Sleep Apnea

What is sleep apnea?

Sleep apnea is a serious, potentially life-threatening condition. It's far more common than thought. Sleep apnea can occur at any age, but risk increases as you get older. It happens in both genders, but it's more common in men.

Sleep apnea is a breathing disorder causing brief interruptions of breathing during sleep. The involuntary breathing pauses are called "apneic events." There are 3 types of sleep apnea:

• Obstructive sleep apnea. This happens when air can’t flow into or out of the nose or mouth due to obstruction although efforts to breathe continue.
• Central sleep apnea. This happens when the brain fails to send the right signals to the muscles to start breathing. Central sleep apnea is less common than obstructive sleep apnea.
• Complex sleep apnea. This is a mix of symptoms found in both central and obstructive sleep apnea.

During the apneic event, you can’t breathe in oxygen or exhale carbon dioxide. This results in low levels of oxygen and increased levels of carbon dioxide in the blood. This alerts the brain to resume breathing and cause an arousal. With each arousal, a signal is sent from the brain to the upper airway muscles to open the airway. Breathing is resumed, often with a loud snort or gasp. Frequent arousals, although necessary for breathing to restart, prevent restorative, deep sleep.

Early recognition and treatment of sleep apnea is important, as it may be associated with:

• Irregular heartbeat
• High blood pressure
• Heart attack
• Stroke
• Daytime sleepiness
• Increased risk of motor vehicle accidents

What causes sleep apnea?

Certain mechanical and structural problems in the airway cause the interruptions in breathing during sleep. Apnea happens:

• When the throat muscles and tongue relax during sleep and partially block the opening of the airway
• When the muscles of the soft palate at the base of the tongue and the uvula relax and sag, the airway becomes blocked, making breathing labored and noisy and even stopping it altogether
• In overweight people when an excess amount of tissue in the airway causes it to be narrowed
• With a narrowed airway, the person continues their efforts to breathe, but air can’t easily flow into or out of the nose or mouth
• In central sleep apnea, there is a brief lack of communication between the brain and the muscles that control breathing possibly due to underlying brain or heart conditions

Who is at risk for sleep apnea?

Sleep apnea seems to run in some families, suggesting a possible genetic basis. People most likely to have or develop sleep apnea include those who:

• Snore loudly
• Are overweight
• Have high blood pressure
• Have some physical abnormality in the nose, throat, or other parts of the upper airway

Use of alcohol and sleeping pills increases the frequency and duration of breathing pauses in people with sleep apnea.

What are the symptoms of sleep apnea?

In either form of sleep apnea, your breathing pauses a number of times during sleep. These are called apneic events. This may happen several times a night or, in more severe cases, several hundred times a night. Between events, you may snore. But, not everyone who snores has sleep apnea. Sleep apnea may also cause a choking sensation. When breathing restarts, you may snort or gasp. These frequent breaks in deep, restorative sleep often lead to headaches and excessive daytime sleepiness.

Other symptoms include dry mouth, sore throat, and daytime sleepiness or fatigue.

How is sleep apnea diagnosed?

A primary healthcare provider, pulmonologist, neurologist, or other healthcare provider with specialty training in sleep disorders may make a diagnosis and start treatment. Several tests are used to evaluate sleep apnea, including:

• Polysomnography. This test is done in a sleep lab. It records a variety of body functions during sleep. This includes the electrical activity of the brain, eye movement, muscle activity, heart rate, respiratory effort, air flow, and blood oxygen levels.
• Home sleep apnea test. This is a portable device that can diagnose sleep apnea. Your healthcare provider will arrange for you to take it home to wear during sleep and then it's returned to the office where results are processed.

How is sleep apnea treated?

Treatment will depend on your symptoms, age, and general health. It will also depend on how bad the condition is.

Medicines generally don't work to treat sleep apnea. Treatment may include:

• Oxygen. Giving oxygen may safely help some people, but doesn't end sleep apnea or prevent daytime sleepiness. Its role in the treatment of sleep apnea is controversial.
• Behavioral changes. These are an important part of treatment. In mild cases of sleep apnea, behavioral therapy may be all that is needed. You may be advised to:
  • Avoid use of alcohol or tobacco.
  • Avoid use of sleeping pills.
  • Lose weight if overweight. Even a 10% weight loss can reduce the number of sleep apnea events for most people.
  • Use pillows and other devices to help sleep in a side position.
• Physical or mechanical therapy. Continuous positive airway pressure (CPAP) is a device used nightly. For this treatment, you wear a mask over the nose or mouth and nose during sleep. Pressure from an air blower forces air through the nose and throat.
• Dental appliances. These can reposition the lower jaw and the tongue and have been helpful to some people with mild sleep apnea, or who snore but don't have apnea.
• Orofacial therapy. This can help by improving the tongue positioning and strengthen mouth and facial muscles.
• Surgery. Some people with sleep apnea may need surgery. Examples of these procedures include:
  • Surgery to remove adenoids and tonsils, nasal polyps, or other growths or tissue in the airway, or to correct structural deformities
  • Surgery to remove excess tissue at the back of the throat (tonsils, uvula, and part of the soft palate)
  • Surgery to reconstruct deformities of the upper jaw (maxilla) and lower jaw (mandible).
  • Surgery to treat obesity
• Nerve stimulator. A newer treatment option for those who may have difficulty using CPAP is called a hypoglossal nerve stimulator. It's an implanted device in the upper chest that electrically stimulates the hypoglossal nerve, which causes tongue movement. This stimulation is timed with breathing to relieve upper airway obstruction.

Key points about sleep apnea

• Sleep apnea is a breathing disorder that causes brief times when you stop breathing during sleep.
• There are three types of sleep apnea: central sleep apnea, obstructive sleep apnea, and complex sleep apnea.
• Sleep apnea seems to run in some families, suggesting a possible hereditary basis.
• Diagnosis of sleep apnea is not simple because there can be many different causes.
• Medicines generally don't work to treat sleep apnea.
• Treatment may involve behavioral changes, weight loss, CPAP therapy, and sometimes surgery.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider tells you.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are and when they should be reported.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your healthcare provider if you have questions, especially after office hours or on weekends.