Sleep apnea

Sleep apnea is a sleep disorder characterized by brief interruptions of breathing during sleep.

Sleep apnea is far more common than many people realize, affecting as many as 20 million Americans. It can affect anyone, at any age. If left untreated, sleep apnea can be serious or even life-threatening.

About sleep apnea

Apneic events

Sleep apnea is characterized by multiple interruptions of breathing during sleep, called “apneic events,” that can happen 20 to 30 times an hour. During an apneic event, you don’t breathe in oxygen or exhale carbon dioxide. This results in low levels of oxygen and increased levels of carbon dioxide in the blood. Your brain automatically senses these imbalances and briefly wakes you up so you can start breathing again.

These brief periods of arousal interrupt or prevent the deep restorative sleep you need to feel well-rested, resulting in sleepiness and other problems.

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Types of sleep apnea

  • Obstructive sleep apnea is when air can’t flow into or out of the nose or mouth, but the body still makes an effort to breathe. It happens when the muscles in the back of your throat (the throat muscles, soft palate, tonsils, tongue, and uvula) relax too much, which narrows the airway and prevents adequate airflow.
  • Central sleep apnea happens when the brain fails to send the right signals to the muscles to start breathing. In other words, your body makes no effort to breathe for a short period. Central sleep apnea is less common than obstructive sleep apnea.
  • Complex sleep apnea is a mix of symptoms found in both central and obstructive sleep apnea.

The severity of sleep apnea is described by the apnea-hypopnea index (AHI), which indicates the number of sleep disturbances per hour.

Mild sleep apnea has an AHI of 5-15, moderate sleep apnea has an AHI of 15 to 30, and severe sleep apnea has an AHI of more than 30. Your AHI can help your doctor determine what treatments are suitable for you.

 

Sleep apnea symptoms

Symptoms of sleep apnea include:

  • Choking or gasping while sleeping. This occurs when your brain rouses you from sleep suddenly to restart your breathing
  • Difficulty concentrating while awake.
  • Dry mouth and sore throat upon waking.
  • Excessive daytime sleepiness (hypersomnia).
  • Feeling irritable or out of control.
  • Feeling sapped of energy during the day.
  • Morning headaches.
  • Snoring. In between apneic events, you may snore. Snoring happens when air can’t move freely through the upper airway and vibrates the surrounding tissue. However, not everyone who snores has sleep apnea.
  • Waking up several times throughout the night, sometimes with the urge to urinate.
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Sleep apnea risk factors, side effects, and complications

Risk factors for obstructive sleep apnea

A risk factor is anything that increases your chance of developing a condition. Risk factors for obstructive sleep apnea include:

  • Being older.
  • Being overweight or obese.
  • Having a family history of sleep apnea.
  • Having another medical condition, such as high blood pressure, chronic lung disease, and hormonal imbalances.
  • Inheriting a narrowed throat or physical abnormality in the nose, throat, or other parts of the upper airway that obstructs normal airflow.
  • In children, having enlarged tonsils or adenoids can contribute to sleep apnea.
  • Male sex.
  • Smoking, which can cause inflammation and swelling in the upper airway.
  • Using sedatives or tranquilizers. As the names imply, these drugs cause your body and muscles to relax, which can cause or worsen obstructive apnea.

Risk factors for central sleep apnea

Central sleep apnea happens when the brain fails to send the signal to breathe. Because it is rooted in the brain, not the structure of the throat, it has different risk factors, including:

  • Being older.
  • Having a history of stroke.
  • Having a heart disorder. Congestive heart failure and having an irregular heartbeat can both increase risk of sleep apnea.
  • Male sex.
  • Using opioid medications: opioids are drugs that depress the nervous system, which can lead to sleep-disordered breathing.

Side effects and complications

Not only does sleep apnea prevent you from having a good night’s sleep, but it can also cause serious complications. These include:

  • Atrial fibrillation. Sleep apnea significantly increases your risk of developing atrial fibrillation. Atrial fibrillation occurs when the upper chambers of the heart quiver, rather than contracting normally. This allows blood to pool and clot. These clots can then cause strokes or heart attacks. Sleep apnea contributes to high blood pressure, which in turn increases the risk for atrial fibrillation. Furthermore, apnea events themselves cause abnormal heart rhythm.
  • Daytime sleepiness. Not surprisingly, this can increase your risk for motor vehicle accidents.
  • Heart disease. In addition to high blood pressure, sleep apnea is associated with coronary heart disease and even heart attacks
  • High blood pressure. when your blood oxygen levels fall, your blood pressure increases to compensate. Over time, sleep apnea may contribute to developing high blood pressure.
  • Stroke and transient ischemic attacks (“mini-strokes”). Having sleep apnea puts you at greater risk for having a stroke, which may be fatal or cause life-altering effects.

A diminished quality of life can be hard to quantify, but it’s important to consider. Sleep apnea can leave you feeling drained, moody, depressed, and unable to get work done. These feelings can impact your job, your personal life, and your mental health. Sleep apnea and the resultant snoring or gasping may inadvertently affect your partner, who may lose sleep.

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Sleep apnea in children

While sleep apnea is more common in older adults, it can also affect babies and children. Children can have either central sleep apnea or obstructive sleep apnea. Obstructive sleep apnea is more common than central sleep apnea for children, but the exact prevalence of each is unknown.

Symptoms of sleep apnea can happen during the night or during naps. Symptoms in children include:

  • Bedwetting.
  • Breathing pauses while the child is asleep.
  • Daytime sleepiness and irritability behavior.
  • Gasping, snorting, or choking during sleep.
  • Night terrors.
  • Snoring (especially for infants, who should not snore).
  • Sleepwalking.

Getting prompt treatment for sleep apnea in children is essential.

Children’s brains develop rapidly during the first few years of life, and deep sleep is needed to ensure this development. Catching and treating sleep apnea early can help prevent long-term complications.

If you are a parent and you notice the above symptoms in your baby or child, be sure to talk with your pediatrician.

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How is sleep apnea diagnosed?

If you have symptoms of sleep apnea, you should talk to your doctor. They will ask you about your symptoms, family and medical history, and sleep history. In some cases, they may ask your partner about your sleep history and habits to get a better idea of your symptoms. From there, your doctor may refer you to a sleep specialist, or a doctor who specializes in diagnosing and treating sleep disorders. They may use the following tests to diagnose sleep apnea:

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  • Polysomnogram (sleep study). These tests are usually done at sleep clinics. You are given a private room and hooked up to specialty recording equipment. These devices monitor and record your breathing, heart rate, oxygen levels, brain activity, and movement. The results are then analyzed by a sleep specialist.
  • At-home sleep apnea test. In some cases, your doctor may give you some portable equipment to use at home. This equipment collects similar information as the more advanced polysomnogram. Sometimes, the results are enough to diagnose sleep apnea.

If you have been diagnosed with sleep apnea, your doctor may refer you to another specialist to find the underlying cause. If you have obstructive sleep apnea, you may be referred to an ear, nose, and throat (ENT) specialist, who can diagnose and help treat inherited abnormalities or underlying conditions in the nose and throat. You may be referred to a cardiologist or a neurologist if you have an abnormal heartbeat or signs of central sleep apnea.

Lifestyle changes.

For mild obstructive sleep apnea (5-15 interruptions per hour), your doctor may recommend lifestyle changes, including:

  • Changing medications, like finding an alternative to sedatives.
  • Changing your sleep position and sleeping on your side.
  • Following a healthy diet and exercise routine.
  • Losing weight.
  • Quitting smoking or joining a smoking cessation program.

These lifestyle changes can also help reduce your risk of developing other, related health conditions, like high blood pressure and cardiovascular disease.

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Therapies and surgery for obstructive sleep apnea.

CPAP therapy. CPAP therapy stands for continuous positive airway pressure therapy, and it is used to help people with moderate to severe obstructive sleep apnea. Your doctor will prescribe you a CPAP machine, which is to be worn at night when you sleep. This machine is equipped with a mask, worn over your nose or mouth, and it delivers constant airflow to your throat. This keeps your throat open while you sleep, allowing you to breathe easily. While the mask and machine might take some getting used to, CPAP therapy is among the most successful treatments for obstructive sleep apnea around. There are many different shapes of masks to accommodate most face shapes. Other breathing machines,  such as bi-level CPAP and auto-CPAP, change the airway pressure based on your needs. If normal CPAP isn’t working for you, talk to your doctor about your options.

Oral appliance. Oral appliances are an alternative treatment for sleep apnea. Most oral appliances are custom-fit, and they work by holding your jaw or tongue in a certain position to keep your airway open while you sleep. You can get an oral appliance from your dentist. Oral appliances are certainly a good choice for people with mild to moderate sleep apnea, or people who have trouble using a CPAP machine.

Orofacial therapy. Orofacial therapy involves training the muscles in your mouth (including your tongue and soft palate) to reduce airway obstruction. It is a good treatment for adults and children with obstructive sleep apnea, and it can be combined with other therapies.

Surgery. In rare instances surgery is needed to treat obstructive sleep apnea. The exact type of surgery depends on your anatomy.

Addressing the underlying problem.

Central sleep apnea is usually caused by an underlying neurological or cardiovascular issue (brain infections or tumors, heart failure) Treating central sleep apnea, then, often involves treating the underlying problem. Other treatments for central sleep apnea:

  • CPAP machine or alternative breathing device: these are often prescribed for central sleep apnea alongside treatment of the underlying medical condition.
  • Implanting a nerve stimulator in the chest. This is only done for severe or life-threatening central sleep apnea. The nerve stimulator acts like a pacemaker to keep breathing regular during sleep. It monitors your breathing and stimulates the nerve connecting the brain and diaphragm if you stop breathing.
  • Reducing or changing opioid medications.
  • Taking certain prescription medications that help stimulate breathing.

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Sleep apnea outlook

Sleep apnea can take a toll on your health, your quality of life, and even your relationships.

Getting the right diagnosis and treatment is essential for preventing long-term health complications. Sometimes, you’ll have to try multiple different treatments to find one that works for you. That’s why it’s important to have an empathetic and expert team at your side.

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