Fatigue got you down? Could it be sleep apnea?

Gonna get real personal here with this one. Over the past few months, I had several episodes where I woke up in the middle of the night in a panic, my heart racing, gasping for air. I felt like I was gagging on the back of my throat. These were what I presume to be pretty long apneic episodes - meaning I stopped breathing in my sleep. Of course I knew what was going on, but I a) was in denial, and b) am a terrible patient. 

Fortunately, I am a good dental patient. At my regular cleaning, they asked me about sleep. The practice I go to has a dentist who specializes in sleep, and I have referred people there before, so I knew exactly what they were getting at with this question. I fessed up, and bought myself a ticket to a home sleep study. (Check out this home sleep study unboxing video. It was pretty simple to do.)

Long before my own experience, I was a big advocate for sleep studies in my patients, as I always include sleep apnea on my differential. Why, you ask? Read on. 

What is sleep apnea, anyway?

Sleep apnea is a common condition where your breathing stops repeatedly while sleeping. These pauses can last a few seconds (or longer) and may happen a few to many times an hour, interrupting your ability to get deep, restorative sleep.

The most common type, obstructive sleep apnea (OSA), happens when the muscles in the back of your throat relax too much, blocking your airway. You might not remember waking up, but your body sure does.

Many people (doctors included) think that obesity (BMI >30) and loud snoring are required symptoms of sleep apnea, but that’s not the case. The structure of your mouth (including large tonsils or a small jaw), connective tissue disorders (such as Ehlers Danlos), and even menopause can cause sleep apnea. 

Most tools to screen for sleep apnea were designed around how sleep apnea looks in men — loud snoring, gasping, or falling asleep during the day. Symptoms look a little different in women, with more fatigue, mood changes, or insomnia. Unfortunately, this means their symptoms are often dismissed or attributed to stress or anxiety.

Common signs of sleep apnea:

• Morning headaches or brain fog

• Feeling tired even after a full night of sleep

• Insomnia

• Anxiety, depression, or irritability

• Acid reflux

• Getting up to use the bathroom at night

• 
  

If that sounds familiar, you’re not alone. It’s estimated that 1 in 3 adults has sleep apnea, yet over 80% of people with it don’t know they have it.

How does menopause fit in?

Hormonal changes during perimenopause and menopause can increase the risk of sleep apnea by reducing muscle tone in the upper airway and decreasing the drive to breathe while sleeping. This is one reason why the risk of sleep apnea rises sharply after menopause, even in women who aren’t overweight.

Why this matters:

Untreated sleep apnea isn’t just about feeling tired. It increases the risk of high blood pressure, heart disease, stroke, diabetes, memory problems, and even car accidents due to daytime sleepiness.

Many people hear sleep apnea, and they don’t want CPAP, so they don’t bother with the test. (Also - don’t knock CPAP until you try it. It may not be as bad as you think). However, there are other treatments that might be appropriate, depending on the underlying cause. Weight loss can help when due to excess weight. An oral appliance from a sleep dentist may be appropriate for some. Myofunctional therapy (basically PT for your mouth), can be helpful in some cases too. The key to treatment is to address the underlying issue. 

As for me, this took a turn I wasn’t quite expecting. I have a small jaw, and my teeth are getting in the way of my tongue sitting where it should, especially when I’m sleeping. So I will be getting aligners (like Invisalign) and doing myofunctional therapy. Talk about truly addressing the “root cause” that you won’t find in any lab panels.