Good sleep is crucial to pain management. If you're not sleeping well, you're not going to be feeling well. Period. But what if you think you're sleeping well enough, but you're not? What if you have a sleeping disorder and you don't realize it? In this series, I'm covering the most common (and most overlooked) sleep problems. Today we're talking about sleep apnea.
Sleep Apnea: Definitions & Types
Sleep apnea is a medical disorder where people temporarily stop breathing during sleep. Apnea means “temporary cessation of breathing, especially during sleep.” Apnea is a medical term that comes from the Greek word apnous which literally translates to breathless.
There are two types of sleep apnea: obstructive sleep apnea and central sleep apnea.
Obstructive Sleep Apnea
First, let me briefly explain obstructive sleep apnea. If you’re sleeping and the muscles of your neck relax so much that your airway is blocked; no air is making its way into your lungs. Similar to a kink in a garden hose; when there is a kink in the hose, no water comes out. When your airway is blocked, no air is getting through. Something is obstructing the airway. That is obstructive sleep apnea.
Risk factors for obstructive sleep apnea
People who are severely overweight are four times more likely to experience obstructive sleep apnea. Besides being overweight, other risk factors and signs for sleep apnea including snoring, high blood pressure, waking up gasping, and having a larger than average neck circumference (17 inches or more for men and 15 inches or more for women). That last one may seem a bit weird, but that comes straight from science.
Central Sleep Apnea
The second reason you could temporarily stop breathing in your sleep is if something is going awry with your brain’s signalling your body to breathe. That’s called Central Sleep Apnea. In central sleep apnea, tour brain’s signals to breathe, called respiratory drive, are not getting through accurately.
Rick factors for central sleep apnea
The biggest risk factor for developing central sleep apnea us using opioid pain medications.
Men are more likely than women to experience central sleep apnea. Other risk factors include problems with your circulatory system, like congestive heart failure. Using opioid pain medications (including medications like Vicodin, Percocet, Oxycodone, and morphine) can also increase the risk of developing central sleep apnea. Bodyweight does not correlate with risk factors for central sleep apnea; people who are thin are just as likely as people who are heavy to experience central sleep apnea.
What Happens In The Body During Sleep Apnea?
Sleep apnea may not sound that alarming, but let’s take a look at what actually happens in your body when you experience sleep apnea. Each time you experience apnea (doctor’s term for this is apneic event or airflow drop), no air is getting through to your lungs. As a result, oxygen levels in your blood start to go down. The brain, which is constantly monitoring for that type of event, goes “Oh shit!” and kick starts some emergency processes until a breath is drawn. Then sleep resumes. A person may never actively wake up or be conscious of lapses in breathing throughout this whole process.
Trying to sleep with uncontrolled sleep apnea is essentially like sleeping when a fire alarm keeps going off.
If you are experiencing sleep apnea, this essentially means that your brain can never rest. It constantly gets alarms, goes on high alert, and settles back again.
The severity of sleep apnea can vary from person to person. Usually, doctors measure how many times you have an apneic event or airflow drop, where your lungs aren't getting air intake. For mild sleep apnea is usually diagnosed when someone experiences 5-15 apneic events per hour of sleep. Above 30 apneic events per hour qualifies someone for a diagnosis of severe sleep apnea.
Imagine a sleeping infant. Now imagine you clap loudly in the infant’s ear once every 60 seconds. Do you think you’re going to have a happy, smiley baby the next day? No.
Now, imagine your brain goes on high alert 5 times an hour every hour you're sleeping? 20 times an hour? More? Do you think you're going to be feeling well?
What are the effects of sleep apnea?
Someone with sleep apnea is going to feel exhausted all the time, want to nap constantly, and grumpy. Coincidentally, someone with chronic pain might feel the same way. Someone with severe sleep apnea can have an “apneic event” more than once a minute. Wake up exhausted. Fight through another day. Try to rest the next night. The deficit this can build is incredible.
Remember poor sleep Patrick from yesterday? He came to me mostly due to chronic pain. But he also told me he was constantly exhausted, slept many hours but woke up tired, and had no energy. He was also quite overweight, had high blood pressure, and also had a larger neck circumference. These are classic signs and symptoms of sleep apnea.
Sleep Apnea and Chronic Pain
Someone once described living with sleep apnea like this:
“I felt like I was constantly circling the drain, about to get sucked under.”
This is a typical description of how it feels to live with sleep apnea.
And now imagine you’ve gotten a doctor’s standard advice for chronic joint pain: Lose weight. Really? You want someone who is effectively only sleeping in 45 second bouts to have enough energy to make effort at eating better? That’s absurd. People often just attribute poor mood, fatigue, weight gain, and other symptoms to pain, but many times, poor sleep is playing a much bigger role that we realize.
In the next article, we’re going to take a look at what to do if you think you might have sleep apnea.
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