Sleep Apnea Essay, Research Paper

Sleep Apnea

General Psychology

Steven O’Brien, Psy.D

Sleep, why do people sleep at all? Why can’t we just stay awake? Some

biologist suggest that sleep provides the opportunity to conduct self-repair and

purge the body of it’s waste that has built up during the day’s activity.

Nevertheless, the body is capable of repairing itself and disposing of wastes

during waking hours, so sleep in a way really isn’t necessary for routine

maintenance (e.g., urinating, etc.). Dr. Quentin Regestein, lead sleep and sleep

disorders researcher at Harvard Medical School also believed that sleep kept our

distant ancestors out of harms way during the night when they could not see as

well as their night roaming predators.

Sleep is regulated by a connected series of structures in the deep midline

areas, and along other way stations that extend through the central axis of the

brain, these structures relay information about things that affect sleep. In Dr.

Regestein notes, he spoke of experiments that were performed by researchers.

The researchers he spoke of would destroy specific brain structures of a lab

animal and then note how the animal slept. For instances, in one lab animal

the researcher cut through the axis of the brain at one level, which would

prevented the animal from awakening; showing that brain structures below the

level of the cut were responsible for awakening the lab animal.

The American Sleep Disorders Association (ASDA), Association for the

Psychophysiological Study of Sleep (APSS), Association of Sleep Disorder Centers

(ASDC), and the American Psychiatric Association (APA) has studied sleep and

sleep disorders since the early 1970’s. Out of all the sleep disorders

currently being studied, sleep apnea has gain world wide attention, affecting

over 15 million people. Apnea, derived from the Greek word “want to breath.”

Sleep Apnea (cessation of air flow at the mouth for greater than 10 seconds) can

reflect 1) loss of central nervous system drive to maintain ventilation, 2)

mechanical upper airway obstruction, or combinations of both. The second

edition of Anesthesia and Co-Existing Disease states “Conversely, obstructive

forms of sleep apnea are due to an abnormal relaxation of the posterior

pharyngeal muscles” – there is persistence of respiratory movements, but airflow

is absent due to upper airway obstruction. Study shows awakening occurs when the

arterial partial pressure of carbon dioxide rise or oxygen falls. Severe apnea,

which affects about 1 percent of the general adult population, often results in

400-500 awakenings a night. Moreover, depending on the severity and the number

of episodes of sleep apnea, the patient’s daily life and survival can be greatly

endangered. According to the Wisconsin Sleep Cohort Study, over an eight-year

period, a 37 percent death rate has been reported among persons with apnea (20

episodes or more per hour). The Wisconsin Sleep Cohort Study also reported sleep

apnea is more likely to occur in men then women, for the male hormone,

testosterone is believed to be related to sleep apnea. Admittedly, researchers

believe a female hormone, progesterone stimulates respiration and therefore may

help prevent breathing problems. In the Wisconsin Sleep Cohort Study, the

researchers noted a strong link between smoking and sleep apnea. Smokers that

smoked 40 or more cigarettes a day had the greatest risk of developing sleep

apnea then patients who had never smoked. The medical community has yet to fully

understand the intra play of factors producing the sleep apnea syndrome.

Sleep affects psychological well-being. Because sleep apnea deprives

patients of sleep, numerous of studies have consistently shown that sleep loss

affects daytime performance, sleepiness and mood. One of the first capacities

that Dr. Arthur J. Speilman of the Department of Psychology in New York spoke of,

is the ability to produce creative solutions to problems., and how being deprive

of sleep can impair a patients functional capacity. Dr. Paul Glovinsky, Dr.

Spielman’s research colleague noted “the focus of psychology is behavior, which

at first glance might be thought to cease during sleep”. Dr. Glovinsky also

noted “neither the mind nor the body truly cease activity during sleep. Far

from turning off, the brain in sleep generates a variety of states , accompanied

by predictable physiological changes and typical forms of mentation.” By

studying Drs. Speilman and Glovinsky works one can conclude, the sleeplessness

of sleep apnea or the prolonged wakefulness of creative output, the timing of

physiological rhythms can be affected by psychological states.

In 1988 a congressional commission determined that sleep related

problems cost American Society 50 billion dollars a year and that 95% of

individuals with sleep disorders were going undiagnosed. According to the

American Academy of Family Physician (AAFP), The standard method for diagnosing

sleep apnea is nocturnal polysomnography. In order for the this test to be

preformed often requires the patient to stay overnight in a sleep laboratory,

which can be quite costly. There are also less costly methods of diagnosing

sleep apnea. Dr. Tivinnereim of the AAFP developed the use of a five portable

pressure transducer catheters connected to a data logger that can be clipped to

the patients garment. The transducers are used to measure the intrathoracic

pressure fluctuations. Case study: Ten patients with obstructive sleep apnea

were recruited from a sleep clinic to undergo simultaneous evaluation with the

portable transducer catheter. Pressure signals were synchronized with the

polysomnographic tracings to compare the classification of 200 events of apnea.

The portable transducer catheter detected all 200 events recorded during the

nocturnal polysomnography procedure.

Because of in-depth research of sleep apnea and sleep disorders, the

ASDA can now safely treat sleep apnea. One method that is widely used is C-PAP

(Continuous – Positive Airway. C-PAP is a mask that covers the patients face

that provides a slightly increased air pressure for easier breathing. As a

result from using the C-PAP machine, muscles lining the airway and structures

such as the soft palate are no longer sucked into the airstream. Another method

of treating sleep apnea (a fairly new surgical procedure) called

uvulopalatopharyngoplasty. This procedure involves revision of the uvula (the

tissue that hangs from the midline of the throat) and tightening up the throat’s

lining. Study has shown surgery to be the best route for sleep apnea patients.

Case study: A 38-year-old production supervisor was interviewed four months

postoperative and reported that the surgery had changed his life. He was no

longer weary, and he had astonished his employers by coming up with some new

business innovations. He also added that he felt so energetic that he had taken

on a second job. Some patients that were seen postoperative reported comparable

improvements. The biochemistry of sleep is only partially understood; yet the

knowledge of sleep apnea and how it occurs intra plays a great role in treatment.

In short, being deprived up sleep because of a sleep disorder like sleep apnea

can eventually lead to interruption of daily task and human survival is greatly

reduced. Many people choose to prognosis themselves as to why they are having

trouble sleeping. Researchers urge patients with a unbalanced sleep pattern to

seek professional help.

“Five billion people go through the cycle of sleep and wakefulness every day,

and relatively few of them know the joy of being fully rested and fully alert

all day long.”

– William Dement (1988)

References

Arthur J. Speilman, Phd.D., and Paul B. Glovinsky, Ph.D.

– Department of Psychology. The City College of New York

Pinellas Public Library Cooperative, Inc. – InfoTrac System

– Largo, Florida

Drs. Robert K. Stoelting, Stephen F. Dierdorf , and Richard L. McCammon.

-Second Edition / Anesthesia and Co-Existing Disease

John P. Dworetzky

– Psychology / Fifth Edition

Dr. Quentin Regestein – lead sleep researcher, Harvard Medical School

– Sleep problems and solutions

Dr. Scott Mantel – Anesthesiologist

– Morton Plant Hospital, Department of Anesthesiology

Dr. Paul Borelli – Anesthesiologist

– Morton Plant Hospital, Department of Anesthesiology