NOCTURNAL APNEA

Dr. Marco Baroni – Pneumologist – Columbus Clinic Center

For some time now, the pages of the most important newspapers and the most fashionable magazines have been discussing sleep apnea, OSAS and hypersomnia. Frequently visited blogs and medical and health websites also describe the problems that people who suffer attacks of sleepiness have with obtaining a driving licence…

But what are these strange conditions?

One thing must be stated immediately: they are not diseases or, better, they are not pathological conditions that should be treated with drugs or healthcare procedures. Rather, they are very important and totally neglected direct or indirect risk factors.

Everything starts from the observation, which is blatantly obvious, but not for this reason less important, that sleep constitutes a third of the life of every human being, even that of inveterate night owls.

These conditions are essentially interruptions of normal breathing (apnea means not breathing, like when you are underwater) lasting from a few seconds up to 30/40 seconds, which are completely unintentional (they happen during sleep, so normally during the night). These interruptions can be sporadic or very numerous, occur in sequence, with even 50/60 per hour, and are always followed by semi-waking (arousal) and sometimes by noisy inspiration and disordered movements that can frighten those who observe them or are woken up by them (bedmate or children ).

They are mainly due to obstruction of the upper airways (pharynx, larynx) caused, especially when the person is lying on his or her back, by the tongue falling onto the base of the throat: the people most commonly affected are overweight or obese subjects and those with particular conformations of the neck or jaw, but the problem can affect anyone, even children: snoring is the typical sign that leads the affected person to a doctor, albeit often at the insistence of the family, disturbed by this noisy habit!

It is understandable that, over the years, this problem causes imbalances in the complicated mechanisms of regulation of the heartbeat, blood pressure and other complex metabolic processes. But the most disturbing and immediate consequence is the loss of the benefits of sleep on our daily lives and on those who live with us.

Difficulties with waking up, poor concentration and irritability are the most frequent signs but are almost always underestimated. However, there are much more important signs of poor sleep quality: the most significant is certainly daytime hypersomnia, which, particularly for those who perform dangerous activities or who drive many hours during the day is a serious threat to themselves and others. For this reason, since the beginning of this year it has become mandatory for people who suffer from this disorder to report it when requesting renewal of their driving license.

There are, however, many other pathological conditions for which poor quality of sleep due to sleep apnea (OSAS) is one of the main causes, such as arterial hypertension, especially in younger people resistant to treatment, and obesity that is not resolved with diets.

In children, the signs that should lead to investigation are: lack of growth, hyperactivity, an inexplicably poor performance at school and, of course, snoring.

What should you do if you think you have this problem? First of all, talk to your doctor, who will order polysomnography, if necessary. This is an investigation that can be carried out at home and records all the events that happen to your body during sleep (even changes in position).

In the case of a positive examination, you should contact a center specialized in the field of sleep disorders in order to acquire detailed information on your condition and have the possibility of evaluating, together with a specialist doctor, the treatment best suited to your individual case, which could range from “simple” weight loss to the use of equipment called CPAP that completely eliminates the problem by blowing air into the airways in a very simple way or even surgery to the palate.

The important thing is to contact a reliable, experienced center that is able, within a short time,  to accompany you through the entire diagnostic/therapeutic process without interruption and, contemporaneously, ensure that both the equipment and the clinical problem, whether this is  pneumological, cardiological, metabolic or ENT, are monitored over time.