1) What is Sleep Apnea?

Sleep apnea is a serious sleep disorder that occurs when a person’s breathing is interrupted during sleep. People with untreated sleep apnea stop breathing repeatedly while sleeping, sometimes hundreds of times during their sleep. This means the brain — and the rest of the body — may not get enough oxygen. There are two types of sleep apnea:

  • Obstructive sleep apnea (OSA): The more common of the two forms of apnea, it is caused by a blockage of the airway, usually when the soft tissue in the back of the throat collapses during sleep.
  • Central sleep apnea: Unlike OSA, the airway is not blocked, but the brain fails to signal the muscles to breathe due to instability in the respiratory control center.

2) What are the Signs and Symptoms of Sleep Apnea?

The signs and symptoms of obstructive and central sleep apneas overlap, sometimes making it difficult to determine which type you have. The most common signs and symptoms of obstructive and central sleep apneas include:

· Loud snoring

· Episodes in which you stop breathing during sleep — which would be reported by another person

· Gasping for air during sleep

· Awakening with a dry mouth

· Morning headache

· Difficulty staying asleep (insomnia)

· Excessive daytime sleepiness (hypersomnia)

· Difficulty paying attention while awake

· Irritability

3) What is the Difference Between Simple Snoring and Sleep Apnea?

Snoring generally occurs when you breathe and the soft tissues of your neck narrow the passageway of the air. When the breathing passage gets narrowed, and then you try to draw in air, as you draw in air, it makes the tissue vibrate and then gives you kind of a vibratory noise, and that noise is the snoring.

Anything that narrows your breathing passages can cause snoring, including:

· Large tonsils

· An enlarged uvula (the tissue that hangs from the middle of the back of your throat)

· A deviated septum (when the thin wall between your nostrils is misaligned)

· Nasal congestion

· Excess weight

· Drinking alcohol

Snoring is the key symptom of Sleep Apnea. However, the difference between sleep apnea and simple snoring is that, with sleep apnea, the snoring is accompanied by pauses where you literally stop breathing because your airway collapses or is blocked (obstructive sleep apnea) or when your brain fails to signal the muscles to breathe, (central sleep apnea). These pauses, which can last from a few seconds to minutes, are followed by choking, snorting, or gasping.

4) For VA purposes, What is Required for a Diagnosis of Sleep Apnea?

A diagnosis of sleep apnea requires a sleep study. There are two types:

· Polysomnogram (PSG). This is the most common. It records brain activity, eye movements, heart rate, blood pressure, oxygen levels in your blood, air movement through your nose, snoring, and chest movements. (The chest movements show whether your body is making an effort to breathe.)

· Home-based portable monitor. Your doctor may recommend a home-based sleep test with a portable monitor, which records some of the same information as a polysomnogram. A sleep specialist may use the results to consider whether you need a full study in a sleep center.

5) How Does the VA Rate Disability Determine Levels for Sleep Apnea (OSA)?

The VA rates disability levels of respiratory illness, including sleep apnea, according to fixed criteria: They are:

· 100 percent: chronic respiratory failure with carbon dioxide retention or cor pulmonale; or requires tracheostomy

· 50 percent: requires the use of a breathing assistance device such as continuous airway pressure (CPAP) machine

· 30 percent: persistent daytime hypersomnolence

· 0 percent: asymptomatic, but with documented sleep disorder breathing

For most veterans with sleep apnea, the 50 percent disability rating is the primary target. A 50% VA sleep apnea rating “Requires use of breathing assistance device such as continuous airway pressure (CPAP) machine.” The phrase such as means that a CPAP machine is one (but not the only) example warranting a 50% disability rating. Other breathing assistance devices are used to relieve the effects of sleep apnea because they are less obstructive than CPAP machines. One alternative treatment is dental appliances, which re-position the tongue or jaw while you sleep to improve airflow. Other forms of breathing assistance devices include a nasal expiratory positive airway pressure which involves a disposable valve covering the nostrils, and a hypoglossal nerve stimulation which stimulates a patient’s chest leading to the hypoglossal nerve, which controls tongue movement as well as a breathing sensor.

Any breathing assistance device used to treat sleep apnea warrants a 50% disability rating.

6) What are the More Serious and Long-Term Complications of Sleep Apnea?

More serious and long-term complications of sleep apnea (OSA) can include:

· Daytime fatigue. The repeated awakenings associated with sleep apnea make normal, restorative sleep impossible, making severe daytime drowsiness, fatigue, and irritability likely.

You might have difficulty concentrating and find yourself falling asleep at work, while watching TV, or even when driving. People with sleep apnea have an increased risk of motor vehicle and workplace accidents.

You might also feel quick-tempered, moody, or depressed. Children and adolescents with sleep apnea might perform poorly in school or have behavior problems.

· High blood pressure or heart problems. Sudden drops in blood oxygen levels that occur during sleep apnea increase blood pressure and strain the cardiovascular system. Having obstructive sleep apnea increases your risk of high blood pressure (hypertension).

Obstructive sleep apnea might also increase your risk of recurrent heart attack, stroke, and abnormal heartbeats, such as atrial fibrillation. If you have heart disease, multiple episodes of low blood oxygen (hypoxia or hypoxemia) can lead to sudden death from an irregular heartbeat.

· Type 2 diabetes. Having sleep apnea increases your risk of developing insulin resistance and type 2 diabetes.

· Metabolic syndrome. This disorder, which includes high blood pressure, abnormal cholesterol levels, high blood sugar, and an increased waist circumference, is linked to a higher risk of heart disease.

· Complications with medications and surgery. Obstructive sleep apnea is also a concern with certain medications and general anesthesia. People with sleep apnea might be more likely to have complications after major surgery because they’re prone to breathing problems, especially when sedated and lying on their backs.

· Liver problems. People with sleep apnea are more likely to have abnormal results on liver function tests, and their livers are more likely to show signs of scarring (nonalcoholic fatty liver disease).

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