Is Sleep Apnea Compromising Your Health and Job Performance?

In the March 2011 issue of EMS World Magazine, Associate Editor John Erich took an in-depth look at sleep deprivation and what the lack of sleep means to EMS. He pointed out that not getting enough sleep can result in a laundry list of negative consequences, including inattention, confusion, memory lapses, depression, headaches, irritability and increases in blood pressure and stress. It can also impair cognitive function, slow response time and decision making, and has been associated with a wide range of illness and disease.

In the world of EMS, on-the-job fatigue can have dire consequences given the nature of the job. While an unscientific study conducted by EMSWorld.com noted that 50% of respondents were not aware of any mistakes they'd made because of fatigue, 4% responded they have regularly made errors due to tiredness.

Sleep Apnea Defined

But sometimes getting enough sleep to ensure top performance isn't simply a matter of making sure you go to bed early enough to get the recommended number of hours of sleep. For people who suffer from sleep apnea, it's more a concern of sleep quality versus quantity.

Sleep apnea is defined as a temporary suspension of breathing that occurs repeatedly while you sleep. Muscles inside the throat relax and gravity causes the tongue to fall back and fully block the airway. A partial blockage, of about 80-90%, that shrinks the airway causes snoring.

"The tongue is a muscle," notes Bryan Keropian, D.D.S., a dentist who founded the Center for Snoring and CPAP Intolerance in Tarzana, CA, a state-of-the-art facility that focuses on sleep dentistry. "We start to lose muscle tone at about 35 to 40 years of age, including muscle tone in our tongue. When that happens, it can fall back and block the airway which causes the apnea."

There are three types of apnea: obstructive (the most common), central and mixed. While it can occur in men and women of any age, it is most common in middle-aged men who are obese. "But it can affect anyone of any age," he stresses. "Everyone is susceptible."

It is also common among those who snore. In studies conducted by the Center for Snoring and CPAP Intolerance, Dr. Keropian found that 90% of snorers also have sleep apnea.

The Importance of Oxygen

For the worst suffers, apnea episodes can occur several hundred times per night for 10 seconds or more. "That's why this [problem] is so dangerous," he notes. "Every cell in our body needs food, oxygen and water. If the body is depleted of oxygen several times every hour, every night, the cells will degrade and they can't regenerate."

According to the National Sleep Foundation, low blood oxygen levels--coupled with fragmented sleep--can lead to hypertension, heart disease and mood/memory problems. It can also increase the risk of vehicle crashes, which can be a concern for EMS medics given the fact they operate big vehicles at high speeds and under immense pressure.

While sleep apnea can be a hindrance for healthy people, it can be especially detrimental to those with other ailments, such as those with kidney problems, cancer, AIDS, etc. "If the body isn't getting air for 30, 50, 70 even 90 times an hour every night, the cells have a rough time regenerating to improve patient health," he continues. "The entire body is greatly compromised."

Treatment Options

The National Sleep Foundation estimates that more than 18 million American adults suffer from sleep apnea. Many more are undiagnosed. How do you know if you're in the latter group?

While certain symptoms--including sleeplessness, difficulty concentrating, depression, irritability, sexual dysfunction, learning and memory difficulties, and falling asleep while at work, on the phone, or driving--can be cause for concern, consulting with your doctor and conducting a sleep study is the only way to accurately diagnose sleep apnea. The sleep test will monitor a variety of functions including sleep state, eye movement, muscle activity, hear rate, respiratory effort airflow and blood oxygen levels to determine the level of severity.

The most common and most effective treatment for sleep apnea is a continuous positive airway pressure (CPAP) device. It fits over your nose and/or mouth, and gently blows high-pressure air into the airway to help keep it open while you sleep. It is recommended for the most severe cases. Although highly effective, Dr. Keropian notes CPAP devices are also highly rejected. "Many people just don't like them," he says.

Other non-surgical options for mild to moderate sleep apnea include dental appliances, such as mandibular advancing devices which reposition the lower jaw and tongue, and those like the Full Breath Solution, which effectively curtails sleep apnea through tongue depression.

The Full Breath Solution device features a tail that lightly depresses the tongue and prevents it from moving backward and blocking the airway. The custom-fit FDA-approved device uses 3D dental imaging techniques to ensure comfortable and effective placement.

"This device keeps a person's jaw in the normal position," he says, noting it eliminates some of the side effects of mandibular advancing devices, such as jaw pain. "Compliance for the Full Breath mouthpiece is high. It's much like wearing a retainer. And its effectiveness is high, too, reducing airway blockage by 74-81%.

"I believe sleep apnea is one of the most, if not the most, dangerous diseases on the planet," he continues. "When I hear of people dying in the night, my first thought is that it may be related to sleep apnea and the lack of oxygen causing the body and organs to be stressed. It's important to educate the public, to educate the medical community about sleep apnea and its treatments. I believe we can change the health of this country if everyone got tested for sleep apnea and those who suffer from it got treatment."

For more information about sleep apnea, visit these online resources:

• www.cpapalternative.com
• www.sleepfoundation.org/article/sleep-topics/sleep-apnea-and-sleep
• www.sleepapnea.org
• www.nlm.nih.gov/medlineplus/sleepapnea.html

For more information about the Full Breath Solution, visit www.fullbreathcenter.com.