Sleep apnea

Sleep apnea, abbreviated as apnea, is a cessation of breathing during sleep. If someone stops breathing more than five times per hour during sleep and this lasts for at least ten seconds, it is called an
apnea syndrome. A hypopnea is 'a near apnea'. The severity of the condition is shown in AHI. This is a combination of the number of
apneas and hypopneas in an index.

 

Apnea Hypopnea Index

  • AHI 5 to 15 per hour - mild
  • AHI 15 to 30 - moderately severe
  • AHI greater than 30 - severe

 

An apnea can affect the entire body, because the organs do not get enough oxygen. In addition, someone can remain extremely tired because the body has not been able to recover during the night.

 

There are two types of sleep apnea: OSAS or CSAS

These two types of sleep apnea have different causes.

We describe both forms. 

 

OSAS: Obstructive Sleep Apnea Syndrome

As the name suggests, there is an obstruction. The obstruction is caused by the tongue and the soft parts in the throat blocking breathing. During sleep, the tongue can drop into the throat due to a weak larynx or a too weak trachea. This causes people to snore loudly. An OSAS apnea due to obstruction in the throat neck can even lead to a risk of a stroke!
In addition to the advice to lose weight if ther is overweight, there are two most commonly used treatments for an obstructive sleep apnea syndrome (OSAS). T
he 'bit/denture' or also called mandibular repositioning device (MRA) and Continuous Positive Airway Pressure therapy (CPAP).

The CPAP is a device that provides slight overpressure, which keeps the airways open at night. This can be done via an air hose to a nose mask or a nose-mouth mask.
Research shows that a CPAP treatment can improve cognitive functioning in OSAS patients who have had a stroke.

If someone only snores when lying on the back, an aid can prevent  from sleeping on the back.

 

CSAS: Central Sleep Apnea Syndrome
'Central' here means from the brain. This is because the brain does not give enough signal to breathe during sleep.
CSAS is discussed in detail below. Someone with this form of apnea does not even have to snore.

 

Central Sleep Apnea Syndrome, CSAS

When the brain does not provide enough stimuli to breathe, this is called central sleep apnea syndrome (CSAS). Central means that the brain is involved. The central control of breathing falters.
The respiratory center in the brain (medulla oblongata in the brainstem) controls the number of times you breathe and how deeply you breathe. Normally, the brain responds to an increase in carbon dioxide and a decrease in oxygen, after which the signal is sent to the respiratory muscles to breathe.

In people with brain injury this can be disrupted. Particularly in people with brain stem damage.
People who had oxygen deficiency as a cause of the brain damage are also vulnerable to this condition. Patients with multi-system atrophy (MSA) and Parkinson's disease can also have this (unnoticed).

 

Characteristic is the very great difficulty to fall asleep that can last for hours. The person wakes up several times when there is no breathing from a survival reflex. But if this happens so often per night then one is extremely tired by the time of getting out of bed.

 

With CSAS the person is not necessarily snoring during sleep

 

Breathing may slow to as few as two to three times normal breathing per minute and may stop completely.

 

CSAS occurs in a mixed form with OSAS, but also occurs alone.

 

People with CSAS have:

  • Sleep problems where one wakes up often, sleeps restlessly and does not enter deep sleep
  • Difficulty falling asleep
  • Drowsiness or severe fatigue during the day
  • Often headaches upon waking
  • Not feeling rested upon waking
  • Often the urge to urinate at night
  • Too little breathing (hypoventilation) and therefore possibly
    hypercapnia
    Hypercapnia is too much carbon dioxide in the blood. This occurs particularly at night. The carbon dioxide level PCO2 can be normal during the day: normocapnic.
  • Physical complaints over a longer period of time that often seemed inexplicable before.

 

Be alert for brain damage in these brain areas
The following brain areas must be checked for abnormalities:
brain stem containing the mesencephalon (midbrain),
pons (bridge of varol), medulla oblongata, epiphysis (pineal gland),
hypophysis and hypothalamus.

Is the diaphragm sufficiently controlled by the brain? This can be measured with an outpatient night registration. Are there multiple respiratory arrests during the night during a registration?
Does the person wake up with a headache? Is the person too tired to get through the day?