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Hearing that the driver suddenly drove into the opposite lane and caused a fatal accident, we usually think that he had a heart attack or a stroke. Meanwhile, he usually just fell asleep at the wheel. Anyone with nocturnal obstructive sleep apnea is a potential culprit of an accident in which they may kill themselves or someone else. While not everyone who snores has apnea, there is no apnea without snoring. That is why everyone who snores should be tested in this direction to exclude apnea. Because apnea is a greater risk of death, not only behind the wheel.
Apnea often occurs in overweight men, especially in the nape of the neck. So doctors talk about the so-called collar criterion – size over 40 is already an alarming size. Often, hypertension and diabetes go hand in hand with apnea, so whoever has these diseases may also have this problem at night.
The good news is that the apnea can be cured. And then not only does the risk of death decrease, but also the quality of sleep, mood during the day and sexual performance improve. It even happens that depression that psychiatrists could not cope with medication disappears.
Unfortunately, as the doctors dealing with the problem say – this problem does not exist for professional drivers in Poland. Doctors suspect that drivers simply do not admit their problems during tests (they even hide snoring), or that some doctors do not order detailed diagnostics for drivers, so as not to deprive them of the possibility of practicing their profession.
The research on awareness of the dangers of snoring conducted at the beginning of May 2017 by the SW Research Market Research and Opinion Agency on the recommendation of Infoscan shows that practically all Poles know the problem of snoring, because it concerns them or their loved ones. As many as 3 out of 10 people deal with it every night. Unfortunately, most of those who snore feel that this has to be the case and don’t even try to figure out the cause of the problem. Meanwhile, probably as much as 35 percent. people who snore suffer from sleep apnea, i.e. during sleep they have moments (sometimes there are many of them) in which they stop breathing and expose the body (including the brain) to hypoxia.
During sleep, the muscle tone is lowered, including the throat and tongue. They become partially flaccid and then the rear part of the throat falls (hangs down), touching the root of the tongue. There is a small gap that allows us to breathe normally in our sleep. When the airways are obstructed, it becomes difficult to get air into the lungs, and hence the strange night noises.
For example, people with a deviated nasal septum, elongated soft palate, enlarged tonsils, enlarged uvula or other abnormalities in the structure of the respiratory tract can snore. Obese people, suffering from hypertension, «give concerts at night» more often, but drinking more alcohol may also contribute to this.
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There is no apnea without snoring. However, not every snoring person has apnea, so it is good to get tested – emphasizes prof. Zbigniew Gaciong, head of the Department of Internal Diseases, Hypertension and Angiology of the Independent Public Clinical Hospital in Warsaw. – Apnea is diagnosed on the basis of an interview and polysomnographic examination. This test allows to assess the subject’s sleep duration, among others, its duration or the number of awakenings.
We talk about apnea when someone has cyclical pauses in breathing lasting at least 10 seconds, resulting in hypoxia in the body. There can be even several dozen such episodes during sleep in an hour, and then a person does not get enough sleep, is constantly tired and may complain of morning headaches.
Apnea dangerous for the driver – The more apnea episodes a patient has during the night, the more hypoxic in the body and the patient feels excessive daytime sleepiness during the day. Untreated apnea may risk that the patient – due to lack of sleep – will fall asleep at the wheel – says prof. Gaciong.
Patients with sleep apnea make many more mistakes while driving, which is why they are more likely to be responsible for road accidents.
According to the data of the Police Headquarters, in 2016 in our country, 655 accidents were caused by falling asleep or fatigue (there are no statistics that say what percentage of drivers had apnea). As a result of these accidents, 98 people were killed and nearly a thousand were injured.
The research carried out on behalf of the Infoscan company shows that every fourth Pole admitted that he or she ever fell asleep or fell asleep while driving a vehicle. 4 percent said it happens often or very often.
Apnea facts
Apnea is divided into:
Obstructive sleep apnea – consists in cyclical interruption of breathing during sleep. It is caused by partial or complete closure of the throat lumen during sleep due to a decrease in muscle tone.
Central sleep apnea – the basis is damage to the structures in the brain that control breathing (e.g. complications after a stroke, the effect of vascular changes in the brain).
A person with apnea usually sleeps restlessly, gasping for breath and panting in his sleep. She wakes up with a choking feeling. This is because when he falls asleep, the muscle tone of the throat lowers and the side walls of the throat collapse and, as a result, close during inhalation: the patient makes breathing movements, but the air does not reach the lungs temporarily.
The patient is breathing, but to a limited extent, so that there is less oxygen in the blood and the amount of carbon dioxide increases. Then the respiratory muscles tension increases, which awakens the patient from sleep. As the muscles throughout the body tighten, the throat becomes open again. However, when the sick person falls asleep, the whole cycle repeats itself. These alternating apnea and brief periods of awakening can repeat many times over the course of the night. This is why – in severe forms of apnea – the blood oxygen saturation decreases.
Apnea risk factors:
- Obesity – then the throat may narrow, most often it is caused by the pressure of the subcutaneous fat layer on the throat walls. The disease is more common in obese men with a short, thick neck (collar number over 43).
- Small and retracted lower jaw – this can cause even slim people to snore.
- Hypertrophy of the tongue and palatine tonsils, soft palate and uvula are additional factors that can narrow the throat.
- Menopause – after this, women start to have OSA more often
- Alcohol
- Sedatives – they have a sedative and hypnotic effect on the central nervous system.
- Family burden – in 25 to 40 percent cases of apnea were found among family members. The likelihood of developing the disease increases proportionally to the number of cases of the disease in relatives.
- Chronic diseases – OSA is often associated with other chronic diseases, such as: arterial hypertension (can be caused by apnea), heart failure (it can be a consequence and cause of OSA), stroke, diabetes, gastroesophageal reflux disease, hypothyroidism.
The most common treatment is the use of a special mask during sleep, which facilitates breathing. The device covers the nose tightly and forces air into the respiratory tract through the mask, the flow of air prevents the throat from collapsing, preventing apnea. In some embodiments, operational methods are used. Good effects – in obese people with OSA – brings weight reduction.
In untreated patients, the prognosis is significantly worsening and serious complications develop. The most common ones are hypertension, heart failure, drowsiness, memory and attention disorders, and impotence. All these symptoms significantly reduce the quality of life of patients.
Men are four times more likely to develop sleep apnea. It is estimated that obstructive sleep apnea (OSA) in developed countries affects approx. 2-4 percent of people.