14 Mar Substance Use and Sleep Apnea
Sleep apnea is a common breathing disorder that is characterized by abnormally shallow breathing during sleep or the presence of abnormal breathing pauses. Most people develop obstructive sleep apnea, which is a form of the disorder that occurs when a sleeper’s airway collapses shut or gets blocked off. Others develop a form of the disorder called central sleep apnea, which occurs when the brain fails to send the signals required for the maintenance of normal breathing. Use of alcohol or medications classified as barbiturates, benzodiazepines, or opioids can potentially worsen existing cases of sleep apnea. In some cases, they can trigger death by completely disrupting normal breathing.
Sleep Apnea Basics
When you sleep, muscles throughout your body naturally relax and lose some of their ability to perform the tasks they perform during waking hours. In the case of the muscles in the upper throat, this relaxation leads to a narrowing of the space available for air passing into and out of the lungs. Even with the effects of upper throat muscle relaxation, most people maintain a passageway that’s large enough to supply air in an effective manner. However, in some people, relaxation produces excessive narrowing of the airway that either periodically suspends normal breathing or shallows the overall pattern of breathing. It is this phenomenon that doctors refer to as sleep apnea.
Apart from substance use/abuse, known risk factors for the onset of obstructive sleep apnea include obesity, having an unusually large neck size for your gender, the presence of unusually large adenoids or tonsils in children, having an unusually large tongue, having a relatively large upper jaw in relation to your lower jaw, having a throat interior or mouth roof (palate) that restricts your airflow to an unusually high degree, and having a tendency to sleep on your back. Apart from substance use/abuse, potential underlying causes of central sleep apnea include obesity, degenerative bone changes in the upper spine, swelling or inflammation in the brain, a stroke that originates in the brainstem, and conditions that include Parkinson’s disease and bulbar poliomyelitis.
People with both obstructive and central sleep apnea can stop breathing for as long as 10 to 20 seconds, or even longer in some cases. In relatively severe cases, this breathing disruption can recur more than 30 times in any given night of sleep. Potential consequences of sleep apnea include daytime fatigue, loss of normal alertness while performing work-related tasks, an increased likelihood of involvement in various types of accidents, and heightened risks for serious or deadly health complications such as high blood pressure, heart failure, significant heartbeat irregularities and strokes.
Alcohol’s Potential Effects
Alcohol is a central nervous system depressant, which means it reduces the normal rate of cellular communication in both the brain and spinal cord. Since breathing is controlled by the central nervous system, the presence of significant amounts of alcohol can contribute to the effects of central sleep apnea by making your breaths abnormally shallow, slowing down your overall rate of breathing or generally reducing the normal expression of your natural breathing reflex. The presence of alcohol can also contribute to the effects of obstructive sleep apnea by encouraging increased relaxation in your upper throat muscles and increasing the likelihood of an airway collapse at some point during sleep. Potential consequences of alcohol use in people with sleep apnea include an increased number of separate apnea events, a severe reduction in the amount of oxygen circulating in the bloodstream, and the onset of an excessive carbon dioxide concentration in the blood known as hypercapnia.
Medication’s Potential Effects
Barbiturates and benzodiazepines belong to a class of sleep-promoting, anti-anxiety medications known as sedative-hypnotics or tranquilizers. Generally speaking, barbiturates are older than benzodiazepines and come with a higher risk for various types of harmful side effects. Opioids (sometimes referred to as narcotics or opiates) are a group of medications directly or indirectly produced from mind-altering substances contained in a plant called the opium poppy. Common uses for these medications include treatment of severe pain and cough reduction.
Barbiturates and benzodiazepines induce sleepiness by directly reducing the normal rate of activity in the central nervous system, while opioids induce sleepiness as a side effect of their pain-relieving capacity. All of these medications can trigger either obstructive or central sleep apnea. Like alcohol, they can also disorient users enough to reduce their response to the immediate harmful effects of sleep apnea and increase overall risks for severe breathing disruptions, as well as instances of accidental suffocation and breathing-related fatalities. Doctors typically avoid using barbiturates, benzodiazepines or opioids in people with sleep apnea whenever possible. However, abusers of these medications (or illegal opioids like heroin) have a tendency to ignore health warnings in general, whether or not they have known cases of sleep apnea.
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