Sleep apnea in seniors

Definition

Sleep apnea is the temporary interruption of breathing during sleep, usually lasting less than 30 seconds at a time. However, episodes may occur several times a night.

Description

There are two types of sleep apnea—obstructive and central. Obstructive sleep apnea (also called OSA) can be caused by such factors as obesity or an obstruction in the mouth or nose that blocks the airway. Central sleep apnea is less common, more difficult to treat, and can be caused by a problem with the brain, nervous system, or spine. Without treatment, either type of sleep apnea can cause other life-threatening conditions, including pulmonary hypertension, stroke , heart failure, or even death when the apnea is severe.

Sleep apnea can result in oxygen deprivation, which may cause seniors to experience personality changes, depression, headaches , and fogginess. Some researchers believe severe sleep apnea may also lead to high blood pressure , stroke, and heart attack , which can lead to death.

Most people who have sleep apnea wake in the morning and have no recollection of their apnea. That is why the condition is usually recognized by another person living in the same home or room as the senior with sleep apnea. The housemate may notice a senior exhibits patterns of excessive snoring, followed by 5–30 second intervals of silence, then coughing or gasping for air. This usually occurs several times throughout the night. The senior will usually awaken in the morning with no recollection of the apnea, but may be tired from the recurrent episodes of apnea.

Sleep apnea can lead to daytime sleepiness. Some seniors who don't feel well rested upon waking or who may have difficulty going to sleep will turn to sedatives or alcohol to induce sleep in an effort to feel more rested the next day. This type of behavior is dangerous for a senior with sleep apnea because the sedatives can actually suppress the respiratory functions further, which can hinder waking during episodes of apnea.

When the airway is already somewhat closed, deep breaths can collapse the windpipe, blocking the ability of air to pass. When the airflow is blocked, the blood oxygen level falls, which causes the brain to tell the person to wake to breath. This interrupts rapid eye movement (REM) during sleep, which seniors already have less of as they age. REM is crucial to every person because it makes up for 15 to 25 percent of sleep and is responsible for creating dreams and the internal Circadian rhythm (a biological process which occurs naturally on a daily basis that tells the body when to sleep). More importantly, REM also assists in the regulation of blood pressure, heartbeat, and respiration.

Demographics

Though OSA affects people of all ages, it is the most common type of sleep apnea in senior patients. Studies show that 24% of seniors living independently have OSA. And between 33–42% of seniors living in an institution or facility are affected by the condition. However, it is widely believed that the percentage of seniors with OSA who live independently is potentially higher than these statistics. This is due to the fact that most people with OSA do not realize they have the condition while they are sleeping and, therefore, the condition is underreported.

Causes and symptoms

Men are more likely than women to have sleep apnea. This may be due in part to low testosterone or hypogonadism in men as they age. However, for all seniors, obesity or an obstruction of the nose or mouth may cause sleep apnea.

Sleep apnea is a serious condition that, if left untreated, may result in a host of other conditions or diseases. If daytime drowsiness impairs the senior's ability to drive or function mentally, it may also lead to accidental falls, death or worsening of mental disease, such as increased disorientation in dementia patients.

Snoring or daytime sleepiness alone cannot be used to define sleep apnea in seniors because these are prevalent for much of the population. A senior must also exhibit the following trademark symptoms during sleep on a frequent basis: Severe snoring, then interrupted breathing lasting 5–30 seconds or longer, followed by a gasp for air, choking, or some other indication that the senior is trying to open their airway to breathe again.

More controversial reasons to test for sleep apnea are unexplained hypertension , a large neck circumference, obesity, or right ventricular failure.

The diagnostic tool that is used by a doctor to determine whether a senior has sleep apnea is a polysomnogram, which is costly and not always available. It tests the number of episodes of apnea per night and how long each one lasts. This determines what classification of apnea the senior may fall in: mild, moderate, or severe.

If the polysomnogram is not covered by insurance or unavailable, an ambulatory polysomnogram is another option. It costs less, is used at home, and may be more feasible for insurance companies to cover.

Because diagnosis may be costly and insurance may not always cover diagnostic tools without just cause, a second-hand witness to the condition can be crucial. Bed partners and housemates are the ideal reporters for sleep apnea. They are able to view the senior exhibiting the symptoms and are able to offer a full description of the symptoms to medical professionals.

Diagnosis

A proper diagnosis is critical because the consequences of untreated sleep apnea can be dangerous. Seniors with severe, untreated sleep apnea are two to three times more likely to cause or participate in an automobile accident because of their sleep deprivation. They also run the risk of developing pulmonary hyperthyroidism, high blood pressure, heart attack, or stroke. Severe, untreated sleep apnea can also lead to death.

Treatment

Although sleep apnea is a treatable condition, there are only a handful of treatments available. The most common treatment for a moderate to severe case

QUESTIONS TO ASK YOUR DOCTOR

• Do you think I have a sleep disorder? If so, what type?
• If so, do you recommend any sleep studies?
• Do you think I should take a polysomnogram? If so, will you speak to my insurance company about coverage and options?
• Do you think I could have a psychological or physical factor that is causing or contributing to my problem?
• I (choose one or more, if applicable) use sedatives, drink alcohol, drink caffeine. Do you think that could contribute to my problem?
• Do you think my weight could be a contributor?
• What treatment is right for me? Will it have any side affects?

of sleep apnea requires a senior to wear a Continuous Positive Airway Pressure (CPAP) nasal mask while sleeping. Since the pause in breathing during an episode of sleep apnea deprives the senior of oxygen, the CPAP nasal mask ensures a steady stream of oxygen flows throughout the night.

If obesity is a factor in a senior, weight loss is always recommended. Slimming down the body will slim a thick neck, which is important since this will reduce weight and pressure surrounding the airway.

If alcohol, caffeine , or sedatives are sedatives are being used or abused, doctors usually recommend ceasing their use or only using them earlier in the day. All three substances affect REM sleep and alcohol and sedatives can affect respiration during sleep.

One of the most common remedies for some snorers is to refrain from sleeping on their back. The same is true for seniors who have mild sleep apnea.

Most people must sleep an average of eight hours per night. Seniors are no exception. However, with the naturally occurring decrease in REM sleep as people age, a senior's sleep is already interrupted. And sleep apnea may compound the problem. To increase the amount of REM sleep in seniors, researchers assert that exercise and exposure to bright light regulates the Circadian rhythm of the body, which may improve sleep at night. Also, since daytime drowsiness or sleepiness is common, refraining from napping may improve the odds of nighttime sleepiness during bedtime hours.

KEY TERMS

Circadian rhythm —A biological process that occurs naturally on a daily basis that signals the body when to sleep.

CPAP (Continuous Positive Airway Pressure) —The most common treatment for a moderate to severe case of sleep apnea requires a senior to wear a CPAP nasal mask while sleeping.

OSA (Obstructed Sleep Apnea) —One type of sleep apnea that may be caused by obesity or an obstruction in the mouth or nose that blocks the airway.

Sleep apnea —The temporary interruption of breathing during sleep, usually lasting less than 30 seconds at a time.

Nutrition/Dietetic concerns

Avoid caffeine, alcohol, and sedatives because they interrupt crucial REM sleep and may cause daytime drowsiness.

Therapy

The most common treatment for a moderate to severe case of sleep apnea requires a senior to wear a Continuous Positive Airway Pressure (CPAP) nasal mask while they sleep.

Prevention

A sleep study or evaluation of sleep patterns in seniors—especially those living alone—can be crucial since seniors will have no recollection of their episodes of apnea upon waking. Some studies show keeping weight at a normal level may prevent the worsening of sleep apnea.

Resources

PERIODICALS

Brunk, Doug. “Serum testosterone could be marker for OSA.” Clinical Psychiatry News 13(1) (January 2005):48–58.

Heart Advisor. “Why pauses in breathing during sleep should be a wake-up call.” Gale. Thomson Gale Trial Site. 2007 (Oct 2006): 2(1).

Wexler, Barbara, ed. “Weight in America: Obesity, Eating Disorders, and Other Health Risks.” Gale Virtual Reference Library. Gale. Thomson Gale Trial Site. 2007 ed. (2006): 23–50.

OTHER

American Heart Association. “Severe Sleep Apnea and Risk of Ischemic Stroke in the Elderly.” 2006. http://www.americanheart.org/presenter.jhtml?identifier=3041799.

American Lung Association. “Sleep Apnea (Sleep-Disordered Breathing).” June 2005. http://www.lungusa.org/site/apps/s/content.asp?c=dvLUK9O0E&b=34706&ct=67313.

Beers, Mark H., MD. “Sleep apnea.” The Merck Manual of Geriatrics Online, 3rd ed. 2000. http://www.merck.com/mkgr/mmg/sec6/ch47/ch47f.jsp.

National Institute of Neurological Disorders and Stroke. “NINDS Sleep Apnea Information Page.” Nursing Magazine Online June 22, 2007. http://www.ninds.nih.gov/disorders/sleep_apnea/sleep_apnea.htm.

Neurbauer, David N., M.D. “Sleep Problems in the Elderly.” American Academy of Family Physicians 1999. http://www.aafp.org/afp/990501ap/2551.html.

Sleep Disorders Channel. “Obstructive Sleep Apnea.” 2008. http://www.sleepdisorderchannel.com/osa/index.shtml.

ORGANIZATIONS

American Sleep Disorders Association, 1424 K St NW, Washington, DC, 20005-2410, 202-293-3650, http://www.sleepapnea.org/.

National Sleep Foundation, 1522 K Street, NW, Suite 500, Washington, DC, 20005, 202-347-3471, http://www.Sleepfoundation.org.

American Heart Association, 7272 Greenville Avenue, Dallas, TX, 75231, 1-800-242-8721, http://www.americanheart.org.

American Stroke Association, 7272 Greenville Avenue, Dallas, TX, 75231, 1-800-478-7653, www.strokeassociation.org/.

National Institute of Neurological Disorders and Stroke (NINDS), P.O. Box 5801, Bethesda, MD, 20824, 1-800-352-9424, ninds.nih.gov.

Lauren L. Stinson