Arousals Wake You Up
Arousals are brief awakenings or partial awakenings that occur after an apneic event—where the airway is blocked and breathing stops.
During an apneic event, the upper airway becomes obstructed, causing a temporary halt in airflow. This can last from a few seconds to over a minute. As a result, oxygen levels in the blood drop and carbon dioxide levels rise. The body detects these changes in blood gases through chemoreceptors. Low oxygen (hypoxia) and high carbon dioxide (hypercapnia) levels trigger a stress response, activating the sympathetic nervous system. The body's response to the low oxygen and high carbon dioxide levels includes an increase in heart rate, blood pressure, and a brief arousal from sleep. This arousal is essentially a mechanism to restore normal breathing.
The brain's partial awakening helps to stimulate muscle tone and open the airway. After the airway is re-opened and normal breathing resumes, the individual usually falls back into sleep.
However, this process can happen 30 or more times per hour in severe cases of sleep apnea, leading to severely fragmented sleep. Frequent arousals affect sleep architecture and prevent the individual from reaching or maintaining deeper stages of sleep (like REM sleep), leading to poor sleep quality.
What happens if the airway obstruction isn’t cleared?
If airway obstruction in sleep apnea is not cleared and persists over a prolonged period, it can pose serious risks to your health, and in extreme cases, it can be life-threatening. Here's how:
Severe Hypoxia
Prolonged obstruction leads to dangerously low oxygen levels in the blood (severe hypoxia). Oxygen is critical for cellular function and survival, so a significant and sustained lack of oxygen can impair vital organ function, including the heart and brain.
Cardiac Arrest
Severe and prolonged hypoxia can lead to life-threatening arrhythmias (irregular heartbeats) or cardiac arrest. The strain on the cardiovascular system from repeated apneas and the resulting low oxygen levels can increase the risk of fatal heart conditions.
Respiratory Failure
If the obstruction is not cleared, it can lead to respiratory failure, where the body is unable to get enough oxygen or remove carbon dioxide effectively. This condition can be life-threatening if not addressed promptly.
Cerebrovascular Accidents
Severe hypoxia and stress on the cardiovascular system increase the risk of strokes. A stroke can result in sudden death or long-term severe disability, depending on its severity.
Sudden Death
In the most extreme cases, particularly with severe obstructive sleep apnea and no intervention, there is a risk of sudden cardiac death. This is often due to a combination of severe hypoxia, cardiovascular stress, and arrhythmias.
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