Ear, Nose and ThroatRespiratorySleep / Sleep Disorders / Insomnia

Sleep apnea: What to know

Sleep apnea is a common sleep condition, in which the breathing of an person ceases periodically and continues during sleep. Symptoms include sleepiness in the daytime, heavy snoring and disturbed sleep.

The involuntary respiration pause may result from either a blocked airway or a brain signaling problem. The first type, obstructive sleep apnea (OSA) is present in most people with the disorder. Sleep apnea is known as central sleep apnea (CSA), due to a signaling problem.

Unknowingly the person will stop continuously breathing during sleep. If the airway is opened or the breathing signal is obtained, the person can snort, take a deep breath, or fully awaken with a feeling of gasping, smothering, or pain.

Untreated sleep apnea, such as heart disease and depression, can lead to potentially severe health problems. This may also leave a person feeling drowsy, when driving or working, raising the risk of accidents.

Fast facts on sleep apnea

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.

Treatment

CPAP therapy is one of the treatment choices, where air is pumped through a mask to hold the airways open during sleep.
CPAP therapy is one of the treatment choices, where air is pumped through a mask to hold the airways open during sleep.

Sleep apnea is a common problem linked to decreased overall health and increased risk of life-threatening complications such as motor vehicle accidents, concentration difficulty, depression, heart attack, and stroke.

There are different treatment methods according to the cause and level of apnea. Treatment is directed at normalizing breathing during sleep.

Apnea has the following effects on normalizing the breathing:

  • 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 changes

Changes in lifestyle are necessary to normalize breathing, and are important first steps in recovery.

They include:

  • alcohol cessation
  • smoking cessation
  • weight loss
  • side sleeping

Other options

Other treatment options include:

IContinuous positive airway pressure (CPAP) therapy: t is the frontline sleep apnea therapy. By gently delivering a steady stream of positive pressure air through a mask, it holds the airway open.

Many people have difficulty using CPAP, and interrupt treatment before any permanent gain is obtained. There are also several steps that can be taken to make the equipment more comfortable and smooth the transition process. You can adjust the mask and its settings, and adding moisture to the air as it flows through the mask may relieve nasal symptoms.

Surgery: OSA has various surgical techniques, which may enlarge the airway. Surgery can be used to stiffen or shrink obstructing tissue, or remove excess tissue or tonsils that have been enlarged. Depending on the nature of the operation, operations can be done in a doctor’s office or in a hospital.

Mandibular repositioning device (MRD): This is a custom-made oral device for people with mild to moderate OSA. During sleep, this mouthpiece holds the jaw in forward position to enlarge the space behind the tongue. It helps to hold the upper airways open, to avoid apneas and to snor.

A MRD’s side effects may include pain in the jaw or teeth and possible aggravation of temporomandibular joint disease.

Untreated sleep apnea may have serious implications and its symptoms. Any person with an extreme daytime sleepiness or other sleep apnea symptoms should ask a doctor about their symptoms.

Symptoms

A man Snoring
One of the most common symptoms of sleep apnea is snoring.

A individual with sleep apnea may be unaware of their symptoms, but someone will note that the sleeper stops breathing, unexpectedly gasps or grunts, wakes up and then goes back to sleep.

Daytime sleepiness due to disturbed sleep at night is typical symptom of sleep apnea.

Other symptoms include:

A individual who has a large neck circumference is more likely to have sleep apnea. For men this is larger than 17 inches, and for women it is greater than 15 inches.

Causes

Various factors can contribute to the blocking or collapse of the airway:

Muscular changes: The muscles that hold the airway open relax as people sleep, along with the tongue, allowing the airway to close. This relaxation usually does not prevent air from flowing in and out of the lungs, but it can do so in sleep apnea.

Physical obstructions: Additional thickened tissue or unnecessary fat stores around the airway that block the airflow, and any air that squeezes through can cause OSA-typically associated noisy snoring.

Brain function: The neural mechanisms for breathing are defective in central sleep apnea (CSA), causing dysfunction in the coordination and rhythm of breathing. CSA is generally associated with an underlying medical condition, such as a stroke or heart failure, recent rise to high altitude or the use of pain relief medication.

When the airway is completely blocked, the snoring ceases and there is no respiration for a duration of 10-20 seconds or before the brain detects the apnea and signals the muscles to relax, restoring the airflow. The respiratory delay is known as apnea.

Though this cycle occurs throughout the night hundreds of times, the person who experiences the apnea is not aware of the problem.

Risk factors

Risk factors for sleep apnea include:

  • supine (flat on back) sleeping
  • obesity
  • chronic sinusitis
  • large neck circumference
  • recent weight gain
  • menopause
  • large tonsils or adenoids
  • Down syndrome
  • smoking
  • family history of sleep apnea
  • recessed chin or large overbite

Complications

Sleep problems were also related to a variety of infections and other conditions.

These include:

  • motor vehicle accidents
  • impaired cognition and difficulty focusing
  • metabolic syndrome
  • mood changes
  • hypertension
  • stroke
  • glaucoma
  • memory troubles
  • chronic fatigue
  • decreased quality of life
  • increased risk of mortality
  • headaches
  • dry mouth or sore throat after sleeping with the mouth open

Diagnosis

Someone who feels chronically exhausted or groggy during the day should meet with a health care professional to assess both the exact cause and the measures taken to resolve the issue.

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 treated with a sleep test (night polysomnography) performed at a laboratory for overnight sleep. It tracks movements of the brain waves, eyes and legs, oxygen levels, airflow and heart rate during sleep. The examination is evaluated by a doctor who specializes in sleep disorders.

Home Sleep Apnea Testing (HSAT) can be performed for certain individuals in lieu of the laboratory test. The number of apnea episodes occurring at each hour determines the frequency of sleep apnea:

  • 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.

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