The process of sleep is closely linked to the endocrine system.
Hormones play a big role in sleep health, and full, quality sleep is important for the correct balance of hormones in the body.
Sometimes there are cases when sleep hygiene and regime, but despite this there is a feeling of constant insomnia and various manifestations of hormonal imbalance. The reason for this is inexplicable at first glance.
It is precisely such cases that are primarily caused by sleep apnea.
What is sleep apnea
This is a condition when a person stops breathing for 10-30 seconds during sleep. The number of such episodes every night can be from 5 to 30 or more per hour.
As the cessation of breathing is followed by a drop in blood oxygen levels, the brain responds by telling the body to wake up and resume breathing.
This reaction is so fast, you may not fully wake up and it will be difficult to remember these moments in the morning, but the main thing is that the quality of sleep is disturbed and it becomes impossible to fall asleep and have a full rest.
The types of sleep apnea
According to the causative mechanism, there are two types of sleep apnea, central and obstructive.
Central sleep apnea – is relatively rare and is caused by a violation of signaling connections between the brain and the muscles involved in breathing.
In the majority of cases, however, sleep apnea is of the obstructive type.
The leading factor in the development of obstructive sleep apnea is over-relaxation of the throat muscles, due to which a part of the airway (trachea) may be blocked due to the nose, tonsils or tongue moving sharply back and can no longer pass air into the lower airways.
Obstruction can also be caused by excess accumulated fatty tissue in the neck area due to obesity.
While it is not possible to make a correct diagnosis and sleep medications are prescribed to improve sleep, this further strengthens muscle relaxation and worsens the symptoms of sleep apnea, so special care and attention in this direction is required from the doctor.
Symptoms associated with sleep apnea
Symptoms that may be observed by a family member/partner during the patient's sleep:
- Frequent alternation between episodes of breathing cessation and resumption.
- Frequent and louder-than-usual snoring
Symptoms reported by the patient:
- Drowsiness and a feeling of fatigue during the day
- Difficulty concentrating, forgetfulness
- Dry mouth upon waking
- Headache
- Frequent nighttime awakenings with a sensation of breathlessness
- Frequent urination at night
- Sexual dysfunction and decreased libido
- Personality changes, anxiety, depression
Risk-factors for sleep apnea
The probability of developing sleep apnea is higher when the following factors are observed:
- Obesity - the airways are narrowed due to the presence of excess fatty tissue in the neck area.
- Male gender - although cases increase in women after menopause
- Age – it is more common in elderly people, but it can be found even in children
- Alcohol consumption - causes muscle relaxation, including in the neck area
- Sedative drugs, tranquilizers- also cause muscle relaxation
- tobacco consumption – smokers are three times more likely to have apnea than non-smokers
- Medical conditions – heart failure, high blood pressure, diabetes type 2, asthma, polycystic ovary syndrome, hormonal disorders.
Endocrine diseases and sleep apnea
Sleep apnea causes disruption of the normal secretion of some hormones, such as testosterone, estradiol, progesterone, growth hormone, aldosterone, vasopressin.
In turn, the imbalance of these hormones can lead to the development of sleep apnea or its worsening.
This chain relationship dictates the need to treat both conditions in parallel in order to achieve success in the management of each disease.
Obesity
Obesity is one of the main risk factors for sleep apnea. Overweight is present in 70% of sleep apnea cases.
Weight loss leads to a significant improvement in the sleep process.
The effect of sleep apnea itself on obesity is mixed. By certain mechanisms, it can lead to an increase in mass, and by other mechanisms, on the contrary, to a decrease. Therefore, there is a place for mass conservation to some extent.
Dysglycemia
With such a close association with obesity, it is not surprising that sleep apnea is associated with with prediabetes and type 2 diabetes. However, the connections intersect as well with type 1 diabetes, in the mechanism of the development of which excess mass does not appear at all.
Independent of obesity, sleep apnea affects insulin resistance and insulin-producing pancreatic beta cells.
When sleep apnea occurs in type 2 diabetes, there are higher fasting blood glucose numbers, higher glycated hemoglobin, and general blood sugar instability. Also deterioration of micro and macro vascular complications accompanying diabetes.
It is hypothesized that the development of sleep apnea in type 1 diabetes must be due to autonomic neuropathy as a complication of diabetes. More research is needed to fully determine this connection.
HYPOTHYROIDISM
Hypothyroidism is a common pathology, like sleep apnea, and it is possible that their coexistence just coincides, although often hypothyroidism itself is the cause of sleep apnea, and in this case its treatment leads to improvement of both conditions.
Hypothyroidism is characterized by mucopolysaccharide swelling of the mucous membranes, including the larynx, which causes mechanical obstruction of the airways and sleep apnea.
In addition, hypothyroidism itself is characterized by increased daytime sleepiness, similar to sleep apnea.
Based on the above, it is recommended that in case of confirmation of sleep apnea, the thyroid gland should be examined, and vice versa, sleep apnea should also be examined in hypothyroidism.
Growth hormone
Acromegaly is a relatively rare endocrine pathology. It usually develops due to a benign tumor of the pituitary gland, which secretes large amounts of growth hormone.
An excess of growth hormone is accompanied by the enlargement of soft tissues, bones, and cartilage, and because of this, one of the manifestations in 80% of cases is the suffocation of the airways during sleep.
Timely detection and treatment of the problem prevents irreversible changes and improves the sleep process.
Sex hormones
Sleep apnea is often associated with hypogonadism - a decrease in the function of the genital organs. The reason for this may be the disruption of signaling connections between the pituitary gland and the reproductive organs as a result of hypoxia of the brain due to sleep apnea.
As a result, during sleep apnea, there is a decrease in the amount of estradiol and progesterone in women. This fact suggests a link between sleep apnea and ovarian dysfunction and infertility, which may be reversible with sleep apnea treatment.
Also, women with polycystic ovary syndrome often have sleep apnea, which is probably related to obesity and excess visceral fat tissue.
Cortisol and aldosterone
Cortisol synthesis and release are closely related to sleep phases. Cortisol itself can also affect the sleep process.
And due to the effect on aldosterone secretion, sleep apnea can become the cause of resistant arterial hypertension.
Complications of sleep apnea
Thus, if left unattended, sleep apnea can become the cause of such big problems as:
- Heart disease, high blood pressure, arrhythmia
- Metabolic syndrome, type 2 diabetes
- Daytime sleepiness, which is particularly dangerous behind the wheel.
- Memory problems, depression
Diagnosis and treatment of sleep apnea
If sleep apnea is suspected, a polysomnographic study is performed to confirm the diagnosis, which involves monitoring the heart's work, breathing process, brain activity, and blood oxygen concentration throughout the night.
Treatment first requires management of comorbidities associated with apnea. In addition, in mild cases, it is usually enough to modify the lifestyle, which is also useful for the prevention of the disease, and includes the following actions:
- Losing weight in cases of excess weight
- Regular physical activity
- Reducing alcohol intake or giving it up
- Stop smoking
- Sleeping on your side instead of lying on your back
- Avoiding the use of sleeping aids.
In more difficult cases, in order to relieve symptoms and prevent complications, it is necessary to use a special CPAP machine, which provides continuous oxygen supply during sleep.
Author: Elga Giorgadze (MD of Endocrinology)
