What is Sleep Apnea?
Sleep apnea is a serious sleep disorder affecting approximately 18 million Americans. Those with sleep apnea experience pauses in breathing lasting from ten seconds to more than a minute. These pauses (or apneas) can occur more than 30 times every hour. With increasing awareness and diagnosis, comfortable therapy for sleep apnea is widely available.
What kinds of sleep apnea exist?
Obstructive Sleep Apnea (OSA) occurs when the airway is partially blocked (hypopnea) or completely blocked (apnea) by tissue in the upper airway. OSA is the most common form of sleep apnea.
Central Sleep Apnea is much less common and involves the brain. Instead of a physical blockage, the muscles for breathing are sent incorrect messages.
Mixed or Complex Sleep Apnea describes a mixture of Obstructive Sleep Apnea and Central Sleep Apnea.
It is hard to tell the different kinds of sleep apnea apart as they have so much in common. Often a polysomnogram at a sleep center is the only way to confirm. Some of the most common sleep apnea symptoms are described below.
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Loud and/or constant snoring can be a symptom of sleep apnea. Snoring can be caused by a partially blocked airway. Although many people with sleep apnea snore, not everyone that snores has sleep apnea.
These pauses between breaths can last from ten seconds to over a minute and happen more than thirty times per hour. Although this is a very common sleep apnea symptom, the individual may not be aware of these events.
Gasping or Choking
Often a pause in breathing is followed by a feeling of gasping or choking. These events may or may not be remembered. It is usually the bed partner that notices this sleep apnea symptom.
Poor sleep at night can lead to excessive sleepiness during the day. This sleep apnea symptom can lead to falling asleep at work, while watching TV, or even while driving.
Regular awakening at night may result in difficulty staying asleep.
Emotional changes can be a sleep apnea symptom. When the mind and body are not getting good rest, this can result in mood swings, aggressive behavior, and/or feelings of depression or anxiety.
Poor sleep can result in physical suffering such as headaches in the morning hours.
Dry Throat or Mouth
Regularly waking with a dry throat or mouth can be a sleep apnea symptom. Sometimes this can be the result of snoring.
The need to urinate frequently during the night may be a symptom of sleep apnea. When someone is regularly awakened, their body releases stress hormones that send a signal to get rid of excess water.
Who’s at Risk?
Anyone can develop sleep apnea at any time. However, eight factors can help identify people who are at an increased risk for sleep apnea.
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Over 50% of those with sleep apnea are overweight or obese. Fat around the neck puts extra pressure on the airway, increasing the chances of blockage and the risk for sleep apnea.
Having a Narrow Airway
There are many reasons for a narrow airway. These include facial structure, head and neck shape, large tonsils, a large tongue, extra tissue in the throat, a large uvula, and allergies.
Sleep apnea is more common in men. Women’s risk for sleep apnea is higher during pregnancy and after menopause.
An increase in age means an increase in risk for sleep apnea. About one in every twenty five people in the general population has some form of sleep apnea. In people over the age of sixty-five, this number increases to one in ten.
Having a Large Neck
A large neck (anything over seventeen inches or 43 centimeters) puts extra pressure on the airway. When the muscles relax during sleep, this extra pressure increases the chance of blockage. This results in an increased risk for sleep apnea.
Having a Family History of Sleep Apnea
People who have a family history of sleep apnea have a greater risk of developing the disorder themselves.
The chemicals inhaled while smoking can cause irritation in the airway. A swollen airway can increase the risk for sleep apnea. Quitting smoking can reverse this effect.
Using Muscle Relaxants
Alcohol, sedatives, and tranquilizers are all muscle relaxants. Further relaxed muscles in the airway during sleep can mean an increased risk for sleep apnea.
It is important to talk to a doctor or another medical professional immediately if an individual, their bed partner, or anyone else thinks that they might have sleep apnea. A doctor can give a physical exam, collect a personal and family history, or refer a patient to a sleep center.
At a sleep center, a sleep study is done. This is a painless test that can be done in a hospital as a polysomnogram, or in the patient’s home with portable equipment. During the test, a lot of information is collected while the patient sleeps. This includes blood oxygen levels, heart rate, blood pressure, breathing, brain activity, eye movement, chest and leg movement, and air moving in and out of the lungs. This test may be done over one or two nights.
The results of the sleep study are reviewed by the sleep technician. He or she sends a copy to the doctor, explains the results to the patient, and together they work to determine the best treatment.
If the results show a diagnosis of sleep apnea, another study called a titration study is done. This will help to find the air pressure needed to keep the airway open. Usually different sleep apnea masks will be presented and the technician will show the patient how to fit them correctly. There are many kinds of masks, and not all of them will be available. In the end it is up to the patient to look into and try out different mask options until a good fit is found.
There is no cure for sleep apnea, but there are treatment options. For mild sleep apnea treatment, changes in lifestyle may be enough to decrease or get rid of symptoms. Some options include weight loss, quitting smoking, avoiding alcohol or medicines that result in feeling sleepy, avoiding supine (back) sleeping, and propping up the head and neck while sleeping.
Positive Airway Pressure
Continuous Positive Airway Pressure (known as CPAP) is the most effective sleep apnea treatment. Pressurized air is used to keep the airway open during sleep. The machine itself is the size of a shoebox or smaller and connects by a hose to a mask worn on the face. There are different kinds of masks to choose from including nasal masks, full face masks, nasal pillows, and hybrids. Different options should be tried until a comfortable fit is found. Side effects can include a stuffy nose, dry nose or mouth, sore throat, headaches, skin irritation, and stomach bloating.
There are also other kinds of positive airway pressure devices. A Bi-level positive airway pressure machine provides two different air pressures: one for breathing in and a lower one for breathing out. This can be useful at high pressures when it may be hard to exhale. An automatic positive airway pressure (APAP) machine can automatically adjust the air pressure within a set range to exactly what is needed with each breath. For example, this is an effective sleep apnea treatment for someone who experiences rare but severe apneas.
Positive airway pressure is not the best sleep apnea treatment for everyone and usually takes some getting used to. However, when used correctly, the results can be remarkable.
Oral appliances are an easy-to-use option in mild to moderate obstructive sleep apnea treatment. These mouthpieces are specially made by a dentist to open up the airway by moving the jaw, the tongue, etc. Oral appliance users should have regular check-ups to make sure that the device is fitted and working properly. Side effects may include pain and/or damage to the teeth, gums, or jaw. Their benefits include being easy to travel with, easy to wear, and easy to care for. However, they are not as effective as positive airway pressure therapies in sleep apnea treatment.
Some people may benefit from surgery for sleep apnea treatment. The surgery depends on the kind of sleep apnea.
In severe cases, a hole is cut in the windpipe and a tube is inserted. This allows the air to avoid the upper airway completely.
The operation removes the tonsils, the uvula, and part of the soft palate to create a larger airway. Snoring may decrease, but it is not always a successful sleep apnea treatment.
Laser Assisted Uvulopalatoplasty (LAUP)
A laser is used to remove the uvula and some of the soft tissue in the throat. It is intended to help treat snoring and may not be an effective sleep apnea treatment.
Pillar Palatal Implant
This non-invasive surgery is usually a snoring rather than a sleep apnea treatment. Small pieces of polyester are put in the soft palate to stiffen the tissue.
A larger airway is created by moving the lower jaw forward. This can be a good obstructive sleep apnea treatment when the cause is a narrow airway due to facial structure.
This category refers to surgeries such as fixing a deviated septum. The results may help with sleep apnea treatment in some cases.
Any of the surgeries available to treat obesity may help in the treatment of sleep apnea. In many cases the loss of excess weight may lessen or get rid of symptoms.
Your primary care physician, your sleep doctor, your Respiratory Therapist, specialists, and other healthcare professionals can provide a lot of helpful information on sleep apnea and its various forms of treatment. Family and friends can be wonderful sources of encouragement and care. Support groups and online communities are two great resources for asking questions, sharing experiences, and learning. The American Sleep Apnea Association (ASAA) has a network of A.W.A.K.E. (Alert, Well, And Keeping Energetic) groups across the country.
Helpful organizations and websites:
Sleep apnea is not curable, but it is manageable with the right therapy and especially the right outlook.