Untreated Sleep Apnea: The Quiet Danger on the Road

By Dr. David O. Volpi

It is common knowledge that untreated sleep apnea can have dire health effects, but researchers in England found out that loss of sleep also increases a person’s risk of nodding asleep at the wheel, and getting in a car accident. That endangers not only the person suffering from the sleep disorder, but any person driving around them at any given time.

The study, which was organized by the European Respiratory Society and the European Sleep Research Society, and presented April 12, 2013 at the Sleep and Breathing Conference in Berlin, determined that people with untreated sleep apnea are more likely to fail a driving simulator test, and report nodding asleep while driving.

Let’s review: What is sleep apnea?

Sleep apnea is a breathing disorder that causes a person’s breathing during sleep to be paused and/or shallow. The pauses generally last 10 to 20 seconds, and in severe cases, can occur hundreds of times a night. With obstructive sleep apnea (OSA), the airway is blocked and/or collapses while sleeping. Air squeezing by the blockage can cause loud snoring and interrupted sleep.

As a result of the paused breathing and/or snoring, many sleep apnea sufferers are woken up throughout the night and spend more time in light sleep, rather than deep, restful REM (rapid eye movement) sleep. This chronic sleep deprivation results in daytime sleepiness, and can negatively affect job performance, mood, reflexes, concentration, and it can lead to hypertension, heart disease, and memory problems.

Testing and results of the study

To determine the effect of untreated sleep apnea on driving, the researchers conducted two separate studies. The first was a driving simulation test where 133 patients with untreated sleep apnea and 89 without sleep apnea were asked to “drive” 90 km—about 55 miles.

Various criteria was recorded, including the participants’ ability to complete the driving distance, their time spent in the middle lane, and any participation in an unprovoked crash or a “veer event” crash.

The results of the driving simulation test showed that:

• Patients with untreated sleep apnea were more likely to fail the driving simulation test—24 percent of the sleep apnea patients failed the test, compared to 12 percent of those without sleep apnea.
• In addition, many patients with untreated sleep apnea were unable to complete the test at all, had more unprovoked crashes, and were unable to follow the clear driving instructions given at the beginning of the simulation test.

In the second study, 118 people with untreated sleep apnea and 69 without sleep apnea completed a questionnaire about their driving behavior, and also took the 90 driving test on the simulator.
The results showed that:

• 35 percent of those with untreated sleep apnea admitted to nodding asleep while at the wheel, and 38 percent of this same group failed the driving simulation test.
• By comparison, only 11 percent of people without sleep apnea said they have nodded off while driving, and none of this group failed the simulator test.

Key differences in the reasons for failure

While some people in the control group (those without sleep apnea) also failed the driving simulator test, the researchers noted key differences in why they failed the test:

• 13 people with untreated sleep apnea did not finish the test because they fell asleep or veered completely off the road.
• 5 people with untreated sleep apnea failed because they spent more than 5 percent of the study outside the lane they had been instructed to stay in.

But in the control group, no one failed the simulation for either of these reasons. Again, no one in the “without sleep apnea” group failed the driving simulation due to falling asleep, veering completely off the road, or driving outside the lane.

Dan Smyth of Sleep Apnea Europe noted, "The dangers of untreated sleep apnea and driving are highlighted in both studies. These studies give weight to the need for provision of sufficient resources for early diagnosis and treatment.

While further investigation is needed to examine the reasons for failure of the simulator tests, I acknowledge the researchers for bringing light to this very dangerous side effect of untreated sleep apnea. of sleep apnea, where effective treatment ensures a return to acceptable risk levels for road users."

Are you at risk for sleep apnea?

So how do you know you may have obstructive sleep apnea? Some common symptoms include snoring, paused breathing during sleep and excessive sleepiness during the day. Increased blood pressure is another sign you may have sleep apnea.

While sleep apnea is more common in men, OSA increases in women after age 50. Being overweight may also increase a woman’s risk of having sleep apnea. Menopausal women are three and a half times more likely to get OSA, possible due to reduced amounts of progesterone.

If you experiencing one or more of the above sleep apnea symptoms on a regular basis, see a qualified sleep doctor to get diagnosed and treated properly. There are multiple options and minimally invasive techniques available today to treat your sleep disorder.

Sleep apnea causes systemic inflammation: CPAP can help

By Dr. David O. Volpi

If you, or someone you know, have been diagnosed with obstructive sleep apnea (OSA), you’re probably familiar with a treatment called CPAP, or Continuous Positive Airway Pressure.

While some people find the mask worn for CPAP treatment uncomfortable—more on that later—it has been proven to be a highly effective way to keep the airways open that become obstructed in sleep apnea patients, and reduce or prevent snoring and paused breathing.

There’s a new study that found that CPAP treatment also reduces the systemic inflammation caused by sleep apnea, usually in the bronchial and nasal passages.

Systemic inflammation is the chronic biological response, or inflammation, of blood vessel tissues due to dangerous or foreign elements, such as pathogens or damaged cells. It is increasingly being recognized that systemic inflammation is a risk factor for a number of health complications, including atherosclerosis, and is a well-established factor in the development of cardiovascular disease.

The new study published March 22 in the Journal of Inflammation found that treating OSA with a CPAP machine helps to lower systemic inflammation, which might prevent some of the other problems associated with OSA. The source of the research was the PubMed, Embase and Cochrane library.

Here’s a refresher on how CPAP machines help OSA patients: When you fall asleep, your muscles relax, and the soft palate at the back of the throat may sag. When this happens, the upper airway can become obstructed, causing the soft palate and uvula to vibrate, causing snoring.

When the airway is completely obstructed, breathing stops for a period of time, until the body is jerked awake in reaction. This is known as obstructive sleep apnea. OSA can cause interrupted breathing hundreds of times a night, usually around 20 seconds per pause. This paused breathing causes waking through the night, preventing deep, restorative sleep. This often leads to a host of problems, from daytime sleepiness and reduced job performance to hypertension, heart disease, mood, and memory problems.

A CPAP machine helps this condition by pumping a continuous flow of air into the nasal passages—via a mask worn at night—keeping the airway open—and preventing or greatly reducing snoring and paused breathing.

To find out if CPAP treatment reduces inflammatory symptoms or “markers” in OSA patients, the researchers pooled data from 24 trials involving more than 1,000 patients. The resulting data suggested that treating OSA with CPAP significantly reduces levels of two proteins associated with systemic inflammation: tumor necrosis factor and C-reactive protein (CRP).

While more study is needed, the researchers believe that reducing systemic inflammation in OSA patients with CPAP treatment may be one way to reverse some of the long-term health disorders associated with OSA.

If you or someone you know is considering Continuous Positive Airway Pressure (CPAP) treatment, you'll need a sleep study to diagnosis whether or not you have sleep apnea, and a sleep specialist will recommend the correct CPAP machine, or treatment, for you.

Dissecting the Pillar Procedure

The Pillar Procedure, a minimally
invasive, simple and safe
treatment for snoring.

Since its approval by the FDA a few years ago, the Pillar Procedure has been gaining in popularity as a remedy for snorers throughout the world. With widespread adoption by the medical community, many snoring sufferers are finally finding relief by turning to this procedure. Here are the facts.

Snoring is a complicated disorder, and there are many reasons why a person might snore. Causes such as a deviated septum, sinus disease and large tonsils are just a few reasons, and they are all physical conditions that need to be treated using specific methods. Another common cause of snoring is the fluttering of the soft palate while asleep, which can also occur with less severe forms of obstructive sleep apnea (OSA). If that is the cause of a snorer’s condition, then there is a good chance it can be treated by the Pillar Procedure.

Worldwide, so far more than 30,000 people have been treated with the Pillar Procedure. It is a minimally invasive, simple and safe treatment for snoring and mild to moderate OSA which can be performed in a visit to the doctor’s office.

The Pillar Procedure involves stiffening the soft palate and offering structural support, reducing the vibration of the tissue that is causing the snoring when the palatal tissue collapses and obstructs the upper airway. During the procedure, three small polyester implants are placed into the soft palate and over time, the implants, together with the body’s natural fibrotic response, provide support to the soft palate.

After the procedure, patients’ snoring is reduced or cured, providing relief to their daytime sleep deprivation symptoms. The Manhattan Snoring and Sleep Center is a leading provider of the Pillar Procedure in New York City, and has successfully cured hundreds of patients from suffering from their snoring disorders.

The Stress of Snoring on a Marriage

Can snoring ruin a marriage? In my practice, I hear the complaints all the time. Since it is more common in men than women, wives often make the appointments for their husbands, or the husband will say “my wife made me come in.” Snoring can cause a couple who are normally affectionate and enjoy a healthy home life to become resentful of each other. The non-snoring spouse blames the snorer for causing them to be up all night, the snorer blames the non-snoring spouse for not being understanding.

The reason for resentment is understandable. Snoring can cause daytime symptoms that can wreak havoc on one’s waking life, and unfortunately, it is not just the snorer that suffers – the spouse can suffer just as much. The sleep loss associated with snoring impairs a person’s ability to perform tasks involving memory, learning, reasoning, and mathematical processes. It can cause morning headaches, irritability, burnout and depression to mention just a few symptoms.

It is thought that more than forty million Americans snore every night and that 60% of men snore, and 30% of women. With all that snoring at night, couples are having a hard time sleeping together. According to the National Sleep Foundation, 53 percent of adults say they have relationship problems because of their or their partner's sleep disorder. The housing industry even seems ready to capitalize on this trend, with one survey predicting that by the year 2015, more than 60 percent of custom homes will have dual master bedrooms to be occupied primarily by snoring spouses.

In his book, "Two in a Bed: The Social System of Couple Bed Sharing," Paul C. Rosenblatt explores couples sharing their sleeping space, and it is a groundbreaking book in the field of sleep and relationships. For the book, Rosenblatt interviewed 42 couples, and examines how sharing a bed affects the couple’s relationship.

Many couples described that sleeping in the same bed is extremely important to them, because “it's a time for intimacy, pleasure and feeling comfortable together. During the time before drifting off to sleep, couples catch up on what's going on with one another, plan, make decisions, deal with disagreements and solve problems. For most couples, their time chatting in bed is the most time they have to talk with each other on a daily basis and that talk can be crucially important to their relationship,” Rosenblatt said."If couples don't have this time in bed, then they're in trouble.”

Although many couples know that it’s healthier for their marriage to share that time, sense of security and intimacy, many with snoring spouses are opting to go it alone in separate rooms for the sake of a good night’s sleep and a productive, healthy day.

If your marriage is suffering because you or your spouse snores, the answer to your problem maybe easier to solve than you think. The key is to understand that snoring is a symptom of a physical condition, such as sleep apnea, sinusitis, or nasal obstruction and it can be treated. There are many non-surgical and surgical treatments available to snorers today, dependant on the cause of the disorder. Sometimes snoring can be treated with changes in lifestyle, but when that doesn’t work, medical evaluation is necessary.

Help get your marriage get back on track, and start getting a good night’s sleep. Contact us at the Manhattan Snoring and Sleep Center to schedule your online appointment or call 212-873-6036 today.

-David O. Volpi, M.D., P.C., F.A.C.S.,