obstructive sleep apnea be prevented?
  48. When should I call my healthcare provider?
  49. Key points about obstructive sleep apnea
  50. Sleep Apnea
  51. Who is at risk for sleep apnea?
  52. What are the symptoms of sleep apnea?
  53. How is sleep apnea diagnosed?
  54. How is sleep apnea treated?
  55. Key points about sleep apnea

Behavioral Sleep Medicine Clinic at Johns Hopkins

Sleep Conditions | Johns Hopkins Medicine

The Behavioral Sleep Medicine Clinic is a multidisciplinary outpatient clinic dedicated to the behavioral treatment of sleep disorders and their consequences. Our expert staff consists of psychologists, physicians, and related health professionals who are experienced and knowledgeable in the assessment, diagnosis, and treatment of sleep disorders.

We know that behavioral therapies for insomnia and many other sleep disorders produce longer lasting effects than sleeping pills.

Therefore we seek to idenitify the root causes of an individual’s sleep disorder and then implement behavioral and lifestyle changes to address these causes and bring relief.

 We work closely with the Johns Hopkins Sleep Disorder Center to provide our patients with the best integrative care possible.

Our Patients

Typically, patients first visit the clinic for one or more of the following four reasons:

  • they experience difficulty falling asleep or staying asleep at night (insomnia)
  • they fall asleep and/or wake up too late or too early (circadian rhythm disorders)
  • they are tired of taking sleeping pills and want to stop, or they need help with sleep medication management
  • they are frustrated with trying to adjust to Continuous Positive Air Pressure (CPAP) treatment for obstructive sleep apnea.

Services Offered

All patients of the Johns Hopkins Behavioral Sleep Medicine Program receive a thorough assessment, diagnosis, and therapy to address the presenting problem(s). During the assessment phase, you and your provider will work together to develop a comprehensive treatment plan that will identify the goals for treatment.

Depending upon the presenting problem, treatment often consists of cognitive-behavioral therapy (CBT), a form of brief psychotherapy that has extensive scientific support as an effective way to help people with insomnia, circadian rhythm disorders, and difficulty adjusting to Continuous Positive Airway Pressure (CPAP) therapy for obstructive sleep apnea.

The National Institutes of Health recommend CBT as a first-line treatment for insomnia and other sleep disorders.

The goals of CBT are to help you learn about the factors influencing your sleep and to make specific, lasting changes to improve your condition.

As part of the treatment process, you will be asked to monitor your behavior and you and your therapist will set daily goals to help you improve your sleep experience.

You will then meet approximately once per week for up to 50 minutes, to work toward these goals. Signficant improvement if often achieved in 2-6 sessions depending on the causes of your sleep disturbance.

Other treatments may include:

  • Medication management
  • Light therapy
  • Sleep hygiene
  • Sleep pattern monitoring
  • Standardized assessment of how sleep may impact your mood and function

Fees and Insurances

The Department of Psychiatry participates in some, but not all insurance plans. Please call the clinic for more information.

Even if the department does not participate in your particular insurance plan, most plans will cover some percentage of the fee. Some insurance plans require prior authorization.

Medicare patients do not need to obtain authorization and will only be required to pay their standard copay amount.

How to Schedule an Appointment

For more information and to schedule an appointment call 410-550-6337, between 9:00AM and 4:00PM, Monday through Friday.

Location

Behavioral Sleep Medicine Clinic
Psychiatric Outpatient ClinicAlpha Commons Building, 4th FloorJohns Hopkins Bayview Medical Center5300 Alpha Commons DriveBaltimore, MD 21224Phone: 410-550-6337

Fax: 410-550-5992

Directions to The Johns Hopkins Bayview Medical Center

Before Your First Visit

Before your initial evaluation, we will mail you a packet of information that includes directions to the clinic as well as several brief questionnaires about your health history and sleep patterns.

You should complete these forms and bring them with you to your appointment, so that you and your treatment provider can review the information together. Your responses will help guide the personalized treatment plan that you and your provider develop.

If you already had a sleep study at another hospital, please fax us a copy of the report before your visit at 410-550-5992.

What to Expect During Our First Visit

Your first visit will consist of an assessment session and will last approximately an hour and half to two hours. Please arrive 20 minutes before your scheduled appointment time in order to complete your clinic registration. Once your registration is complete, you will meet with a clinic therapist, who will begin your evaluation.

Source: https://www.hopkinsmedicine.org/psychiatry/patient_information/bayview/medical_services/adult/sleep_clinic.html

Sleep Tests and Treatments

Sleep Conditions | Johns Hopkins Medicine

Johns Hopkins Medicine Sleep Centers offer an array of tests that can help practitioners diagnose sleep disorders and formulate individualized treatment plans for each patient.

Read more about sleep studies in the Johns Hopkins Health Library.
Learn more about healthy sleep habits at Johns Hopkins' Healthy Sleep portal.

Polysomnogram

To diagnose your sleep problem and provide appropriate therapy, your specialist may recommend an overnight stay at one of our sleep centers so you can get a polysomnogram. You will be given a comfortable room to sleep in while a trained and licensed sleep technologist monitors and records your brain waves, heartbeat, breathing patterns, eye movements and blood oxygen levels.

Home Sleep Apnea Test 

Sleep apnea is a common and serious disorder that affects your breathing while you sleep, and can result in bothersome snoring, severe sleep deprivation, memory issues, heart disease, stroke and other health problems.

In some cases, you can test yourself for this condition and other sleep problems at home.

Your care provider will send you home with one or more devices that help measure your breathing, blood oxygen level, heart rate or other data.

Continuous Positive Airway Pressure (CPAP) 

CPAP therapy provides a constant flow of air through a mask you wear over your nose and mouth while sleeping. If you have been diagnosed with obstructive sleep apnea, your doctor may recommend a CPAP, since the pressure created by the device helps you sleep through the night without pauses in breath that disturb your rest.

Titration 

CPAP and oral or dental appliances are common treatments for disorders such as obstructive sleep apnea. Titration involves an overnight study during which the technologist adjusts your CPAP or oral appliance to help you breathe. After observation, your sleep specialist may recommend adjusting the CPAP or oral appliance settings so they are more appropriate for you.

Multiple Sleep Latency Test 

This study helps your specialist assess how sleepy you are during the day by measuring how easily you fall asleep in a quiet environment. Excessive daytime sleepiness may be a sign of narcolepsy and other disorders.

The multiple sleep latency test is conducted after an overnight in-lab sleep study. The test itself takes a full day to conduct, but it is simple and painless. You will take five 20-minute nap trials, one every two hours. During the trials, you lie quietly in bed, and a series of sensors will determine how long it takes you to fall asleep and what sleep stage(s) you enter.

Maintenance of Wakefulness Test 

the Multiple Sleep Latency Test, this is an all-day study that is administered after you complete an overnight in-lab sleep study, either the next day or on another date.

The test helps gauge your daytime alertness in a quiet environment. Reduced alertness may be a sign of a sleep disorder.

During each of the four 40-minute trials — one every two hours — you sit quietly in bed while the sleep specialist uses sensors to determine your ability to stay awake.

Cognitive-Behavioral Therapy 

Cognitive-behavioral therapy (CBT) is a form of brief psychotherapy that has extensive scientific support as an effective way to help people with insomnia, circadian rhythm disorder and difficulty adjusting to CPAP therapy for obstructive sleep apnea. The National Institutes of Health recommends CBT as a first-line treatment for insomnia and other sleep disorders.

CBT may help you learn about the factors influencing your sleep and to make specific, lasting changes to improve your well-being.

The treatment process involves meeting approximately once a week with your caregiver and monitoring your behavior. You will work on daily goals to help you improve your sleep experience.

You will ly see improvement in two to six sessions, depending on the causes of your sleep disturbance.

Light Therapy 

This treatment can address circadian sleep disorders — those your physical, mental and behavioral responses to the 24-hour cycle of light and darkness. Therapy typically involves sitting near a special light-box each day for a time period recommended by your therapist. You can read, use a computer, converse or do other activities during your session.

Source: https://www.hopkinsmedicine.org/sleep-medicine/tests-treatments.html

Insomnia

Sleep Conditions | Johns Hopkins Medicine

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Insomnia, which means difficulty initiating or maintaining sleep, is a symptom, not a diagnosis or a disease. It may be due to a lack of sleep or poor quality of sleep.

You’ve probably had nights when you couldn’t fall asleep, no matter how desperately you tried.

When you can't sleep, the ticking of the clock only reminds you of your exhaustion and the endless hours until morning. And perhaps you finally drop off around dawn, only to be jarred awake by the alarm an hour later.

Insomnia is one of the most common sleep complaints. About 1 in 3 adults has bouts of insomnia that last a few days at a time. This is acute insomnia. But 1 in 10 adults suffers ongoing difficulty sleeping, known as chronic insomnia. This is defined as insomnia that occurs more than 3 nights a week for over a month.

Insomnia affects people in different ways. If you suffer from it, you may not be able to go to sleep or you may not be able to stay asleep. You might constantly wake up earlier than you would , perhaps in the wee hours of the morning, and find yourself unable to go back to sleep. 

Women are more ly to have insomnia than men. It is also more common among shift workers, who don't have consistent sleep schedules; people with low incomes; people who have a history of depression; and those who don't get much physical activity.

Around 18 million Americans fail to get a good night's sleep.If you or someone you love is among them, these research findings and expert insights could help you figure out what’s holding you back and what can help.

Insomnia has many possible causes. The reasons you're lying awake when you don't want to be are individual. They can include any or all of these:

  • Medications that interfere with sleep
  • Dietary choices, such as caffeine late in the day, that interfere with sleep
  • Stressful thoughts
  • Depression
  • Recent upheavals in your life, such as a divorce or death of a loved one
  • Hormone changes, such as those accompanying menopause
  • Bedtime habits that don't lead to restful sleep
  • Sleep disorders
  • Chronic pain
  • Medical conditions such as acid reflux, thyroid problems, stroke, or asthma
  • Substances alcohol and nicotine
  • Travel, especially between time zones

What are the symptoms of insomnia?

These are common symptoms of insomnia:

  • Frustration and preoccupation with your lack of sleep
  • Physical aches and pains, such as headaches and stomachaches
  • Impaired performance at work
  • Daytime drowsiness or low energy
  • Difficulty paying attention
  • Anxiety
  • Tension and irritability
  • Depression and mood swings

How is insomnia diagnosed?

You may need to see a sleep medicine specialist to find out what's causing your insomnia. It will be helpful to bring a record of your sleep patterns.

The process of making a diagnosis may include:

  • Your medical history. Your doctor will consider any medical conditions, any medications you're taking, and stressful life changes that could be causing insomnia.
  • Your sleep history. Be prepared to describe your insomnia with details such as how long it's been going on, what you think could be contributing to it, and what your sleep is , such as whether you can barely get to sleep at all or if you wake up too early.
  • Physical exam. The doctor will look for any physical reasons that could be causing sleep problems.
  • Sleep study. You may need to sleep overnight in a sleep lab where researchers monitor your sleep.

Diagnosis of insomnia begins with a good medical history. The physician will seek to identify any medical or psychological illness that may be contributing to the patient’s insomnia, as well as screen for drug and alcohol use.

The patient may be asked about chronic snoring and recent weight gain, which may lead to the possibility of obstructive sleep apnea. In such cases the doctor may request an overnight sleep test, or polysomnogram, though sleep studies are not part of the routine initial workup for insomnia.

Patients may also be asked to keep a daily diary of their alertness

How is insomnia treated?

You have many options for treatment:

  • Medications to help you get to sleep and stay asleep
  • Change in existing medication if that's what's causing the problem
  • Counseling to help relieve stress and other issues bothering you
  • Change in lifestyle choices that may interfere with sleep
  • Insomnia generally resolves itself when the underlying medical or psychiatric cause is removed. Treating the symptoms of insomnia without addressing the main cause is rarely successful. Most people seek medical attention when their insomnia becomes chronic. Therapies include both nonpharmacologic and pharmacologic treatments. Studies have shown that combining medical and nonmedical treatments typically is more successful in treating insomnia than either one alone.

What are the complications of insomnia?

Insomnia can have serious complications. Poor sleep quality is linked to:

  • Increased risk for heart disease
  • Increased risk for stroke
  • Increased risk for diabetes
  • Excessive weight gain or obesity
  • Depression
  • Increased risk for injury to yourself or others, such as a car accident caused by driving while drowsy

Key points

Insomnia, the term for having trouble sleeping at night, is one of the most common sleep complaints. About 1 in 3 adults has bouts of insomnia that last a few days at a time. Women are more ly to have insomnia than men.

  • Insomnia has many possible causes. You may need to see a sleep medicine specialist to find out what's causing your insomnia.
  • Common symptoms of insomnia include impaired work performance, daytime drowsiness or low energy, difficulty: paying attention and others.
  • Diagnosis may involve a sleep study in which a sleep specialist monitors your sleep.

Next steps

Tips to help you get the most from a visit to your health care provider:

  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.

Source: https://www.hopkinsmedicine.org/health/conditions-and-diseases/insomnia

Conditions and Disorders

Sleep Conditions | Johns Hopkins Medicine

The most common explanation for complaints of sleepiness in our society is inadequate sleep. Due to the stress and rigors of society, most Americans often get less than 7 hours of sleep per night.

the current sleep deprivation research findings, most individuals require 7.5 to 8.5 hours of sleep nightly in order to function at their best, emotionally, cognitively, and physically.

Sleep deprivation can also magnify the severity of other sleep disorders including sleep apnea and restless legs syndrome.

Obstructive Sleep Apnea (OSA)

Obstructive sleep apnea (OSA) is the reduction of breathing during sleep that lasts for at least 10 seconds, as a result of repetitive episodes of upper airway obstruction that occurs during sleep.

This obstruction is usually associated with a fall in blood oxygen or an arousal from sleep and may be caused by large tonsils, large tongue, excess tissue in the throat, blocked nasal passages, or an abnormal jaw and airway structure.

Patients with OSA may experience daytime symptoms such as sleepiness, fatigue, and problems with memory and concentration. Additionally, OSA can exacerbate other medical conditions such as high blood pressure, diabetes, heart problems, stroke, acid reflux, and insomnia. Adequate treatment of sleep apnea can improve both symptoms and associated medical conditions.

How is OSA Diagnosed?

OSA is diagnosed using an overnight sleep study called a polysomnogram (PSG). Although a patient's symptoms and medical history can suggest they might have OSA, until a sleep study is done, the formal diagnosis cannot be made.

Insomnia

Insomnia is defined as a recurrent problem initiating sleep, maintaining sleep, and/or waking up feeling un-refreshed, and is associated with problems functioning during the day. Daytime consequences for insomnia include irritability, fatigue, and inattention. The sleep field currently recognizes approximately 30 types of insomnia the presumed underlying cause for the sleep disruption.

Circadian Rhythm Disorders

The brain has an internal clock that regulates several biorhythms including the timing of an individual’s sleep-wake cycle.

In most cases, the environment provides clues in the form of sunlight, activity, and temperature to help align this internal clock with the external environment.

In situations when the two clocks are sync, individuals have difficulty sleeping during “conventional” sleep hours.

Circadian rhythm disorders can come in a variety of forms the pattern of the sleep clock misalignment, including:

  • Night owl form (CRD-delayed sleep phase syndrome)
  • Morning lark form (CRD-advanced sleep phase syndrome)
  • Shift work disorder
  • Jet lag

The misalignment between the internal clock and the environment can lead to a number of difficulties including insomnia, daytime sleepiness, and fatigue.

Narcolepsy

Narcolepsy is a clinical disorder that involves a collection of symptoms. Chronic daytime sleepiness despite appropriate sleep opportunity is absolutely required for the diagnosis.

At times, the desire to sleep becomes so overwhelming that small “cat naps” are required throughout the day to feel refreshed.

Individuals may also experience episodes of cataplexy (muscle weakness associated with expression of emotion), muscle paralysis during sleep-wake transitions, and dream- images experienced when they are awake.

Parasomnias

Para-somnia literally means behaviors occurring during sleep. In general, these behaviors occur during the transition from sleep-wake or during transitions within the different stages of sleep.

In most cases, parasomnias are infrequent and benign and do not require medical attention. A formal evaluation by a sleep specialist should be considered in the following situations:

  • Episodes result in injury to the individual or others
  • Episodes result in significant sleep disruption to the individual or members of their household
  • Episodes result in significant daytime dysfunction.

Some of the conditions categorized as parasomnias include:

  • Nightmares
  • Night terrors
  • Sleep walking
  • Bruxism (teeth grinding)
  • Sleep-related eating disorders
  • Somniloquy (talking in one’s sleep)

Restless Leg Syndrome (RLS)

RLS is a disorder diagnosed by the presence of four essential symptoms:

  • An uncomfortable sensation usually located in the legs that are associated with an overwhelming urge to move.
  • The experience of these sensations when the individual is immobile or at “rest.”
  • When the individual moves, the symptoms improve.
  • The symptoms are most prominent at night.

Due to the nature of these clinical symptoms, individuals with RLS often experience difficulties sleeping at night and functioning during the day.

Learn more about RLS and the Johns Hopkins Center for Restless Legs Syndrome.

Source: https://www.hopkinsmedicine.org/pulmonary/clinics/sleep-medicine/conditions_disorders.html

Sleep Deprivation

Sleep Conditions | Johns Hopkins Medicine

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Sleep deprivation means you’re not getting enough sleep. For most adults, the amount of sleep needed for best health is 7 to 8 hours each night.

When you get less sleep than that, as many people do, it can eventually lead to a whole host of health problems. These can include forgetfulness, being less able to fight off infections, and even mood swings and depression.

What causes sleep deprivation?

Sleep deprivation is not a specific disease. It is usually the result of other illnesses or due to life circumstances.

Sleep deprivation is becoming more common. Many people try to adjust their schedule to get as much done as possible, and sleep is sacrificed.

Sleep deprivation also becomes a greater problem as people grow older. Although older adults probably need as much sleep as younger adults, they typically sleep more lightly and for shorter time spans than younger people. It’s estimated that half of all people older than 65 have frequent sleeping problems.

Sleep deprivation can occur for a number of reasons:

  • Sleep disorder. These include insomnia, sleep apnea, narcolepsy, and restless legs syndrome.
  • Aging. People older than 65 have trouble sleeping because of aging, medicine they’re taking, or medical problems they’re experiencing.
  • Illness. Sleep deprivation is common with depression, schizophrenia, chronic pain syndrome, cancer, stroke, and Alzheimer’s disease.
  • Other factors. Many people have occasional sleep deprivation for other reasons, including stress, a change in schedule, or a new baby disrupting their sleep schedule.

What are the symptoms of sleep deprivation?

At first, sleep deprivation may cause minor symptoms, but over time, these symptoms can become more serious.

Initial sleep deprivation symptoms may include:

  • Drowsiness
  • Inability to concentrate
  • Impaired memory
  • Reduced physical strength
  • Diminished ability to fight off infections

Sleep deprivation complications over time may include:

  • Increased risk for depression and mental illness
  • Increased risk for stroke and asthma attack
  • Increased risk for potentially life-threatening complications, such as car accidents, and untreated sleep disorders insomnia, sleep apnea, and narcolepsy
  • Hallucinations
  • Severe mood swings

How is sleep deprivation diagnosed?

Sleep specialists say that one of the telltale signs of sleep deprivation is feeling drowsy during the day. In fact, even if a task is boring, you should stay alert during it if you are not sleep-deprived.

Also, if you frequently fall asleep within 5 minutes of lying down, then you ly have severe sleep deprivation. People with sleep deprivation also experience “microsleeps,” which are brief periods of sleep during waking time.

In many cases, sleep deprived people may not even be aware that they are experiencing these microsleeps.

If you have any of these warning signs or the symptoms listed above, see your doctor or ask for a referral to a sleep specialist. Your doctor will ask you detailed questions to get a better sense of the nature of your sleeping problems.

In some instances, if a more serious and possibly life-threatening sleep disorder, such sleep apnea, is suspected, then the sleep specialist may conduct a test called a polysomnography, or a sleep study.

This test actually monitors your breathing, heart rate, and other vital signs during an entire night of sleep.

It gives the sleep specialist useful information to help diagnose and treat your underlying disorder.

How is sleep deprivation treated?

Treatments for sleep deprivation vary how severe it is. In some cases, your doctor may want you to try self-care strategies before turning to medicine.

Your doctor may prescribe sleeping pills, but keep in mind that they tend to lose effectiveness after a few weeks and can then actually disrupt your sleep.

For more serious insomnia, your doctor may have you try light therapy, which can help your body’s internal clock readjust and allow you to sleep more restfully.

If you are diagnosed with sleep apnea, your doctor may prescribe a special breathing machine you’ll use while you sleep called CPAP (continuous positive airway pressure). This machine provides a continuous flow of air to help keep your airway open.

Can sleep deprivation be prevented?

If your sleep deprivation is mild, these simple strategies may help you to get a better night’s sleep:

  • Exercise at least 20 to 30 minutes each day, at least 5 to 6 hours before going to bed. This will make you more ly to fall asleep later in the day.
  • Avoid substances that contain caffeine, nicotine, and alcohol, all of which can disrupt your regular sleep patterns. Quitting smoking is always a good idea.

How to manage sleep deprivation

Creating a relaxing bedtime routine often helps to conquer sleep deprivation and get a good night’s sleep. This can include taking a warm bath, reading, or meditating and allowing your mind to drift peacefully to sleep.

Another step that may help you to get a good night’s sleep is sticking to a consistent schedule, meaning that you go to bed and wake up at the same time every day. If possible, waking up with the sun is a good way to reset your body’s clock more naturally.

Also, keep your bedroom at a reasonable temperature. A bedroom that is too hot or too cold can disrupt sleep.

If you’re having trouble sleeping, try doing something else reading a book for a few minutes. The anxiety of not being able to fall asleep can actually make sleep deprivation worse for some people.

Finally, be sure to see a doctor if your problems with sleep deprivation continue. Don’t let sleep problems linger.

Key points about sleep deprivation

Sleep deprivation is not a specific disease. It is usually the result of other illnesses or life circumstances.

  • Sleep deprivation can become a greater problem as people grow older.
  • One of the telltale signs of sleep deprivation is feeling drowsy during the day.
  • Treatments for sleep deprivation vary how severe it is.
  • Creating a relaxing bedtime routine often helps to conquer sleep deprivation and get a good night’s sleep.
  • The anxiety of not being able to fall asleep can actually make sleep deprivation worse for some people.

Source: https://www.hopkinsmedicine.org/health/conditions-and-diseases/sleep-deprivation

Obstructive Sleep Apnea

Sleep Conditions | Johns Hopkins Medicine

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Obstructive sleep apnea occurs when your breathing is interrupted during sleep, for longer than 10 seconds at least 5 times per hour (on average) throughout your sleep period.

These periods are called hypopneas when your breathing is reduced and you're not taking in enough oxygen. They're called apneas if your breathing completely stops.

Your breathing typically stops because something is blocking your upper airway, such as the muscles, tongue, and other body tissues.

Obstructive sleep apnea can range from moderate to severe, a measurement and rating system called the apnea-hypopnea index (AHI). The AHI measures an average number of apnea and hypopnea episodes that you experience per hour that you sleep.

Obstructive sleep apnea is classified by severity:

  • Severe obstructive sleep apnea means that your AHI is greater than 30 (more than 30 episodes per hour)
  • Moderate obstructive sleep apnea means that your AHI is between 15 and 30
  • Mild obstructive sleep apnea means that your AHI is between 5 and 15

More than 60 million Americans suffer from poor sleep quality, and more than 40 million meet the diagnostic criteria for sleep disorders. Sleep is critical to a healthy mind and body – learn how to get a better, more restful night’s sleep in the Johns Hopkins Healthy Sleep portal.

When you sleep, your body is completely relaxed — even the muscles that help you breathe. In people with sleep apnea, these relaxed muscles combine with a narrowed airway to interrupt breathing.

Anyone at any age can have obstructive sleep apnea, but it's most common in middle-aged and older adults. Only about 2% of children have obstructive sleep apnea. It's also more common in men than in women.

But what's frightening is that as many as 90% of people who have obstructive sleep apnea don't know that they have it. Untreated, sleep apnea can lead to serious health problems.

Who is at risk for obstructive sleep apnea?

Knowing the risk factors for obstructive sleep apnea can help you get a diagnosis. Risk factors include:

  • Family member with obstructive sleep apnea
  • Large or thick neck (greater than 16 inches for women and 17 inches for men)
  • Chronic nasal congestion
  • Thyroid disorder or other endocrine condition
  • Postmenopause
  • Being overweight
  • Defect of the tissues that support the head and neck
  • Down syndrome
  • Smoking
  • Swollen or large adenoids and tonsils (in children)

What are the symptoms of obstructive sleep apnea?

Some people have obstructive sleep apnea with no symptoms. Others find that they just don't feel rested after a night of sleep and feel sleepy during the day.

Snoring is one of the biggest symptoms of obstructive sleep apnea. Other symptoms include:

  • Snoring that's interrupted with periods of quiet (called an apnea episode)
  • Snoring that resumes with a loud sound as breathing starts again
  • Morning headache
  • Frequently falling asleep during the day
  • Being easily irritated
  • Depression
  • Difficulty remembering things

How is obstructive sleep apnea diagnosed?

Diagnosis of obstructive sleep apnea usually involves participating in a sleep study, in which you're observed as you sleep.

You may participate in a test called a polysomnogram at a hospital or sleep center. But you may also use a take-home version of the test.

Your doctor may give you a monitor to wear when you sleep that measures your oxygen levels and heart rate, to help diagnose sleep apnea.

Your doctor will also typically do a physical exam, including an exam of the throat, neck, and mouth, and take your medical history. You'll probably also have to answer questions about your sleep and bedtime routine, as well as your symptoms.

How is obstructive sleep apnea treated?

These are common treatments to maintain consistent breathing and stop or reduce apnea episodes:

  • Sleeping with a CPAP (continuous positive airway pressure) machine and mask – this treatment provides a constant flow of air to help keep your airway open
  • Wearing an oral appliance, a custom-fit mouthpiece your dentist or orthodontist can make for you to keep airways open while you sleep

Several types of surgery can be done to treat obstructive sleep apnea:

  • Surgery to repair defects in facial structures
  • Surgery to get rid of extra tissues that can block airways
  • Surgery to repair abnormalities that cause obstructions when you breathe or to create a wider airway
  • Removal of adenoids and tonsils; this is most effective in children

Making a few changes to your sleep and other behaviors can also help manage obstructive sleep apnea:

  • Shed any excess weight.
  • Sleep on your side instead of on your back.
  • Avoid alcohol.
  • Limit your use of sedatives.

What are the complications of obstructive sleep apnea?

Letting obstructive sleep apnea continue untreated is risky — you can get in a serious accident if you fall asleep while operating machinery or driving a car.

Health problems may develop as a result of obstructive sleep apnea, including:

  • Increased blood pressure
  • Instability of oxygen levels
  • Changes in your body's response to insulin and glucose
  • Changes in mental function and mood
  • Cardiovascular problems heart failure, stroke, or abnormal heartbeat (arrhythmia)

Can obstructive sleep apnea be prevented?

Avoiding behaviors that relax your muscles can help prevent apnea episodes. Don't drink alcohol or take sedatives to help you sleep, and maintain a healthy weight.

When should I call my healthcare provider?

If your bed partner hears symptoms of apnea episodes or your snoring is problematic, it's a good idea to visit your doctor to talk about your symptoms and ask about a sleep study. Feeling drowsy or falling asleep frequently during the day are also signs that you should call your doctor.

Key points about obstructive sleep apnea

  • Don't risk falling asleep in a dangerous situation, such as while driving.
  • Try to set up an appointment with your doctor if your fatigue continues.
  • If obstructive sleep apnea persists over a long period without treatment, you're at risk for major health problems and serious events. These can include cardiovascular problems heart failure and increased blood pressure.

Source: https://www.hopkinsmedicine.org/health/conditions-and-diseases/obstructive-sleep-apnea

Sleep Apnea

Sleep Conditions | Johns Hopkins Medicine

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Sleep apnea is a serious, potentially life-threatening condition. It is far more common than previously thought. Sleep apnea happens in all age groups and both genders, although it is more common in men. It is estimated that as many as 18 million Americans have sleep apnea.

Sleep apnea is a breathing disorder characterized by brief interruptions of breathing during sleep. There are two types of sleep apnea:

  • Central sleep apnea happens when the brain fails to send the appropriate signals to the muscles to start breathing. Central sleep apnea is less common than obstructive sleep apnea.

  • Obstructive sleep apnea happens when air can’t flow into or the nose or mouth although efforts to breathe continue.

Sleep apnea is characterized by a number of involuntary breathing pauses or “apneic events” during a single night's sleep. There may be as many as 20 to 30 or more events per hour.

These events are usually accompanied by snoring between apnea episodes. But, not everyone who snores has sleep apnea. Sleep apnea may also be characterized by choking sensations.

The frequent interruptions of deep, restorative sleep often lead to early morning headaches and excessive daytime sleepiness.

During the apneic event, you can't breathe in oxygen or exhale carbon dioxide. This results in low levels of oxygen and increased levels of carbon dioxide in the blood. This alerts the brain to resume breathing and cause an arousal.

With each arousal, a signal is sent from the brain to the upper airway muscles to open the airway. Breathing is resumed, often with a loud snort or gasp.

Frequent arousals, although necessary for breathing to restart, prevent restorative, deep sleep.

Early recognition and treatment of sleep apnea is important, as it may be associated with:

  • Irregular heartbeat

  • High blood pressure

  • Heart attack

  • Stroke

  • Daytime sleepiness

  • Increased risk of motor vehicle accidents

Certain mechanical and structural problems in the airway cause the interruptions in breathing during sleep. Apnea happens:

  • When the throat muscles and tongue relax during sleep and partially block the opening of the airway.

  • When the muscles of the soft palate at the base of the tongue and the uvula relax and sag, the airway becomes blocked, making breathing labored and noisy and even stopping it altogether.

  • In obese people when an excess amount of tissue in the airway causes it to be narrowed.

  • With a narrowed airway, the person continues his or her efforts to breathe, but air can't easily flow into or the nose or mouth.

Who is at risk for sleep apnea?

Sleep apnea seems to run in some families, suggesting a possible genetic basis. People most ly to have or develop sleep apnea include those who:

  • Snore loudly

  • Are overweight

  • Have high blood pressure

  • Have some physical abnormality in the nose, throat, or other parts of the upper airway

Use of alcohol and sleeping pills increases the frequency and duration of breathing pauses in people with sleep apnea.

What are the symptoms of sleep apnea?

In either form of sleep apnea, your breathing pauses a number of times during sleep. These are called apneic events. There may be as many as 20 to 30 or more events per hour. Between events, you may snore.

But, not everyone who snores has sleep apnea. Sleep apnea may also cause a choking sensation. When breathing starts, you may make a loud snort or gasp.

These frequent breaks in deep, restorative sleep often lead to headaches and excessive daytime sleepiness.

Other symptoms include dry mouth or sore throat and problems paying attention.

How is sleep apnea diagnosed?

Diagnosis of sleep apnea is not simple because there can be many different causes. Primary healthcare providers, pulmonologists, neurologists, or other healthcare providers with specialty training in sleep disorders may be involved in making a diagnosis and starting treatment. Several tests are available for evaluating sleep apnea, including:

  • Polysomnography. This test records a variety of body functions during sleep, such as the electrical activity of the brain, eye movement, muscle activity, heart rate, respiratory effort, air flow, and blood oxygen levels.

  • Multiple Sleep Latency Test (MSLT). This test measures the speed of falling asleep. People without sleep problems usually take an average of 10 to 20 minutes to fall asleep. People who fall asleep in less than 5 minutes are ly to need some type of treatment for sleep disorders.

Diagnostic tests usually are done in a sleep center, but new technology may allow some sleep studies to be done in your home.

How is sleep apnea treated?

Specific treatment will be determined by your healthcare provider :

  • Your age, overall health, and medical history

  • Severity of the disease

  • Your tolerance for specific medicines, procedures, or therapies

  • Expectations for the course of the disease

  • Your opinion or preference

Medicines are generally not effective in the treatment of sleep apnea. Therapy may include the following:

  • Giving oxygen may safely help some people, but does not end sleep apnea or prevent daytime sleepiness. Its role in the treatment of sleep apnea is controversial.

  • Behavioral changes are an important part of a treatment program, and in mild cases of sleep apnea, behavioral therapy may be all that is needed. You may be advised to:

    • Avoid the use of alcohol.

    • Avoid the use of tobacco.

    • Avoid the use of sleeping pills.

    • Lose weight if overweight (even a 10% weight loss can reduce the number of apneic events for most people).

    • Use pillows and other devices to help sleep in a side position.

  • Physical or mechanical therapy options are also available.

    Nasal continuous positive airway pressure (CPAP) is a device that is used nightly in which you wear a mask over the nose during sleep, and pressure from an air blower forces air through the nasal passages.

    Dental appliances that reposition the lower jaw and the tongue have been helpful to some people with mild sleep apnea, or who snore but do not have apnea.

  • Some people with sleep apnea may need surgery. Examples of these procedures include:

    • Surgical procedures to remove adenoids and tonsils, nasal polyps, or other growths or tissue in the airway, or to correct structural deformities may be done.

    • Uvulopalatopharyngoplasty (UPPP) is a procedure used to remove excess tissue at the back of the throat (tonsils, uvula, and part of the soft palate).

    • Surgical reconstruction for deformities of the lower jaw may benefit some people.

    • Surgical procedures to treat obesity are sometimes recommended for a person with sleep apnea who is obese.

Key points about sleep apnea

Sleep apnea is a breathing disorder characterized by brief interruptions of breathing during sleep. Sleep apnea is a serious, potentially life-threatening condition that is far more common than generally understood.

  • There are two types of sleep apnea:

    • Central sleep apnea

    • Obstructive sleep apnea

  • Sleep apnea seems to run in some families, suggesting a possible genetic basis.

  • Diagnosis of sleep apnea is not simple because there can be many different causes.

  • Medications are generally not effective in the treatment of sleep apnea.

  • Treatment may involve behavioral changes, weight loss, CPAP therapy and sometimes surgery.\

Source: https://www.hopkinsmedicine.org/health/conditions-and-diseases/sleep-apnea