Sleep Disordered Breathing In The Cervical Spinal Cord Injury Patient
Editors note: This is a guest post that was provided by an outside contributor and does not necessarily reflect the opinions of SpinalCord.com.
Cervical SCI patients are at an increased risk for several sleep breathing disorders that, left undiagnosed and untreated, may negatively affect the patient’s health and well-being. The following case illustrates some of the challenges that SCI patients face in management of sleep disorders. The patient’s name has been changed to protect her privacy.
Sleep Apnea And Atrial Fibrillation
Obstructive sleep apnea has been shown to put people at a higher risk of atrial fibrillation, or an irregular heartbeat. Atrial fibrillations can lead to multiple health issues, including stroke, heart failure, and other heart complications.
Heres how it works: Due to the uncommon pressure sleep apnea puts on your chest, you are forced to suck in air aggressively through a narrower throat. At the same time, youre sucking blood back into the chest faster, which tricks your heart into thinking its overloaded. This leads to the release of atrial natriuretic peptide in the kidney, which blocks the right atrium and can spur the disruption of the conduction system. This is how atrial fibrillation is caused.
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Sleep Apnea Comorbidities: Diabetes And Hypertension
If youre reading this article, then youre hopefully familiar with obstructive sleep apnea and why its so dangerous to your health. This includes how OSA contributes to health conditions that are closely tied to tinnitus.
If sleep apnea is a contributing factor to the conditions mentioned below, treating it may have an additional benefit of reducing your tinnitus symptoms.
Heres a brief description of OSA and its connection to other diseases also linked to tinnitus:
- Obstructive sleep apnea occurs when your airway is partially or completely blocked, making it difficult for you to breathe at night. Its most common symptoms are loud snoring, gasping or choking during the night, or daytime fatigue.
- Sleep apnea sufferers may stop breathing anywhere between 5 or even more than 30 times in a single hour. When you stop breathing during sleep, your body and your brain become oxygen-deprived.
- Sleep apnea is connected to many health issues including heart disease, diabetes, high blood pressure, and anxiety. If you have obstructive sleep apnea, youre more likely to have these conditions because OSA contributes to or worsens them. Its also difficult to adequately treat them unless the apnea is addressed first.
Several of the conditions that sleep apnea contributes to or worsens also happen to be conditions that according to research worsens tinnitus too. For example, if you have diabetes or hypertension , these two conditions are linked to tinnitus as well.
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How Cpap Can Help Treat Tinnitus Symptoms
Theres a reason why a CPAP machine, or continuous positive airway pressure, is the most popular apnea treatment for OSA: Its effective not only for treating sleep apnea, but in treating any underlying conditions exacerbated by the apnea.
CPAP unblocks your airways by using a constant stream of air to hold your airway open and support it so you can breathe freely as you sleep. This allows your brain and body to receive the oxygen it needs to function.
In patients with diabetes, CPAP treatment lowers 24-hour glucose levels, improves glucose response, and reduces morning spikes in blood pressure. CPAP also helps increase artery size and reduce hypertension in people with high blood pressure.
So how exactly does CPAP treat tinnitus?
In the previous section, we mention how tinnitus and sleep apnea are connected because reduced oxygen levels during apnea can damage the cells in your ears and cause hearing loss.CPAP therapy can help reduce your tinnitus symptoms by improving oxygen levels in your blood, and reducing the pressure in your ears. This can prevent further cell damage that can harm your hearing.
Health conditions including high blood pressure and heart disease increase your risk of tinnitus and hearing loss. CPAP is also highly effective in treating or preventing cardiovascular problems such as high blood pressure or heart disease. In treating these, you can also address any potential hearing loss or ear disorders.
What Causes Sleep Apnea
- Age As you age your risk of developing CSA increases. The groups most at risk are individuals over the age of 45 are at the greatest risk.
- Biological Sex CSA is more common among men than it is among women.
- Heart Health Heart health can have a tremendous impact on your risk factors. Conditions such as congestive heart failure or an irregular heartbeat are significant risk factors for CSA.
- Medications Certain medications, particularly sedatives, opioids, and methadone can increase your risk.
- Stroke Around 75% of patients who need physical therapy after a stroke are also diagnosed with sleep-disordered breathing. CSA is the most common diagnosis.
- Other Brain Abnormalities Brain tumors and lesions on the brain stem can impair its ability to properly relay messages to the body.
- CPAP Use Studies show that patients who use a CPAP machine to create positive pressure in their airway are more likely to develop CSA. Continued use of a CPAP often resolves this issue.
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Natural Help For Tmj Pain From Upper Cervical Chiropractic Care
If you are suffering from TMJ issues long-term and self-care is only helping take the edge off, then it may be time to give upper cervical chiropractic care a try. It might be able to help you avoid things like long-term anti-inflammatory use. How does adjusting the top bone in the neck help the jaw and affect things like headaches?
The atlas is located at the top of the spine which puts it nearby the jaw joint, ears, and facial nerve. As a result, the changes that take place in the surrounding structures when an atlas subluxation exists can cause everything from jaw pain to headaches. Without correcting this underlying issue, it can be difficult to get long-term relief from any of the conditions that it is resulting in.
Our website can help you to locate one of our preferred upper cervical practitioners in your area. Just use the search feature to find a doctor near you and schedule a consultation today. This can set you on the path to better overall well-being and may help you to finally break away from jaw pain, and the complications that surround it, for good.
to schedule a consultation today.
Does Sleep Apnea Qualify As A Disability
According to the Nolo legal network, the Social Security Administration doesnt have a disability listing for sleep apnea. It does, however, have listings for breathing disorders, heart problems, and mental deficits that might be attributed to sleep apnea.
If you dont qualify for the conditions listed, you may still be able to receive benefits through a Residual Functional Capacity form. Both your doctor and a claims examiner from Disability Determination Services will fill out an RFC form to determine whether youre able to work due to:
- your sleep apnea
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Central Sleep Apnea And Obstructive Sleep Apnea
Most discussions of sleep apnea focus on obstructive sleep apnea and its treatment. Sleep apneas, however, come in more than one form.
The sleeper who suffers from OSA periodically struggles to breathe but is unable to inhale effectively because his or her airway has become blocked or collapsed. The sleeper whose problem is central sleep apnea periodically doesnt breathe at all so oxygen intake is ineffectual. In either type of sleep apnea, the lack of oxygen usually causes the patient to wake up or arouse, at least briefly.
To put it another way, the OSA patient has a mechanical problem, one that almost always can be corrected by a continuous positive airway pressure device.
Treatment of CSA is more challenging because the signal to the body to inhale is not being transmitted from the breathing center in the brain, or not received by the body. Sleep experts report that the great majority of central apnea sufferers also experience OSA although the CSA may not be noted until the OSA is treated.
In some cases the sleeping CSA sufferer displays a periodic shallow breathing or under-breathing that alternates with deep over-breathing, a condition known as Cheyne-Stokes breathing Estimates vary as to the frequency of central sleep apnea. Some say it accounts for 20 percent of all cases of sleep apnea.
An online discussion of central sleep apnea prepared by experts at Minnesotas Mayo Clinic breaks the disease down into five types:
Can Sleep Apnea Cause An Irregular Heartbeat
There are numerous people who complain about waking up with a fast-beating heart. While some think this isnt anything to worry about, there are studies that link waking up with an irregular heartbeat to sleep apnea. Sleep apnea is a very common sleeping disorder that is very alarming. In fact, a report by the National Sleep Foundation said that there are over 18 million adults in America that are diagnosed with this condition. Also, that it can be found in all age groups and for both sexes. The report also shows that a minimum of 3% of children are suspected of having sleep apnea and even up to 20% of children who snore have a higher chance of getting the condition.
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Sleeping Too Much And Heart Health
The impacts of sleep deprivation on heart health receive considerable attention, but many studies have also found associations between sleeping too much, generally defined as more than nine hours per night, and cardiovascular problems.
While more research is needed, many experts believe that underlying health conditions that cause excess sleep are also the cause of this higher rate of heart issues. Nevertheless, this data is a reminder that its a myth that more sleep is always better.
Positional Therapy & Sleep Apnea
- In the 2014 Journal of Sleep Research, the authors ask the questions, Are we missing a simple treatment for most adult sleep apnea patients? Indicating obstuctive apnea can be divided into positional and non-positional individuals. Positional individuals have most breathing problems sleeping on the back. By simply sleeping on the side, symptoms of apnea may be reduced or even eliminated.
The authors recommend positional therapy by avoiding back sleeping as a valuable therapy for mild to moderate obstructive apnea, indicating they represent between 65 and 87% of obstructive apnea patients, and this would be a cheap and effective solution for them. For those with neck problems, there are special side sleeping pillows and anti-snore pillows that can help.
- A 2021 study in the Journal of Sleep Research found that when back sleeping, head flexion was associated with more obstruction, whereas head rotation improved obstruction. For back sleepers, it is important to have a pillow that supports the natural cervical curve. Head rotation better approximates side sleeping, which is the best position.
This is why, although results will vary, special pillows are very popular positional therapy devices.
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Sleeping With Neck Pain: Can A Neck Injury Cause Sleep Apnea
Nobody plans on injuring any part of their body. But accidents happen, and sometimes the result is a ripple effect.
The same is true for sleeping with neck pain. Theres a great possibility it can lead to sleep apnea.
Sleeping in positions that dont cause further injury to your neck and spine helps your overall health. Not only do you spare yourself more pain, but you rest better. And because sleep apnea can lead to other fatal health problems, you save your own life.
Its time to pay attention to the pain in the neck.
If youre searching for a better way to sleep that spares your health, keep reading. Learn how sleeping with neck pain may also lead to sleep apnea.
Skin Marks And Rashes
Skin marks, skin irritation, and rashes are probably the most common side effects of CPAP therapy. Almost every patient has faced this issue at one point during their treatment. Skin issues can vary in severity if treated on time, or prevented, skin marks and rashes tend to go away quickly. However, in some cases, skin irritation, rashes, or redness seem to be persistent and translate into a different form of dermatitis and skin allergies.
The reason for this lies in the device itself. First of all, the CPAP machine can be a haven for bacteria, which can get onto the skin as the patient breathes through the mask. This shows how important it is to clean the CPAP mask and hose regularly. This can be done using CPAP machine cleaners, mask cleaners, or CPAP mask wipes.
On the other hand, skin irritation can be caused by silicon allergy or the allergy to the silicone in the masks. There can also be an issue with poor-fitting masks, which can cause red marks on the skin and skin breakage.
This can be solved by opting for a better-fitting mask, or opting for masks that are skin-friendly these masks are made from fabric and are less likely to cause skin issues.
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Whats The Connection Between Sleep Apnea And Cervical Spine Disorders
Cervical Spine Disorders?
Lets face it. No one wants to be interrupted during a good nights sleep. Whether its a snoring partner, a phone call, or aches and pains that keep a person from catching our full seven or eight hours of zzzzs, a lack of solid sleep at night can make most of us tired and cranky the next day. But for the estimated 22 million Americans suffering from sleep apnea, the results can be much more serious, and studies show that, unfortunately, patients who are already afflicted with cervical spine disorders are much more susceptible to this dangerous sleep condition.
The facts about sleep apnea
Sleep apnea is a condition that can occur when the upper airway becomes blocked repeatedly during sleep, reducing or completely obstructing airflow. When left undiagnosed or untreated, sleep apnea can lead to serious health conditions, including high blood pressure, heart disease, glaucoma, diabetes, and cognitive and behavioral disorders. Plus, the grogginess that comes after a night of suffering from sleep apnea can lead to falling asleep while driving in fact, people suffering from this condition are more than 2.5 times more likely to have a car accident caused by drowsy driving.
The facts about cervical spine disorders
How the two are connected
Diagnosing and dealing with sleep apnea with a spinal disorder
Study Of Postural Alignment Using 3d Biplanar Imaging
The EOS® system was used to simultaneously acquire bi-planar images of the entire skeleton . Participants were placed in a reference position with their hands on their cheeks while breathing normally. Individual 3D models were constructed from the biplanar imaging, including the points OD, defined as the uppermost point of the odontoid peg of the second cervical vertebrae , the spine of the third cervical vertebrae to the sacrum , and the pelvis, using established methods . The following values were then calculated: 3D spinal curvatures: cervical, between C3 and C7 , thoracic, between T1 and T12 , lumbar, between L1 and S1 , expressed in degrees pelvic variables the angle between the vertical and a line drawn from OD to the mid-point of a line intersecting the femoral heads the angle between the vertical and a line drawn from OD and the uppermost point of C7 .
Figure 1. Analysis of postural alignment using 3D biplanar imaging. PT pelvic tilt, PI pelvic incidence, OD superior tip of the odontoid process of C2, OD-HA the angle between the vertical plane and the line through OD and the midpoint of the line connecting the center of the two femoral heads, OD-C7 the angle between the vertical plane and the line through OD and C7. C3C7, 3D cervical curvature T1T12, 3D thoracic curvature L1S1, 3D sacral curvature.
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Sleep Apnea And Cardiovascular Disease: Role Of Obesity
According to data from the National Center for Health Statistics, about two-thirds of American adults are either overweight or obese . The age-adjusted prevalence of overweight/obesity in ethnic minorities, especially minority women, is higher than in whites in the United States, reaching a critical level of greater than two-thirds of the female minority population. Blacks are at greater risks because they are disproportionately more obese than whites .
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Sleep And Coronary Heart Disease
Research has found that sleep deprivation contributes to atherosclerosis. Plaque forms as a consequence of inflammation, which involves white blood cells, which are produced by the immune system, to collect in the arteries. Poor sleep triggers chronic inflammation, which contributes to plaque formation and hardening of the arteries.
The impact of sleep deprivation on coronary heart disease is also believed to be influenced by sleeps effects on blood pressure. Hypertension strains the arteries, making them less effective at bringing blood to the heart and as a result contributing to heart disease.
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Got Migraines Your Sleep Apnea May Be To Blame
Sleep apnea can cause headache and neck pain. The mechanism of the headache is complex, but probably involves decreased oxygen in the blood that occurs during apneas, and the resultant dilation of small blood vessels in the brain to deliver more oxygen. Also, increased venous pressure and glymphatic pressure occurs with sleep apnea, and can lead to sluggish lymphatic and venous return. This by itself can cause increased intracranial pressure and stretching of pain sensitive structures in the head. In some cases this can lead to brain swelling.
The neck pain is thought to be caused by neck hyperextension that occurs when a patient involuntarily attempts to open their airway during apneas that occur in sleep. This hyperextension leads to increased pressure on nerves as they exit the cervical spinal canal, and can worsen cervical radiculopathy.
Kansas City Neurologists at the Rowe Neurology Institute in Lenexa, Kansas, saw many patients over the years with the primary complaint of intractable headache, who also had sleep problems. A retrospective chart review was carried out for patients with the primary complaint of headache or intractable headache. The results can be viewed here.
New patients with primary headache diagnosis
Of the 700 headache patients included in the study, 71% had a diagnosed sleep disorder, and 277 of these had an overnight sleep study or polysomnogram. Many patients also had EMG studies if they had any symptoms of pinched nerves in their neck.