Docs: Sleep apnea awareness, especially among elderly is lacking

Most of us would probably like to get more sleep.

When we don’t get enough, it’s hard to get out of bed on time. We feel tired sitting at our desks.

For those with obstructive sleep apnea — when a person briefly stops breathing due to an obstructed airway — often no amount of sleep means feeling well-rested, however.

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Sleep apnea at any age is a major concern because of the health problems it can lead to, but it’s even more problematic in older adults, who are more likely to have issues with breathing at night, but are less likely to be diagnosed.

Dr. Jeffrey Erukhimov, a sleep medicine specialist with Heritage Valley Pulmonology and Sleep Medicine in Beaver, recently treated an elderly man who was diagnosed with sleep apnea while recovering from a stroke. A sleep study showed the man stopped breathing an average of 20 times per hour, Erukhimov said, and he needed to wear a mask to keep his airways open at night — a treatment known as continuous positive airway pressure (CPAP).

“He hates (the CPAP),” Erukhimov said. “He doesn’t understand what the problem is; he doesn’t feel this obstructive sleep apnea. He says, ‘So what? I sleep a lot.’”

The case is typical among older patients.

A large neck, obesity, extra tissue in the back of the airway and loss of muscle tone that helps to keep the airways open are only some of the reasons obstructive sleep apnea can occur. Loud snoring or gasping during sleep and issues such as memory loss, daytime fatigue or sleepiness are some of the most common signs.

But some studies have shown sleep apnea symptoms are not always obvious at first, and not always the same in older patients.

 

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“It’s not like you know you have a chest pain where you cannot really function and you need to take care of it right away,” Erukhimov said.

Older people often have lived with the condition for a long time and might not think anything is wrong, Dr. Patrick Sturm, medical director of the sleep lab at Heritage Valley Beaver, explained.

“They’re used to it,” Sturm said. “An older person doesn’t work so he’s not having problems at work; he may not drive around as much; he may sleep a lot during the day because he’s bored and no one notices it. … Memory issues may not be as apparent as in a younger person, they may attribute it to different things.”

Low oxygen levels in the blood can affect the oxygen supply to the brain, causing cognitive issues, Erukhimov explained.

“I often have patients who are elderly and they are complaining of memory loss and we find them to have obstructive sleep apnea,” he said.

Sleep disordered breathing affects between 20 percent and 50 percent of older adults, and the prevalence of sleep disorders increases with age — adults age 70 to 80 are twice as likely to be affected than those around age 40, according to a 2009 article in the Internet Journal of Internal Medicine.

The dangers of sleep apnea also increase with age.

The 2009 article, written by internal medicine specialists from Iowa, Wisconsin and Philadelphia, said obstructive sleep apnea has been linked to numerous other diseases, including hypertension, congestive heart failure, stroke and coronary artery disease.

Sleep apnea is only one of more than 60 sleep disorders, but all of them cause patients to suffer from sleep deprivation, Sturm said.

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“You know how it feels when you don’t get enough sleep; if you do it chronically over a long period of time, you don’t function well,” he said. “So, in the elderly that’s particularly a problem because they have other medical issues and also it could be why they’re not (as) independent as they could be or why they’re suffering.”

Research shows obstructive sleep apnea patients, especially those who are elderly, also are at greater risk for traffic accidents — and traffic accidents involving personal injury. A 2014 physician review of numerous studies on sleep deprivation showed that excessive sleepiness is the second leading cause of car crashes and a major cause of truck crashes in the United States.

In the Pittsburgh area especially, Erukhimov said, it’s very important to address issues of sleep apnea because of the number of older drivers.

“We don’t have a lot of public transportation here, so all these elderly people they do drive,” Erukhimov said. “They can fall asleep at the wheel and cause an accident. And there were fatal accidents related to people falling asleep at the wheel.”

Erukhimov said awareness — this is National Sleep Awareness Week — is not where it should be, and a lot of people don’t know the hazards of obstructive sleep apnea, partially because it has only been studied for a few decades.

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“When you stop breathing the oxygen saturation drops, and that actually means that the amount of oxygen delivered to the tissue decreases, and if you have comorbidities in addition to that, things like sudden death can occur,” he explained. Comorbidities are multiple diseases or chronic conditions.

Obstructive sleep apnea can contribute to some chronic diseases, but when they are already present, it usually makes them worse, Erukhimov said. In diabetes patients, for example, sleep apnea can make it very difficult to control blood glucose levels at night and exacerbate the condition over time.

“Sleep apnea is the same as like having very high blood pressure or cholesterol; it kills you slowly,” Erukhimov said.

 

 

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