Sleep apnea is a sleep disorder that involves pauses in breathing when a person is asleep. Sleep apnea prevents the body from taking in adequate oxygen, which can cause a serious medical condition, as oxygen supply is essential for the proper functioning of the vital organs.
Sleep apnea is usually classified into the following three types:
- Obstructive Sleep Apnea: when there is intermittent blockage of airflow during sleep due to narrow or obstructed airway space
- Central Sleep Apnea: when the connection between the brain and the muscles that control your breath is not working properly
- Treatment-emergent central sleep apnea, also known as complex sleep apnea, happens when you have both Obstructive Sleep Apnea and Central Sleep Apnea
The inadequate oxygen levels activate a survival reflex that triggers wakefulness, so breathing is resumed. While this survival reflex ensures your breathing doesn’t stop permanently, and you are alive, it also hinders your sleep cycle and restful sleep. Interruptions in restful sleep impact the body in different ways, including putting stress on your heart that could result in deadly health complications.
It is more common in men, and risk factors include obesity and aging. Sleep apnea is often treatable, and multiple treatment options are available. The current article will cover symptoms, causes, and management strategies.
Symptoms of Sleep Apnea
Symptoms of Obstructive and Central Sleep Apnea overlap most of the time, making it extremely difficult to determine which one you have include:
- Severe fatigue
- Dry throat
- Gasping for air during sleep
- Night sweats and feeling restless at night
- Increased irritability and mood swings
- Weight gain
- Sexual dysfunction
- Breathing through the mouth or loud breathing
- Difficulty in focus and concentration while being awake
- Hypersomnia: excessive daytime sleepiness and drowsiness
Obstructive Sleep Apnea
This is the most common form of sleep apnea. It happens when your head and neck relax too much while sleeping, causing the enclosing tissue to press on your windpipe. This pressure blocks the air’s ability to pass through it.
Central sleep apnea
It is caused due to various factors, including:
- Heart failure
- Damaged nervous system, especially the brainstem (the component that manages your breathing) or parts of your spinal cord
- Low blood oxygen levels (hypoxia) because of high altitude
- Treating obstructive sleep apnea initially with Continuous positive airway pressure (this typically goes away with consistent Continuous positive airway pressure use)
- Neuromuscular diseases such as amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease)
Sleep apnea can impact anyone, both adults and even children. However, certain factors increase the risk of sleep apnea.
Obstructive sleep apnea
Factors that increase the risk of Obstructive Sleep Apnea include:
- Excess weight or obesity
- Thicker necks will have narrower airways
- Tonsils or adenoids can enlarge and block the airway, especially in children
- Nasal congestion
- Being male (2 to 3 times more likelihood). Women who are obese and have attained menopause are at higher risk of sleep apnea
- Being older
- Family history
- Use of alcohol, sedatives or tranquilizers
- Smoking increases inflammation and fluid retention in the upper airway
- Nasal congestion
- Medical conditions: people who have underlying health conditions like hormonal disorders, high blood pressure, POS – Polycystic Ovary Syndrome, prior stroke, asthma, and other chronic lung diseases, Congestive heart failure, and type 2 diabetes are some of the health issues that may increase the risk of obstructive sleep apnea.
Central sleep apnea
Risk factors for Central sleep apnea include:
- Being older
- Being male
- Heart disorders
- Using narcotic pain medicines (methadone – Opioid medicines)
All types of sleep apnea can cause serious health complications like:
- Coronary artery disease and heart failure
- Sleep deprived partners
- Heart rhythm problems known as arrhythmias
- Metabolic syndrome
- Liver problems
- High blood pressure
- Acid reflux
- Brain fog
- Memory loss and depression
Diagnosis of Sleep Apnea
A healthcare provider may refer you to a sleep clinic for an evaluation by sleep specialists if he/she suspects a sleep disorder. A sleep specialist will ask questions to gather information about your medical history and use the gathered information to evaluate your sleep problem. The sleep specialist may also perform a physical exam and suggest maintaining a sleep diary, conducting a sleep study, and asking to get other tests done:
Detailed History: A sleep specialist will ask questions about your general health and any symptoms you experience. Questions about sleep habits and sleep schedules will also be asked. The sleep specialist may ask your sleeping partner questions to find out his or her observations.
Medication History: The sleep specialist will review your medication history to see if these may affect the symptoms being experienced.
Physical Exam: The sleep specialist will perform a complete physical exam and check for a deviated nasal septum, nasal congestion, enlarged tonsils, or a narrowed airway that may be causing snoring or sleep apnoea.
Sleep Diary: Your sleep specialist may ask you to maintain a sleep diary for two weeks and record information about how well and how often you sleep. Your sleep doctor will recommend the next steps based on the recorded information.
Other Testing: Your sleep specialist may recommend other tests to determine your sleep schedule, level of sleepiness, and/or your ability to stay awake. Some other tests may be required to look for stimulants, anti-anxiety medicines, etc., that may be contributing to your symptoms.
Types of other tests:
Some other types of tests used to help diagnose a sleep condition include:
- Lab Tests: drug screening for stimulants, opiates, pain killers, narcotics, and anti-anxiety medicines influence alertness level. Blood tests for iron (Fe) and/or thyroid are also beneficial.
- Multiple Sleep Latency Test (MSLT): This test is performed to objectively determine the degree of your sleepiness. You will be asked to take four or five naps over an 8 to 10-hour period during the following day to do an overnight sleep study. Each nap usually lasts 20 minutes, and you will be closely monitored, just as you were during the sleep study. This test helps to diagnose narcolepsy.
- Maintenance of Wakefulness Test (MWT): This test measures your ability to stay awake. It consists of four periods of 40 minutes, during which you will be required to stay awake. Most people remain awake during these sessions, but the ones suffering from excessive sleepiness tend to fall asleep or feel drowsy.
- Actigraphy: This test is performed to get information about periods of rest/sleep activity. An actigraph is worn around the wrist, just like a wristwatch. It records signals when you move, and few or no signals are recorded when you are asleep or inactive.
- Polysomnography (PSG): It is a multi-parameter sleep study and involves the use of an electroencephalogram (EEG) to record brain activity, electrooculogram for measuring corner-retinal -positive standing potential relative to the back of the eye, Electromyography (EMG) that evaluates electrical activity by skeletal muscles during sleep, electrocardiogram, and pulse oximetry, as well as airflow and respiratory effort to evaluate your oxygen levels, heart functioning and how these could disrupt your sleep. These parameters help to diagnose sleep apnea.
- Electroencephalogram (EEG): This test is performed to assess electrical activity in the brain and detect any potential problems associated with this activity. It is performed as a part of polysomnography.
- Maintain healthy sleeping habits
- Do not sleep on your back but on your stomach or side
- Use Continuous positive airway pressure (CPAP), implants, and other oral devices to prevent sleep apnea
- Manage weight as it decreases respiratory disturbance index RDI, lowers blood pressure, improves arterial blood gas values, pulmonary function, and snoring, and reduces optimum Continuous Positive Airway Pressure required
- Maintain a healthy diet
- Do regular exercise and yoga
- Avoid alcohol and smoking: limiting alcohol consumption and giving up smoking improves sleep patterns
- Learn to breathe through your nose rather than your mouth
- Losing weight: this prevents extra weight from pressing down the throat, resulting in blocking your airways, thereby causing snoring and sleep apnea
Obstructive Sleep Apnea
1. Therapies for OSA
- Continuous positive airway pressure (CPAP): For moderate to severe OSA, CPAP is a machine that delivers air pressure using a mask while you are asleep. The air pressure through this machine is great enough to keep your upper airway passages open, preventing snoring and sleep apnea.
- Oral appliances: Mandibular advancement devices with an 80% compliance rate.
2. Surgery for OSA
Surgical options might include:
- Tissue removal: this procedure is called uvulopalatopharyngoplasty (UPPP). The tissues, tonsils, and adenoids are removed from the rear of your mouth and the top of the throat. This prevents throat vibrations from causing snoring
- Tissue shrinkage: shrink the tissue using radiofrequency ablation
- Jaw repositioning is also known as maxillomandibular advancement.
- Implants: plastic soft rods are surgically implanted
- Nerve stimulation: increased stimulation keeps the tongue in so the airways remain open.
- Creating a new air passageway, known as tracheostomy
Central Sleep Apnea
- Positive airway pressure (PAP) therapy uses a machine to pump air into the airway to help breathing during sleep.
- Supplemental oxygen: machine to deliver extra oxygen to the lungs
- Medication: like acetazolamide to stimulate breathing
- Phrenic nerve stimulation: surgical implantation of a device in the chest that increases breathing. This machine activates an electrical current and stimulates the diaphragm. The diaphragm contracts and breathing becomes smooth
- Adaptive servo-ventilation (ASV): airflow device
Sleep apnea is a common sleeping issue that affects sleep and daytime functioning. Symptoms include snoring, fatigue, daytime sleepiness, irritability, and reduced concentration.
Fortunately, it is treatable, and various treatment options are available. One key thing about sleep apnea is that people who have it should ensure they get enough sleep at night or that reduced sleep has other negative impacts on the body. Basic sleep hygiene practices and a prescribed treatment plan can treat sleep apnea.