by D. Williams
Sleep apnea can be caused by physical blockage of the airway, which is obstructive sleep apnea, or it can be caused by the brain’s inability to properly control normal breathing, which is known as central sleep apnea. Both obstructive and central sleep apneas can occur for many different reasons, but when the causes for both obstructive and central sleep disease are experienced at the same time in a patient, it is called complex (mixed) sleep disease.
Complex sleep disease is often a wide range of problems, often stemming from a previous, untreated apnea condition. An example would be a patient who suffers from obstructive sleep disease developing chronic heart failure, leading to lower blood flow to the brain, making the brain less able to regulate breathing while asleep. In this case, the patient would then be suffering from both the obstructive sleep apneas in addition to the central sleep apnea caused by the brain’s inability to control the patient’s breathing in a normal manner. The patient would then be suffering from complex sleep apnea, which is much more disruptive to the patient’s sleep and overall health than one type of apnea alone.
Complex sleep issue’s symptoms are often more severe versions of the symptoms seen in obstructive or central sleep issue, even in mild cases, because of the compounded nature of the apneas experienced. For example, when the patient experiences an apnea due to physical obstruction of the airway, a central sleep issue may also be triggered, and for a moment the patient may not even attempt to breathe through the obstruction. The patient would then either be awakened by the lack of breathing and have his/her sleep pattern disrupted, or the patient would experience a hyperpnea (rapid, shallow breathing) to compensate for the lack of oxygen. This cycle would continue throughout the patient’s sleep, leaving the body taxed when it should have been recuperating.
Treating complex sleep apnea is a tentative and experimental field, as complex sleep apnea has only been recognized as a distinct form of apnea relatively recently. Because of this, methods of treatment are still in experimental development, as treatment of traditional sleep disorder such as CPAP and BiPAP, as well as drugs used to treat central sleep disorder, often have detrimental effects on the patient’s condition, usually worsening it.
A few of the treatments of complex sleep disorder currently in the experimental phase are a PAP Gas Modulator device, which introduces small amounts of CO2 to stabilize CO2 homeostasis in the patient, as well as an ASV device, which rapidly changes the pressure of the air the patient is receiving, evening out breathing and eliminating the erratic ventilation that would otherwise occur. Though both of these methods show promising results, only ASV has been approved by the FDA in the United States, and even then, they are both considered in experimental phase by most physicians.
Complex sleep disorder is a very intricate and complicated sleep disorder. Much care must be taken with the patient to ensure that their condition isn’t further complicated. Although conventional methods of treating sleep disorders are ineffective, science is making headway into treating complex sleep disorder, and new developments as well as current experimental treatments are constantly being advanced.
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