The Risk of Sleep Apnea for Quadriplegics

For many years, the N-ABLE team has heard stories about friends with quadriplegia who don’t sleep well at night or who only sleep a few hours a night.  We wondered if there was a medical reason for this. As it turns out, there is.

A new study in The Journal of Physiology tries to show why more than 70 percent of people with quadriplegia also have obstructive sleep apnea (OSA), a medical condition that causes the upper airway to narrow and close repeatedly while people are asleep.

In gist, the body’s throat muscles are impacted by quadriplegia and this can cause a sudden breathing interruption.

According to the Mayo Clinic, sleep apnea is a potentially serious sleep disorder in which breathing repeatedly stops and starts. You may have sleep apnea if you snore loudly, and you feel tired even after a full night’s sleep.

In this recent Journal of Physiology study, conducted in Australia, participants wore a breathing mask to simulate the narrowing of the airway that occurs with sleep apnea. During the study conducted at multiple sleep labs, clinicians inserted electrodes into the participants’ genioglossus, the largest muscle that surrounds the upper airway, to measure the reflex responses when an individual’s airway narrowed.

Study coordinators anticipated that reflexive responses would be similar for people who have  quadriplegia and those who do not, as medical professionals previously believed quadriplegia didn’t affect a patient’s airway.

Lo and behold, study results show that for some people with quadriplegia, “Key protective throat reflexes were absent, or indeed led to the switching off (instead of activation) of the genioglossus muscle. These findings help to explain why obstructive sleep apnea is so common in those with tetraplegia and sleep apnea.”

As the study concluded, researchers said their “observations provide valuable insight into upper airway reflex responses, and pave the way for future physiological sleep reflex studies looking to develop effective and tolerable targeted therapies for those with [quadriplegia] and sleep apnea.”

What does this mean if you have quadriplegia?

If you have quadriplegia and are experiencing sleep issues including snoring loudly, waking up suddenly, not being able to sleep well or finding yourself struggling to breathe, contact your doctor.  You may want to share this information with them and discuss potential treatment options for sleep apnea. Treatment can ease your symptoms and may help prevent heart problems and other complications.

Note: Many people don’t think of snoring as a sign of something potentially serious, and not everyone who has sleep apnea snores. But be sure to talk to your doctor if you experience loud snoring, especially snoring that’s punctuated by periods of silence. LEARN MORE

The N-ABLE team also hopes if you are having sleep issues, and you have a disability, that you’ll consult a doctor before you turn to self-medicating with sleeping pills or other over-the-counter medication, due to the complexity of this issue.

Treatment Options for Sleep Apnea

For milder cases of sleep apnea, you may only need to make lifestyle adjustments like losing weight or stopping smoking. If nasal allergies are contributing to your sleep apnea, your doctor will recommend allergy treatment too. If these actions don’t improve your symptoms or if your apnea is moderate to severe, a number of other treatments are available.

One of the most common treatments for obstructive sleep apnea may include using a Continuous positive airway pressure (CPAP) device when you go to sleep at night.

The Mayo Clinic says if you have moderate to severe sleep apnea, “you may benefit from a CPAP machine that delivers air pressure through a mask placed over your nose while you sleep. With CPAP (SEE-pap), the air pressure is somewhat greater than that of the surrounding air, and is just enough to keep your upper airway passages open, preventing apnea and snoring.”

CPAP is the most common treatment for sleep apnea, but some people find them uncomfortable. Before you give up on using a CPAP, try to adjust the tension of the device straps to get a more comfortable and secure fit.

Remember, just like other medical products, you may need to try more than one type of mask to find one that’s comfortable and works well for your individual preference and needs. Some also prefer to use a humidifier along with their CPAP system.

Whatever you do, if you are prescribed a CPAP as treatment for sleep apnea and you are a quadriplegic, don’t just give up on using the CPAP machine if you experience problems. Check with your doctor to see what adjustments can be made to make you more comfortable.

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