Obstructive Sleep Apnea (OSA) is a condition in which the airway becomes obstructed during sleep by the collapse of the soft palate and tongue, leading to multiple near-waking arousals during the night through the ‘emergency’ effort of the diaphragm.  This sudden contraction of the diaphragm is triggered by the respiratory drive center in the brainstem, when it senses a drop in oxygen content in the blood.

What makes Obstructive Sleep Apnea so dangerous if not detected and treated is that, when a person goes for long periods without taking a breath while asleep, the oxygen saturation of the blood’s hemoglobin decreases and, for some reason, the coagulability of the blood increases.  This increases the chances of having a blood clot in the veins of the brain or other parts of the body, leading to stroke, heart attack, or other adverse cardiac events.

High blood pressure (hypertension) has been called, “the silent killer.”  This is because the arteries of the body do not have pain sensors in their walls, so a person often cannot perceive that he or she has high blood pressure.  Because it is not perceived by the patient, it therefore often goes undetected and untreated, leading to heart attacks or strokes.

In an analogous way, Obstructive Sleep Apnea can be described as “the silent killer II,” because, when a patient has nocturnal apneic (stopped breathing) episodes, the patient does not come to a full waking state.  Therefore the patient usually does not recall the apneic episodes and will not be aware that he or she has the disorder, increasing the chance that it will not be detected and treated.  Often it takes an observant spouse or family member to bring it to the attention of the patient.

Obstructive Sleep Apnea (OSA) is usually caused by a combination of genetic and environmental factors, and involves the collapse of the upper airway by the tongue, soft palate, and other structures.  Environmental factors include:  a) faulty orthodontics, done at too early an age, which may push back the maxillary (upper tooth) ridge, which may push the mandible (lower jaw) to far posteriorly,  allowing the tongue the collapse when the patient is lying on his or her back;  b) gaining weight through life; c) advancing age, which reduces the elasticity of soft tissue, and c) smoking.

If you feel unrested upon awakening, snore loudly, have gained weight over the years, smoke tobacco, or have been told by family members that you hold your breath up up to a minute while sleeping before taking your next breath, then talk with Dr. Firnberg or your primary care provider (PCP).  You may also visit good websites for more information (www.sleepnet.com, and www.sleepapnea.org).

Obstructive Sleep Apnea carries both medical and psychiatric risks.   Medical risks include having ten times the risk of nocturnal sudden death, due to stroke, heart attack, and pulmonary embolism, compared to those without sleep apnea.  This is because, during apneic episodes, the oxygen saturation of the hemoglobin decreases and, for some reason, this increases the coagulability of the blood, leading to blood clots anywhere in the body.

Psychiatric risks include depressive disorders and anxiety disorders, even bipolar or psychotic disorders.  Some patients’ psychiatric symptoms can completely disappear when their OSA is correctly treated.  Thus, OSA is can be a rapidly treatable cause of psychiatric disorders.

Talk with Dr. Firnberg about whether obstructive sleep apnea should be investigated as a possible cause of your psychiatric symptoms.