Sleep apnea

Sleep apnea is a sleep disorder that has potentially serious effects on a person’s health. It happens when a person’s breathing fluctuates while they’re sleeping. Sometimes, breathing can actually stop during sleep, indicating that the brain and the body may not be getting ample oxygen.

What are the signs and symptoms of sleep apnea?

The signs and symptoms of sleep apnea may vary depending on the type; however, there are some that overlap such as the following:

  • Jolting awake all of a sudden because of shortness of breath
  • Insomnia
  • Hypersomnia (being really sleepy during the daytime)
  • Loud snoring
  • Breathing stops while sleeping (usually noticed or witnessed by those who sleep with a companion)
  • Waking up with a sore throat or dryness around the mouth
  • Headaches in the morning
  • Problems focusing
  • Being easily irritated

If a person or their partner notices the following symptoms, they should immediately seek the help of a medical professional:

  • Snoring becomes so loud that it disrupts the sleep of people around them
  • Choking or gasping of air in the middle of sleep
  • On and off breathing while asleep
  • Hypersomnia becomes to excessive, to the point that a person falls asleep while working, or worse, while driving or operating heavy machinery.

Types of sleep apnea

There are three types of sleep apnea:

 

  • Obstructive sleep apnea – the most common type that happens when a person’s throat muscles relax during sleep
  • Central sleep apnea – happens when the brain fails to send signals to muscles in the body that control breathing
  • Complex sleep apnea syndrome – also called “treatment-emergent central sleep apnea” and happens when a person has a combination of obstructive sleep apnea and central sleep apnea.

 

 

What causes obstructive sleep apnea?

Obstructive sleep apnea happens when the muscles at the back of the throat relax during sleep. These are the muscles that provide support to the soft palate , the uvula, tonsils, tongue, and the muscles on either sides at the back of the throat

 

When this happens, a person’s airway narrows down or even closes during inhalation, making it difficult to get enough oxygen while asleep. This can potentially lower the oxygen levels in a person’s blood. The brain will then sense the deprivation of oxygen in the blood that it signals the body to wake up so it could get enough air.

 

A person can snort, choke, or gasp during sleep when they experience obstructive sleep apnea and it can happen from five to thirty times (sometimes even more) per hour. These disruptions during sleep can wreak havoc to a person’s system and can affect how they go about during their waking hours.

 

When a person has obstructive sleep apnea, they are unaware that their sleep gets interrupted multiple times during the night. It’s not that surprising for these people to be convinced that they’re actually getting ample sleep until they get diagnosed.

 

What causes central sleep apnea?

Central sleep apnea is a less common form of sleep apnea that occurs when your brain fails to transmit signals to your breathing muscles. This means you make no effort to breathe for a short period of time. You may awaken with shortness of breath or have a difficult time getting to sleep or staying asleep.

 

Central sleep apnea is uncommon than obstructive sleep apnea. This happens when the brain doesn’t effectively send signals to the muscles responsible for breathing. A person can end up not breathing during a short period of time during sleep. They tend to suddenly jolt awake, out of breath. They also don’t get to sleep through the night or find it difficult to fall asleep.

 

Risk Factors

 

Sleep apnea can be experienced by anybody, even by young children. However, there are factors that can increase a person’s chances of getting sleep apnea:

 

Obstructive sleep apnea

 

  • Overweight people – An overweight or obese person is four times more likely to get sleep apnea because fat deposits around the upper airway may hinder the breathing.
  • Thicker neck – If someone has a thicker neck, it means that they may have narrow airways. Men who have 17 inches or larger neck circumference may have sleep apnea. While women are more at risk when their neck measures around 15 inches or more.
  • Narrow airways – Sometimes, people are just born with narrow airways because of hereditary traits. On the other hand, the tonsils can get enlarged and block someone’s airways, especially in children.
  • Being a man – Men are more likely to develop sleep apnea compared to women. However, overweight and post-menopausal women are also at risk for the condition.
  • Older people – Sleep apnea has been observed to occur more frequently amongst older people.
  • It runs in the family – Sleep apnea can be inherited in families.
  • Alcoholics and substance abusers – Alcohol, sedatives, and tranquilizers can relax the throat muscles, which can obstruct breathing during sleep.
  • Smokers – Smokers are three times more likely to get sleep apnea, as nicotine can increase the inflammation of muscles and fluid retention in the airway. However, the risk significantly drops upon quitting.
  • Colds, allergies, or sinusitis – If a person has difficulty breathing through their nose, they’re more likely to experience obstructive sleep apnea.

Central sleep apnea

 

  • Older people – people who are in their middle age or older are at a higher risk of getting central sleep apnea.
  • Heart issues – If someone has a congestive heart ailment, they are more at risk of getting the condition.
  • Use of narcotics for pain management – opioids such as methadone are found to have a significant effect in enabling central sleep apnea in a person.
  • History of stroke – a person who has had a stroke are more likely to get central sleep apnea.

 

Complications

 

Experts consider sleep apnea as a serious condition which may include the following complications:

 

 

  • Extreme fatigue during the daytime – The on and off sleep cycle that comes with sleep apnea makes it impossible for a person to get a full night’s rest. As a result, they tend to feel severely groggy or drowsy during the day. They find it difficult to focus on tasks such as working, watching TV, and even driving. Along with this comes the risk of getting into vehicular and workplace accidents due to lack of sleep. People with sleep apnea may also feel an increased level of irritability and depression. For children with the condition, they may have poor performance in school or even behavioral issues.
  • Hypertension and heart issues – The sudden drop of oxygen in the blood during sleep apnea increases blood pressure and put strain on the cardiovascular system. For those with obstructive sleep apnea, they are more at risk of developing hypertension, recurrent heart failures, and arrhythmia (abnormal beating of the heart.) There is also an increased chance of stroke. As for those who already have an existing cardiovascular issue, the constant dropping of oxygen levels in the blood can lead to a sudden cardiac arrest due to the irregularity of heartbeats.
  • Type 2 Diabetes – People who suffer from sleep apnea have a tendency to develop a resistance from insulin and to be diagnosed with type 2 diabetes.
  • Metabolic syndrome – This condition is actually a result of a myriad of risk factors that are connected to being at a higher risk of getting heart disease. These risk factors include hypertension, high cholesterol, and hyperglycemia.
  • Complications resulting from surgery and medications – Obstructive sleep apnea becomes a concern for people who need to undergo general anesthesia or are prescribed with certain medications, as they are more likely to develop complications and issues after a major surgery due to breathing problems while lying on their backs. It’s important to inform doctors of any possible issues with sleep apnea so it could be remedied prior to undergoing major surgery.
  • Liver issues – People with sleep apnea tend to get abnormal or fluctuating results when their liver’s function gets tested, as their livers may have some signs of scarring (also known as non-alcoholic fatty liver disease)
  • Marriage/Relationship troubles – This is one of the most common but less talked about complication of sleep apnea. The loud snoring and constant anxiety can keep people around those with the condition sleepless. Many partners tend to sleep in another room or even get frustrated with the relationship due to sleep deprivation.

 

Diagnosis

 

 

If someone is starting to show symptoms of sleep apnea, a doctor may ask them to have a nocturnal polysomnography or a sleep apnea test, which can be done in a medical facility or at home. It’s a test with multiple components that evaluate physical activities during sleep.

 

If done at a facility, the patient gets hooked up to multiple machines and equipment that monitor activities in the heart, lung, and the brain. Breathing patterns, blood oxygen levels, and movement of the limbs are also monitored during sleep. As for those who opt to do it at home, doctors often provide simple tests instead that involve the measuring of heart rate, airflow, breathing patterns, and blood oxygen levels. However, if results are found to be abnormal, a doctor may have to prescribe a full nocturnal polysomnography at a facility to double check the possibility of sleep apnea.

 

A sleep specialist will then analyze the results and determine if a person has sleep apnea or a different sleeping disorder. An additional sleep testing might be required if a person is found to have sleep apnea in order to determine the most adequate treatment.

 

If diagnosed with obstructive sleep apnea, a referral to an ear, nose, and throat doctor will be provided in order to check for any blockages within the system. As for central sleep apnea, a cardiologist or a neurologist will be necessary to determine the causes.

 

 

Treatment

 

For milder versions of sleep apnea, doctors may prescribe lifestyle changes such as weight loss, quitting smoking, or treatment for nasal allergies. For those with moderate to severe sleep apnea, devices may be recommended for use during sleep, or alternatively, therapies and surgery, which may include:

 

Therapies

  • Continuous positive airway pressure (CPAP) – This therapy is for people who have moderate to severe cases of sleep apnea. A CPAP machine delivers air pressure to the body via a mask that is worn over the nose during sleep. This machine keeps the upper airways passages from closing in, preventing apnea and snoring.This is the most common and effective way of treating sleep apnea, but some patients may find sleeping with the mask uncomfortable and end up giving up on the therapy altogether. As a solution, there are different variations of the CPAP mask that’s available so a patient can find something that’s most suitable to them. Doctors encourage patients to reach out instead of stopping therapy when they find it difficult to use the machine so they can provide modifications.
  • Expiratory positive airway pressure (EPAP) –These are small, disposable devices that are placed over the nostrils prior to going to sleep. It’s a valve that lets air enter the body freely, but upon exhalation, forces the air to expel through small holes on the device, increasing the pressure in the airway and keeping it from closing down.EPAP helps reduce snoring and keep a patient with obstructive sleep apnea asleep. It’s also an alternative option for those who don’t like their CPAP device.
  • Treating causes of sleep apnea – Associated medical issues such as heart problems or neuromuscular disorders can always be treated first before using devices, as sometimes, these ailments are the main causes of sleep apnea, especially for those who have central or complex sleep apnea.
  • Oxygen supplementation – Using an oxygen tank while sleeping can help alleviate central sleep apnea. There are different types of oxygen and associated devices/masks that can be used to ensure the proper delivery of the gas to a patient’s lungs.
  • Adaptive servo-ventilation (ASV) – ASV is a recently available device that’s used to “learn” a patient’s breathing patterns in a small computer. The machine will use this information to deliver pressure and help normalize breathing patterns to hinder pauses from happening during sleep. This device has been highly recommended by doctors for those with complex sleep apnea, as it’s been found to be successful in providing adequate pressure to the airways.
  • Oral appliances – Another alternative option for those who don’t prefer CPAP or EPAP devices is for them to wear oral appliances designed to keep the throat open. Although the CPAP is more reliable and effective compared to oral appliances, they can be a bit difficult to use. There are oral appliances that bring the jaw forward to keep airways open, relieving snoring and helping alleviate obstructive sleep apnea.Dentists can also provide oral appliances from sleep apnea and they will usually recommend a patient to try out a variety of devices to find the best fit. Once a patient finds the right appliance for them, they are required to make repeat visits to their dentists in order to ensure that adjustments are properly made and symptoms are truly being alleviated.

 

Surgery

 

Surgery is a “last-resort” option for patients after surgery and home remedies have failed to help with their sleep apnea. Usually, doctors will recommend at least three months of doing a treatment option before surgery is considered. However, if the sleep apnea is caused by problems in the bone structure of the face, then surgery is usually the first option.

The objective of surgery for sleep apnea is to provide larger airways through the nose or throat that may cause obstruction during breathing while asleep.

 

Surgical options for patients may include:

  • Tissue removal (uvulopalatopharyngoplasty)- during this surgery, doctors will remove tissues from the back of the mouth and the top of the throat. The tonsils and adenoids are also removed during the process, successfully stopping the throat from “closing” or vibrating together during sleep. However, this surgery isn’t found to be as effective as using the CPAP machine.
  • Jaw repositioning – If the sleep apnea is caused by the bone structure of a patient’s jaw, repositioning may be required. Maxillomandibular advancement is done by moving the jaw forward, enlarging the area behind the tongue and the soft palate to lessen obstruction.
  • Tracheostomy –  If all else fails, a tracheostomy may be required, especially for more severe cases of sleep apnea. Surgeons will create a hole in the neck and will insert a tube made out of metal or plastic where the patient can breathe. During the daytime, the opening must be covered by the patient, only uncovering it before going to bed to allow air to come and go through the lungs.

 

No matter what kind of sleep apnea a patient has, it’s always best to consult a doctor in order to find out the best course of action or treatment. It may seem just like a normal case of snoring loudly, but it could also be potentially life threatening if not diagnosed and treated correctly.