What you need to know about sleep apnea
The involuntary pause in breathing can result either from a blocked airway or a signaling problem in the brain. Most people with the condition have the first kind, obstructive sleep apnea (OSA). Sleep apnea due to a signaling problem is known as central sleep apnea (CSA).
The person will unknowingly stop breathing repeatedly throughout sleep. Once the airway is opened or the breathing signal is received, the person may snort, take a deep breath, or awaken completely with a sensation of gasping, smothering, or choking.
Untreated sleep apnea can lead to potentially serious health complications, such as heart disease and depression. It can also leave a person feeling drowsy, increasing the risk of accidents while driving or working.
Here are some key points about sleep apnea:
- Around 1 in 5 adults have mild symptoms of obstructive sleep apnea (OSA), while 1 in 15 have moderate-to-severe symptoms.
- Approximately 18 million Americans have this condition, but only 20 percent have been diagnosed and treated.
- Menopausal and postmenopausal women have an increased risk of OSA.
- Sleep apnea is an independent risk factor for hypertension (high blood pressure).
- While sleep apnea is more prevalent in those aged 50 years and above, it can affect people of all ages, including children.
One of the treatment options is CPAP therapy, where air is pushed through a mask to keep the airway open during sleep.
Sleep apnea is a common problem associated with decreased overall health and a higher risk of life-threatening complications, such as motor vehicle accidents, difficulty concentrating, depression, heart attack, and stroke.
Depending on the cause and the level of apnea, there are different methods of treatment. The goal of treatment is to normalize breathing during sleep.
Normalizing breathing has the following effects on apnea:
- It eliminates daytime fatigue.
- It removes unwanted mental health changes from apnea or lack of sleep.
- It prevents cardiovascular changes caused by the excess strain of improper breathing.
Lifestyle modifications are essential to normalizing breathing, and they are critical first steps in treatment.
- alcohol cessation
- smoking cessation
- weight loss
- side sleeping
Other treatment options include:
Continuous positive airway pressure (CPAP) therapy: This is the frontline treatment for sleep apnea. It keeps the airway open by gently providing a constant stream of positive pressure air through a mask.
Some people have trouble using CPAP and stop the treatment before achieving any lasting benefit. However, there are many measures that can be taken to make the equipment more comfortable and the adjustment period smooth. The mask and its settings can be adjusted, and adding moisture to the air as it flows through the mask can relieve nasal symptoms.
Surgery: There are various surgical procedures for OSA that can widen the airway. Surgery can be used to stiffen or shrink obstructing tissue, or remove excess tissue, or enlarged tonsils. Depending on the extent of the surgery, procedures can be carried out in a doctor's office or a hospital.
Mandibular repositioning device (MRD): This is a custom-made oral appliance suitable for individuals with mild or moderate OSA. This mouthpiece holds the jaw in a forward position during sleep to expand the space behind the tongue. This helps keep the upper airway open, preventing apneas, and snoring.
Side effects of an MRD may include jaw or tooth pain, and potential aggravation of temporomandibular joint disease.
Untreated sleep apnea and its effects can have severe consequences. Any individual with excessive daytime sleepiness or other symptoms of sleep apnea should ask a doctor about their symptoms.
One of the most common symptoms of sleep apnea is snoring.
A person with sleep apnea may be unaware of their symptoms, but another person may notice that the sleeper stops breathing, suddenly gasps or grunts, wakes up, and then goes back to sleep.
A common symptom of sleep apnea is daytime sleepiness due to interrupted sleep at night.
Additional symptoms include:
- restless sleep or insomnia
- difficulty concentrating
- loud snoring
- waking up several times a night to urinate
- awakening with a dry mouth or sore throat
- morning headache
- decreased libido and erectile dysfunction
A person is more likely to have sleep apnea if they have a large neck circumference. This is greater than 17 inches for men, and greater than 15 inches for women.
Various factors can contribute to the blocking or collapse of the airway:
Muscular changes: When people sleep, the muscles that keep the airway open relax, along with the tongue, causing the airway to narrow. Normally, this relaxation does not prevent the flow of air in and out of the lungs, but in sleep apnea, it can.
Physical obstructions: Additional thickened tissue or excessive fat stores around the airway can restrict the airflow, and any air that squeezes past can cause the loud snoring typically associated with OSA.
Brain function: In central sleep apnea (CSA), the neurological controls for breathing are faulty, causing the control and rhythm of breathing to malfunction. CSA is usually associated with an underlying medical condition, such as a stroke or heart failure, recent ascent to high altitude, or the use of pain relief medication.
When the airway becomes completely blocked, the snoring stops and there is no breathing for a 10-20 second time period or until the brain senses the apnea and signals the muscles to tighten, returning the airflow. This pause in breathing is known as apnea.
Although this process continues hundreds of times throughout the night, the individual experiencing the apnea is not conscious of the problem.
Risk factors for sleep apnea include:
- supine (flat on back) sleeping
- chronic sinusitis
- large neck circumference
- recent weight gain
- large tonsils or adenoids
- Down syndrome
- family history of sleep apnea
- recessed chin or large overbite
Sleep disorders have also been associated with a number of complications and other conditions.
- motor vehicle accidents
- impaired cognition and difficulty focusing
- metabolic syndrome
- mood changes
- memory troubles
- chronic fatigue
- decreased quality of life
- increased risk of mortality
- dry mouth or sore throat after sleeping with the mouth open
Anyone who feels chronically tired or groggy during the day should consult a medical provider to determine both the exact cause and necessary steps to address the problem.
Common questions they might ask include:
- What is your typical sleep schedule on weekdays and weekends?
- How long does it take you to fall asleep?
- Are you taking any medications to help you sleep?
- How much sleep do you think you get each night?
- Has anyone told you that you snore?
- Do you wake up with a feeling of panic or jolt awake?
- How do you feel when you wake up?
- Do you nod off easily when watching television or reading?
- Does anyone in your immediate family have a diagnosed sleep disorder?
- Describe your sleep environment.
Sleep apnea is diagnosed with a sleep study (nocturnal polysomnography) carried out at an overnight sleep laboratory. This records brain waves, eye and leg movements, oxygen levels, airflow, and heart rhythm during sleep. A physician who specializes in sleep disorders interprets the test.
For some individuals, Home Sleep Apnea Testing (HSAT) can be done in place of the laboratory study. The number of apnea episodes that occur every hour determines sleep apnea severity:
- Normal - 0-5 apnea episodes per hour.
- Mild sleep apnea - 5-15 apnea episodes per hour.
- Moderate sleep apnea - 16-30 apnea episodes per hour.
- Severe sleep apnea - 31+ episodes per hour.