What’s the Big Deal? Sleep Apnea is Just Snoring…or Is It?

Discover the Impact of Obstructive Sleep Apnea (OSA) in Individuals with Intellectual and Developmental Disabilities

Sleep apnea is common. However, it is often overlooked in people with intellectual and developmental disabilities (IDD). It can have significant consequences on overall health and impact on quality of life. The key is to recognize the signs and symptoms, then report them to the primary care physician to begin the process of evaluation and management of the condition if diagnosed with sleep apnea.

Apnea literally means no breath. Sleep apnea leads to breathing interruptions during sleep. This can result in inadequate rest and lower oxygen levels in the body. The two primary types are Obstructive Sleep Apnea (OSA), which occurs when an airway is blocked due to issues such as enlarged tonsils or obesity, and Central Sleep Apnea, where the brain does not send the proper signals to initiate breathing.

Identifying OSA in those with IDD.

Often it is the support person who may notice or report signs/symptoms of OSA. These can include:

• Loud Snoring: This is a common symptom, but snoring alone does not necessarily mean that the person has sleep apnea.
• Pauses in Breathing: Observing pauses or interruptions in breathing during sleep.
• Gasping or Choking: Episodes of gasping or choking during sleep.
• Restless Sleep: Frequent tossing and turning or waking up during the night.
• Daytime Sleepiness: Excessive sleepiness or fatigue during the day.
• Behavioral Changes: Increased irritability, hyperactivity, or difficulty concentrating.
• Morning Headaches: Waking up with headaches.
• Dry Mouth or Sore Throat: Feeling dry mouth or sore throat upon waking.

If these signs or symptoms are noted, it is essential to reach out to the medical provider to discuss concerns surrounding a potential obstructive sleep apnea diagnosis. The next step would be an evaluation called a sleep study. This can confirm sleep apnea by monitoring sleep and breathing patterns. Sleep studies in general are done in a clinical environment such as a hospital, clinic, or sleep lab. This is the gold standard for testing. However, there are sleep studies that can be done in the home. The physician can determine by the information from the individual and support team which testing environment will provide the best outcome.

Challenges for People with IDD

Conducting sleep studies for individuals with intellectual and developmental disabilities (IDD) presents a range of unique challenges. They may include:

Communication Barriers – An individual with IDD may have a difficult time communicating sleep issues or discomfort during the study. They may also struggle with understanding the instructions or following guidelines for the sleep study, which can be difficult to comprehend.

Behavioral Issues – Anxiety and stress may occur due to several factors such as being in an unfamiliar environment or having to wear devices including CPAP masks or electrodes, which may be uncomfortable or frightening. They may refuse to wear the equipment necessary for the sleep study due to fear or not understanding.

Sensory Sensitivities – Many individuals with IDD experience heightened sensitivity to touch, which can complicate the application of sensors and electrodes. The noises and lighting in the sleep study environment can cause disruption of sleep and make it difficult for the individual to relax.

Pre-existing Conditions and Tips

In addition to these challenges, there can be other conditions that can affect the study including epilepsy, facial structure anomalies, a diagnosis of Down syndrome due to weakness in the neck muscles and an enlarged tongue, gastroesophageal reflux disease (GERD), and certain medications such as sedatives, antipsychotics, and stimulants.

It is important to communicate all concerns to the sleep study specialists to see if there could be adaptations made to the testing area and/or specialized equipment utilized to meet the needs of the person with IDD. The goal is to ensure the most accurate results are obtained.

It can be helpful to utilize strategies to overcome challenges that could impact the sleep study. If possible, it might be helpful to introduce the individual to the sleep study environment prior to the actual testing. Social Stories can illustrate what takes place during a sleep study. These could also help to educate the individual on what to expect. Encouraging the individual to ask questions or voice concerns regarding the testing. This can help to open conversation about any anxiety or stress they may be anticipating.

Sleep Apnea Management for People with IDD

Managing sleep apnea in IDD may require the use of positive airway pressure (PAP) such as with a CPAP/BIPAP machine. This can be challenging and may require trial of different styles to find one that will work for that person. The physician may recommend removal of tonsils and adenoids, improving sleep habits, weight loss, and management of co-occurring conditions. There are oral devices that can assist in keeping the airway open as well as an implantable device that stimulates the hypoglossal nerve to also keep the airway open while sleeping. The primary care physician and sleep specialist can aid in developing the appropriate individualized treatment plan for managing sleep apnea.

Why is it important?

Untreated, sleep apnea can impact the body as a whole. For instance, it can have a negative effect on cardiovascular health. This puts the person at risk for stroke, high blood pressure, cardiac arrhythmia, congestive heart failure, and more. It can cause poor sleep, mood disturbances, including depression and anxiety, daytime sleepiness, gastroesophageal reflux disease-GERD, diabetes mellitus type 2, and obesity.

Addressing obstructive sleep apnea in IDD requires recognizing signs/symptoms, getting proper diagnosis, and developing a personalized plan. Using effective treatments can improve overall health and quality of life for those with IDD.

For more information check out www.sleepapnea.org