Sleep apnea affects more than 22 million Americans, and about 2 – 9% of the adults have them, most of which (around 80%) are undiagnosed. A person with sleep apnea may not be clocking the entire 7 – 8 hours of sleep as they may think.
Besides the quality of sleep, sleep apnea is also a life-threatening condition that causes the patients to stop breathing intermittently. Unless you know the symptoms, you would not be able to get to take the next steps.
Our article takes you through everything you need to know about sleep apnea: the types, signs to watch out for, diagnosis, causes, risks, treatment, and much more.
What Is Sleep Apnea Syndrome?
Sleep apnea is a potentially serious sleep disorder marked by an abnormal breathing condition where the breath starts and stops throughout the sleep cycle. The starts and stops happen when there is a partial or complete obstruction in the upper respiratory system.
People with this disorder have several long lapses in breath, especially while sleeping. These pauses reduce the level of oxygen in the body and bring about poor quality sleep leading to grave health consequences. With each event, the brain awakens the sleeper, reminding him/her to breathe.
Sleep apnea is quite common in the United States. While it predominantly afflicts men, it can affect adults of both sexes and children, too.
Sleep apnea is of two types depending on the breathing:
- Obstructive Sleep Apnea (OSA): OSA is where your airway is partially or wholly blocked. In this case, your chest muscles work harder to draw air despite the block. Treatment for OSA includes weight loss, positional therapy, and other lifestyle changes.
- Central Sleep Apnea (CSA): While the airway is not blocked with central sleep apnea or CSA, the brain fails to signal the muscles to breathe. Hence you simply lack the drive to breathe, which results in reduced respiratory events. CSA is usually associated with illnesses that affect the lower brain stem, which controls breathing.
Finally, there is complex or mixed sleep apnea, a combination of both types, as mentioned earlier.
Signs and Symptoms
Though the warning signs of sleep apnea are different for obstructive and central, both share a few common symptoms. Most of these are a result of reduced oxygen levels, poor sleep, and interrupted breathing.
- Disrupted Breathing – Breathing that is disturbed repeatedly or even stops intermittently
- Daytime Sleepiness & Fatigue – You are constantly tired and exhausted even after getting 7 – 9 hours of sleep
- Restless Sleep or Insomnia – Having trouble falling asleep or remaining asleep
- Loud Snoring – Includes snorting, choking, grasping, etc.
- Mood Swings & Irritability
- Morning Headaches – Headaches akin to tension headaches or migraines
- Dry Mouth and/or Sore Throat upon Waking
- Limited Attention Span – Difficulty concentrating on simple, everyday tasks
- Heartburn – Changes in airway pressure that causes nighttime acid reflux
- Nocturia – The need to urinate multiple times throughout the night
You may want to remember that not everyone with sleep apnea snores. While snoring is the most common symptom of OSA, it is not so in the case of CSA. Generally, a person with sleep apnea is not aware of their breathing problems until their roommates’ or bed partner tells them.
While there are several reasons for sleep apnea, certain risk factors can increase the occurrence more than others. They may be the result of your lifestyle or even heredity.
- Male gender
- Large neck circumference
- Hypothyroidism (low level of crucial hormones produced in the thyroid gland)
- Family history of sleep apnea
- Post-menopausal (women)
- Small lower jaw
- Hypertension (high blood pressure)
- Large tonsils
- Alcohol misuse at bedtime
- Acromegaly (high levels of growth hormone)
To start with, you need a proper sleep apnea diagnosis from a doctor. Based on your symptoms and sleep history, he/she makes an evaluation and then most likely referred to a sleep disorder center. A sleep specialist then conducts a sleep study.
It involves overnight monitoring called a Nocturnal Polysomnography. During the test, you are hooked to equipment that monitors your:
- Brain activity
- Breathing movements
- Arm and leg patterns
- Blood oxygen level
Apart from that, you also have Home Sleep Tests where your doctor may provide you with a simple test kit that can be used at home. The tests monitor your:
- Heart rate
- Blood oxygen level
- Breathing patterns
Not every home test is successful. If the results are ambiguous, your doctor may still suggest a Polysomnography.
In case of constructive sleep apnea, your doctor may refer you to an ENT specialist (Ear, Nose, Throat) for further testing. For central sleep apnea, you may need an evaluation from a cardiologist or a neurologist.
Treatment Options for Sleep Apnea
Treatment approaches for sleep apnea vary depending on the severity.
Mild conditions may be treated via lifestyle changes such as quitting alcohol and weight loss.
However, moderate and severe sleep apnea requires medical attention in the form of devices or even surgery.
- CPAP: Otherwise called Continuous Positive Airway Pressure, the device delivers a consistent pressure slightly greater than the surrounding air. This keeps your upper airways open, preventing apnea.
- Bi-PAP: Otherwise called Bilevel Positive Airway Pressure, the device provides more pressure when inhaling and less when exhaling.
- Adaptive Servo-Ventilation (ASV): The latest treatment approach where the device learns your breathing pattern and stores the information in a built-in computer. When you fall asleep, it uses pressure to normalize the airflow.
Oral appliances are custom-fit devices used to open the airway when you sleep.
- Mandibular repositioning mouthpieces hold the upper and lower jaw in a position such that it doesn’t block the airways.
- Tongue retaining devices hold the tongue open to prevent it from blocking the airways.
- The device senses breathing patterns and mild stimulation to open the airways.
- A nerve stimulator is placed in the hypoglossal nerve, which controls tongue movement. Increased stimulation helps position the tongue properly.
Orofacial therapy helps position the tongue better and strengthen the muscles that control the face, tongue, lips, lateral pharyngeal wall, and soft palate.
Severe obstructive sleep apnea that doesn’t respond to other devices or obstructs the upper airway is treated by surgery. However, this is the final resort.
- Tonsillectomy: Surgery to remove tonsils, an organ present in the back of the throat.
- Uvulopalatopharyngoplasty: Surgery to remove tissue from the rear of the mouth and top of the throat.
- Maxillary or Jaw Advancement: Surgery to move the upper and lower jaw forward.
- Tracheostomy: Surgery to make a hole in the trachea to fit a breathing tube called a trach tube.
Unless you have a severe case, you can control sleep apnea with self-care and a few changes to your lifestyle, diet, etc.
- Quit smoking
- Reduce the use of alcohol, especially close to bedtime
- Sleeping on your side. Avoid sleeping on your back.
- Reduce weight if obese. Even a 5-10 pound loss can make a remarkable difference in sleep quality.
- Treat allergies or nasal congestion.
- Mindful diet
- Regular physical activity
- Avoid fatty foods
- Healthy sleeping habit
Obstructive Sleep Apnea
OSA is one of the common sleep disorders, so much so that 4% of American men and 2% of women have the condition. However, it is a conservative number since most cases are not diagnosed. OSA happens when the throat muscles relax and breathing stops involuntarily for a short period of time.
The warning signs of OSA include:
- Excessive daytime sleepiness
- Memory problems
- Mood swings including irritability or depression
- Loud snoring
- Difficulty concentrating on simple, everyday tasks
- Dry mouth and/or sore throat
- Episodes of stopped breaths
- Abrupt awakenings accompanied by gasping or choking
- High blood pressure
- Nighttime sweating
- Decreased libido
Obstructive sleep apnea happens when the muscles in your throat relax way too much and disrupt airflow. These muscles support the soft palate, uvula, tonsils, and tongue.
When these relax, the airways narrow or closes for maybe 10 seconds or longer. Repeated episodes can lower the oxygen levels in the blood. When your brain senses the impaired breathing, it wakes you up so that you can reopen the airway. However, the periods of awakenings are so brief that you probably do not remember them.
Central Sleep Apnea
CSA happens when your brain fails to signal the breathing muscles, and there is a lack of respiratory effort. It is common among people who have underlying medical conditions that affect the lower brain stem.
Generally, your brain sends signals to the muscles in the rib cage and the diaphragm to contract to initiate an inhalation. In the case of central sleep apnea, there is a lack of communication between the brain and these muscles.
The symptoms of CSA are pretty similar to that of OSA. However, people suffering from CSA have distinct periods of awakenings, most commonly noted by the bed partner.
Having said that, since the airway is not obstructed, there is little to no chance of snoring.
- Being tired throughout the day
- Daytime sleepiness
- Abrupt awakenings accompanied by breathlessness
- Headaches early in the morning
- Trouble concentrating
- Memory problems
- Mood swings
- Lower tolerance for exercise
- Difficulty staying asleep
CSA is common among older people over 65 years old who have underlying health conditions. People with the following conditions are highly likely to get CSA:
- Congestive heart failure
- Kidney failure
- Neurological diseases
- Damage to the brain stem due to stroke, encephalitis, etc
Health Problems due to Untreated Sleep Apnea
The quality of sleep is also vital to your well-being. Having said that, untreated sleep apnea can affect your cardiovascular and metabolic health.
- Heart attack
- Short life span
OSA vs Heart Disease
OSA increases the risk of heart disease by 30%, heart failure by 140%, and stroke by 60%. People with OSA have a reduced oxygen level in the blood, leading to stress in their heart, which negatively affects heart health.
Additionally, every time the airflow stops, the body releases stress hormones, leading to heart diseases and failure in due course. Heart diseases are the leading cause of death in the United States.
Heart diseases are also associated with obesity, the same as sleep apnea. Ironically, sleep apnea can also be the cause of an increase in weight.
Sleep Apnea Treatment without a CPAP Machine
CPAP is one of the most common treatment approaches for sleep apnea. However, it is not a very pleasant experience and can affect the quality of sleep.
Here are a few alternative methods for people who want to avoid CPAP altogether:
- Wear an oral appliance
Oral appliances work by holding the tongue in place or pulling the lower and upper jaw forward so that the airways do not collapse. You can get it fitted by a dentist specializing in sleep medicine.
Surgeries for sleep apnea may range from minimally invasive to more complex ones. Generally, the most common option is to remove the extra tissue in your throat that collapses and blocks the airways when you are sleeping. It may include:
- Soft palate and uvula
- Tonsils and adenoids
- Upper and lower jaw
Keep in mind that your jaw may be wired shut, and you would have to be on a modified diet until it heals.
- Lose your weight
In the case of obese and overweight people, weight loss can help improve the patient’s sleep. Their thick necks carry extra tissue that may block the airway.
However, there is no guarantee that it will help with your sleep apnea.
- Positional therapy
Positional therapy involves a device which when worn around your waist, helps you to stay in the side position. Sleep apnea is primarily seen when in the supine position (sleeping on their backs).
- Behavioral Changes
Consumption of alcohol and smoking can cause your airway to collapse, causing respiratory issues. The reason being alcohol relaxes your throat muscles.
In cases of allergies, a decongestant can help improve the airflow through the nose.
Sleep apnea is manageable but only when treated at the right time. Uncontrollable sleep apnea can lead to a multitude of other health conditions, which in turn can worsen your condition. The result is a vicious circle that never stops.
There are quite a few treatment approaches when it comes to controlling the signs of sleep apnea. There are no one-size-fits-all when it comes to sleep disorders. It requires a personalized and multi-faceted plan to find the one that works for you.
Make an appointment with a sleep medicine specialist to discuss your concerns, symptoms, treatment options, etc.