Sleep Apnea: Causes and Solutions

We have seen a growing number of sleep apnea cases diagnosed and expect the rate of those afflicted to continue to rise for the foreseeable future.

• By Paul S. Valentine, Larry Epstein
• Jul 01, 2011

The dangers of excessive daytime sleepiness, or "EDS," periodically reach our national consciousness when we hear stories about air traffic controllers napping on the job or fatal airline, or truck, crashes resulting from sleepy operators. But EDS isn't an occasional occurrence. It's a national health epidemic that is increasingly being recognized as a hazard for business if left untreated.

One of the main causes of EDS is sleep apnea, a medical condition that results in people waking up dozens -- and sometimes hundreds -- of times a night because their airway closes off and they stop breathing periodically during sleep. Companies are starting to incorporate the diagnosis and treatment of disorders such as sleep apnea into their health and wellness programs in order to mitigate the risks associated with sleep-deprived workers. These risks range from safety concerns in industries such as transportation, manufacturing, and health care to productivity and management issues that can arise with absenteeism in almost any industry.

In choosing a treatment program for employees, it's important for companies to understand the underlying causes of sleep apnea so that workers can be provided with the appropriate resources and support needed to overcome the condition.

Sleep apnea occurs when a person's airway becomes partially or fully blocked during sleep. Inability to breathe causes the body's oxygen level to drop. They struggle for air until their body wakes them up in an effort to open up the airway. Sleep apnea is a two-part process. When a person falls asleep, the muscles relax. This narrows the airway because the tube consists of a series of muscles that make it bigger, or smaller, to accommodate different tasks, such as eating, speaking, and breathing. In most people, the narrowing is not a problem. However, if the airway is closed off and the body is unable to breathe, it responds by waking up the person so that it can exert muscle control and open up the passage.

Currently, the biggest cause of sleep apnea is obesity. As an individual's weight increases, fat deposits develop around the airway, narrowing the passage. When the airway muscles relax upon falling asleep, the passage narrows further, preventing air from getting through. With almost a third of Americans now considered obese or overweight, according to the Centers for Disease Control and Prevention, we have seen a growing number of sleep apnea cases diagnosed and expect the rate of those afflicted to continue to rise for the foreseeable future.

Sleep apnea also can occur in non-obese individuals with genetic conditions that narrow the size of the airway. For example, people born with jaw abnormalities, such as micrognathia (an unusually small lower jaw that can affect the alignment of teeth) or retrognathia (a jaw that is set back compared to the normal position) have narrow air passages. The passage is kept open while awake because of the work of the airway muscles. However, they also can suffer from this condition because of the muscle relaxation that happens when they fall asleep.

The third most common cause of sleep apnea is large tonsils, a condition that typically occurs in young children.

Benefits of Treating Sleep Disorders
The most obvious consequence of sleep apnea is sleepiness during the daytime, which can affect how a person feels and performs daily tasks. The ability to react, to attend to a task, and to learn new tasks are all impaired. At work, it would be difficult for these people to perform their jobs well, decreasing productivity and putting them and their colleagues at risk for accidents.

There are long-term health complications, as well. Sleep apnea has been shown to cause hypertension; it also has been linked as a risk factor for stroke, coronary heart disease, and heart failure. When a person's airway closes off and he can't get oxygen, his body starts breathing harder in an attempt to open the airway. This triggers the body's sympathetic nervous system -- the system that triggers the "fight or flight" response -- which results in as much as a 35 percent increase in blood pressure each time he wakes up. Eventually, the higher blood pressure and heart rate become a permanent state that, over time, can permanently stiffen the blood vessels.

The best solution for the majority of people diagnosed with sleep apnea is to lose weight. However, because many people have trouble losing weight or have a tendency to gain the weight back again, there is a second solution: Continuous Positive Airway Pressure (CPAP), which is a mask that blows air into a patient's airway to keep it propped open.

Most patients do well with CPAP. However, some patients may find the CPAP device awkward to use continually. They may consider two alternatives, including a dental mouthpiece that has been proven effective in at least half of the cases of those diagnosed with mild to moderate sleep apnea. Some patients may opt to undergo a surgical procedure in which some tissue is removed from the airway to open it up. The advantage of surgery is a potential cure, but the cure rate is low for the most commonly performed procedure.

Although sleep apnea is a treatable disease, the nature of the condition requires long-term care. Employers who are considering including the treatment of sleep disorders in their health and wellness programs need to make sure their providers offer education, screening, testing, and long-term care services for patients in order to provide them with the support they need to overcome the disease. Without these services, patients won't be kept accountable for their own progress and may not experience the full health benefits of treatment.

In the long term, addressing sleep disorders can result in savings for disability and other health care expenditures. But there are additional benefits for a company's bottom line. A good night's sleep can help to improve the performance and productivity of workers. Well-rested individuals have been shown to feel better about their jobs, which reduces turnover and training expenses. And a decline in EDS can help lower both error rates and potential liability from accidents.

The savings and benefits of sleep treatment are not only related to health care. If we can help people get a better night's sleep, it will set off a domino effect that will yield positive returns for companies, as well as their employees.

This article originally appeared in the July 2011 issue of Occupational Health & Safety.