Sleep apnea leaves you tired, even after a full night’s sleep

People who have sleep apnea can wake up 15 to 25 times an hour during sleep – without knowing it. The condition briefly wakes them, leaving them exhausted despite a full night’s sleep. “Sleep apnea is a problem with the upper airway, the part of the airway that runs from the voice box to the back of the throat,” says Aris Iatridis, M.D., a pulmonologist and sleep medicine specialist at Piedmont Physicians Pulmonary and Sleep Medicine Austell.

The airway is held open only by muscle and when you fall asleep, this muscle naturally relaxes. This is why so many people snore, Dr. Iatridis says.In sleep apnea, the airway narrows, causing choking and reduced airflow.

What happens to the body

“As they are lying in bed asleep, they start choking, and the body starts to panic a little bit,” Dr. Iatridis explains. “Adrenaline kicks in, the chest starts to work, the heart starts beating faster, they wake up for two to three seconds, then their body goes back to sleep, and they don’t remember a thing about it.” This occurs overnight, and in severe sleep apnea, people may wake 15–25 times per hour or more.

Most people aren’t aware that they are waking up throughout the night. “One of the properties of sleep is that it causes amnesia,” he says. “Nobody really remembers what happened during their sleep, even though most people come awake several times during the night.” You won't remember being awake unless you wake for a minute or more. “Sleep apnea patients perceive that they go to bed, they lie in bed for eight hours and are fully asleep, they wake up the next morning and feel just as tired as they did the night before,” he says.

How sleep apnea is detected

If a physician suspects a patient has sleep apnea, he or she may recommend the patient undergo a sleep study. During a sleep study, patients arrive around 9 p.m. and are connected to sensors on the scalp, chin, chest, and legs, Dr. Iatridis explains. Patients are monitored by sleep technicians, who record brain activity, breathing, EKG results and muscle activity. “If you have sleep apnea, it becomes obvious,” he says.

Treatment options

For severe sleep apnea, patients may be awakened midway and placed on a CPAP (continuous positive airway pressure) machine. A CPAP machine is a mask over the nose and mouth connected by tubing to a small device. The machine generates pressurized air to push through the tubing into the mask, which inflates the airway. Dr. Iatridis likens this process to inflating an inner tube with a bicycle pump. “It works very well,” he says. “It has been shown that people who wear CPAP and are able to use it routinely, not only feel better in general – a lot less tired and a better quality of life, but also long-term it will help prevent strokes, heart attacks and other morbidities associated with sleep apnea.”

Unless the upper airway is changed, sleep apnea patients typically need CPAP for life. However, there are options for certain patients. “If you weigh 300 pounds and you lose a substantial amount of weight, there is a chance you could cure your sleep apnea,” Dr. Iatridis says. “There are also surgeries you can do for sleep apnea.” In some cases, an oral appliance, or mouthpiece, is used to attach the lower jaw to the upper jaw.

It is worn inside the mouth, pushing the lower jaw forward and opening the airway. “This device is reasonably effective in mild to moderate sleep apnea, and in people who are relatively thin,” he says. “The success rate is about 50-60%. It’s a reasonable option to try in people who can’t tolerate or don’t like the CPAP and want to try something else.” For more information, visit Piedmont Sleep Services.

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