Waking Up to the Importance of Sleep

The many idioms about sleep that we incorporate in our daily conversations; phrases such as “beauty sleep” or “let me sleep on it” are an indication of the value we place on a “good night’s sleep.” Research supports this view with consensus that adults need seven to nine hours of sleep each night to maintain good health and to function their best. For a variety of reasons, however, many Americans aren’t getting the sleep they need, and it’s having an impact. One cause contributing to fitful nights is sleep apnea.

There are three primary types of sleep apnea. The most common, Obstructive Sleep Apnea (OSA), occurs when the tongue collapses against the soft palate, which then collapses against the back of the throat. The airway becomes blocked, which generally causes the sleeper to awaken briefly. The symptoms of central sleep apnea are similar, but the airway is not blocked. Instead, the body’s signal to inhale is not transmitted to the brain. Complex sleep apnea combines attributes of both conditions — that is, the airway becomes blocked, but the brain fails to signal the body to breathe.

Although OSA can affect anyone, it is most common in men over the age of 40 and post-menopausal women, particularly those who with overweight or obesity. So while roughly 25 percent of adults experience sleep apnea, that number climbs to 45 percent among adults with obesity. Further, the American Sleep Apnea Association posits that 80 percent of moderate and severe obstructive sleep apnea remains undiagnosed, suggesting an even higher number.  Diabetes, hypertension and hypercholesterolemia — all of which are linked to obesity — also contribute to sleep apnea.

Outcomes are similar regardless of the type of sleep apnea. Sleep is fragmented throughout the night, especially during Rapid Eye Movement (REM) sleep, which results in poor sleep quality. This often leads to grogginess during the day, which can impact the ability to work or drive, and also can increase anxiety, depression, mood problems and insomnia.  A brutal cycle is created because obesity contributes to sleep apnea, while at the same time inadequate sleep predisposes people to gain weight. A weight gain of 10 percent can increase the risk of disease progression by six times for people who suffer from mild OSA.

Fortunately there are options, with Continuous Positive Airway Pressure (CPAP) as the most conventional treatment for OSA. However, because obesity and limited physical activity are associated with OSA, exercise and weight loss are key treatment areas. Losing 10 percent of body weight correlates to a 20 percent improvement in the severity of OSA.  In severe cases, bariatric surgery may be recommended to address both issues.

OSA is increasing in direct relation to the continued rise of obesity and, as such, early diagnosis and education are critical to overcoming not only obesity and sleep apnea, but also the metabolic syndrome with which they are associated. With focus and attention, we might all be lucky enough to “sleep like babies!”