The Dangers of Sleep Disorder Breathing: From Snoring to Apnea

Is your nighttime breathing actually going to kill you? Now this is serious. We are as a society have accepted things like snoring to be a just a common thing that people do at nighttime. Now, I'm not saying snoring is going to necessarily kill you unless your wife gets you around the throat because you said enough, but it's a red flag that you have a sleep breathing disorder. Now today we're going to talk about the categories of sleep disorder breathing. We're going to go with an overview of them, going to give you a little bit of an insight of what to look out for and what to do if you should have or you suspect someone in your family has sleep disorder breathing. So that is the overall what we'd call the umbrella category for snoring, obstructive sleep apnea, central sleep apnea and obesity hyperventilation. We'll break down each one of those, we'll go into some of the characteristics of them, what those typical treatments or patterns of breathing might look like and what to look out for. And hopefully you'll take away something from this and even be able to make an impact and just identify in your loved ones, in your partners and your clients, whoever that is around you. Why are we talking about this today? Because the prevalence of sleep disorder breathing is increasing as obesity increases, as stress increases, as this disconnect between our mind and body and understanding ourselves increases. And whilst the medical profession, they can do a good job to help treat it, help people to get onto machines to help them overcome to the main problem, I do believe that the medical system has a very narrow focus on a particular subset and a lot of people will get misdiagnosed or just like under diagnosed in our population. So typically the prevalence in the whole world ranges between 4 to 10% of people globally. But then in specific areas, places like the United States and the UK and other areas in the world such as Singapore, they have prevalences of maybe 40 to 60% of things like obstructive sleep apnea, particularly males over the age of 45 at the highest risk. However, that is a stereotypical category of an obese male over the age of 45 being the only people that get things like obstructive sleep apnea. So what is snoring? First of all, snoring is just an audible vibration in our airway when we inhale. Imagine when you're sleeping, your airway should be nice and patent, nice and open if it relaxes too much or if it closes because there's excess fatty tissue on the neck, then there's going to be a higher amount of pressure that then goes through the airway. We can start to get some turbulence in the flow vibrates the relaxed gloss of muscles, and therefore we start to create this vibration noise that is very annoying. And yes, it disturbs people's sleep, but it is worse than that because that is the precursor to what we would say is obstructive sleep apnea. Obstructive sleep apnea is where there is a complete halt or there is a cessation of your airflow that causes your oxygen level to drop or your brain to be going to an arousal state which kind of fragments your sleep and it's to do with airway obstruction. The person's still trying to breathe. In fact, they might even be noticing there's some diaphragm spasm going on, but they just can't get the air out. Now, if you imagine oxygen levels fall, as their oxygen levels are dropping, the nervous system is going to start to pick up that we're going beyond homeostasis and we'll start to kick in some sympathetic activity which then causes the person to take a big gasp, take a big breath and then they repeat. This can happen anywhere between five to 30 times an hour, which I have seen happen up to 185 times per hour. Yes, that person was falling asleep in front of me, barely awake, practically living in a coma. Signs of obstructive sleep apnea. Clearly snoring. Snoring is the first obvious sign. But not everyone with sleep apnea will snore, but most people who snore will not. Everyone who with snoring will have sleep apnea, but most people who have sleep apnea will snore. The next thing is witness apneas. If you are a person at home, you're a wife or a husband, or you have clients who have wives and husbands or bed partners and they have this kind of a little bit of a joker. Yeah, I have to keep nudging them to make sure that they're. They're alive because they don't breathe at night. That is a classic sign of obstructive sleep apnea. Other things are going to be excessive daytime sleepiness. If the person is having to nap consistently. Falling asleep during meetings, falling asleep at the cinema, falling asleep just literally on a car, in the car, whilst driving, falling asleep whilst just having a little rest and at the desk, that is excessive daytime sleepiness. Other things is sore throat in the morning, headaches in the morning, and increased risk of mental health problems because of nervous system dysregulation are associated with these things. So they are classic signs people who are at high risk. There are males relative to females, particularly when we get to the ages where testosterone starts to drop round about the age of 40, 45. Females, when they start to hit post menopause, they have an increased risk of obstructive sleep apnea. And also ethnicity wise we have Asians, Indians who have very narrow jaw sets. If they put a little bit of weight on, they can narrow and close the jaw off. But also Pacific Islanders have large tongues, large necks. As soon as they put a bit of weight on again we're going to start to see obstructive issues related to that. Other things that might be associated or often discussed with having obstructive sleep apnea is mouth breathing. And mouth breathing at nighttime has been shown to reduce sleep quality and therefore create a feeling of lethargy, inability to focus, grogginess in the morning. And essentially what can happen is when we mouth breathe the jaw can, can slide back, we can have the airway narrow and that for therefore it's going to increase the risk of obstructive sleep apnea. So if you maybe suspected that you have or someone else has obstructive sleep apnea, what you want to do is you want to go and have a sleep study. Now depending on the country you're in, here in Australia there are a range of different sleep studies. You can get some from a local pharmacy that can just screen your obstructive sleep apnea. And if it's a, therefore if it comes back at a high risk or severe, you're probably going to need to go on something called a CPAP machine, which we'll talk about in a moment. But what I would recommend to get a bit more of a detailed look is having a look at a home based or an in lab sleep study of your insurances allow you to do that then can also have a more detailed report and we can see the ins and out of exactly what's going on with your breathing, where the positioning you're in, how much it's impacting your oxygen levels, even to the extent of what's going on with your fragmentation of your sleep stages. And that can really help decipher whether or not there are alternate treatments that you might be able to go for. So what would be a classic treatment? I just for obstructive sleep apnea, as I mentioned, the main treatment that is going to be happening for most people with sleep apnea is not A cure. It's what we call cpap, Continual positive airway pressure. It's a mask that goes over the nose or the nose and mouth and basically it just generates a small amount of air pressure that goes into the nose and it keeps the airways open, it extends them open so that they don't collapse. If they don't collapse, we don't have this whole cascade of this issue of breathing, oxygen levels not dropping. And once a person gets used to wearing the device, they can get benefits from it in terms of it can change their life. I've seen people who have used it for two, three days have been able to accept it, embrace it, and it's turned them from being someone who's fallen asleep all the time, who can barely function, to someone who can literally motivate themselves to get back into the gym and you know, weeks later they started to lose weight. That takes me to weight loss. If you're someone who is a little bit overweight, maybe you've got an additional 5 kilos or 10 kilos on you. Decreasing that weight will have a huge benefit on your breathing, on your nighttime breathing, on your daytime breathing. However, it's not always just the case. There are more and more literature coming out to suggest that not only is there a weight dependent or fat mass dependent increased risk of sleep apnea, there is also a stress dependent risk, sleep apnea too. Now, throughout my career as a clinical, respiratory and sleep scientist, one of the common patterns that I saw was individuals who were not obese. They were people who were pretty reasonably fit but were go getters. They were high performers. And a lot of them, when they get to the age of 40, 45, 50, they tend to be on this phase of burnout. They sleep unwell and eventually they get obstructive sleep apnea. And it's like doctors like why? It seems to be that there is an issue related to stress, the metabolic system in general, and our metabolic system obviously tyrant is tied to our breathing and the hormonal and circadian rhythm changes that occur at nighttime related to also cortisol, insulin and leptin dysfunction lead to breathing issues related at nighttime. So not only is there a fat weight dependent of it, there is a metabolic dependent reason for getting obstructive sleep apnea. In that case, clearly reducing stress, improving breathing functionality, and also in changing diet and improving the metabolic system is going to improve obstructive sleep apnea. In that case, you'd probably still want to be using CPAP. In the meantime, then we might go to the Next bit, which is what we call central sleep apnea. This is more so the brain. The brain just stops firing the signals so that the person does not have a breath. And that can happen throughout the night. We can get what we call waxing and waning in our breathing, where the breathing will get bigger and smaller and then just disappear. Typically, central sleep apnea usually happens when someone has something related to brain damage. They will have maybe congestive heart failure. Altitude or excessive opioid medication can all suppress breathing and cause central sleep apnea. In that case, a person needs to go on more of a ventilator, a machine that will actually breathe for them. So that would be different from a cpap, which is a continuous pressure. A ventilator will actually have two different pressures and it will basically force the pressure of air in to take the breath of an inhale and then relax the pressure down to allow for an exhale whilst remaining the airways open still. Finally, we're going to move on to obesity hypoventilation. Now, this is a combination of essentially someone becoming so large, their belly gets so big that they actually squeeze their lungs. They increase what we call the functional residual capacity. The point at which they breathe from this will then cause the lungs to squish, so they have a smaller lung volume. So now they've only got a smaller breath to get air in anyway. That tied into being a more mechanically inefficient breath because of the body mass, the size, the mechanics of the body itself, increased work of breathing and can lead to chronic respiratory muscle fatigue. And what will that do? That will suppress breathing even further. Now we have potentially signs of what we call respiratory acidosis, where CO2 will be elevated long term. The body will try and compensate for this by creating excessive bicarbonate and that will then shift and create a fixed underbreathing point. Now we might even start to see metabolic issues related to insulin resistance, electron resistance on top of that. And we have someone who is barely breathing at nighttime and probably even barely breathing during the day, and that person eventually ends up in a coma if they don't get put on a ventilator. Unfortunately, they don't survive very long. Now, this is in the extreme cases of obesity. I have seen this, I've witnessed this. I had to help people with ventilators on this. There's people at 200, 230, 250 kilos, if you've ever seen the film. The whale basically will document and show you what it's like to be an individual who is that large now they were people who were very challenging to work with. There's two parts of the brain that your mind that go I feel sorry for this person. Like how much trauma does it take for this person to be able to allow them to get into the position how much pain and suffering is there be? And then also there's the part the way you're judging it, like how, how large are they? At what point do you start to realize that you're eating and consuming too much food and not moving enough? However, there is a point at which an individual will get what leptin resistance. And leptin resistance means that the safety hormones, the hormones that make us feel full are just impaired and not receiving the signals to the brain to say that they are no longer need to consume food and therefore excessive food is consumed and energy balance just becomes a an issue in the body. Obesity hyperventilation requires ventilation, requires checking out blood gases and getting blood gases back into normal range again. So just a quick video there on sleep disorder breathing, because I haven't got any contact for a little while and I apologize about that. But we've got snoring, obstructive sleep apnea, central sleep apnea, and obesity hyperventilation, all of which are under the umbrella category sleep disorder breathing. So if you did enjoy this and you enjoy learning about breathing and sleep in general, I'll pop the last sleep video I did on here that introduced sleep science in general, broke down some phases of sleep and what they they do and how we can generally just get better quality sleep. Anyway, don't forget to subscribe, leave a comment. If this has helped you at all, please let us know because I really appreciate it.