Sleep Apnea

Sleep apnea is a serious, potentially life-threatening condition. It’s far more common
than thought. It happens in all age groups and both genders, but it’s more common in
men. Over 20 million Americans have sleep apnea.

Sleep
apnea is a breathing disorder characterized by brief interruptions of breathing during
sleep. There are 3 types of sleep apnea:

  • Obstructive
    sleep apnea
    happens when air can’t flow into or out of the nose or mouth
    although efforts to breathe continue.
  • Central sleep apnea happens
    when the brain fails to send the right signals to the muscles to start breathing.
    Central sleep apnea is less common than obstructive sleep apnea.
  • Complex sleep apnea. This is a mix of symptoms
    found in both central and obstructive sleep apnea.

Sleep
apnea causes involuntary breathing pauses or “apneic events” during a single night’s
sleep. There may be as many as 20 to 30 or more events per hour. Between events you may
snore. But, not everyone who snores has sleep apnea. Sleep apnea may also make you feel
like you are choking. The frequent interruptions of deep, restorative sleep often lead
to early morning headaches and excessive daytime sleepiness.

During the apneic event, you can’t breathe in oxygen or exhale carbon dioxide. This
results in low levels of oxygen and increased levels of carbon dioxide in the blood.
This alerts the brain to resume breathing and cause an arousal. With each arousal, a
signal is sent from the brain to the upper airway muscles to open the airway. Breathing
is resumed, often with a loud snort or gasp. Frequent arousals, although necessary for
breathing to restart, prevent restorative, deep sleep.

Early
recognition and treatment of sleep apnea is important, as it may be associated with:

  • Irregular heartbeat
  • High
    blood pressure
  • Heart
    attack
  • Stroke
  • Daytime
    sleepiness
  • Increased risk of motor vehicle accidents

Certain mechanical and structural problems in the airway cause the interruptions in breathing during sleep. Apnea happens:

  • When
    the throat muscles and tongue relax during sleep and partially block the opening of
    the airway
  • When the
    muscles of the soft palate at the base of the tongue and the uvula relax and sag, the
    airway becomes blocked, making breathing labored and noisy and even stopping it
    altogether
  • In
    overweight people when an excess amount of tissue in the airway causes it to be
    narrowed
  • With a
    narrowed airway, the person continues his or her efforts to breathe, but air can’t
    easily flow into or out of the nose or mouth

Sleep apnea seems to run in some families, suggesting a possible genetic basis. People most likely to have or develop sleep apnea include those who:

  • Snore loudly
  • Are overweight
  • Have high blood pressure
  • Have some physical abnormality in the nose, throat, or other parts of the upper airway

Use of alcohol and sleeping pills increases the frequency and duration of breathing pauses in people with sleep apnea.

In
either form of sleep apnea, your breathing pauses a number of times during sleep. These
are called apneic events. There may be as many as 20 to 30 or more events per hour.
Between events, you may snore. But, not everyone who snores has sleep apnea. Sleep
apnea may also cause a choking sensation. When breathing restarts, you may snort or
gasp. These frequent breaks in deep, restorative sleep often lead to headaches
and excessive daytime sleepiness.

Other symptoms include dry mouth or sore throat and problems paying attention.

A
primary healthcare provider, pulmonologist, neurologist, or other healthcare provider
with specialty training in sleep disorders may make a diagnosis and start treatment.
Several tests are used to evaluate sleep apnea, including:

  • Polysomnography. This test is done in a sleep lab. It records a variety of
    body functions during sleep. This includes the electrical activity of the brain, eye
    movement, muscle activity, heart rate, respiratory effort, air flow, and blood oxygen
    levels.
  • Home sleep apnea test. This is a portable device that can diagnose sleep
    apnea. Your doctor will arrange for you to take it home to wear during sleep and then
    it returned to the office where results are processed.

Treatment will depend on your symptoms, age, and general health. It
will also depend on how severe the condition is.

Medicines generally don’t work to treat sleep apnea. Treatment may include:

  • Oxygen.
    Giving oxygen may safely help some people, but doesn’t end sleep apnea or prevent
    daytime sleepiness. Its role in the treatment of sleep apnea is controversial.
  • Behavioral changes are an important part of treatment. In mild cases of sleep apnea,
    behavioral therapy may be all that is needed. You may be advised to:

    • Not use alcohol or tobacco.
    • Not use sleeping pills.
    • Lose weight if overweight. Even a 10% weight loss can reduce the number of
      sleep apnea events for most people.
    • Use pillows and other devices to help sleep in a side position.
  • Physical
    or mechanical therapy. Continuous positive airway pressure (CPAP) is a device used
    nightly. For this treatment, you wear a mask over the nose or mouth and nose during
    sleep. Pressure from an air blower forces air through the nose and throat.
  • Dental appliances. These can
    reposition the lower jaw and the tongue have been helpful to some people with mild
    sleep apnea, or who snore but don’t have apnea.
  • Orofacial therapy. This can help by improving the tongue
    positioning and strengthen mouth and facial muscles.
  • Surgery. Some people with sleep apnea may need surgery. Examples of these procedures
    include:

    • Surgery to remove adenoids and tonsils, nasal polyps, or other growths or
      tissue in the airway, or to correct structural deformities
    • Surgery to remove excess tissue at the back of the throat (tonsils, uvula, and
      part of the soft palate)
    • Surgery to reconstruct deformities of the upper jaw (maxilla) and lower jaw
      (mandible).
    • Surgery to treat obesity
  • Nerve
    stimulator. A newer treatment option for certain people is called a hypoglossal nerve
    stimulator. It’s an implanted device that triggers the neck muscle to tighten when
    the device detects that the airway is closing during sleep.
  • Sleep apnea is a breathing disorder tjat causes brief times when you stop breathing
    during sleep.
  • There
    are 3 types of sleep apnea: central sleep apnea, obstructive sleep apnea, and complex
    sleep apnea.
  • Sleep
    apnea seems to run in some families, suggesting a possible genetic basis.
  • Diagnosis of sleep apnea is not simple because there can be many different
    causes.
  • Medicines generally don’t work to treat sleep apnea.
  • Treatment may involve behavioral changes, weight loss, CPAP therapy, and sometimes
    surgery.

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.