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Sleep Apnoea

Posted Feb 10 2010 7:22am

Sleep related problem is very common among people with ME/CFS. According to Phoenix Rising, 20% of us may not be suffering from ME/CFS, but suffering from identifiable and treatable sleep disorder.

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Sleep Apnoea is the condition of breathing problem while sleeping. Breathing problems can be seen as;

  • a person stops breathing completely,
  • take less than 25% of breath for more than 10 seconds, or
  • at least 4% drop in oxygen in the blood.

There are three types of sleep apnoea; Obstructive Sleep Apnoea (OSA), Central Sleep Apnoea (CSA), and Mixed Sleep Apnoea. Mixed Sleep Apnoea is a combination of OSA and CSA.

Less severe version of apnoea is called hypopnoea. It is the condition that the person breathes between 69% and 26% of a normal breath. It may still have more than 4% drop in oxygen in the blood.

Sleep apnoea is formally defined as an apnoea-hypopnoea index of at least 15 episodes/hour if they do not have medical problems that are believed to be caused by the sleep apnoea. 15 episodes/hour is equivalent of having apnoea and/or hypopnoea episode every 4 minutes.

Apnoea disturbs sleep due to inadequate breathing and poor oxygen levels in the blood. The person may wake up completely, or come out of a deep level of sleep and into a more shallow level of sleep. Obviously, quality of sleep is not achieved, therefore the person suffers from problems of sleep deprivation.

When sleep apnoea is not treated, it increases risks of complication with medication and surgery, hard-to-control blood pressure problem, low blood oxygen (hypoxia or hypoxemia), abnormal heart rhythms such as atrial fibrillation, congestive heart failure, stroke, and sudden death.

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OSA is the most common sleep disorder.

With OSA, throat muscles or back of tongue get relaxed while sleeping and blocks/obstructs airway. Brain is alarmed when oxygen level in blood decreases, and it sends signal to wake the body to breaths.  (Video from Mayo Clinic: What happens during obstructive sleep apnea?)

  • Excessive daytime sleepiness (hypersomnia)
  • Loud snoring (The most noticeable sign of obstructive sleep apnoea. However, not everyone who has obstructive sleep apnoea snores.)
  • Observed episodes of breathing cessation during sleep
  • Abrupt awakenings accompanied by shortness of breath
  • Awakening with a dry mouth or sore throat
  • Morning headache
  • Frequent urination at night
  • Difficulty staying asleep (insomnia)
  • Cognitive problem such as poor memory and attention
  • Mood swing & irritability
  • Depression

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Although CSA is a rare form of sleep apnoea (< 5% of sleep apnoea), I feel it is worth mentioning. In my humble opinion, some conditions that may cause CSA share similarity with ME/CFS.

CSA in adults usually caused by other medical problems. In infants, it usually caused by prematurity or other congenital disorders.

With CSA, the cause of apnoea is not obstruction of air way, but the problems with the lower brainstem that controls breathing. It can also occur while sleeping at a high altitude.

  • Neurological diseases, such as Parkinson’s disease, Alzheimer’s disease, and amyotrophic lateral sclerosis (Lou Gehrig’s disease)
  • Damage to the brainstem caused by encephalitis, stroke, injury, or other factors
  • Complications of cervical spine surgery
  • Radiation to the cervical spine area
  • Damage to the cervical spine or base of the skull caused by severe arthritis, other types of degenerative bone disorders, or some other type of injury
  • Primary hyperventilation syndrome
  • Congestive heart failure
  • Bulbar poliomyelitis
  • Severe obesity
  • Use of certain medications such as narcotic-containing painkillers
  • Observed episodes of stopped breathing or abnormal breathing patterns during sleep
  • Abrupt awakenings accompanied by shortness of breath
  • Shortness of breath that’s relieved by sitting up
  • Difficulty staying asleep (insomnia)
  • Excessive daytime sleepiness (hypersomnia)
  • Cognitive problem such as difficulty concentrating and poor memory,
  • Snoring (Snoring may be heard in the presence of CSA. However, snoring may not be as prominent.)
  • Chronic fatigue
  • Morning headaches
  • Restless sleep
  • Frequent urination at night
  • Mood problems
  • Difficulty swallowing
  • Voice changes
  • Weakness or numbness throughout the body

Dr TL is suspecting I may be suffering from OSA and we are discussing about possible Sleep Study.

Snoring seems to be the strong sign of sleep apnoea. However, I am not sure if I snore. Nobody never complained about me snoring. (That is including some humans, not just my dogs.)

However, I am not completely denying the possibility because people I knew, who snored, didn’t know they were snoring very loudly. That could happen to me.

I have made momentary loud snort a couple of times while sleeping. But it woke me up straight away. Remembering how I felt with the snort and I don’t feel the same sensation, I don’t think I snore. It is not just defending my vanity.

I often experience nocturnal tight chest and dysponea. I also get air hunger while I’m lying and relaxing. I have woken up with the feeling of suffocation. It didn’t come as obstruction in air way, but it came as if my lungs are sealed. In my case, these could be because of Asthma or COPD.

I can identify more signs and symptoms in CSA than OSA. (Mind you, many of them are identical.) Dr TL pointed out red throat and dry mouth/throat for OSA. However, they could be relating to medications and ME/CFS symptoms…

Who knows? This is the reason why I need a good doctor. I am sure he will sort out this puzzle for me. Probably, I need to take the Sleep Study first.

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