I talk a lot about reducing your blood pressure naturally, but without looking at the bigger picture, we might be missing other causes for high blood pressure besides your diet and sodium intake.
A secret cause of high blood pressure, especially hard to treat resistant high blood pressure, is called obstructive sleep apnea (OSA). I mean it’s so secret that you don’t even know that it’s happening because it’s while you sleep.
I know you’re thinking, how does my sleep affect my health? Well, it has a huge impact and that’s why I’m here to share the symptoms and risk factors so that you can identify whether your blood pressure may be due to sleep apnea.
In this post you will learn about
Exactly what obstructive sleep apnea is and what it has to do with your blood pressure (and diabetes!)
The harmful effects of obstructive sleep apnea if left untreated
Symptoms to notice that identify sleep apnea
Measurements that might put you more at risk for sleep apnea
Before we go over how to identify sleep apnea through symptoms and risk factors, we need to learn some back story. Let’s dive in. Check out my condensed questionnaire to help you identify if you are at risk for sleep apnea.
Obstructive Sleep Apnea- what is it and what causes it:
Sleep apnea is a condition that makes you stop breathing for short periods while you are asleep and is the most common sleep-related breathing disorder.
The techy description: OSA is characterized by recurrent, functional collapse of the upper airway during sleep, causing substantially reduced or complete cessation of airflow despite ongoing breathing efforts. This leads to intermittent disturbances in gas exchange (eg, hypercapnia and hypoxemia) and fragmented sleep.
In obstructive sleep apnea, you stop breathing (apnea) because your throat narrows or closes (obstructive) while you sleep.
People with sleep apnea do not know that they stop breathing when they are asleep. But they do sometimes wake up startled or gasping for breath. They also often hear from loved ones that they snore.
About 20 to 30 % of males and 10 to 15 % of females in North America have obstructive sleep apnea. That's a huge percentage of people who go about their normal lives without knowing they have this. You can see why I call it a secret cause of high blood pressure.
In both males and females, the strongest risk factor for OSA is obesity.
Now we know what exactly sleep apnea is and what causes it, but WHY is it important that it be treated at all?
Why is treating obstructive sleep apnea important
You may wonder, If I can't tell that I'm waking up in the middle of the night all the time due to this, why does it matter and how does it affect my health?
Sleep apnea is strongly associated with cardiovascular morbidity. That means, if you have sleep apnea you may experience death due to heart failure, heart attacks, resistant hypertension, coronary artery disease, and cardiac arrhythmias.
The Sleep Heart Health Study and the Wisconsin Sleep Cohort Study found that OSA is a risk factor for hypertension, myocardial infarction, heart failure, and stroke.
In order to decrease your risk of heart disease, OSA must be treated!
Patients with OSA are also at an increased risk of motor vehicle accidents. In fact, motor vehicle crashes are 2-3 times more common among patients with OSA than without OSA.
To be complete, other complications include: daytime functioning, cognition, inattention, type 2 diabetes, metabolic syndrome, nonalcoholic fatty liver disease, and perioperative complications (might need oxygen around surgery and on pain medications).
We have some pretty valid rationales for learning about the symptoms of sleep apnea. Remember, there is a treatment section at the end of this, but first let's check out how to identify the symptoms of OSA.
How to identify the symptoms of obstructive sleep apnea
Evaluate the following to see if you are experiencing any symptoms of obstructive sleep apnea:
- Have you ever been told that you snore during the night? Do you snore very loudly, so loud that it can be heard through closed doors?
- Daytime sleepiness
- Do you often feel tired, fatigued, or sleepy during the daytime (such as falling asleep during driving)?
- A lot of times this sleep apnea symptom can be masked by taking stimulants when we are tired. Are you reaching for caffeine throughout the day to stay alert?
- Do you have trouble with concentration due to daytime sleepiness?
- Do you frequently require naps to catch up on your sleep, even if you got 8-10 hours of sleep?
- Breathing pauses or gasping
- Have you been told that you stop breathing and gasp for air during the night? You could be completely unaware of this and must rely on someone else to note whether this is happening.
- Have a family member observe you while you take a nap. Have them take note if you are breathing normally and then suddenly stop for a few seconds and then restart breathing normally.
- This is the most significant symptom that may lead to a diagnosis of obstructive sleep apnea.
- Morning headaches
- Do you wake up with a headache in the morning? Not all the time, but sometimes?
- Morning headaches are reported by 10 to 30 % of patients with untreated OSA.
- The headaches usually resolve completely within several weeks of initiating treatment; lack of improvement may suggest an alternative cause of headache.
Risk factors and measurements important in OSA
Determine if you have the following. If you have all of the following, it does NOT mean you have OSA. You need to be experiencing the symptoms of sleep apnea and undergo a sleep study. More on that later.
- High blood pressure
- Do you have or are being treated for high blood pressure?
- Body mass index more than 35 kg/m2
- We know that obesity is a huge risk factor for OSA and obesity is measured by BMI.
- Body mass index is NOT a great predictor of health, but it does play a role in sleep apnea.
- Instructions on how to calculate your BMI are listed below.
- Neck circumference
- For males, is your shirt collar 17 inches or larger?
- For females, is your shirt collar 16 inches or larger?
- Don't know your collar size, just use a measuring tape and follow the instructions below.
- OSA is 2-3 times more common in males
- Are you older than 50 years old?
Additional risk factors identified in some studies include smoking, nasal congestion, menopause, and family history. Rates of OSA are also increased in association with certain medical conditions, such as pregnancy, end-stage renal disease, congestive heart failure, chronic lung disease, stroke.
How to calculate your body mass index or BMI:
BMI = weight (lb) ÷ height squared(in) × 703
- Multiply your height in inches (in) by itself
- Divide your weight in pounds (lb) by your step 1 result
- Multiply the result from step 2 by 703.
Example, for an adult with height of 5 ft 5 inches and weight of 150 pounds (lb). Step one is to convert the height into inches only. There are 12 inches in a foot, so we simply multiply the 5 ft by 12 and then add the 5 inches. This gives us a total of 65 inches.
BMI = (150 ÷ (65 × 65)) × 703
BMI = (150 ÷ 4225) × 703
BMI = 0.0355 × 703
This gives us a BMI figure of 24.9
Or you can use any of the million online calculators to just plug in your numbers.
How to measure your collar size:
- Wrap the measuring tape around the neck, beginning at about one inch from the meeting of your neck and shoulders. This may also coincide with the bottom part of your Adam's apple.
- Hold the tape tight. Come fully around the neck, leaving no dangling space in between the neck and the tape. Don't pull too tightly so as to create unnecessary tension, just enough so that you are getting a true measurement. Make sure the tape is level and not being held at an angle.
- Note the measured number. This is the actual neck size. The collar size will be half an inch bigger. For example, if you measure your neck to be exactly 15 inches (38 cm) around, then your collar size will be 15½ inches (39.5 cm).
Diagnosis and treatment of obstructive sleep apnea
At your doctor's office, you will either fill out a questionnaire (like the one I have attached to this blog post) or your doctor will evaluate you and then you will need to complete a sleep study.
To be diagnosed with the sleep apnea, in general, you need to have five or more apnea events per hour of sleep (identified by the sleep study) PLUS one or more of the following:
- Sleepiness, nonrestorative sleep, fatigue, or insomnia symptoms
- Waking up with breath holding, gasping, or choking
- Habitual snoring, breathing interruptions, or both noted by a bed partner or other observer
- Hypertension, mood disorder, cognitive dysfunction, coronary artery disease, stroke, congestive heart failure, atrial fibrillation, or type 2 diabetes mellitus
OSA is a chronic disease that requires long-term treatment, there is NO quick fix and you may require treatment for life. But the benefits of treatment are incredibly motivating!
Potential benefits of successful treatment of OSA include improved quality of life, improved systemic blood pressure control, reduced healthcare utilization and costs, and possibly decreased cardiovascular morbidity and mortality.
Weight loss and continuous positive airway pressure (CPAP) therapy are the cornerstones of therapy. Both have been shown to improve outcomes in randomized trials.
These CPAP machines make you sound like a familiar Star Wars character.
There is so much more I could share about obstructive sleep apnea but to keep this post from being its own novel, I'll leave treatment and which medications to avoid if you are diagnosed with sleep apnea for another time. Or let me know in the comments below and I'll get started on that post next!
Consider sleep apnea as a cause for your resistant hypertension if you are experiencing the symptoms listed in this post. You can even print out your questionnaire and show it to your doctor!
What was your score on the Obstructive Sleep Apnea Questionnaire?