Sleep Apnea

Sleep Apnea
Symptoms, Causes, Diagnosis, and Treatment

Sleep apnea, a disruption of breathing while asleep, is a deceiving sleep disorder - 90% of people who have sleep apnea don't know that they have it! Although episodes of choking or gasping for air might occur hundreds of times throughout the night, you may not have any recollection of struggling for breath.

Usually it is the bed partner who first notices that the person is struggling to breathe. If left untreated, this common disorder can be life-threatening.


Signs and symptoms of sleep apnea
Warning signs and symptoms of sleep apnea include:

* Frequent silences during sleep due to breaks in breathing (apnea)
* Choking or gasping during sleep to get air into the lungs
* Loud snoring
* Sudden awakenings to restart breathing or waking up in a sweat
* Daytime sleepiness and feeling unrefreshed by a night’s sleep, including falling asleep at inappropriate times



What happens when you have an episode of sleep apnea?
When you stop breathing during sleep due to sleep apnea, the balance
of oxygen and carbon dioxide in the blood is upset. This imbalance stimulates
the brain to restart the breathing process. The brain signals you to wake up so
that the muscles of the tongue and throat can increase the size of the airway.
Then, carbon dioxide can escape, and oxygen can enter the airway. These waking episodes are necessary to restart breathing (and to save your life), and you may not remember them, but they do disrupt your sleep and cause daytime exhaustion.





Is snoring the same as sleep apnea?

Snoring is not the same as sleep apnea. Snoring is simply
a loud sound that you make during breathing while asleep if there is any
obstruction in your airway. While it may be unpleasant for your sleep partner,
snoring is not in itself a harmful condition. On the other hand, people with
sleep apnea are deprived of oxygen due to a complete blockage of airways, which can have a major impact on health. Snoring does often accompany sleep apnea, but just because you snore does not mean you have sleep apnea.



Obstructive Sleep Apnea (OSA)

OSA is the most common type of sleep apnea. It is caused by a breathing obstruction, which stops the air flow in the nose and mouth. The rest of this article discusses the causes, symptoms and treatments for OSA.



Central Sleep Apnea (CSA)

Central sleep apnea (CSA), less common than OSA, is a central nervous system disorder that occurs when the brain signal telling the body to breathe is delayed. CSA can be caused by disease or injury involving the brainstem, such as a stroke, a brain tumor, a viral brain infection, or a chronic respiratory disease. People with CSA seldom snore. However, while the causes of apnea are different in CSA and OSA, the symptoms and results are much the same – a deprivation of oxygen and poor sleep. The treatments for CSA include medications that stimulate the need to breathe and administration of oxygen.



Causes and risk factors of obstructive sleep apnea

When you have obstructive sleep apnea, your throat collapses during sleep, blocking the airway and preventing air from getting to the lungs. Generally, your throat muscles keep the throat and airway open.


Primary causes and risk factors of obstructive sleep apnea
* Being overweight or obese (although 50% of people with sleep apnea are not obese)
* Large tonsils or adenoids
* Other distinctive physical attributes (deviated septum, shape of head and neck, receding chin, enlarged tongue)
* Nasal congestion or blockage (from cold, sinusitis, allergies, smoking, etc.)
* Throat muscles and tongue relax more than normal during sleep (possibly due to alchohol or sedatives or age)
Obstructive sleep apnea does seem to run in families which may be a result of anatomic abnormalities or medical conditions that are genetic.


Effects of sleep apnea on health
Sleep apnea has serious health consequences and can even be life-threatening. The main effects of sleep apnea are sleep deprivation and oxygen deprivation.


Sleep deprivation
Sleep deprivation hurts the person with sleep apnea and the bed partner. Frequent waking, whether remembered or not, causes fitful sleep and prohibits therapeutic rest. A bed partner may lose an hour or more of sleep each night from sleeping next to a person with sleep apnea. Along with the apnea episodes, side effects like excessive sweating and a frequent need to urinate disrupt sleep. Often, a person with sleep apnea will wake up feeling like they have not slept or have difficulty staying awake during the day. Some trickle-down effects of sleep deprivation include a compromised immune system, poor mental and emotional health, and irritability.


Oxygen deprivation
When you stop breathing, your brain does not get enough oxygen. Serious problems can result from the oxygen deprivation of sleep apnea, including heart disease, high blood pressure, sexual dysfunction, and learning/memory problems.


Depression and sleep apnea
Approximately one in five people who suffer from depression also suffer from sleep apnea, and people with sleep apnea are five times more likely to become depressed. Existing depression may also be worsened by sleep apnea. While it is not clear whether the apnea causes the depression or vice-versa, studies show that by treating sleep apnea symptoms, depression may be alleviated in some people.


Diagnosing sleep apnea
If you suspect you have sleep apnea, there are a few things that you might do before going to see a doctor or sleep specialist.


1. Keep a sleep diary – For a few nights, you or a sleep partner can record if you are snoring and how loud your snoring is, how well you are sleeping, whether you are having trouble breathing (choking or gasping), and whether you feel refreshed in the morning.
2. Record yourself sleeping – Recording yourself can be a helpful tool for your doctor. You can use a sound-activated audio recorder or a software program that turns your computer into a recorder.
With your sleep record in hand, consult a knowledgeable doctor or a sleep specialist. If your doctor suspects sleep apnea, you will probably be sent for an overnight sleep study in a sleep clinic (also known as a sleep lab or sleep center). Sleep tests in a sleep clinic help to diagnose sleep apnea by measuring how frequently you stop breathing.




Self-help treatment for sleep apnea
Minor sleep apnea is responsive to self-help remedies, or “behavioral treatments.” Some of the following self-help treatments for sleep apnea may work for you.


* Lose weight. Overweight individuals who lose even 10% of their weight can reduce sleep apnea and improve sleep quality.
* Stop using alcohol, tobacco, and sedatives, or anything that relaxes the muscles of the throat and encourages snoring.
* Sleep on your side. Special pillows or remedies that encourage side-sleeping, such as the “tennis ball trick,” might help people who only experience sleep apnea when they sleep on their back. See Snoring Causes and Cures for more tips.
* Elevate the head of your bed 4 -6 inches. This can alleviate snoring and make breathing easier.
* Maintain regular sleep hours.
* Use a nasal dilator, breathe right strips or saline nasal spray to help open nasal passages.


Treatment for sleep apnea


CPAP (Continuous Positive Airway Pressure)
CPAP is the most widely recommended treatment for moderate to severe obstructive sleep apnea. CPAP entails wearing a mask-like device while you sleep, which provides pressurized air to prevent the airway from collapsing. Most CPAP units are the size of a tissue box and many now come with a built in humidifier for comfort.


While CPAP works very well in preventing apnea symptoms, many people find the apparatus uncomfortable and difficult to use. Luckily, recent advancements to CPAP technology have made these once cumbersome devices much lighter, quieter and much more comfortable. Recent refinements include options such as


* “bilevel PAP,” which switches from higher to lower air pressure during the exhalation, making breathing easier for some,
* “AutoPAP”, which uses an internal regulator that adjusts pressure rather than remaining at one fixed setting.


Different types of masks are available and can make using the device more comfortable CPAP can cost $1000 or more - but they are usually effective when used correctly. Unfortunately, many people don’t receive proper coaching and guidance for using these breathing devices, and give up on them quickly.


The following tips may help you use CPAP more comfortably and successfully:


* Take your time. Start by using your CPAP for short periods during the day. Use the “ramp” setting to gradually increase air pressure.
* Make small adjustments to the mask, tubing and straps to find the right fit. Soft pads are available to cover the straps and reduce skin irritation.
* Try masks of different sizes and types. A full mask might work better if you breathe through your mouth. A mask with nasal pillows should decrease nose discomfort. A mask with a chin strap will help keep your mouth closed and reduce throat irritation.
* Put your CPAP unit under the bed if the noise bothers you.
* Use a humidifier with the CPAP unit (or get a unit with a humidifier) to decrease dryness and skin irritation. Try a special face moisturizer for dry skin.
* Try a saline nasal spray or a nasal decongestant for nasal congestion.
* Keep your mask, tubing and headgear clean. Replace CPAP and humidifier filters regularly.
* Work with your doctor or sleep specialist to ensure the right fit and find the right settings on your CPAP unit.
* Find a support group or others who use CPAP to exchange tips and give and receive moral support.
* Use the CPAP consistently – every night and during every nap. This will make the adjustment easier and ensure maximum benefit.


Dental appliances, oral devices, and lower jaw adjustment devices
Most dental devices are acrylic and fit inside your mouth, much like an athletic mouth guard or orthodontic appliance. Others fit around your head and chin to adjust the position of your lower jaw. Two common oral devices are the Mandibular Repositioning Device and the Tongue Retaining Device. These devices open your airway by bringing your lower jaw or your tongue forward during sleep.


While oral devices are less cumbersome than CPAP and relatively simple to use, they are only effective for mild to moderate sleep apnea. There are also a number of troubling side effects from using this type of treatment – soreness; damage to/permanent change in position of the jaw, teeth, and mouth; saliva build-up; and nausea. It is very important to get fitted by a dentist that specializes in sleep apnea, and to see the dentist on a regular basis for any dental problems that may occur.


Surgery as treatment
Surgery can increase the size of your airway. The surgeon may remove tonsils, adenoids, or excess tissue at the back of the throat or inside the nose. Or, the surgeon may reconstruct the jaw to enlarge the upper airway.


Surgery may be an effective option for some, and can even provide permanent relief from symptoms. However, any surgery carries risks of surgical complications and infections, and in some rare cases, symptoms can become worse after surgery. If you have exhausted other apnea treatment options, you may want to discuss surgical options with your doctor or sleep specialist.