Understanding Sleep Apnea

By: Shannon Ullman

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We make all kinds of noises when we sleep, from mumbling nonsense to gentle snoring. But if your snoozing sounds are so loud and disruptive that they bother your partner or yourself, it’s time to see a doctor because you could have sleep apnea.

What is Sleep Apnea?

Sleep apnea is a sleep disorder in which your breathing repeatedly stops and starts, keeping your body from getting the oxygen it needs. There are three types of sleep apnea:

  • Obstructive
  • Central
  • Complex

The most common form is obstructive sleep apnea (OSA), which is when the soft tissue in the back of your throat relaxes and blocks your airways. This can cause your breathing to stop for 10 seconds or more at a time, lowering your oxygen levels and building up carbon dioxide in your bloodstream.

Central sleep apnea (CSA) is less common and occurs when your brain fails to send the right signals to the muscles that control your breathing, usually due to an underlying health issue. Complex sleep apnea is a combination of both OSA and CSA.

Because the symptoms are so subtle—and happen while you’re fast asleep— sleep apnea often goes undiagnosed. Some doctors estimate that in the United States alone, 85 to 90 percent of people have the issue and don’t know it.

If left untreated, sleep apnea can lead to several serious health problems, including:

  • Hypertension
  • Type 2 Diabetes
  • Metabolic Syndrome
  • Arrhythmias
  • Heart failure
  • Stroke
  • Heart attack

Symptoms of Sleep Apnea

It may be difficult to tell if you have sleep apnea, especially if you sleep alone, and symptoms depend on the type you have. For OSA, look out for:

  • Loud snoring
  • Gasping or choking sounds
  • Waking up with a dry mouth or sore throat
  • Morning headaches
  • Irritability
  • Fatigue
  • Trouble focusing or concentrating
  • Feeling excessively sleepy during the day (also known as hypersomnia)
  • Having difficulty staying asleep at night (also known as insomnia)
  • Night sweats
  • Frequent nighttime urination
  • Sexual dysfunction or decreased libido
  • Any episodes reported by another person in which you stop breathing during sleep

For CSA, symptoms include:

  • Daytime mouth breathing
  • Difficulting swallowing
  • Excessive night sweating
  • Bedwetting
  • Inward movement of rib cage while inhaling
  • Learning and behavioral disorders, especially in children

For those with complex sleep apnea, symptoms of both OSA and CSA may be present.

Causes and Risk Factors of Sleep Apnea

While anyone can experience all three types of sleep apnea, there are conditions, demographics, and lifestyle factors that can increase your risk.

Here are the risks and causes of OSA:

  • Excess weight: Fat deposits around your neck, chin, and throat can narrow your airway.
  • Nasal problems: A deviated septum or other structural issues in your nose can make breathing difficult.
  • Enlarged tonsils or adenoids: These can block the airway, especially in children.
  • Family history: If sleep apnea or snoring runs in your family, you may be more likely to experience it yourself.
  • Smoking: Cigarette smoke irritates the throat and can contribute to inflammation, which narrows the airway.
  • Alcohol use: Drinking alcohol relaxes the muscles in your throat, which can block your airway.
  • Age: Sleep apnea is more common in middle-aged adults and older.
  • Gender: Sleep apnea is more common in men than women.
  • Use of sedatives or sleep aids: These can relax the muscles in your throat and make it more likely for your airway to collapse.
  • Change in hormone levels: Low thyroid levels and high insulin levels can contribute to sleep apnea.
  • Heart and kidney failure: Experiencing these conditions can cause fluid build-up in your neck.

In addition to age, family history, and gender, CSA has other causes and risk factors, which include:

  • High-altitude sleep: This can disrupt the levels of carbon dioxide and oxygen in your blood, leading to a drop in breathing.
  • Opioids: Long-term use of opioids can alter how your brain signals your body for sleep.
  • Certain health conditions: Stroke, heart failure, amyotrophic lateral sclerosis (ALS), and myasthenia gravis  (a neuromuscular disorder) can all increase your risk for sleep apnea.
  • Premature birth: This increases the risk of sleep apnea in infants and children.

Diagnosis of Sleep Apnea

Getting diagnosed with sleep apnea usually starts with a physical exam and questions about your sleep habits. From there, your doctor might refer you to a sleep specialist for a sleep study.

During a sleep study, you’ll spend a night in a sleep lab (called a polysomnogram) or be sent home with a Home Sleep Test (HST) to monitor your breathing and bodily functions. The sleep specialist will look for patterns in your sleep that suggest sleep apnea.

Your doctor may also order other tests to rule out other conditions or get more information about your sleep apnea. These could include:

  • Blood tests: To check for conditions that may contribute to sleep apnea, like low thyroid levels or heart failure
  • Pelvic ultrasound: To rule out PCOS

Treatment Options

There are a few different routes of treatment your doctor may order, depending on the type of sleep apnea you have and what they believe is causing it.

Conservative treatments

For milder cases of OSA, your doctor may first recommend some conservative treatments, like weight loss, sleeping on your side, nasal sprays, or breathing strips. They may also recommend avoiding alcohol and sleeping pills, which can worsen sleep apnea.

Mechanical therapy

If simple changes don’t do the trick, your doctor may recommend sleeping with a device to keep your airway open while you sleep. These devices (called Positive Airway Pressure therapy) include CPAP machines, BiPAP machines, Auto CPAP machines, and ASV machines.

It may take some experimenting to find the right machine and mask for you, but once you do, these devices are highly effective in treating sleep apnea.

Mandibular advancement devices

For mild to moderate sleep apnea, your doctor may also recommend a MAD, which is a mouthpiece that you wear at night. This device brings your lower jaw forward to open up your airway while you sleep and keep your tongue from blocking it.

Hypoglossal nerve stimulator

For people with sleep apnea that can’t be treated with other methods, your doctor may recommend surgery to implant a hypoglossal nerve stimulator. This device sends electrical signals to the muscles in your tongue and throat to keep them from collapsing and blocking your airway.

Other surgeries

For sleep apnea that can’t be treated with other methods, your doctor may also recommend one of these surgeries:

  • Uvulopalatopharyngoplasty (UPPP): This surgery removes the tonsils and soft palate to open up the airway.
  • Somnoplasty: This minimally invasive procedure uses radiofrequency ablation to remove tissue in the soft palate and uvula, opening up the airway.
  • Nasal surgery: This can be done to improve the function of your nasal passages and decrease snoring.
  • Tonsillectomy: If enlarged tonsils are the problem, this procedure removes the tonsils to open up the airway.
  • Maxillomandibular advancement (MMA): This surgery pulls the upper and lower jaws forward to open up the airway. It’s for severe cases.

Living with Sleep Apnea

Regardless of the type of sleep apnea you have, always follow your doctor’s treatment plan. If you’re using a sleep apnea machine, it’s important to use it every night, even if you’re feeling better. These machines can be bulky and uncomfortable, but they’re effective in treating sleep apnea.

Following an active lifestyle by losing weight, limiting or avoiding alcohol, sleeping pills, and opioids, and quitting smoking can also help improve sleep apnea. Moving your body regularly and sleeping on your side can also help reduce sleep apnea symptoms.

Takeaway

If you think you might have sleep apnea, it’s crucial to talk with your doctor. With treatment, you can get a good night’s sleep and improve your overall health.

Source List

Cleveland Clinic. (2018). Could you have sleep apnea — Without knowing it? https://health.clevelandclinic.org/sleep-apnea-its-waaaay-more-common-than-you-think/

Cleveland Clinic. (2020). Sleep apnea. https://my.clevelandclinic.org/health/diseases/8718-sleep-apnea

Ferini-Strambi. et al. (2017). Neurological deficits in obstructive sleep apnea. https://pubmed.ncbi.nlm.nih.gov/28374233/

Mayo Clinic. (2021). Obstructive sleep apnea https://www.mayoclinic.org/diseases-conditions/obstructive-sleep-apnea/symptoms-causes/syc-20352090#

Mayo Clinic. (2021) Central sleep apnea https://www.mayoclinic.org/diseases-conditions/central-sleep-apnea/symptoms-causes/syc-20352109#:

Mayo Clinic. (2021). Sleep apnea https://www.mayoclinic.org/diseases-conditions/sleep-apnea/symptoms-causes/syc-20377631#

National Heart, Lung, and Blood Institute. (2022). What is sleep apnea? https://www.nhlbi.nih.gov/health/sleep-apnea