OSA - Obstructive Sleep Apnea

Obstructive Sleep Apnea (OSA) is the most common type of sleep apnea and is caused by complete or partial obstructions of the upper airway. It is characterized by repetitive episodes of shallow or paused breathing during sleep, despite the effort to breathe, and is usually associated with a reduction in blood oxygen saturation. These episodes of decreased breathing, called "apneas" (literally, "without breath"), typically last 20 to 40 seconds.

Sleep Apnea and Nightmare Recall

Name of Review Item: 
The Nightmares of Sleep Apnea: Nightmare Frequency Declines with Increasing Apnea Hypopnea Index
Media Type: 
Paper
Author/Creator: 
J. F. Pagel, M.S, M.D.; Carol Kwiatkowski, Ph.D
Name of Reviewer: 
Michael C. Willis
Date of Review: 
04/01/2019
Stars: 
4
This scientific paper explores the frequency of nightmares among those to suffer from OSA, or Obstructive Sleep Apnea.
 
To begin, the nightmare is defined as "a disturbing mental experience that generally occurs during REM sleep and often results in awakening. The typical  nightmare is a coherent dream sequence that seems real and becomes increasingly more disturbing..." Nightmares can evoke all kinds of negative emotions, but the most frightening can be those where imminent physical danger can be sensed.
 
Wikipedia defines Obstructive Sleep Apnea (OSA) as "the most common type of sleep apnea and is caused by complete or partial obstructions of the upper airway. It is characterized by repetitive episodes of shallow or paused breathing during sleep, despite the effort to breathe, and is usually associated with a reduction in blood oxygen saturation. These episodes of decreased breathing, called "apneas" (literally, "without breath"), typically last 20 to 40 seconds."
 
This paper's purpose is to clarify the correlation between the severity of OSA and the frequency of nightmare recall in a large selection of patients in a laboratory setting. Over a two year period, a selection of 393 patients were observed polysomnographically at an American Academy of Sleep Medicine (AASM) accredited sleep laboratory. The patients were surveyed about their dreams and nightmares with general sleep questions incorporated into the questionnaire so as to minimize skewed reporting by the patients. The age range was normally distributed, and 33% were female, 67% male. OSA usually affects men more than women - please see the Wikipedia page for details.
 
REM sleep is the stage most susceptible to abnormal breathing events, so we could say that OSA "selectively suppresses" REM sleep because the cognitive ability to remember REM sleep experiences is diminished in patients with more severe OSA. Nightmares are generally thought to occur during REM sleep, while other dreaming happens at all stages of sleep. The scientists who conducted this study concluded that because people with severe apnea are not able to remember their REM sleep dreams as well as people with less severe (or no) apnea, that this is the reason nightmare recall among those diagnosed with severe OSA was acutally found to decrease linearly with the severity of diagnosis of Obstructive Sleep Apnea. And, this happens independently of normal dream recall.
 
People might be tempted to say this is a good thing - after all, if you can't remember your nightmares as much, wouldn't that mean a better quality of life? Not really, folks. Quoting from the paper, "OSA is known to result in cognitive deficits that include declines in working memory and deficits in frontal cortex executive functions"
 
If you suffer from sleep apnea and your blood oxygen saturation drops during the night because your breathing slows or stops periodically, you could be causing damage to your body which could mean secondary cognitive and alertness issues for yourself. Lots of OSA sufferers report being sleepy a lot during the day. I know when I'm sleepy, my brain is usually not functioning at its best. This can lead to all sorts of problems if left untreated: irritability, poor work performance, even falling asleep at the wheel.
 
In conclusion, we can now say that as the severity of a person's OSA goes up, their ability to remember nightmares goes down due to diminished cognitive process around the incorporation of REM sleep dreams into waking life. This is because nightmares typically happen during REM sleep and REM sleep acitivity is most affected by OSA. And contrary to what one might think, this is not a good thing because it means your overall ability to remember your REM sleep dreams goes down while the disease causes other kinds of problems for your body.
 
 

Obstructive Sleep Apnea and Dreaming

WHILE OUR MAIN FOCUS HERE IS THE REMEMBRANCE AND EVENTUAL conscious participation in our dream life I am also quite interested in anything related to type and quality of sleep, what makes it better or worse, and how to set up the best circumstances for the most conscious activity while dreaming. One major factor in many peoples’ lives – up to 18 million people in the USA alone – is the condition known as OSA or obstructive sleep apnea. This is a condition in which the air passages in the throat droop and close during sleep and thereby prevent clear passage of air or it may even prevent any air passage. This leads to the sleeper awakening sometimes gasping for air potentially many times a night and effectively keeps the individual from getting a healthy night’s sleep. Snoring to the extent that one’s sleep partner may not be able to sleep and has to temporarily or permanently move to another room. OSA can also be very stressful for the partner when hearing the sufferer stop breathing and then struggling to inhale through blocked passages. Even if a person is in bed and essentially unconscious for 7-8 hours if OSA is experienced she or he can awaken sometimes feeling less rested than when she went to bed. This can cause headaches in the morning and bouts of overwhelming drowsiness during the workday which causes the experiencer to struggle to stay awake for even the simplest of tasks. This drowsiness becomes a dangerous condition when it descends on someone while she's driving an automobile.

Because of the constant interruption of sleep the approximately 20% of REM (rapid eye movement) sleep, considered to be the period of most active dreaming, is interrupted. This can cause a significant reduction of dream recall such that OSA sufferers are only about 43% likely to remember dreams compared to the 71% of non-sufferers.* OSA leads to other complications such as reduced memory, increased risk of depression, obesity and stroke and heart disease.

In some increased stress and anxiety can worsen the condition. It can also increase a propensity for nightmares of the dreams that are remembered. OSA is also sometimes correlated with obesity but often times it is not. As such improvement of one’s diet and caloric intake could reduce OSA to a non-threatening level but that is not yet completely proven to be true.

Positive diagnosis of OSA is accomplished by an overnight test performed at a hospital sleep clinic. In this situation the “patient” has numerous sensor wire leads (electrodes) attached at strategic points of the body so heartbeat, respiration, blood oxygen level all can be monitored by a team during an overnight stay and sleep session at the clinic. Sounds of breathing are recorded and analyzed in conjunction with the resulting data collected from the body and a diagnosis is derived from this.

A simple way to do an initial diagnosis of OSA – in addition to observing the various symptoms noted above – is to use some sort of an app in ones cell phone that monitors the sounds of breathing overnight and produces an graph and assessment of sleep quality and activity the next morning. If your mate tells you that you snore and you don’t believe it such apps will tell you the truth when you hear the recording of yourself snoring like a freight train the next morning.

A remedy for OSA commonly in use these days is a CPAP (constant positive air pressure) machine. Various nose pads or breathing masks are used to maintain a small positive pressure above atmospheric pressure of your room such that the lungs and airway remain more inflated and therefore open than they otherwise would with OSA. This prevents breathing stoppage and sleep interruption. These systems must be adjusted to each user by qualified physicians and technicians to optimize each person’s sleep experience.

If you think you suffer for obstructive sleep apnea it is recommended you speak with your physician to arrange an overnight diagnosis at a sleep clinic so you can get a proper assessment. This could significantly improve your quality of sleep and life (as well as in extreme cases possibly lengthen or save a life!) And it could significantly increase your ability to remember your dreams and thereby help you make major progress in extending your consciousness into the subtle world by removing this difficult obstacle!

* See this URL for the full paper reporting the study: http://jcsm.aasm.org/viewabstract.aspx?pid=27713