"I KEEP FALLING ASLEEP DURING
THE DAY"
by
"Louito C. Edje, MD
Frank S. is a 45 year old man who had been gaining
weight steadily over the past three years. He had put on over twenty-five
pounds and was starting to feel short of breath climbing one flight of
stairs. When he would speak on the phone friends frequently asked him if
they had interrupted him doing something strenuous mainly because of the
huffing and puffing he would do when he picked up the phone. He was
falling asleep during the day while driving longer than twenty minutes.
He came to my office because his boss was concerned
that he was falling asleep in meetings and this was affecting his
productivity. His wife also mentioned that he snores and “stops
breathing” for periods of time while sleeping.
I examined his mouth and throat and measured his
neck. He still had his tonsils and adenoids and his neck collar size was
more than 17 inches.
I discussed the need to consider a sleep study which
is a test that helps determine if a patient has sleep disorders. He agreed
to the sleep study which is done at a sleep center. He stayed at the
center for approximately eight hours overnight where his sleep was
monitored. The sleep study gave me information on his oxygen levels, the
number of times he stopped breathing and how long the pauses were, amongst
other results it also gave information on his heart-rate during sleep and
the depth of his sleep.
He was diagnosed with moderate Obstructive Sleep
Apnea (OSA.) This is a condition which very commonly occurs in patients
who are overweight or who have gained weight rapidly and have some of the
symptoms that Frank had. Not everyone who snores has OSA however; most
individuals with sleep apnea have had a history of snoring. The is also
an increased likelihood of this condition in men whose collar size is more
than 17 inches and in women whose neck circumference is more than 15
inches. In OSA, the upper airway becomes obstructed as the soft tissues
relax during sleep. The body registers that it is not receiving enough
air and starts to wake the patient up from deep sleep into shallow sleep
and sometimes to full wakefulness. The airway patency is restored as the
patient wakes up and airflow resumes. The patient then returns to sleep
and the cycle repeats itself, sometimes up to four hundred times a night.
As you can imagine, the patient is frequently not rested in the morning.
This condition can also affect the lungs and right side of the heart.
Frank was prescribed a CPAP machine which consists of
a mask hooked up to a machine that provides a certain pressure to the
airway keeping it open. He wakes up rested and is doing very well at
work. There are other options for treatment including surgery that is
done by an otolaryngologist who removes some of the soft tissues from the
throat.
Louito C. Edje, MD
Academy of Medicine of Toledo and Lucas County
