ASF-2011-01

www.AdkSports.com JANUARY 2011 13
THE NON-MEDICATED LIFE
Treating
Sleep
Apnea
by Paul E. Lemanski, MD, MS, FACP
edicines are a mainstay of American
Mlife and the healthcare system not
only because they are perceived to work
by the individual taking them, but also
because their benefit may be shown by
the objective assessment of scientific
study. Clinical research trials have shown
that some of the medicines of Western science
may reduce the risk of heart attacks,
strokes and cardiovascular death.
In the first 39 installments of The Non-
Medicated Life, informed diet and lifestyle
have been shown to accomplish naturally
for the majority of individuals, many, if
not most of the benefits of medications.
Interestingly this also extends to the benefits
of medical devices and surgery in the
case of sleep apnea.
Obstructive sleep apnea (OSA) is a
condition in which an individual stops
breathing for short periods during sleep.
The bed partner of the individual is usually
the first to recognize something is
awry. The abnormal breathing pattern
is made obvious because most individuals
with sleep apnea snore, sometimes
loudly. Periodically this rhythmic snoring
is interrupted by a prolonged period
of no breathing and hence silence. It is
during this silence that serious damage
is done leading to high blood pressure,
heart arrhythmias, heart failure, and a
predisposition to daytime sleepiness that
may cause serious injury if an individual
falls asleep while driving or operating
machinery.
This is the 40th in a series on optimal
diet and lifestyle to help prevent
and treat heart disease. Any planned
change in diet, exercise or treatment
should be discussed with and
approved by your personal physician
before implementation. The help of a
registered dietitian in the implementation
of dietary changes is strongly
recommended.
The mechanism of obstructive sleep
apnea seems fairly straightforward. As an
individual falls asleep the muscles in the
neck and throat relax. In normal individuals
without this condition, there is sufficient
resiliency of throat tissues to resist
the loss of muscle tone, which partially
holds structures in position as we assume
a supine posture.
But in individuals predisposed to OSA,
such relaxation may actually cause the
airway to collapse. The first signs of collapse
is snoring which is actually an initial
partial collapse resulting in the typical
staccato sound as air under the increased
pressure of inspiration forces its way past
obstructing structures including tonsils,
adenoids and soft palate. As one enters
the deeper stages of sleep the muscular
relaxation becomes more pronounced
thereby increasing the obstruction.
Ultimately, there is complete collapse and
a period of apnea or no breathing.
During the period of apnea, oxygen
levels in the blood drop and carbon dioxide
levels rise. Low oxygen levels can cause
blood vessels in the lungs to constrict and
make it harder for the right heart to pump
blood through the lungs to the left side of
the heart. Over time such a condition can
cause the right side of the heart to fail.
Low oxygen levels can also cause the heart
muscle cells to become irritable and such
irritability may predispose to abnormal
rhythms of the heart some of which may
be life threatening. These same conditions
may result in high
blood pressure which
may increase the risk of
heart attack and stroke.
The period of apnea
will last until the need
for oxygen takes precedence
over the need to spend time in the
deeper stages of sleep. Survival programs
will activate and the individual will arouse
from sleep, muscle tone in throat structures
will increase, and the individual will
take a breath or a gasp ending the period
of apnea. This process may be repeated
many times during a night with the total
time spent in the deeper stages of sleep
severely reduced thereby ensuring another
hallmark of OSA, excess sleepiness during
waking hours.
Individuals who have snoring, excess
daytime sleepiness, and witnessed apneas
during sleep should discuss with their
physician possible screening for obstructive
sleep apnea. Screening may be
achieved with a sleep study or polysomnogram
completed at a sleep lab. Those
with diagnosed sleep apnea may consult
further with an Otolaryngologist (ENT) or
Pulmonologist.
Treatment for obstructive sleep apnea
may involve a device, surgery, or behavior/lifestyle
changes. Devices include an
oral appliance which repositions the jaw
to improve air flow and C-PAP device consisting
of mask and air compressor that is
used to force air under pressure into the
upper airway to counteract the tendency
for collapse. Surgery may involve removal
of the tonsils and adenoids and a removal
of portions of the soft palate to make the
opening for air flow bigger and less prone
to collapse. The oral appliance is used
generally for those with less severe OSA.
C-PAP is effective in those who tolerate
the device, unfortunately many patients
have problems adjusting to the mask or
increased air flow. Surgery is reserved for
severe OSA or for those not amenable to
the less invasive approaches.
For individuals with obstructive sleep
apnea who are overweight or obese,
behavior and lifestyle changes that promote
weight loss may cure OSA simply
with the shedding of pounds. While not
easy, weight loss is much less expensive
than the other approaches, may work as
well or better than other approaches, and
carries with it the additional benefits of
improvements in blood pressure, cholesterol
and blood sugar. All diets which
reduce caloric intake and total calories
should work equally well. A daily modest
exercise such as walking may help as well
by burning calories.
In summary, obstructive sleep apnea is
a serious medical problem characterized
by excessive snoring, witnessed periods of
apnea, and excessive daytime sleepiness.
OSA increases the risk of heart failure, high
blood pressure, irregular, and possibly life
threatening heart rhythms, as well as heart
attacks and strokes. Treatment for OSA
exists in the form of dental devices, C-PAP
and surgery. At the same time informed diet
and lifestyle resulting in weight loss in those
who are overweight or obese may correct this
condition and avoid these more invasive and
expensive approaches to address this correctable,
albeit serious medical problem.
Paul E. Lemanski, MD, MS, FACP (paul.
lemanski@primecarepc.com) is a board
certified internist with a master’s degree in
human nutrition. He is director of the Center
for Preventive Medicine, Albany Associates in
Cardiology, Prime Care Physicians, P.C. Paul
is an assistant clinical professor of medicine
at Albany Medical College and a fellow of
the American College of Physicians.
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THE CENTER FOR PREVENTIVE MEDICINE
Paul Lemanski, MD, FACP • Laurie Burton-Grego, MS, RD • Amy Milstein, MS, RD, CDE
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• CARDIOFIT weight reduction program
• Mediterranean Cooking Classes
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More info: CenterforPreventiveMedicine.com and NorthCountryAcupuncture.com
The Center for Preventive Medicine • Prime Care Physicians, PLLC
400 Patroon Creek Blvd, Suite 100, Albany • 518-618-1100
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