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What's stealing your good night's rest?   By THEA RUTHERFORD ~ Guardian National Correspondent ~ thea@nasguard.com At the very least, it can rob of you a good night's sleep. At it's worst, it can be life threatening and require surgical treatment. Shaking its sufferers out of sleep as they struggle to breathe through obstructed airways, sleep apnea is the thief in the night that can have an equally disruptive effect on your day. At night you snore excessively while struggling to attain a deep sleep. The next day you're irritable and you're extremely drowsy. Even worse, you're at risk for a number of other complications including heart attack, stroke, uncontrolled high blood pressure and sexual dysfunction. "Sleep Apnea is a respiratory condition," explains Dr. Edwin Demeritte of the Bahamas Neurological Center on Dean's Lane. "Whenever somebody is sleeping, the airway closes off. 'Apnea' is pauses in breathing." These pauses in breathing while sleeping last for 10 seconds and occur multiple times within each hour of sleep. "What normally happens is that you may have somebody who may present initially with snoring," he says. "As the airway gets more narrow, it collapses because the body tone is floppy when you're sleeping . . . What happens is although you're still trying to breathe, no air is flowing through the area. Carbon dioxide builds up; no oxygen is coming in. When the carbon dioxide builds up to a high enough level in the brain it tells the brain . . . you have to wake up." This, says Demeritte, "can be happening five, 10, 15, 20, 30 times each hour of sleep. By the time you wake up in the morning, although you may theoretically have been asleep for adequate time, you never feel rested." The word "apnea," is a Greek one which means "without breath," according to the American Sleep Apnea Association (ASAA). Symptoms for a condition so common that the ASAA offers nationwide support groups in the U.S. include excessive snoring, cessation of breathing, choking while asleep, excessive daytime sleepiness and poor judgment. The three types of sleep apnea are obstructive, central and mixed. According to the ASAA, obstructive sleep apnea is the most common. Demeritte says that studies have shown that the common disorder occurs in four percent of men, two percent of women and one percent of children. "We talk about increased risk in men whose neck sizes are 17 [inches] and women whose neck sizes are 16," says Demeritte. "If you have a very short chin and jaw, and the throat is very crowded, it can cause blockage. In children, large tonsils can be a source." The neurologist says that the disorder is more common in adults and patients who have had strokes or heart attacks. Child sufferers may experience decreased academic performance and cognitive decline, as well as behavioral problems, says Demeritte. The Sleep Test While sleep apnea may seem anywhere from daunting to a nuisance, depending on where a sufferer falls in the range, treatment is available. When doctors suspect that their patients may have the disorder, they recommend the patient to a sleep clinic to undergo a sleep test. At the Bahamas Neurological Center, Renaldo Clarke, the registered polysomnography technologist (RPSGT), administers the test that Demeritte then interprets. "The doctor has to first and foremost say if this person needs a sleep study or not," says Clarke. "I cannot perform the study unless you get a referral from the doctor." When the patient comes in, "we try to figure out what questions you have to answer for the doctor. After that you go into the testing," he says. In what is called a "split night study," the patient comes in and goes to sleep in a room at the clinic. The RPSGT monitors the patient from another room as she sleeps and measures her airflow, brain wave activity, limb movement, respiratory activity, pulse among other things. "The first part of the night we look to prove that [a patient] does have sleep apnea. In the second part of the night on the same study we then try to treat it," says Demeritte. The apnea is typically treated by the use of a CPAP (Continuous Positive Airway Pressure) machine that pushes room air into the patient's airways through a small mask while he sleeps. "Once you've proven that they do have it, then you use the machine to treat it and find out what is the best pressure setting that they need," says Demeritte. After diagnosis, patients return to their family doctor where the best course of treatment is prescribed, he says. Some patients are treated by CPAP therapy through continuous use of the machine. In cases where weight is a factor, diet and exercise can be a form of treatment. "If you look at the underlying factors that got them to that point — if you can eliminate the underlying factors, then you can cure them and get them completely off treatment," says Demeritte. Obstructive sleep apnea symptoms Excessive snoring Cessation of breathing Choking when asleep Excessive daytime sleepiness Poor judgment Things sleep apnea sufferers are at risk for: Heart attack Stroke Uncontrolled high blood pressure Diabetes Rapid weight gain Sexual dysfunction Fatigue during the day Source: Bahamas Neurological Center