Trauma refers to life-threatening events that overwhelm the nervous system. The overwhelmed nervous system becomes dysregulated by ongoing continuous autonomic nervous system activity. This hyperactivation of the sympathetic or parasympathetic arms of the ANS is marked by intense sensory memories: for example, the sound of squealing tires before a crash, the image of rage on a parents face before being hit, or other smells and physical bodily sensations. A dysregulated ANS can trigger at least a dozen different sleep disorders (see chapter 1 of Putting Trauma to Sleep).
Sleep apnea, meaning “without breath during sleep,” is a serious sleep disorder that affects nearly half of individuals with PTSD.
· No trauma treatment can reverse the physical, emotional, and cognitive symptoms of sleep apnea, with its multiple health consequences.
· Apneas happen when the upper airway collapses during sleep, cutting off airflow and causing dangerous drops in oxygen levels.
· These interruptions can last from 10 seconds to minutes; the severity of sleep apnea is measured by their frequency: ‘moderate’ apnea means 15 or more of these interruptions every hour of sleep; ‘severe’ apnea means 30 or more every hour.
· Apneas are more likely during REM sleep, because body muscles are paralyzed. Oxygen drops below safe levels, and the body’s alarm LC-NE system works overtime to keep you alive.
· As apneas increase in frequency and in duration, the drops in oxygen level during sleep become threats that require an immediate sympathetic nervous system (SNS) arousal response, to awaken the sleeper so they can breathe again.
· As the condition persists, overcoming the breathing lapses results in more continuous LC-NE activation, forcing the body to wake up repeatedly to breathe.
· This results in fragmented, shallow sleep, increasing the risk of depression, anxiety and panic attacks, memory problems, heart disease, and stroke.
· The standard treatment, Continuous Positive Airway Pressure (CPAP), prevents airway collapse by gently pushing air through a mask.
· With consistent use, CPAP can help normalize sleep and across months and years it reduces these health risks.
· However, many patients struggle to use the device regularly, delaying their recovery.
· To diagnose sleep apnea, an overnight sleep study, or polysomnogram, is required. Screening tools like the STOP-BANG test can identify high-risk individuals.
· Addressing sleep apnea is essential for improving overall health and quality of life, especially for trauma survivors. See chapter 6 in Putting Trauma to Sleep for more details of how to detect, assess, and manage sleep apnea among your trauma patients.